890 resultados para Patient Education as Topic - methods
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Objective - To evaluate the perceptions, expectations and experiences of physicians with regard to hospital-based pharmacists in the West Bank, Palestine. Methods - A self-administered questionnaire was distributed to 250 physicians practising in four general hospitals in the West Bank, Palestine. The main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists. Key findings - One hundred and fifty seven questionnaires were completed and returned (response rate, 62.8%). The majority of respondents were most comfortable with pharmacists detecting and preventing prescription errors (76.4%; 95% confidence interval (CI) 69.5–81.2%) and patient education (57.9%; CI 51.2–63.4%) but they were not comfortable with pharmacists suggesting the use of prescription medications to patients (56.7%; CI 49.8–62.4%). Most physicians (62.4%; CI 56.8–69.1%) expected the pharmacist to educate their patients about the safe and appropriate use of their medication. However, approximately one-third (31.7%; CI 26.0–39.6%) did not expect pharmacists to be available for consultation during rounds. Physicians' experiences with pharmacists were less favourable; whereas 77% (CI 70.2–81.5%) of the physicians agreed that pharmacists were always a reliable source of information, only 11.5% (CI 6.2–16.4%) agreed that pharmacists appeared to be willing to take responsibility for solving any drug-related problems. Conclusion -The present study showed that hospital physicians are more likely to accept traditional pharmacy services than newer clinical services for hospital-based pharmacists in the West Bank, Palestine. Pharmacists should therefore interact more positively and more frequently with physicians. This will close the gap between the physicians' commonly held perceptions of what they expect pharmacists to do and what pharmacists can actually do, and gain support for an extended role of hospital-based pharmacists in future patient therapy management.
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Objectives: To explore interactions between audiology patients and volunteers, to describe encounters and define the role of volunteers. Methods: Qualitative ethnographic and interview study of volunteer-patient interactions. Ten volunteer participants from two volunteer schemes in South West England were observed and interviewed. Three patient participants were interviewed. Results: Analysis of observational data showed that volunteers provided support relating to local services and hearing aids, but did not engage in discussions about hearing loss. Interviews with volunteers identified gaps in audiology provision, including accessible services and clear information and highlighted a need for more support from audiology services to enable them to fulfil their role. Volunteer interactions with patients mimicked a clinician-patient encounter and volunteers employed strategies and behaviours used by professional audiologists. Conclusions: Audiology volunteers could provide an accessible bridge between health services and the community but their care is limited to focus on hearing aids. Practice implications: Volunteers enable patients to use hearing aids appropriately and are a core element of current care arrangements. However, volunteers express a need for adequate support from audiology services. Volunteers have the potential to increase service capacity and to bridge the gaps between community and audiology healthcare services.
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Background - Specialist Lifestyle Management (SLiM) is a structured patient education and self-management group weight management programme. Each session is run monthly over a 6-month period providing a less intensive long-term approach. The groups are patient-centred incorporating educational, motivational, behavioural and cognitive elements. The theoretical background, programme structure and preliminary results of SLiM are presented. Subjects/methods - The study was a pragmatic service evaluation of obese patients with a body mass index (BMI) ≥35 kg/m2 with comorbidity or ≥40 kg/m2 without comorbidity referred to a specialist weight management service in the West Midlands, UK. 828 patients were enrolled within SLiM over a 48-month period. Trained facilitators delivered the programme. Preliminary anonymised data were analysed using the intention-to-treat principle. The primary outcome measure was weight loss at 3 and 6 months with comparisons between completers and non-completers performed. The last observation carried forward was used for missing data. Results - Of the 828 enrolled within SLiM, 464 completed the programme (56%). The mean baseline weight was 135 kg (BMI=49.1 kg/m2) with 87.2% of patients having a BMI≥40 kg/m2 and 12.4% with BMI≥60 kg/m2. The mean weight change of all patients enrolled was −4.1 kg (95% CI −3.6 to −4.6 kg, p=0.0001) at the end of SLiM, with completers (n=464) achieving −5.5 kg (95% CI −4.2 to −6.2 kg, p=0.0001) and non-completers achieving −2.3 kg (p=0.0001). The majority (78.6%) who attended the 6-month programme achieved weight loss with 32.3% achieving a ≥5% weight loss. Conclusions - The SLiM programme is an effective group intervention for the management of severe and complex obesity.
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Objective: To determine the impact of doctors' communication style and doctor-patient race concordance on UK African-Caribbeans' comfort in disclosing depression. Methods: 160 African-Caribbean and 160 white British subjects, stratified by gender and history of depression, participated in simulated depression consultations with video-recorded doctors. Doctors were stratified by black or white race, gender and a high (HPC) or low patient-centred (LPC) communication style, giving a full 2. ×. 2. ×. 2 factorial design. Afterwards, participants rated aspects of doctors' communication style, their comfort in disclosing depression and treatment preferences. Results: Race concordance had no impact on African-Caribbeans' comfort in disclosing depression. However a HPC versus LPC communication style made them significantly more positive about their interactions with doctors (p = 0.000), their overall comfort (p = 0.003), their comfort in disclosing their emotional state (p = 0.001), and about considering talking therapy (p = 0.01); but less positive about considering antidepressant medication (p =0.01). Conclusion: Doctors' communication style was shown to be more important than patient race or race concordance in influencing African Caribbeans' depression consultation experiences. Changing doctors' communication style may help reduce disparities in depression care. Practice Implications: Practitioners should cultivate a HPC style to make African-Caribbeans more comfortable when disclosing depression, so that it is less likely to be missed.
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Objectives: To develop a decision support system (DSS), myGRaCE, that integrates service user (SU) and practitioner expertise about mental health and associated risks of suicide, self-harm, harm to others, self-neglect, and vulnerability. The intention is to help SUs assess and manage their own mental health collaboratively with practitioners. Methods: An iterative process involving interviews, focus groups, and agile software development with 115 SUs, to elicit and implement myGRaCE requirements. Results: Findings highlight shared understanding of mental health risk between SUs and practitioners that can be integrated within a single model. However, important differences were revealed in SUs' preferred process of assessing risks and safety, which are reflected in the distinctive interface, navigation, tool functionality and language developed for myGRaCE. A challenge was how to provide flexible access without overwhelming and confusing users. Conclusion: The methods show that practitioner expertise can be reformulated in a format that simultaneously captures SU expertise, to provide a tool highly valued by SUs. A stepped process adds necessary structure to the assessment, each step with its own feedback and guidance. Practice Implications: The GRiST web-based DSS (www.egrist.org) links and integrates myGRaCE self-assessments with GRiST practitioner assessments for supporting collaborative and self-managed healthcare.
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Report published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2015
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Objective - To understand how parents view and experience their role as their child with a long-term physical health condition transitions to adulthood and adult healthcare services. Methods - Five databases were systematically searched for qualitative articles examining parents’ views and experiences of their child’s healthcare transition. Papers were quality assessed and thematically synthesised. Results - Thirty-two papers from six countries, spanning a 17-year period were included. Long-term conditions were diverse. Findings indicated that parents view their child’s progression toward self-care as an incremental process which they seek to facilitate through up-skilling them in self-management practices. Parental perceptions of their child’s readiness, wellness, competence and long-term condition impacted on the child’ progression to healthcare autonomy. A lack of transitional healthcare and differences between paediatric and adult services served as barriers to effective transition. Parents were required to adjust their role, responsibilities and behaviour to support their child’s growing independence. Conclusion - Parents can be key facilitators of their child’s healthcare transition, supporting them to become experts in their own condition and care. To do so, they require clarification on their role and support from service providers. Practice Implications - Interventions are needed which address the transitional care needs of parents as well as young people.
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Few valid and reliable placement procedures are available to assess the English language proficiency of adults who enroll in English for Speakers of Other Languages (ESOL) programs. Whereas placement material exists for children and university ESOL students, the needs of students in adult community education programs have not been adequately addressed. Furthermore, the research suggests that a number of variables, such as, native language, age, prior schooling, length of residence, and employment are related to second language acquisition. Numerous studies contribute to our understanding of the relationship of these factors to second language acquisition of Spanish-speaking students. Again, there is a void in the research investigating the factors affecting second language acquisition and consequently, appropriate placement of Haitian Creole-speaking students. This study compared a standardized instrument, the NYS Place Test, used alone and in combination with a writing sample in English, to subjective judgement of a department coordinator for initial placement of Haitian adult ESOL students in a community education program. The study also investigated whether or not consideration of student profile data improved the accuracy of the test. Finally, the study sought to determine if a relationship existed between student profile data and those who withdrew from the program or did not enter a class after registering. Analysis of the data by crosstabulation and chi-square revealed that the standardized NYS Place Test was at least as accurate as subjective department coordinator placement and that one procedure could be substituted for li other. Although the writing sample in English improved accuracy of placement by the NYS test, the results were not significant. Of the profile variables, only length of residence was found to be significantly related to accuracy of placement using the NYS Place Test. The number of incorrect placements was higher for those students who lived in the host country from twenty-five to one hundred ten months. A post hoc analysis of NYS test scores according to level showed that those learners who placed in level three also had a significantly higher incidence of incorrect placements. No significant relationship was observed between the profile variables and those who withdrew from the program or registered but did not enter a class.
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Background: Information seeking is an important coping mechanism for dealing with chronic illness. Despite a growing number of mental health websites, there is little understanding of how patients with bipolar disorder use the Internet to seek information. Methods: A 39 question, paper-based, anonymous survey, translated into 12 languages, was completed by 1222 patients in 17 countries as a convenience sample between March 2014 and January 2016. All patients had a diagnosis of bipolar disorder from a psychiatrist. Data were analyzed using descriptive statistics and generalized estimating equations to account for correlated data. Results: 976 (81 % of 1212 valid responses) of the patients used the Internet, and of these 750 (77 %) looked for information on bipolar disorder. When looking online for information, 89 % used a computer rather than a smartphone, and 79 % started with a general search engine. The primary reasons for searching were drug side effects (51 %), to learn anonymously (43 %), and for help coping (39 %). About 1/3 rated their search skills as expert, and 2/3 as basic or intermediate. 59 % preferred a website on mental illness and 33 % preferred Wikipedia. Only 20 % read or participated in online support groups. Most patients (62 %) searched a couple times a year. Online information seeking helped about 2/3 to cope (41 % of the entire sample). About 2/3 did not discuss Internet findings with their doctor. Conclusion: Online information seeking helps many patients to cope although alternative information sources remain important. Most patients do not discuss Internet findings with their doctor, and concern remains about the quality of online information especially related to prescription drugs. Patients may not rate search skills accurately, and may not understand limitations of online privacy. More patient education about online information searching is needed and physicians should recommend a few high quality websites.
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Lääkehoidon turvallinen toteuttaminen edellyttää sairaanhoitajalta hyvää lääkehoidon osaamisperustaa. Sairaanhoitajakoulutuksen tehtävänä on mahdollistaa tämän osaamisen kehittyminen. Kansainvälisissä tutkimuksissa on kuitenkin osoitettu, että lääkehoidon opetuksen laajuudessa, sisällössä ja toteutuksessa on vaihtelevuutta. Aikaisemmissa tutkimuksissa on raportoitu myös puutteita lääkehoidon osaamisessa sekä sairaanhoitajilla että sairaanhoitajaopiskelijoilla. Koulutuksen ja lääkehoidon osaamisen kehittämiseksi lääkehoidon opetuksen ja sairaanhoitajaopiskelijoiden lääkehoidon osaamisen monipuolinen arviointi ja osaamista selittävien tekijöiden tarkastelu on tarpeen. Tämän tutkimuksen tarkoituksena oli i) arvioida lääkehoidon opetusta suomalaisessa sairaanhoitajakoulutuksessa, ii) arvioida sairaanhoitajaopiskelijoiden lääkehoidon osaamista sekä iii) tunnistaa sairaanhoitajaopiskelijan lääkehoidon osaamiseen yhteydessä olevat tekijät. Tutkimus toteutettiin kolmessa vaiheessa. Ensimmäisessä vaiheessa kahden integroidun kirjallisuuskatsauksen kautta määriteltiin tutkimuksen kohteena oleva sairaanhoitajan lääkehoidon osaaminen ja aiemmin tunnistetut sairaanhoitajaopiskelijan lääkehoidon osaamiseen yhteydessä olevat tekijät. Toisessa vaiheessa toteutettiin valtakunnallinen lääkehoidon opetukseen liittyvä kysely hoitotyön koulutusohjelmasta vastaaville koulutuspäälliköille (n=22) ja opettajille (n=136). Tutkimuksen kolmannessa vaiheessa opintojensa alku‐ (n=328) ja loppuvaiheessa olevien sairaanhoitajaopiskelijoiden (n=338) lääkehoidon osaaminen arvioitiin ja osaamiseen yhteydessä olevat tekijät tunnistettiin. Aineistojen analyysissä käytettiin pääosin tilastollisia menetelmiä. Tulosten perusteella lääkehoidon opetuksen laajuus vaihteli eri ammattikorkeakouluissa, mutta opetuksen sisältö oli kuitenkin monipuolista. Lisää huomiota tulisi kiinnittää lääkehoidon teoreettiseen perustaan ja itsehoitoon sekä lääkehoidon ohjaukseen liittyviin sisältöalueisiin. Opiskelijoiden lääkehoidon osaamista arvioitiin säännöllisesti kaikissa ammattikorkeakouluissa. Sairaanhoitajaopiskelijan lääkehoidon osaamista arvioitiin tutkimuksessa tietotestillä, lääkelaskentatehtävillä ja lyhyiden potilastapausten ratkaisemisen avulla. Lääkehoidon osaamiseen yhteydessä olevia tekijöitä tarkasteltiin kolmesta näkökulmasta: 1) yksilölliset tekijät, 2) kliiniseen oppimisympäristöön ja 3) ammattikorkeakouluun liittyvät tekijät. Lääkehoidon teoreettista osaamista arvioivassa tietotestissä opiskelijat vastasivat keskimäärin 72 prosenttiin kysymyksistä täysin oikein; lääkelaskuista täysin oikein oli 74 % ja potilastapauksissa 57 % valitsi parhaan mahdollisen toimintatavan. Tulosten perusteella sairaanhoitajaopiskelijan osaamista selittivät eniten yksilölliset tekijät. Lääkehoidon osaamiseen yhteydessä olevien tekijöiden välillä oli eroa opintojen alussa ja lopussa. Opintojen alkuvaiheessa opiskelijan aikaisempi opintomenestys oli yhteydessä lääkehoidon osaamiseen, kun taas opintojen loppuvaiheessa siihen olivat yhteydessä opiskelijan kyky itseohjautuvaan oppimiseen sekä opiskelumotivaatio. Johtopäätöksenä voidaan todeta tutkimuksen tulosten olevan samansuuntaisia kuin aikaisemmissa tutkimuksissa. Lääkehoidon opetuksen laajuus vaihtelee opetussuunnitelmatasolla, mutta täsmällinen arviointi on vaikeaa opetuksen sisältöjen integroimisen takia. Sairaanhoitajaopiskelijoiden lääkehoidon osaaminen oli hieman parempaa kuin aikaisemmissa tutkimuksissa, mutta osaamisessa on edelleen puutteita. Lääkehoidon opetuksen ja osaamisen kehittäminen edellyttää kansallista ja kansainvälistä tutkimus‐ ja kehittämisyhteistyötä. Tutkimuksen tulokset tukevat lääkehoidon opetuksen sekä osaamisen tutkimusta ja kehittämistä.
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In the current Cambodian higher education sector, there is little regulation of standards in curriculum design of undergraduate degrees in English language teacher education. The researcher, in the course of his professional work in the Curriculum and Policy Office at the Department of Higher Education, has seen evidence that most universities tend to copy their curriculum from one source, the curriculum of the Institute of Foreign Languages, the Royal University of Phnom Penh. Their programs fail to impose any entry standards, accepting students who pass the high school exam without any entrance examination. It is possible for a student to enter university with satisfactory scores in all subjects but English. Therefore, not many graduates are able to fulfil the professional requirements of the roles they are supposed to take. Neau (2010) claims that many Cambodian EFL teachers do not reach a high performance standard due to their low English language proficiency and poor background in teacher education. The main purpose of this study is to establish key guidelines for developing curricula for English language teacher education for all the universities across the country. It examines the content of the Bachelor‘s degree of Education in Teaching English as a Foreign Language (B Ed in TEFL) and Bachelor‘s degree of Arts in Teaching English to Speakers of Other Languages (BA in TESOL) curricula adopted in Cambodian universities on the basis of criteria proposed in current curriculum research. It also investigates the perspectives of Cambodian EFL teachers on the areas of knowledge and skill they need in order to perform their English teaching duties in Cambodia today. The areas of knowledge and skill offered in the current curricula at Cambodian higher education institutions (HEIs), the framework of the knowledge base for EFL teacher education and general higher education, and the areas of knowledge and skill Cambodian EFL teachers perceive to be important, are compared so as to identify any gaps in the current English language teacher education curricula in the Cambodian HEIs. The existence of gaps show what domains of knowledge and skill need to be included in the English language teacher education curricula at Cambodian HEIs. These domains are those identified by previous curriculum researchers in both general and English language teacher education at tertiary level. Therefore, the present study provides useful insights into the importance of including appropriate content in English language teacher education curricula. Mixed methods are employed in this study. The course syllabi and the descriptions within the curricula in five Cambodian HEIs are analysed qualitatively based on the framework of knowledge and skills for EFL teachers, which is formed by looking at the knowledge base for second language teachers suggested by the methodologists and curriculum specialists whose work is elaborated on the review of literature. A quantitative method is applied to analyse the perspectives of 120 Cambodian EFL teachers on areas of knowledge and skills they should possess. The fieldwork was conducted between June and August, 2014. The analysis reveals that the following areas are included in the curricula at the five universities: communication skills, general knowledge, knowledge of teaching theories, teaching skills, pedagogical reasoning and decision making skills, subject matter knowledge, contextual knowledge, cognitive abilities, and knowledge of social issues. Additionally, research skills are included in three curricula while society and community involvement is in only one. Further, information and communication technology, which is outlined in the Education Strategies Plan (2006-2010), forms part of four curricula while leadership skills form part of two. This study demonstrates ultimately that most domains that are directly and indirectly related to language teaching competence are not sufficiently represented in the current curricula. On the basis of its findings, the study concludes with a set of guidelines that should inform the design and development of TESOL and TEFL curricula in Cambodia.
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Objectives: In recent years, Internet access has grown markedly providing individuals with new opportunities for online information retrieval, psychological advice and support. The objectives of the present study were to explore the context through which dentally anxious individuals access an online support group and the nature of their online experiences. Methods: An online questionnaire was completed by 143 individuals who accessed the Dental Fear Central online support group bulletin board. Qualitative analysis was conducted on the responses. Results: Analysis revealed three emergent themes which reflected the motives and experiences of individuals: ‘Searching for help’, ‘Sharing fears’ and ‘I feel empowered’. Conclusion: This exploratory study suggests that for most individuals accessing this online support group was a positive and beneficial experience. Practice Implications: Online support groups may represent a convenient and beneficial tool that may assist certain individuals to confront their debilitating anxiety/phobia and successfully receive dental care.
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Objective: Huntington’s Disease (HD) is an inherited disorder, characterised by a progressive degeneration of the brain. Due to the nature of the symptoms, the genetic element of the disease and the fact that there is no cure, HD patients and those in their support network often experience considerable stress and anxiety. With an expansion in Internet access, individuals affected by HD have new opportunities for information retrieval and social support. The aim of this study is to examine the provision of social support in messages posted to a HD online support group bulletin board. Methods: In total, 1313 messages were content analysed using a modified version of the Social Support Behaviour Code developed by Cutrona & Suhr (1992). Results: The analysis indicates that group members most frequently offered informational (56.2%) and emotional support (51.9%) followed by network support (48.4%) with esteem support (21.7%) and tangible assistance (9.8%) least frequently offered. Conclusion: This study suggests that exchanging informational and emotional support represents a key function of this online group. Practice implications: Online support groups provide a unique opportunity for health professionals to learn about the experiences and views of individuals affected by HD and explore where and why gaps may exist between evidence-based medicine and consumer behaviour and expectations.
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Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF), however it is still underutilized and sometimes refused by patients. This project was divided in two inter-related studies. Study 1 explored the experiences that influence prescription of OAC by physicians. Study 2 explored the experiences which influence patients' decisions to accept, decline or discontinue OAC. Methods: Semi-structured individual interviews were conducted in both studies. In Study 1four sub-groups of physicians (n = 16) experienced with OAC in AF were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. In Study 2 three sub-groups of patients (n = 11) diagnosed with AF were interviewed; those who accepted, refused, and who discontinued warfarin. Results: Study 1: Two over-arching themes emerged from doctors' experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians still adopt a paternalistic approach to decision-making. They should instead motivate patients to take part in treatment discussions and choices should reflect the patient's needs and concerns. Physician education should focus more on communication skills, individualised care and time-management as these are critical for patient adherence. Continuous OAC education for AF should adopt a multi-disciplinary approach. Further, interpreters should also be educated on medical communication skills. Study 2: Three over-arching themes comprised patients' experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients' reflections. Patient education during the initial consultation was critical in increasing patient's knowledge of OAC. On-going patient education is imperative to maintain adherence. Patients valued physicians' concern for their needs during decision-making. Patients who had experience of stroke were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Patients' perceptions of warfarin are also influenced by the media. Comment: Qualitative research is crucial in exploring barriers to treatment as it provides an excellent insight into patients' experiences of healthcare. A patient-centred approach should be adopted and incorporated into physicians' education. Education and patient involvement in the decision-making process is essential to promote treatment acceptance and long-term adherence
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Background: Falls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making. Objectives: To systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals. Methods: We searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions. Results: Fifty-nine systematic reviews were identified which consisted of single, multiple and multi-factorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. Conclusions: The aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.