Care Principles (care + principle)

Distribution by Scientific Domains

Selected Abstracts

Effects of back care education in elementary schoolchildren

G Cardon
The purpose of this study was to investigate the effects of a back care education programme, consisting of six sessions of 1 h each, in fourth- and fifth-grade elementary schoolchildren. Testing consisted of a practical performance and a back care knowledge test. Forty-two subjects and 36 controls performed a pre-test and were tested within 1 wk after the programme. To monitor effects and follow-up effects on a larger sample, 82 different pupils were tested within 1 wk after the programme and 116 other children 3 mo after. Both larger samples were compared with one group of 129 controls. Interrater reliability for the test items of the practical assessment was high; intraclass correlation coefficients varied from 0.785 to 0.980. In the pre/post design study, interaction between time and condition was significant for the sum score of the practical assessment and for the knowledge test (p < 0.001), with higher scores for the intervention group (15% improvement for the knowledge test score, 31.6% for the practical sum score). Significantly higher sum scores for the knowledge test and for all practical assessment items were found in the intervention groups, tested within 1 wk and 3 mo after the programme, in comparison with the control group (p <0.001). Conclusion: The effectiveness of a primary educational prevention programme on back care principles was demonstrated in this study. Effectiveness, long-term outcomes and behavioural changes need further evaluation to optimize back care prevention programmes for elementary schoolchildren. [source]

Are Internal Medicine Residency Programs Adequately Preparing Physicians to Care for the Baby Boomers?

A National Survey from the Association of Directors of Geriatric Academic Programs Status of Geriatrics Workforce Study
Patients aged 65 and older account for 39% of ambulatory visits to internal medicine physicians. This article describes the progress made in training internal medicine residents to care for older Americans. Program directors in internal medicine residency programs accredited by the Accreditation Council for Graduate Medical Education were surveyed in the spring of 2005. Findings from this survey were compared with those from a similar 2002 survey to determine whether any changes had occurred. A 60% response rate was achieved (n=235). In these 3-year residency training programs, 20 programs (9%) required less than 2 weeks of clinical instruction that was specifically structured to teach geriatric care principles, 48 (21%) at least 2 weeks but less than 4 weeks, 144 (62%) at least 4 weeks but less than 6 weeks, and 21 (9%) required 6 or more weeks. As in 2002, internal medicine residency programs continue to depend on nursing home facilities, geriatric preceptors in nongeriatric clinical ambulatory settings, and outpatient geriatric assessment centers for their geriatrics training. Training was most often offered in a block format. The mean number of physician faculty per residency program dedicated to teaching geriatric medicine was 3.5 full-time equivalents (FTEs) (range 0,50), compared with a mean of 2.2 FTE faculty in 2002 (P,.001). Internal medicine educators are continuing to improve the training of residents so that, as they become practicing physicians, they will have the knowledge and skills in geriatric medicine to care for older adults. [source]

,Liberal' vs. ,restrictive' perioperative fluid therapy , a critical assessment of the evidence

Background: Several studies have assessed the effect of a ,liberal' vs. a ,restrictive' perioperative fluid regimen on post-operative outcome. The literature was reviewed in order to provide recommendations regarding perioperative fluid regimens. Methods: A PubMed search identified randomized clinical trials and cited studies, comparing two different fixed fluid volumes on post-operative clinical outcome in major surgery. Studies were assessed for the type of surgery, primary and secondary outcome endpoints, the type and volume of administered fluid and the definition of the perioperative period. Also, information regarding perioperative care and type of anaesthesia was assessed. Results: In the seven randomized studies identified, the range of the liberal intraoperative fluid regimen was from 2750 to 5388 ml compared with 998 to 2740 ml for the restrictive fluid regimen. The period for fluid therapy and outcome endpoints were inconsistently defined and only two studies reported perioperative care principles and discharge criteria. Three studies found an improved outcome (morbidity/hospital stay) with a restrictive fluid regimen whereas two studies found no difference and two studies found differences in the selected outcome parameters. Conclusion: Liberal vs. restrictive fixed-volume regimens are not well defined in the literature regarding the definition, methodology and results, and lack the use of or information on evidence-based standardized perioperative care-principles (fast-track surgery), thereby precluding evidence-based guidelines for procedure-specific perioperative fixed-volume regimens. Optimization of perioperative fluid management may include a combination of fixed crystalloid administration to replace extra-vascular losses and avoiding fluid excess, together with individualized goal-directed colloid administration to maintain a maximal stroke volume. [source]

The experiences and perceived changes of Chinese ex-mental patients attending a holistic psychiatric rehabilitation programme: a qualitative study

The paper reports a study on the subjective experiences and perceived personal changes of Chinese ex-mental patients attending a psychiatric holistic rehabilitation programme. The programme adopted a self-help group approach in which holistic aspects of physical, psycho-social and spiritual needs are emphasized. There are different rehabilitation programmes for chronic mental patients. However, spiritual element is not consciously included in most of these programmes. Furthermore, few studies document the changes of participants attending psychiatric rehabilitation adopting self-help and holistic care principles. A qualitative approach using an in-depth interview was adopted. A total of 20 members from the programme, which was about one-sixth of all the regular group members were recruited. All interviews were audiotaped and transcribed. Data were coded, categorized and developed to different themes using content analysis. Totally, there were 52 themes developed from the data. However, only 13 themes on experiences in the group and nine themes on the perceived personal changes were reported. By attending the programme, participants had positive feelings and gained many positive learning opportunities when interacting with peers. Interacting with group counsellors was also very beneficial to them. Though there were only some improvements physically, there were clear perceived positive changes in the psychological, social and spiritual dimensions. These findings are consistent with those found in the quantitative measures reported previously. The subjective experiences of the participants were positive and they perceived positive personal changes after joining the group. The findings support the effectiveness of the long-term nature of self-help group. Furthermore, the holistic programme helps members rediscover meaning and purpose of life and the religious practices in the group can be regarded to be a protective factor to stress not only to those believers but also to the non-believers. [source]

Geriatric Emergency Medicine with Integrated Simulation Curriculum

Chris Doty
Our initiative is a replicable model curriculum that teaches emergency geriatric care principles utilizing didactics and immersive simulation. Simulated scenarios encompass principles specific to geriatric care. Major curricular principles include: 1) respect for patients' autonomy, 2) accommodating patients' physical and cognitive limitations, 3) appropriate resource utilization, and 4) accurate symptom recognition and clinical decision-making. These four basic principles are incorporated throughout the curriculum and specifically during three simulated scenarios: 1) a patient with respiratory distress in the setting of end-stage cancer and end-of-life teaches topics pertaining to living wills, health care proxies and DNR orders; 2) a fallen patient requiring a trauma evaluation and safe discharge teaches resource utilization, complex evaluation of home environment, social support principles, access to medical care concepts, and utilization of institutional social services; 3) a patient with altered mental status caused by polypharmacy and sepsis teaches geriatric diagnostic and intervention challenges. Faculty teach specific clinical tactics such as minimizing distractions, frequent reorientation, minimal use of urinary catheters and "tethering" devices, prompt triage and medical screening exams, and coordinating disposition with family, nursing, and clerical staff. The curriculum also includes large classroom didactics incorporating active learning via live streamed simulation into the resident conference room. We developed an internet-based tool to manage the curriculum and track resident participation. The tool stores and sends educational handouts via email and displays digital media (e.g., radiographs, EKGs) on screen during lectures and simulation sessions. Learning objectives are measured and reinforced with pre- and post-curriculum test questions. [source]

Laparoscopic colonic surgery , mission accomplished or work in progress?

H. Kehlet
Abstract Laparoscopic colonic resection may facilitate early postoperative recovery due to reduced surgical stress, pain and ileus. However, large randomised studies have only shown marginal improvements in outcome compared with open surgery, reporting a median hospital stay of about 5,7 days. Concomitant with these developments multimodal rehabilitation, which involves a revision of general postoperative care principles, improved pain relief with epidural analgesia and early oral nutrition and mobilization, has demonstrated greater improvements in recovery after open surgery, resulting in a median hospital stay of about 2,4 days. Recent single centre, randomised studies where laparoscopic and open colonic resection are combined with multimodal rehabilitation have not resolved the debate regarding which is the optimal operative technique. Therefore, new strategies are required to integrate laparoscopy with multimodal rehabilitation in order to establish its advantages, cost effectiveness and indications in specific groups of patients or colorectal procedures, thus justifying widespread application of the laparoscopic technique. [source]