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PubMed2005

Pulmonary rehabilitation and COPD.

Pulmonary rehabilitation has been well established and increasingly recommended in disease management plans for patients with chronic obstructive pulmonary disease. Key elements include a multidisciplinary approach to care, focus on the individual patient, and attention to emotional and social as well as physical aspects of health. Appropriate candidates are symptomatic patients with chronic lung disease who are aware of their disability and motivated to participate actively in their own health care. Pulmonary rehabilitation has also been useful for patients with other types of chronic lung diseases. Program components include a careful patient evaluation, education, instruction in respiratory and chest physiotherapy techniques, exercise training, and psychosocial support. Benefits demonstrated in a growing body of evidence include improvement in symptoms, exercise tolerance, and quality of life and reduction in utilization of health care resources. Pulmonary rehabilitation has also been included as an adjunct to surgical programs such as lung transplantation and lung volume reduction surgery.

Breathing Exercises↗
PubMed1989

Adult follow-up of the acquired aphasia-epilepsy syndrome in childhood. Report of 7 cases.

The authors report at adult age 7 patients (6 men, one woman) with the syndrome of "acquired aphasia-epilepsy", 6 of which had been previously studied as children. The results of the language, neuropsychological and socio-educational evaluation detailed many years after the onset of the aphasia are the subject of this report. One man has recovered completely, one has a normal oral language but is severely dyslexic, one has recovered normal comprehension but has severe expressive language problems. Four have absent language comprehension and lack of expressive speech, and only one of them has learned and is using sign language with some efficiency. None has developed functional written language. Attempts to offer a substitutive language to children with prolonged inability to understand and use oral language appears important but is fraught with problems. Although there are no conclusive data about the role of the continuous paroxysmal EEG discharges and the effect of their suppression with drug treatment on the prognosis of the aphasia, the definite fluctuations of the aphasia in some cases, the isolated recent case reports of definitive improvement with drug treatment justify further trials in this potentially severe and chronic condition.

Adolescent↗
PubMed2002

Parental anxiety associated with referral of a child to a pediatric cardiologist for evaluation of a Still's murmur.

OBJECTIVE: We assessed factors contributing to parental anxiety when children are referred to a cardiology clinic for evaluation of a Still's murmur. METHODS: Parents of 95 children completed questionnaires designed to assess family and patient characteristics, parents' ratings of their anxiety and the reassurance they received from their pediatrician, and current (state) and general anxiety levels. RESULTS: Parents reported anxiety about multiple issues including the need for medication (49%), sports restrictions (41%), cardiac surgery (29%), cardiac risk for siblings (20%), and premature death (13%). Of reporting mothers, 19% felt the murmur resulted from something they did wrong during pregnancy. Although 54% of parents were extremely reassured by their pediatrician, only 17% had no anxiety associated with the specialty visit. After reassurance from the cardiologist, 7% of parents had persistent anxiety. In multivariable analysis, 2 features, both related to the referring pediatrician, were significantly related to parental anxiety level. High parental anxiety was associated with lower pediatrician reassurance ratings and greater pediatrician practice years. CONCLUSIONS: Parental anxiety is common among parents of children referred for specialty evaluation. Educational strategies to improve pediatrician communication skills with parents may improve quality of care.

Adolescent↗
PubMed2002

Psychosocial issues near the end of life.

End-of-life care has received increasing attention in the last decade; however, the focus continues to be on the physical aspects of suffering and care to the virtual exclusion of psychosocial areas. This paper provides an overview of the literature on the intra- and interpersonal aspects of dying, including the effects that psychosocial variables have on end-of-life decision-making; common diagnosable mental disorders (e.g., clinical depression, delirium); other types of personal considerations (e.g., autonomy/control, grief); and interpersonal/environmental issues (e.g., cultural factors, financial variables). Six roles that qualified mental health professionals can play (i.e., advocate, counselor, educator, evaluator, multidisciplinary team member, and researcher) are also outlined. Because psychosocial issues are ubiquitous and can have enormous impact near the end of life, properly trained mental health professionals can play vital roles in alleviating suffering and improving the quality of life of people who are dying.

Aged↗
PubMed1998

A comparative analysis of six audit systems for mental health nursing.

PURPOSE: To devise an analytical framework to help identify strengths and weaknesses in the audit process as specified by existing psychiatric nursing audit systems, in order to analyse current audit practice and identify improvements for incorporation in the Newcastle Clinical Audit Toolkit for Mental Health. DATA SOURCES: Published material relating to the following six systems: the Central Nottinghamshire Psychiatric Nursing Audit; Psychiatric Nursing Monitor; Standards of Care and Practice; Achievable Standards of Care; Quartz; and Quest. DATA EXTRACTION: Comparison of the six systems according to an analytical framework derived from detailed empirical study (structures, processes and outcomes) of one of them in use and the educational evaluation literature. Examination of the extent to which guidance is provided for operating the systems and for wider process-related aspects of audit. RESULTS OF DATA SYNTHESIS: Five of the systems failed to specify some important elements of the audit process. Conceptually, the six systems can be divided into two main types: 'instrument-like' systems designed along psychometric lines and which emphasize the distance between the subjects of audit and the operators of the systems, and 'tool-like' systems which exploit opportunities for care setting staff to engage in the audit process. A third type of system is the locally-developed system which is offered to a wider audience but which does not make the same level of claim to universal applicability. CONCLUSION: The analytical framework allows different approaches to audit to be compared and contrasted not only according to the techniques used, but also according to process issues. The analysis of six systems revealed a variety of different techniques and procedures which can facilitate, in a methodologically rigorous manner, practitioner and other stakeholder involvement in audit processes.

Humans↗
PubMed1991

The relation of socioeconomic status to oral and pharyngeal cancer.

We assessed the relation between socioeconomic status and risk of oropharyngeal cancer in a population-based interview study of 762 male cases and 837 male controls in four areas of the United States. Three primary indicators of socioeconomic status were evaluated: education, occupational status, and percentage of potential working life spent in employment. With adjustment for the effects of established risk factors, such as use of tobacco products, alcohol consumption, and poor dentition, a relatively low percentage of years worked was also a risk factor. Educational attainment and occupational status were not independently related to risk of oropharyngeal cancer. These results are consistent with the hypothesis that behaviors that lead to social instability, and/or social instability itself, are linked to an increased risk of oral and pharyngeal cancers.

Adult↗
PubMed2005

Family-centred service: moving ideas into practice.

BACKGROUND: With parents more involved in their child's day-to-day care, concepts of family-centred service (FCS) are increasingly adopted in children's health and rehabilitation service organizations. METHODS: In this paper, we report the results of a study to develop and evaluate educational materials for parents, service providers and health sciences students about FCS. The materials focus on the nature and philosophy of FCS, and the practical skills and systemic changes required for its implementation. RESULTS: Thirty-six participants (12 families, 12 service providers and 12 rehabilitation science students) were randomly assigned to receive one of the six FCS educational packages, each containing three FCS educational sheets. Participants' ratings of the format and content, and the impact of the FCS Sheets were very high, with overall means above 5.0 on a 7-point scale. Using a mixed model analysis, we found significant differences in participants' ratings of familiarity with the materials (students were less familiar than service providers). After statistical adjustment for familiarity, there were no significant differences between the groups or the packages on ratings of format and content or impact. CONCLUSIONS: There were no significant differences in the way in which the participant groups rated the impact of the FCS Sheets and the specific packages did not have an effect on the participants' ratings. The FCS educational materials, even those less familiar to participants, were rated highly on format and content, and impact. Results indicate that the material was perceived to be important to each group, and was formatted and written in a way that was easy to understand. This finding counters current recommendations in the knowledge transfer literature that suggest different versions should be written for different target groups.

Adolescent↗
PubMedDate not supplied

Sudden infant death syndrome and unascertainable deaths: trends and disparities among Aboriginal and non-Aboriginal infants born in Western Australia from 1980 to 2001 inclusive.

AIM: To analyse patterns and trends in mortality from unknown causes (sudden infant death syndrome and unascertainable deaths) for all Aboriginal and non-Aboriginal infants born in Western Australia, 1980-2001. METHODS: Using total population linked data, we reviewed all post-mortem reports, including death scene investigations and final causes of death as ascertained by the coroner. Neonatal, post-neonatal and infant mortality rates attributed to unknown causes were calculated and the latter were analysed according to maternal age, geographical location, gestational age, sex and birthweight. Relative risks (95% confidence interval) for Aboriginal infants (compared with non-Aboriginal) were calculated. RESULTS: The proportion of deaths considered to be of unascertainable cause has significantly increased in recent years. In contrast to the non-Aboriginal population, there has been no significant decrease in deaths in the Aboriginal population and the overall relative risk for Aboriginal infants for the most recent years studied was 7.9 (95% confidence interval 5.1-12.2). The relative risk was significantly increased for most categories analysed. CONCLUSION: Reviewing post-mortem reports enabled identification of changes in the classification of deaths due to unknown causes. This provided a more accurate picture of the patterns and long-term trends of such deaths so that programmes can be developed to specifically target those groups most at risk. Adequately funded and evaluated education campaigns aimed at reducing the risk of sudden infant death syndrome among Aboriginal infants are required, as well as sustaining the current efforts that have been so successful for non-Aboriginal infants.

Cause of Death↗
PubMed1977

Recovery of intellectual ability after closed head-injury.

Seven children with intellectual and personality changes after closed head-injury were followed-up with neuropsychological and psycho-educational evaluations. Two cases are presented in detail. Persistent intellectual changes documented on standardized tests were not always apparent to parents or physicians, and recovery of intellectual abilities lagged behind the disappearance of neurological abnormalities. Some of the children required special class placement for several years after the injury. Personality changes were thought to be secondary to stress on impaired perceptual and cognitive abilities, and the desirability of limiting such stress is emphasized.

Adolescent↗
PubMed1989

Oral health promotion for institutionalised elderly.

The purpose of the present study was to develop and evaluate educational approaches specifically for improvement of oral hygiene behaviour amongst institutionalised elderly. A sample of 201 residents, 48-99 yr of age (mean age 82 yr), was selected from four different institutions in Lothian, Scotland. A clinical examination and a structured interview were conducted immediately before and 2 months after the termination of the programme. The four institutions were blind to the examiner and randomly allocated to a control group or one of the three programmes; 1) active involvement of staff only; 2) active involvement of residents only; 3) active involvement of both residents and staff. The programme comprised three 1-h sessions at monthly intervals in groups of five to six residents or members of staff. The analysis of the results showed poor oral health and oral hygiene, high objective need for oral care but low perceived need. The programme had little impact on most of the included variables and only about half of the participants remembered the programme 2 months after its termination. The implications of the study are that groups of elderly need to be differentiated further so that only well and not confused elderly participate in programmes such as this and less well and confused elderly receive regular professional support with oral hygiene.

Aged↗
PubMedDate not supplied

Age-appropriate care: a system designed to make it happen.

In 1991, the Joint Commission on Accreditation of Healthcare Organizations governing board standards required that a process be designed to ensure that all individuals responsible for the assessment, treatment, or care of patients are competent in age-appropriate care. To meet this requirement, Humana Hospital-Overland Park in Overland Park, KS, developed a process to educate, evaluate, and report competence of staff to the governing board in an efficient and useful way. The focus of this article is to discuss how the process was developed and implemented successfully.

Age Factors↗
PubMed1988

Neuropsychiatric, psychoeducational, and family characteristics of 14 juveniles condemned to death in the United States.

Of the 37 juveniles currently condemned to death in the United States, all of the 14 incarcerated in four states received comprehensive psychiatric, neurological, neuropsychological, and educational evaluations. Nine had major neurological impairment, seven suffered psychotic disorders antedating incarceration, seven evidenced significant organic dysfunction on neuropsychological testing, and only two had full-scale IQ scores above 90. Twelve had been brutally physically abused, and five had been sodomized by relatives. For a variety of reasons the subjects' vulnerabilities were not recognized at the time of trial or sentencing, when they could have been used for purposes of mitigation.

Adolescent↗
PubMed1998

Labour ward midwifery staff epidural knowledge and practice.

A survey was conducted amongst labour ward midwives at our hospital to evaluate education, knowledge and attitudes toward the management of epidural analgesia in labour. Sixty of 80 distributed forms were returned, giving a 75% response rate. Forty-two per cent of respondents had more than ten years' practice experience. Only 51% achieved a predetermined pass score for knowledge about epidural analgesia. Though most had received formal education about epidural analgesia, 35% felt postgraduate education was insufficient. A majority of midwives supported epidural analgesia on demand (78%), during established labour (74%), or for women at increased risk of caesarean section (82%). Midwives with lower knowledge levels were more likely to recommend epidural analgesia early in labour to multiparous women (P = 0.001) and to women with either a small or a large baby (P = 0.06). The majority of midwives (93%, 70% and 65%) would "almost always" top-up women with cardiac or medical diseases, multiple pregnancy or hypertensive disease, respectively. A clear requirement for ongoing education, with input from the anaesthetic department, was identified, irrespective of personal experience. Practice patterns are discussed and recommendations made with respect to improvement of epidural analgesia management and continuing education.

Adult↗
PubMed1984

Personality assessment: practice and teaching for the next decade.

This paper describes some loci for personality assessment practices in the next decade. There are new domains for description of Personality Disorders, stress and coping skills, and individual modernity and acculturation. An emphasis on psychological health assessment is consistent with primary and secondary intervention. A focus on competence and awareness of environmental demands leads to a rationale for assessment components of a psychological health evaluation. Education for the general public and training for professional assessors are relevant teaching goals. Competence, fairness, and an adequate repertoire of tools are requisite for professionals.

Journal Article↗
PubMed2001

Poor school and cognitive functioning with silent cerebral infarcts and sickle cell disease.

The authors evaluated education attainment and neuropsychological deficits in children with sickle cell disease (SCD) and silent cerebral infarcts. Children with silent infarcts had twice the rate of school difficulties as children without infarcts. Eighty percent of silent infarct cases had clinically significant cognitive deficits, whereas 35% had deficits in academic skills. Children with silent cerebral infarcts show high rates of poor educational attainment, cognitive deficits, and frontal lobe injury. Poor school performance in SCD is one indicator of silent infarcts.

Adolescent↗
PubMed2001

Intention of residents in internal medicine to care for patients infected with HIV at a university hospital in Taiwan.

The purpose of this study was to investigate internal medicine residents' HIV-related knowledge and their attitudes towards caring for HIV-infected patients, and determine the extent to which these variables influence their care-providing intention. A cross-sectional survey was conducted in 56 internal medicine residents at a university hospital in Taiwan. Results showed residents' lack of sufficient knowledge was reflected by their inaccurate assessment of HIV-associated risk and their tendency to overuse protective gear in unnecessary situations. In general, residents expressed slightly positive attitudes with a neutral intention to care for HIV-infected patients. Knowledge and attitudes were significantly correlated with intention. The use of stepwise regression analysis revealed attitudes accounted for 59% of the variance in intention. Future efforts should focus on designing, implementing, and evaluating educational programmes that address residents' needs to ensure a solid HIV-related knowledge base, support their positive attitudes, address their ambivalent feelings toward providing HIV care, and enhance their intention to care for HIV-infected patients.

Attitude of Health Personnel↗
PubMed1990

Tailoring teaching to the elderly in home care.

This paper provides a brief overview of teaching and learning principles common to all adult learners and then discusses the latest research findings and their implications for adapting teaching materials and methods for the elderly. Sensory abilities, cognitive abilities, motor dexterity, developmental tasks, cohort influences, and the current situation in which the older person exists are included. Summary tables of key information are provided throughout the text for easy reference. Guides for assessment of the older adult, aids for evaluating educational materials, and a list of resources for teaching the older adult are provided in the appendix.

Aged↗
PubMed2001

Narcotic withdrawal syndrome following gastric bypass--a difficult diagnosis.

BACKGROUND: It is common for bariatric patients to experience postoperative nausea, depression and remorse for several months following surgery. Difficulty exists for the surgeon in delineating the physical from the psychological in treating these patients. Preoperative education, evaluation and preparation, although essential, will not identify nor eliminate all potential problems. METHODS: We report the case history of a patient who ultimately underwent reversal of her gastric bypass. Her symptoms required multiple procedures and hospital admissions for what appeared to be anatomical problems. All procedures were done laparoscopically. RESULTS: The patient's main complaints of persistent nausea and abdominal pain combined with radiographic evidence of sub-optimal anatomic construct led to multiple operative procedures. Psychological intervention relative to the persistent nausea and abdominal pain was ineffectual, although the supportive and consistent nature of the psychotherapy relationship was useful in overall patient stability and emotional well being. Complete reversal of the bypass did not effect improvement. Ultimately, the diagnosis of narcotic withdrawal prompted the institution of methadone treatment with complete cessation of the symptoms of nausea and pain. CONCLUSIONS: The diagnosis of narcotic withdrawal syndrome can be difficult in the postoperative bariatric patient. Psychological evaluation and support are essential elements of the program throughout the entire course of a patient's treatment experience. Laparoscopic techniques simplified the surgical care of this patient.

Adult↗