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Individual Needs (individual + need)
Kinds of Individual Needs Selected AbstractsThe added risk of opioid problem use among treatment-seeking youth with marijuana and/or alcohol problem useADDICTION, Issue 4 2010Geetha A. Subramaniam Abstract Objectives To determine the added risk of opioid problem use (OPU) in youth with marijuana/alcohol problem use (MAPU). Methods A total of 475 youth (ages 14,21 years) with OPU + MAPU were compared to a weighted sample of 475 youth with MAPU only (i.e. no OPU) before and after propensity score matching on gender, age, race, level of care and weekly use of marijuana/alcohol. Youth were recruited from 88 drug treatment sites participating in eight Center for Substance Abuse Treatment-funded grants. At treatment intake, participants were administered the Global Appraisal of Individual Need to elicit information on demographic, social, substance, mental health, human immunodeficiency virus (HIV), physical and legal characteristics. Odds ratios with confidence intervals were calculated. Results The added risk of OPU among MAPU youth was associated with greater comorbidity; higher rates of psychiatric symptoms and trauma/victimization; greater needle use and sex-related HIV risk behaviours; and greater physical distress. The OPU + MAPU group was less likely to be African American or other race and more likely to be aged 15,17 years, Caucasian; report weekly drug use at home and among peers; engage in illegal behaviors and be confined longer; have greater substance abuse severity and polydrug use; and use mental health and substance abuse treatment services. Conclusions These findings expand upon the existing literature and highlight the substantial incremental risk of OPU on multiple comorbid areas among treatment-seeking youth. Further evaluation is needed to assess their outcomes following standard drug treatment and to evaluate specialized interventions for this subgroup of severely impaired youth. [source] Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance usersADDICTION, Issue 6 2009Christy K Scott ABSTRACT Aims Post-discharge monitoring and early reintervention have become standard practice when managing numerous chronic conditions. These two experiments tested the effectiveness of recovery management checkup (RMC) protocols for adult chronic substance users. Intervention RMC included quarterly monitoring; motivational interviewing to provide personalized feedback and to resolve ambivalence about substance use; treatment linkage, engagement and retention protocols to increase the amount of treatment received. Participants and setting Recruited from sequential addiction treatment admissions, participants in the two experiments were, on average, 36 and 38 years of age, mainly female (59% versus 46%), African American (85% versus 80%) and met past-year criteria for dependence (87% versus 76%). Design Participants in both experiments were assigned randomly to the RMC or control condition and interviewed quarterly for 2 years. Measurement The Global Appraisal of Individual Needs (GAIN) was the main assessment instrument. Findings RMC participant outcomes were better than control participants in both experiments. Effect sizes were larger in the second experiment in terms of reducing days to readmission (Cohen's d = 0.41 versus d = 0.22), successive quarters in the community using substances (d = ,0.32 versus ,0.19), past-month symptoms of abuse/dependence (d = ,0.23 versus ,0.02) and increasing the days of abstinence over 2 years (d = +0.29 versus 0.04). Conclusion RMC, which provided ongoing monitoring and linkage, is feasible to conduct and is effective for adults with chronic substance dependence. [source] A Perspective on Developing and Marketing Food Products to Meet Individual Needs of Population SegmentsCOMPREHENSIVE REVIEWS IN FOOD SCIENCE AND FOOD SAFETY, Issue 4 2004I. Mehrotra ABSTRACT The promise of evolving research in the area of genomics suggests a move toward an individualized or customized approach to the diet. However, these advances in research do not come without complexities and raise much tougher questions, such as how will the food industry view this as an opportunity? What challenges will it face? Will it play a pivotal role? [source] Rehabilitation and guidance as reported by women and men who had undergone coronary bypass surgeryJOURNAL OF CLINICAL NURSING, Issue 4 2007Kirsi Koivunen RN Aims and objectives., The purpose of this study was to describe the experience of rehabilitation reported by coronary artery disease patients who had undergone coronary artery bypass surgery. A further purpose was to describe the kind of guidance on rehabilitation that they were given during this period. Methods., The data consisted of thematic questionnaires completed by six women and eight men who had undergone coronary artery bypass surgery. They had recorded their experiences on these questionnaires at one-month intervals for a year after the surgery. The data were analysed using the method of content analysis. Results., On the basis of the results, women had experienced the most balanced period of physical, mental and social rehabilitation during the six months following surgery. Their recovery, however, suffered a setback after the first six months. On the basis of the results, men attained a better balance of physical, mental and social rehabilitation only after the six-month period following surgery. Even men had various problems in their rehabilitation, but their recovery proceeded more smoothly than that of women. Women hoped for more guidance throughout the process of rehabilitation. The support and help from wives had a positive impact on the process of men's recovery. Peer support was another significant source support. Conclusions., A person undergoing rehabilitation needs special guidance from health care professionals, especially when his/her rehabilitation does not proceed optimally. The findings suggest that, especially, the guidance of women should be improved because women seemed to suffer from many problems during their process of rehabilitation, including loneliness, insecurity, uncertainty, fears, depression and anxiety. Relevance to clinical practice., Expanding the role of practical nurses to provide both preventive and rehabilitation guidance should be seen as an important strategy in health care. Individual needs, gender differences and support from families and peers should be taken into consideration when planning and implementing guidance. [source] Cancer patients' satisfaction with communication, information and quality of care in a UK regionEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2005R. DAVIDSON bsc, abps. consultant clinical psychologist , dphil., msc (clin. psych.) Effective patient,professional communication can be of crucial importance to long-term psycho-social outcomes in patients with cancer. This study identifies patient satisfaction with regard to various aspects of communication and perceived quality of care. A well-validated questionnaire was administered to 435 cancer patients throughout Northern Ireland during a 3-month period. Northern Ireland can be regarded as a typical UK region in terms of cancer service configuration. The cohort consisted of patients with breast, colorectal, lung, prostate, gynaecological and gastric cancers. There was a 78% response rate. Satisfaction scores were individually calculated for various aspects of care, particularly diagnosis, treatment, follow-up and overall care. Non-parametric analysis examined the interaction between satisfaction scores and primary tumour site, age and gender. While overall satisfaction scores were relatively high, there was considerable variation. Of particular note was the interaction between perceived satisfaction and quality of care, communication, tumour site and age. Key findings are that there are a number of issues with regard to information and communication which can be clearly improved within Northern Ireland cancer services. The paper concludes that patient,professional communication should be tailored to meet individual need. [source] Insulin intensification , the rationale and the targetINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2009A. Liebl Summary Aims:, To review the key evidence supporting targets for glycaemic control in people with type 2 diabetes and the implications for management in primary care. Method:, Literature review. Results:, Achieving early glycaemic control may reduce long-term risk by minimising the ,metabolic memory' effect of hyperglycaemia. Several large studies have failed to confirm expectations that intensive treatment would offer greater reductions in risk. This may reflect the failure to achieve control blood glucose early in the course of diabetes. Management guidelines emphasise the importance of targets for glycaemic control, but differ in the strategies they recommend for dose intensification. All, however, acknowledge the importance of individualising treatment. Conclusion:, Early achievement of targets for glycaemic control may be important to reduce long-term risk in people with diabetes, but treatment should be tailored to individual need. [source] Assessment of the Component Skills for Cognitive Therapy in Adults with Intellectual DisabilityJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 1 2006Theresa Joyce Background, This study examines the extent to which a random sample of adults with intellectual disabilities possess the component skills necessary to undergo cognitive behaviour therapy (CBT). Method, Seventy-two individuals underwent a range of assessments, including measures of language ability, ability to identify and to label emotions, ability to link events and emotions and a cognitive mediation task. The method broadly replicated a previous study undertaken by Dagnan et al. [Cognitive Therapy and Research (2000) vol. 24, pp. 627,636]. Results, Results showed significant relationships between language ability and ability to recognize and label emotions, ability to link events and emotions and pass the cognitive mediation tasks. The majority of the participants were unable to pass the tasks linking emotions and events and the cognitive mediation tasks. They also demonstrated a limited emotional vocabulary. The findings were similar to those of Dagnan et al. (2000). Conclusions, It is possible to assess some of the component skills necessary for undergoing CBT. People with intellectual disabilities will need support from therapists to teach the skills necessary to undertake cognitive interventions, and a ,step-wise' approach to assessment will enable such support to be appropriately targeted to individual need. [source] Sense-making of employment: on whether and why people read employment advertisingJOURNAL OF ORGANIZATIONAL BEHAVIOR, Issue 6 2006Anat Rafaeli This paper suggests a process of sense-making of "employment" and identifies employment ads to be useful agents in this process. It is suggested that individuals read ads in surveillance of the employment market in addition to reading them to search for employment vacancies. Employment ads are suggested to be a forum for organizational self-presentation that offers current information about the employment exchange as it is viewed by employers. Two exploratory studies are presented to support the thesis. Study 1 is an inductive survey of people's reading of employment ads, showing that people read ads even if they are not looking for a job because they view ads as a source of insight about the employment environment. Study 2 reviews the content of employment ads, showing them to convey prevailing elements of the idea of employment, namely that employment is an exchange of employee skills and responsibilities for organizational intrinsic and extrinsic rewards. Recognizing the individual need for sense-making of employment, and identifying employment ads as a source of information about employment, opens up a new area for research and practice on recruiting, organizational self-presentation, and sense-making. Copyright © 2006 John Wiley & Sons, Ltd. [source] Latest news and product developmentsPRESCRIBER, Issue 8 2008Article first published online: 12 MAY 200 Glargine preferred to lispro as type 2 add-on Basal insulin glargine (Lantus) and insulin lispro (Humalog) at mealtimes improved glycaemic control equally well in patients with type 2 diabetes poorly controlled by oral agents, but patient satisfaction was greater with basal insulin (Lancet 2008;371:1073-84). The 44-week APOLLO trial, funded by Sanofi Aventis, was a nonblinded randomised comparison of basal and prandial insulin regimens added to oral treatment in 418 patients. It found similar reductions in HbA1C (,1.7 vs ,1.9 per cent respectively). Fasting and nocturnal glucose levels were lower with insulin glargine and postprandial levels were lower with insulin lispro. The basal regimen was associated with fewer hypoglycaemic events (5.2 vs 24 per patient per year), less weight gain (3.01 vs 3.54kg) and greater improvement in patient satisfaction scores. Treating hypertension cuts mortality in over-80s Treating hypertension in the over-80s reduces all-cause mortality by 21 per cent, the HYVET study has shown (N Engl J Med online: 31 March 2008; doi: 10.1056/NEJMoa 0801369). Compared with placebo, treatment with indapamide alone or with perindopril for an average of 1.8 years also reduced the incidence of fatal stroke by 39 per cent, cardiovascular death by 23 per cent and heart failure by 64 per cent. The incidence of stroke was reduced by 30 per cent but this was of borderline statistical significance. Fewer serious adverse events were reported with treatment than with placebo. New work for NICE The DoH has announced the 18th work programme for NICE. Seven public health interventions include preventing skin cancer, smoking by children and excess weight gain during pregnancy. Public health guidance will include the provision of contraceptive services for socially disadvantaged young people. Two new clinical guidelines are sedation in young people and management of fractured neck of femur. New technology appraisals may include eight therapies for cancer, two new monoclonal antibodies for psoriasis and rheumatoid arthritis, an oral retinoid for severe chronic hand eczema and methylnaltrexone for opioid-induced bowel dysfunction. Combinations no better against CV disease Taking ezetimibe and simvastatin (Inegy) does not appear to slow the progression of atherosclerosis more than high-dose simvastatin alone, say researchers from The Netherlands (N Engl J Med 2008;358: 1431-43). In patients with hypercholesterolaemia, there was no difference in regression or progression of atherosclerosis after two years' treatment with simvastatin 80mg per day alone or combined with ezetimibe 10mg per day. Adverse event rates were similar. In patients with vascular disease or high-risk diabetes, there was no difference between the ACE inhibitor ramipril 10mg per day or the ARB telmisartan (Micardis) 80mg per day as monotherapy, or their combination, in the risk of a composite outcome of cardiovascular death, MI, stroke and admission for heart failure (N Engl J Med 2008;358:1547-59). Combined treatment was associated with higher risks of hypotensive symptoms, syncope and renal dysfunction. Twice-daily celecoxib increases CV risk Taking celecoxib (Celebrex) twice daily carries a higher risk of cardiovascular events than the same total dose taken once daily, a metaanalysis suggests (Circulation 2008; doi: 10.1161/ CIRCULATIONAHA.108. 764530). The analysis of six placebo-controlled trials involving a total of 7950 patients taking celecoxib for indications other than rheumatoid arthritis found that the combined risk of cardiovascular death, myocardial infarction, stroke, heart failure or thromboembolic event increased with dose over the range 400-800mg per day. The risk was significantly greater with 200mg twice daily (HR 1.8) than 400mg once daily (HR 1.1). Patients at greatest baseline risk were at disproportionately increased risk from celecoxib. Long-term etanercept effective in AS An open-label study suggests that etanercept (Enbrel) remains effective in the treatment of ankylosing spondylitis in the long term (Ann Rheum Dis 2008;67:346-52). Of 257 patients who completed six months' treatment with etanercept and who entered the nonblinded extension study, 126 completed a total of 168-192 weeks' treatment. The commonest adverse events were injection-site reactions (22 per cent), headache (20 per cent) and diarrhoea (17.5 per cent). The annual rate of serious infections was 0.02 per person. Response and partial remission rates after 192 weeks were similar to those reported after 96 weeks. Metformin reduces risk Metformin reduces the risk of developing diabetes in individuals at increased risk, a meta-analysis suggests (Am J Med 2008;121:149-57.e2). The study included 31 mostly small, randomised, controlled trials involving a total of 4570 participants and lasting at least eight weeks (8267 patient-years of treatment). Metformin was associated with reductions in body mass (,5.3 per cent), fasting glucose (,4.5 per cent) and insulin resistance (,22.6 per cent); lipid profiles also improved. The odds of developing diabetes were reduced by 40 per cent,an absolute risk reduction of 6 per cent over 1.8 years. MHRA clarifies cough and colds advice Press reports mistakenly suggested that the MHRA had banned some cough and cold remedies when it issued new guidance on treating young children, the MHRA says. The Agency's advice followed a review of over-thecounter cough and cold medicines for children by the Commission on Human Medicines. Children under two are at increased risk of adverse reactions and should no longer be treated with products containing antihistamine (chlorphenamine, brompheniramine, diphenhydramine), antitussives (dextromethorphan, pholcodine), expectorants (guaifenesin, ipecacuanha) and decongestants (phenylephrine, pseudoephedrine, ephedrine, oxymetazoline and xylometazoline). The MHRA said these products, which are classified as general sale medicines, should be removed from open shelves until available in new packaging that complies with the advice. They may still be supplied by a pharmacist for the treatment of older children. Coughs and colds should be treated with paracetamol or ibuprofen for fever, a simple glycerol, honey or lemon syrup for cough, and vapour rubs and inhalant decongestants for stuffy nose. Saline drops can be used to thin and clear nasal secretions in young babies. Parents are being urged not to use more than one product at a time to avoid inadvertently administering the same constituent drug twice. Perindopril brand switch Servier Laboratories is replacing its current formulations of perindopril (Coversyl, Coversyl Plus) with a new product that is not bioequivalent. The current Coversyl brand contains perindopril erbumine (also known as tert -butylamine). The new formulation contains perindopril arginine; it will be distinguished by new brand names (Coversyl Arginine, Coversyl Arginine Plus) and new packaging. Coversyl 2, 4 and 8mg tablets are equivalent to Coversyl Arginine 2.5, 5 and 10mg. Servier says the change is part of the simplification and harmonisation of global manufacturing; the arginine salt is already used in other countries and offers greater stability and a longer shelf-life. Both Coversyl and Coversyl Arginine will be in the supply chain for the next few weeks. Generic perindopril will continue to be the erbumine salt and prescriptions for generic perindopril are not affected. New from NICE Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Clinical Guidance No. 63, March 2008 This clinical guideline focuses on additional aspects of care for women with gestational diabetes (88 per cent of cases) or pre-existing diabetes (of which about 40 per cent is type 2 diabetes) and their babies. To date, insulin aspart (NovoRapid) is the only drug in the guideline specifically licensed for use in pregnancy and NICE advises obtaining informed consent to implement its recommendations for using other insulins and oral hypoglycaemic agents. As with other guidelines, NICE begins by stressing the importance of patient-centred care and involving women in decisions about their treatment. The guideline is divided into six sections, dealing with consecutive periods of pregnancy. Preconceptual planning should include empowering women to help them reduce risks, optimising glycaemic control (after retinal assessment) and increasing monitoring intensity, and providing information about the effects of pregnancy on diabetes. Metformin may be recommended as an adjunct or alternative to insulin, but other oral hypoglycaemic agents should be replaced with insulin, although glibenclamide is an option during pregnancy. Isophane insulin is the preferred long-acting insulin; lispro (Humalog) and aspart are considered safe to use. ACE inhibitors and angiotensin-II receptor blockers should be replaced with other antihypertensive agents and statins should be discontinued. Recommendations for screening and treatment of gestational diabetes build on previous guidance (CG62). Drug treatment will be needed by 10-20 per cent , this includes insulin (soluble, aspart or lispro) and/or metformin or glibenclamide, tailored to individual need. Antenatal care includes optimising glycaemic control. Insulin lispro or aspart should be considered in preference to soluble insulin. If glycaemic control cannot be achieved with insulin injections, an insulin pump may be indicated. The guideline includes a timetable for appointments and the care that should offered after each interval. Recommendations for intrapartum care, which supplement those in CG55, include frequent monitoring of blood glucose. Neonatal care includes recommendations for monitoring and screening the infant and the management of hypoglycaemia. Postnatal care (supplementing CG37) involves adjusting maternal treatment to avoid hypoglycaemia and recommendations for returning to community care. Metformin and glibenclamide are the only oral agents suitable for breastfeeding women. Women with gestational diabetes need advice about glycaemic control and planning for future pregnancies. Lifestyle advice and measurement of annual fasting plasma glucose should be offered. Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over. Technology Appraisal No. 138, March 2008 The latest technology appraisal of asthma treatments covers inhaled steroids for adults and children over 12 with chronic asthma. It makes only two recommendations. First, the cheapest appropriate option is recommended. Second, when a steroid and a long-acting beta2-agonist are indicated, the decision to prescribe a combined inhaler or separate devices should take into account therapeutic need and likely adherence. Combined inhalers are currently less expensive than separate devices, though they may not remain so. When a combined inhaler is chosen it should be the cheapest. NICE concludes that, at equivalent doses, there is little difference in the effectiveness or adverse event profile of the available steroids or the fixed-dose combinations. According to specialist advice, choosing the best device for an individual remains the overriding concern. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. Technology Appraisal No. 139, March 2008 NICE recommends continuous positive airway pressure (CPAP) for adults with moderate or severe obstructive sleep apnoea, and for those with a milder disorder if quality of life and functioning are impaired and alternative strategies such as lifestyle change have failed. Diagnosis and treatment is the responsibility of a specialist team. A CPAP device costs £250-£550 and lasts for seven years. Copyright © 2008 Wiley Interface Ltd [source] Epilepsy and driving: considerations on how eligibility should be decidedACTA NEUROLOGICA SCANDINAVICA, Issue 2010R. Lossius Lossius R, Kinge E, Nakken KO. Epilepsy and driving: considerations on how eligibility should be decided. Acta Neurol Scand: 2010: 122 (Suppl. 190): 67,71. © 2010 John Wiley & Sons A/S. Although few neurologists are formally trained in traffic medicine, they are frequently asked to assess whether a patient is medically fit to drive. For patients with epilepsy, the physician must assess the risk of the patient having a seizure while driving, and decide what is an acceptable risk. The legislation on this subject is aiming at finding a reasonable balance between two important considerations: public safety and a patient's individual need to drive. For the neurologist to explain and put into practice the legislation may be a demanding task and a challenge to the doctor,patient alliance. The decision on driving capability should be tailored to the individual patient and based on careful evaluation and informed judgement. In Norway, to qualify for a driver's license, a seizure-free interval of at least 12 months is currently required for group 1 drivers (passenger cars), whereas group 2 drivers (heavy motor vehicles, commercial driving) must have been seizure-free for at least 10 years and not have experienced epileptic seizures from the age of 18 years. Norwegian physicians are obliged to report patients with seizures to driving authorities, although this is an unpopular rule. In reviewing the available literature, it is apparent that despite there being relatively few sound studies, the risks of car accidents among persons with epilepsy may previously have been overestimated. [source] Are there Characteristics of Infectious Diseases that Raise Special Ethical Issues?1DEVELOPING WORLD BIOETHICS, Issue 1 2004Charles B. Smith ABSTRACT This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community. [source] Why insulin sensitizers but not secretagogues should be retained when initiating insulin in type 2 diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2008Philip Raskin Abstract The stringent targets set for HbA1c levels in type 2 diabetes are currently achieved by fewer than half the patients in the United States. Failure to manage hyperglycaemia in the early stages of disease results in progressive loss of ,-cell function, which ultimately necessitates the initiation of insulin therapy. At this point, choices have to be made on whether to continue oral anti-diabetic drug therapy and, if so, with which agent(s). Historically, sulfonylureas have been the mainstay of oral anti-diabetic drug therapy; however, their long-term efficacy in patients with depleted ,-cell capacity is doubtful, and other classes of oral anti-diabetic drugs, notably the insulin sensitizers, may prove more reliable. These agents (metformin and thiazolidinediones) appear to provide various benefits over and above sustained glycaemic control, which may variably include reduced loss of ,-cell function as well as improvements to cardiovascular risk factors, morbidity, and mortality. Metformin also limits weight gain associated with insulin therapy. This manuscript presents the case that when insulin therapy is initiated it should be tailored to individual needs through combination with one or more insulin sensitizers rather than a secretagogue. Copyright © 2007 John Wiley & Sons, Ltd. [source] Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapyDIABETIC MEDICINE, Issue 9 2000U. Bott SUMMARY Aims To evaluate a treatment and teaching programme including psychosocial modules for patients with Type 1 diabetes mellitus on intensified insulin therapy who failed to achieve their treatment goals despite participation in standard programmes. Methods The 5-day inpatient programme comprises small groups of 4,6 patients, focusing on individual needs and problems. Beyond the teaching lessons (most topics are deliberately chosen by the patients), the programme provides intensive group discussions and offers individual counselling concerning motivational aspects, psychosocial problems and coping strategies. Of the first consecutive 83 participants, 76 were re-examined after 17.5 ± 5.5 months (range 9,31 months). Results At follow-up, HbA1c was not improved compared to baseline (8.0 ± 1.3% vs. 8.1 ± 1.5%). However, the incidence of severe hypoglycaemia per patient/year (glucose i.v., glucagon injection) was substantially decreased: 0.62 ± 1.5 episodes at baseline compared to 0.16 ± 0.9 at follow-up (P < 0.001). Twenty-six per cent of the patients at baseline, and 4% at re-examination had experienced at least one episode of severe hypoglycaemia during the preceding year (P < 0.001). Sick leave days per patient/year decreased from 17.0 ± 38.5,7.7 ± 13.6 days (P < 0.05). Patients improved their perceptions of self-efficacy, their relationship to doctors and felt less externally controlled (P < 0.001). The majority of patients perceived an improved competence regarding diet (80.6%) and adaptation of insulin dosage (82.4%), an improved knowledge (82.2%), and a renewed motivation for the treatment (84.5%). Treatment success was significantly associated with baseline HbA1c, stability of motivation, frequency of blood glucose self-monitoring, control beliefs and change in subsequent outpatient care. Conclusions The programme improved glycaemic control mainly as a result of a substantial reduction in the incidence of severe hypoglycaemia. Patients with persistent poor glycaemic control may benefit from structured follow-up care focusing on motivational aspects of self-management and psychosocial support. [source] A guide to practical babooning: Historical, social, and cognitive contingencyEVOLUTIONARY ANTHROPOLOGY, Issue 3 2009Louise Barrett Professor of Psychology at the University of Lethbridge Abstract As ecologically adaptable animals, baboons are distributed widely across Africa, and display a variety of morphological and behavioral differences that reflect both local ecology and a complex evolutionary history. As long-lived, slowly reproducing animals, baboons face numerous ecological challenges to survival and successful reproduction. As group-living animals, the social world presents an equally diverse array of challenges that require the negotiation of individual needs within the constraints imposed by others. Understanding how all these facets of baboon evolutionary history, life history, ecology, sociality, and cognition fit together is an enormous but engaging challenge, and despite one hundred years of study, it is clear there is a still much to learn about the various natural histories of baboons. What also is clear, however, is that an appreciation of contingency holds the key to understanding all these facets of baboon evolution and behavior. In what follows, I hope to illustrate exactly what I mean by this, highlighting along the way that history is not to be ignored, variability is information and not merely "noise", and that behavioral and cognitive complexity can be two very different things. [source] Diagnosis and Treatment of the Menstrual Migraine PatientHEADACHE, Issue 2008Stephen D. Silberstein MD Women presenting with recurrent disabling headache frequently have migraine; but physicians need to rule out other headache disorders before they reach a diagnosis of migraine with or without aura. Many women who experience migraine in close association to their menstrual cycle may meet the diagnostic criteria for either menstrually related migraine (MRM), or pure menstrual migraine (PMM). Once an accurate diagnosis is made, treatment may be established to best suit the individual needs of that patient. Most women will find that migraine associated with hormone fluctuations respond well to standard treatment approaches including pharmacological and nonpharmacological treatments. Pharmacological approaches include acute, preventive, and short-term prophylaxis. Herein we review the difference between non-menstrual migraine, PMM, and MRM and identify effective treatment strategies for appropriate management of migraine associated with hormonal fluctuations. [source] Needs and risks of patients in a state-wide inpatient forensic mental health populationINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2010Ariel Segal ABSTRACT Routine needs assessments have become mandated requirements for public mental health services. However, the appropriateness of these generic health needs assessments to specialist populations remains questionable. This study sought to assess individual needs assessed using a widely used clinician rated assessment (Health of the Nation Outcome Scales-Secure; HoNOS-Secure), a subjective needs assessment that considers both staff and patient perspectives (Camberwell Assessment of Need-Forensic version; CANFOR), and a measure of risk for general criminal recidivism (Level of Service Inventory: Screening Version; LSI:SV) in a secure forensic mental health service. Results revealed significant positive correlations between staff ratings on HoNOS-Secure, CANFOR total needs, and CANFOR met needs scores, but no significant association between CANFOR ratings or HoNOS-Secure ratings and LSI:SV scores. Although patients and staff reported the same number of needs overall according to CANFOR (7.2 vs. 7.5, P > 0.05), patients reported that more of these needs were unmet (3.1 vs. 2.3, P < 0.05). Differences between staff and patient ratings of need suggest that needs assessments should include patient perspectives to facilitate more collaborative and comprehensive care planning. Divergent perspectives between patients and staff may impair patient engagement in treatment and therefore negatively impact on outcome. Service planning issues and opportunities for future research are discussed. [source] The cultural,ecological orientation of graduate nurses (novice) in medical,surgical nursingINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 5 2008Mary Oliver The aim of this research was to understand the process of clinical reasoning and decision-making and the impact that trajectory of experience has on the decision-making of graduate nurses by investigating the clinical practice of 10 novice nurses. An ethnographic interpretive approach was used to study the clinical practice of novice nurses in medical,surgical nursing. An in-depth interview was conducted following the periods of observation. The findings of this research demonstrate that the graduates who participated in this study were instrumental in creating a cultural,ecological orientation to their practice, and inherent in their practice was a highly developed perceptual awareness of the individual needs of patients and their families, which resulted in a close bond with their patients. [source] The perplexing role of learner control in e-learning: will learning and transfer benefit or suffer?INTERNATIONAL JOURNAL OF TRAINING AND DEVELOPMENT, Issue 3 2010Benjamin P. Granger The appeal of e-learning is not surprising given its many proposed advantages (e.g. flexibility, responsiveness to trainees' individual needs, potential cost-effectiveness). However, as pointed out by Ruël et al., academic research in support of the proposed advantages of electronic human resource management systems is scarce. Although this is generally the case for technologically mediated training, the extant research on e-learning actually questions many of its proposed advantages. In this conceptual piece we (1) establish the link between e-learning and learner control, (2) summarize the advantages and disadvantages of learner-controlled e-learning, (3) briefly present the results of a recent study conducted in our research lab that addresses the disadvantages of learner-controlled e-learning for the training of complex material, and (4) discuss research-based recommendations for the application of learner-controlled e-learning in organizational settings. [source] Mothers' grief following the death of a childJOURNAL OF ADVANCED NURSING, Issue 1 2001Hilkka Laakso PhD RN Mothers' grief following the death of a child Aim of the study.,Research has shown that caring for a dying child is among the hardest and more demanding tasks in nursing, because the staff are forced to manage their heavy work with inadequate skills and experience. This article deals with the findings of a recent study, the purpose of which was to analyse the mother's grief and coping with grief following the death of a child under the age of 7 years. Design.,Data were collected from mothers using a survey (n=91) and an interview (n=50). As the topic was very sensitive ethically and emotionally, survey data were collected first and the mothers were asked to give their consent to taking part in an interview. The study employed both quantitative and qualitative methods. The data were analysed using statistical methods and content analysis. However, only the qualitative part of the study is presented in this article. Findings.,The findings show that nursing staff had skills to support grieving mothers, but that there were many feelings and experiences of grief that remained unidentified by staff. The staff's ability to meet the mothers' individual needs while the child was in hospital and after the child's death was inadequate. The information received from staff was perceived to be insufficient or offensive to mothers. Conclusions.,The development of basic and further education and of various support measures would enable the staff to better cope with their work. Focusing on interactive skills and meeting the patient's individual needs using reflective practice would improve the quality of care. Communication and collaboration between different occupational groups should be promoted, because mothers were dissatisfied with dissemination of information, and ambiguous responsibilities between different occupational groups hampered the acquisition of information. [source] Perception of Computer-tailored Feedback for Smoking Cessation: Qualitative Findings from Focus GroupsJOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 1 2009Hazel Gilbert Tobacco smoking continues to be a major public health problem. Few smokers present themselves for treatment, and it is important to offer a range of interventions that appeal to different individual needs and preferences. Computer-tailored feedback can fill the gap between generic self-help and intensive clinical therapy. Using focus groups, we investigated smokers' perceptions of generic self-help materials and computer-generated individually tailored feedback reports. Participants recognized the generic nature of self-help material and welcomed the concept of personal support, but were concerned about some aspects of the material. Findings supported the continuation of the development and delivery of computer-tailored feedback, but more research is warranted to optimize the content and style of the feedback for individual perceptions and expectations. [source] Cytotoxic chemotherapy for incurable colorectal cancer: living with a PICC-lineJOURNAL OF CLINICAL NURSING, Issue 18 2008Doreen Molloy Aims., (i) To determine which aspects of living with a peripherally inserted central catheter (PICC) line cause Modified de Gramont (MdG) patients most difficulty. (ii) To explore MdG patients' views of the PICC-line experience. (iii) To determine if patients view PICC-lines as a benefit or a burden when receiving ambulatory MdG chemotherapy. Design., A two-stage, descriptive study. Methods., Phase 1 comprised semi-structured interviews. Phase 2 surveyed the MdG population. Phase 1 interview data informed the Phase 2 questionnaire. The setting was a West of Scotland Cancer Care Centre and the sample was: Phase 1, a convenience sample of 10 MdG patients; Phase 2, 62 consecutive patients. Results., A response rate of 93·9% for Phase 2. The majority of PICC-line patients held favourable views towards having a PICC-line and adapted well with minimal disruption to daily life. Concerns were evident regarding coping at home with a PICC-line, chemotherapy spillage, dealing with complex information and the responsibility of patients/carers regarding PICC-line management. Patients preferred ambulatory chemotherapy to in-patient treatment. Conclusions., PICC-lines should be considered for more chemotherapy patients but service development is necessary to ensure individual needs are addressed. Relevance to clinical practice., Contributes to the PICC-line literature by providing a national patient perspective on a range of daily living activities (DLAs). PICC-line patients prefer out-patient ambulatory chemotherapy rather than in-patient treatment. The longer a patient has a PICC-line, the more able they are to manage activities such as dressing. Concerns remain over chemotherapy spillage, partner/carer responsibility for PICC-line maintenance and the proper balance between required information and what the patient wants to know. [source] A systematic review of professional support interventions for breastfeedingJOURNAL OF CLINICAL NURSING, Issue 9 2008Leena Hannula PhD Objectives., The objectives of this systematic review were first, to describe how breastfeeding is professionally supported during pregnancy, at maternity hospitals and during the postnatal period. Secondly, to find out how effective interventions are in supporting breastfeeding. Background., Breastfeeding is an effective way to promote the health of infants. In many countries, the rates for breastfeeding remain lower than recommended. Many studies have examined breastfeeding promotion interventions; some of them are successful and some fail. It is important to find effective combinations of support. Design. Systematic review. Methods., Search of CINAHL, Medline and Cochrane Central Register databases were conducted for data collection. The search was limited to articles published in Finnish, Swedish and English between the year 2000 and March 2006, focusing on breastfeeding and breastfeeding support interventions. Two reviewers independently analysed 36 articles in the final analysis. Results., Interventions expanding from pregnancy to the intrapartum period and throughout the postnatal period were more effective than interventions concentrating on a shorter period. In addition, intervention packages using various methods of education and support from well-trained professionals are more effective than interventions concentrating on a single method. Conclusions., During pregnancy, the effective interventions were interactive, involving mothers in conversation. The Baby Friendly Hospital Initiative (BFHI) as well as practical hands off -teaching, when combined with support and encouragement, were effective approaches. Postnatally effective were home visits, telephone support and breastfeeding centres combined with peer support. Relevance to clinical practice., Professionals need breastfeeding education and support of their organisations to act as breastfeeding supporters. The BFHI -programme is effective and it would be wise to include the core components of the programme in breastfeeding promotion interventions. Mothers benefit from breastfeeding encouragement and guidance that supports their self-efficacy and feelings of being capable and empowered, and is tailored to their individual needs. [source] Does the experimental design capture the effects of complementary therapy?JOURNAL OF CLINICAL NURSING, Issue 4 2007A study using reflexology for patients undergoing coronary artery bypass graft surgery Aim., Our purpose was to pilot test whether reflexology may reduce anxiety in patients undergoing Coronary Artery Bypass Graft Surgery in Iceland. Background., Nurses need to study the effects of complementary therapies in general and particularly those that may be beneficial to decrease patients' anxiety. It has been assumed that reflexology lessens anxiety, but research is needed to substantiate such expectations. Design., A pilot study using randomized design with experimental and control groups. Methods., Nine patients were recruited and randomly assigned into groups with five patients assigned into an experimental group receiving reflexology for 30 minutes and four patients into control group which rested for 30 minutes. Anxiety and physiological variables were measured pre- and post-reflexology sessions once a day over five days. Results., The anxiety scores were lower for patients in the control group on all measures. Systolic blood pressure lowered significantly more in the control group than in the treatment group. No significant changes were observed for other variables. Patients' comments and responses overwhelmingly suggested increased well-being due to both experimental and control intervention. Conclusion., This study showed little evidence to support reflexology as a mean of reducing anxiety in CABG patients. Several methodological problems were identified that need to be considered further. Relevance to clinical practice., It is suggested that reflexology should be tailored to individual needs and research methods used that allow for capturing its holistic nature. Further scholarly work is warranted to explore several methodological issues in studying complementary therapies in a highly complex treatment situation. [source] Swedish Registered Nurses' incentives to use nursing diagnoses in clinical practiceJOURNAL OF CLINICAL NURSING, Issue 8 2006Lena Axelsson BSc Aims and objectives., The purpose of this study was to describe Registered Nurses' incentives to use nursing diagnoses in clinical practice. Background., The use of nursing diagnoses is scarce in Swedish patient records. However, there are hospital wards were all nurses formulate and use nursing diagnoses in their daily work. This leads to the question of what motivates these nurses who do use nursing diagnoses in clinical practice. Design., A qualitative descriptive design. Methods., A purposeful sampling of 12 Registered Nurses was used. Qualitative interviews to collect data and a content analysis were performed. Results., Five categories were identified: identification of the patient as an individual and as a whole, a working tool for facilitating nursing care, increasing awareness within nursing, support from the management and influence on the professional role. The principle findings of this study were: (i) that the Registered Nurses perceived that nursing diagnoses clarified the patient's individual needs and thereby enabled them to decide on more specific nursing interventions, (ii) that nursing diagnoses were found to facilitate communication between colleagues concerning patient care and thus promoted continuity of care and saved time and (iii) that nursing diagnoses were perceived to increase the Registered Nurses' reflective thinking leading to a continuous development of professional knowledge. Conclusions., The present findings suggest that the incentives to use nursing diagnoses originate from effects generated from performing a deeper analysis of the patient's nursing needs. Further research is needed to test and validate the usability and consequences of using nursing diagnoses in clinical practice. Relevance to clinical practice., Motivating factors found in this study may be valuable to Registered Nurses for the use and development of nursing diagnoses in clinical care. Moreover, these factors may be of relevance in other countries that are in a similar situation as Sweden concerning application of nursing diagnoses. [source] Perinatal nursing education for single-room maternity care: an evaluation of a competency-based modelJOURNAL OF CLINICAL NURSING, Issue 1 2005Patricia A Janssen PhD Aims and objectives., To evaluate the success of a competency-based nursing orientation programme for a single-room maternity care unit by measuring improvement in self-reported competency after six months. Background., Single-room maternity care has challenged obstetrical nurses to provide comprehensive nursing care during all phases of the in-hospital birth experience. In this model, nurses provide intrapartum, postpartum and newborn care in one room. To date, an evaluation of nursing education for single-room maternity care has not been published. Design., A prospective cohort design comparing self-reported competencies prior to starting work in the single-room maternity care and six months after. Methods., Nurses completed a competency-based education programme in which they could select from a menu of learning methods and content areas according to their individual needs. Learning methods included classroom lectures, self-paced learning packages, and preceptorships in the clinical area. Competencies were measured by a standardized perinatal self-efficacy tool and a tool developed by the authors for this study, the Single-Room Maternity Care Competency Tool. A paired analysis was undertaken to take into account the paired (before and after) nature of the design. Results., Scores on the perinatal self-efficacy scale and the single-room maternity care competency tool were improved. These differences were statistically significant. Conclusions., Improvements in perinatal and single-room maternity care-specific competencies suggest that our education programme was successful in preparing nurses for their new role in the single-room maternity care setting. This conclusion is supported by reported increases in nursing and patient satisfaction in the single-room maternity care compared with the traditional labour/delivery and postpartum settings. Relevance to clinical practice., An education programme tailored to the learning needs of experienced clinical nurses contributes to improvements in nursing competencies and patient care. [source] The value increment of mass-customized products: an empirical assessmentJOURNAL OF CONSUMER BEHAVIOUR, Issue 4 2006Martin Schreier The primary argument in favour of mass customization is the delivery of superior customer value. Using willingness-to-pay (WTP) measurements, Franke and Piller (2004), Journal of Product Innovation Management, 21, 401,415 have recently shown that customers designing their own watches with design toolkits are willing to pay premiums of more than 100% (,WTP). In the course of three studies, we found that this type of value increment is not a singular occurrence but might rather be a general phenomenon, as we again found average ,WTPs of more than 100% among customers designing their own cell phone covers, T-shirts and scarves. Building on this, we discuss the sources of benefits that are likely to explain this tremendous value increment. We argue that compared to conventional standard products, a mass-customized product might render the following utilitarian and hedonic benefits: (1) First, the output might be beneficial as self-designed products offer a much closer fit between individual needs and product characteristics. In addition to this mere functional benefit, extra value might also stem from (2) the perceived uniqueness of the self-designed product. As the customer takes on the role of an active co-designer, there may also be two general ,do-it-yourself effects': (3) First, the process of designing per se is likely to allow the customer to meet hedonic or experiential needs (process benefit). (4) Customers may also be likely to value the output of self-design more highly if they take pride in having created something on their own (instead of traditionally buying something created by somebody else). This is referred to as the ,pride of authorship' effect. Copyright © 2006 John Wiley & Sons, Ltd. [source] Evidence-based practice: implications and concernsJOURNAL OF NURSING MANAGEMENT, Issue 4 2008BEd (Hons), PETER NOLAN BA (Hons) Aims, The aim of this paper was to undertake a brief critical appraisal of evidence-based practice (EBP) as it is currently perceived in health care settings. Background, The past two decades have seen EBP become increasingly important in health care planning, clinical thinking, and choice of treatments. It is based on scientific rationalism and adherents claim that decisions based on EBP are superior to those based on other approaches to care. Concerns are now being expressed that positivistic approaches to health care fail to take into account people's preferences, their internal resources and their personal understandings of health and wellbeing. It has been argued that there may be multiple types of evidence, all of which have a part to play in the formulation and execution of health care. Methods, After a literature search, this paper argues that whereas EBP may be useful in treating conditions that have a biological cause, it may be less helpful in understanding and treating conditions that have their origins in the social, psychological or spiritual domains. Results, The nature, strengths and limitations of evidence-based practice is discussed in this paper. Nurses are encouraged to develop the critical skills of evaluating EBP in the lives and experiences of the people they care for. Conclusions, Evidence-based practice has a part to play in improving the treatment provided for patients. Nonetheless, nurses should be aware of other kinds of evidence, and appreciate that any single approach to determining care, no matter how popular, is likely to lead to a service that does not truly meet the complex individual needs of patients. Implications for nursing management, In order for evidence-based practice to be safe, the nursing workforce must be able to evaluate the strength and relevance of research findings, and be able to understand that there are different kinds of evidence which should be called upon in order to respond sensitively and appropriately to the preferences of patients. A responsive workforce embraces multiple ways of thinking, respects different paradigms of care, and is able to respond to and respect the forms of care people value and seek. [source] Frail older people's experiences and use of health and social care servicesJOURNAL OF NURSING MANAGEMENT, Issue 2 2007MARKUS THEMESSL-HUBER PhD Aims, To highlight older people's experiences and expectations of services and the consequences for service provision, service development and research. Rationale, A large amount of resources have been invested in providing services for frail older people who experienced multiple hospital admissions. However, their own views are under-reported. Method, Semi-structured interviews with frail older people were conducted in four Scottish Health Board areas to explore the context of emergency admissions and the use of extramural services. Outcomes, Frail older people are high users of services but claim that services are not responsive to their main concerns: meeting individual needs, maximizing independence and helping to live fulfilled lives. Services not catering for these needs are often cancelled or left in abeyance. Conclusion, The same people who are targeted by care services are reluctant to engage with them. Care providers need to adopt older people's priorities to provide them with responsive patient-centred care. [source] Is Self-Determined Functioning a Universal Prerequisite for Motive,Goal Congruence?JOURNAL OF PERSONALITY, Issue 2 2010Examining the Domain of Achievement in Three Cultures ABSTRACT Research has shown that capacity for accessing implicit motives promotes congruence between the implicit and the explicit motivational system: Individuals able to test a conscious goal for its fit with their implicit motivation commit themselves more fully to self-congruent goals. However, it has not yet been shown whether this is a universal phenomenon or limited to Euro-American cultures in which individual needs are less strictly constrained by the social environment than in other cultural contexts. Thus, the present study examined whether self-determination interacts with the implicit achievement motive to predict how much importance individuals from Cameroon, Germany, and Hong Kong ascribe to achievement goals. Moreover, the importance ascribed to goals should indirectly predict life satisfaction via success in goal realization. Results showed that the associations described above are valid in all three cultural groups and are discussed in terms of their implications for the universal processes characterizing motivation. [source] Consumer participation in mental health services: looking from a consumer perspectiveJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2003J. LAMMERS rn bed mba phd Widespread changes to the structure and delivery of mental health services have effected considerable change in the role of the service user or consumer. The view of consumers of mental health services as passive recipients of care and treatment is gradually undergoing a significant shift, in light of an increasing expectation that consumers be provided with opportunities to become actively involved in all aspects of their care. Consumer participation is now broadly reflected in government policy; however, to date there has been little exploration of the extent to which the policy is being realized in practice. To provide a greater understanding of these experiences and opinions, in-depth interviews were conducted with consumers of mental health services (n = 15). The interview transcripts were analysed through the identification and explication of major themes. The findings reinforce the need to view consumers as heterogenous and respond to individual needs and interests regarding consumer participation. Despite variations in experience there is a clear need to develop mechanisms to support consumer involvement and to influence the attitudes of health professions to become more valuing of a consumer perspective. Nurses are in an ideal position to lead this process. [source] | |||||||||||||||||||||||||||||||||||||