Medicine and Health Sciences Commons^™

Nutrition Status Of Primary Care Patients With Depression And Anxiety, Adrienne K. Forsyth, Peter G. Williams, Frank P. Deane

Frank Deane

The objective of this study was to evaluate the nutrition status of people referred to a nutrition and physical activity program for the management of mental health in a general practice.

An Indoor Localisation And Motion Monitoring System To Determine Behavioural Activity In Dementia Afflicted Patients In Aged Care, Matthew D'Souza, Montserrat Ros, Mohanraj Karunanithi

Dr Montserrat Ros

Dementia is highly prevalent among the older population. Most patients with dementia are admitted to an aged care facility due to wandering behaviour which tends to result in dangerous scenarios such as straying away from the facility and being seriously injured. Due to the decreasing availability of carers in aged care, there is a need to prioritise monitoring of patients that have a severe case of wondering. The challenge is to allow carers to monitor the status of such patients in terms of position localisation and motion behavioural status, in real-time. The long term behavioural analysis of such patients would …

Does Psychological Status Influence Clinical Outcomes In Patients With Inflammatory Bowel Disease (Ibd) And Other Chronic Gastroenterological Diseases: An Observational Cohort Prospective Study, Antonina A. Mikocka-Walus, Deborah Turnbull, Nicole T. Moulding, Ian G. Wilson, Gerald J. Holtmann, Jane M. Andrews

Ian G Wilson

Background: Whether there is a temporal relationship between psychological problems and clinical outcomes in patients with diseases of the digestive tract has not been widely researched. Thus, our aims were 1) To observe and compare prospectively clinical outcomes in relation to psychological co-morbidity in patients with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and chronic hepatitis C (HCV) and, 2) To test the hypothesis that patients with psychological co-morbidities are less likely to have a satisfactory response to standard treatment at 12 months. Methods: Overall, 139 patients were enrolled in this observational cohort prospective study. Over the ensuing year, …

Exploring The Practice And Use Of Western Herbal Medicine: Perspectives From The Social Science Literature, Nina Nissen, Sue Evans

Dr Sue Evans

The literature which concerns Western herbal medicine (WHM) overwhelmingly provides clinical and pharmacological perspectives on the utilisation of herbs as medicine. Research which examines WHM as a social practice and the theoretical concepts associated with it, or the manner in which the knowledge base of WHM is developing and changing is less often discussed. This article provides an overview of the social science literature concerning WHM, as it pertains to practice in Europe, North America and Australasia. One theme emerging from this literature is the mapping of the practice, patients and practitioners of WHM, and another theme addresses more theoretical …

Risk Of Road Traffic Accidents In Patients Discharged Following Treatment For Psychotropic Drug Overdose: A Self-Controlled Case Series Study In Australia, Tharaka L. Dassanayake, Alison L. Jones, Patricia Michie, Gregory Carter, Patrick Mcelduff, Barrie J. Stokes, Ian Whyte

Alison L Jones

Background: Use of psychotropic drugs is known to impair driving and increase the risk of road traffic accidents. They are also the most common drugs taken in overdose in hospital-treated episodes of self-poisoning. Most patients who take psychotropic drug overdoses are discharged within 48 hours, while they still have possible subclinical drug effects. Objective: Using a self-controlled case series design, we aimed to determine whether patients with psychotropic drug overdose are at a higher risk of a traffic accident in the period following discharge compared with a control period not associated with hospital-treated drug overdose. Methodology: Using the New South …

Contrasting Views Of Physicians And Nurses About An Inpatient Computer-Based Provider Order-Entry System, Todd W. Gress, Michael Weiner, David R. Thiemann, Mollie Jenckes, Stephanie L. Reel, Steven F. Mandell, Eric B. Bass

Todd W. Gress

Objective: Many hospitals are investing in computer-based provider order-entry (POE) systems, and providers’ evaluations have proved important for the success of the systems. The authors assessed how physicians and nurses viewed the effects of one modified commercial POE system on time spent patients, resource utilization, errors with orders, and overall quality of care. Design: Survey. Measurements: Opinions of 271 POE users on medicine wards of an urban teaching hospital: 96 medical house officers, 49 attending physicians, 19 clinical fellows with heavy inpatient loads, and 107 nurses. Results: Responses were received from 85 percent of the sample. Most physicians and nurses …

The Ethics Of Vaginal Birth After Cesarean, Sonya Charles

Philosophy and Religious Studies Department Faculty Publications

The decline in providers and facilities that will allow a trial of labor after cesarean forces many women to choose a repeat cesarean. The choice is frequently not much of a choice, however, since the full range of options are often not on the table. This limited 'choice' violates obstetricians' obligations both to respect patients' autonomy and to offer them good care. There has been a vigorous but so far not very fruitful debate in the last few years about the lack of access to a trial of labor after cesarean. Some recently released documents express concern about the limited …

What Do Older Patients Want? Understanding Older Patients' Attitudes Towards General Practice Trainees, Andrew D. Bonney, Sandra C. Jones, Donald Iverson, Christopher Magee

Don C. Iverson

Context: Older patients constitute an increasing proportion of the caseloads in general practice (GP) training practices, but are relatively reluctant to consult trainees. Understanding their attitudes is a first step in improving older patient-trainee interaction. Objectives: Characterise the attitudes of older patients to GP trainees. Design: Cross-sectional survey; exploratory factor analysis; logistic regression. Setting: Randomised, stratified sample of 38 training practices across five Australian states. Participants: Patients aged 60 years and over (N=911; response rate 47.9%). Instrument: Questionnaire for self-completion: previously piloted and subjected to factor analysis. Main and secondary outcome measures: Identification of attitude factors; patient characteristics predicting high …

The Older Patient, The Doctor And The Trainee: Patients' Attitudes And Implications For Models Of Care, Andrew Bonney, Sandra Jones, Donald Iverson

Don C. Iverson

Aims & rationale/Objectives Population ageing poses major challenges for health systems. Additionally, training future general practitioners in the management of older and chronically ill patients is potentially hampered by the reluctance of these patients to consult trainees for chronic care. This paper reports a cross-sectional study investigating the attitudes of older patients to trainees, to inform strategies to improve older patient-trainee interaction. Methods The survey instrument was distributed to 1900 patients aged 60 and over from 38 training practices from five Australian states using a stratified, randomised cluster sampling process. Generalised estimating equation models were used for analysis. Principal findings …

General Practice Registrars: Attitudes Of Older Patients, Andrew D. Bonney, Sandra C. Jones, Lyn Phillipson, Donald C. Iverson

Don C. Iverson

Previous research indicates that older patients may be less willing to consult general practice registrars (GPRs), reducing training opportunities in chronic/complex care. This survey explores older patients’ attitudes in order to inform models of interaction that would be acceptable to patients. METHODS Ten training general practices distributed questionnaires for self completion to 50 patients aged 60 years and over. Chi-square, Spearman’s rho and logistic regression were used for analysis. RESULTS The response rate was 47%. Ninetysix percent wanted ongoing contact with their general practitioner if they saw a GPR. Twenty-four percent were comfortable with GPR chronic/complex care, increasing to 73% …

Preparing For An Ageing Population: A Survey Of Older Patients' Attitudes To General Practice Registrars, Andrew D. Bonney, Sandra C. Jones, Lyn Phillipson, Donald C. Iverson

Don C. Iverson

The ageing population makes it imperative to provide appropriate training for general practice registrars (GPRs) in the community-based care of older patients. However, data suggest that older patients may be less willing to consult GPRs for chronic/complex care; adversely affecting training opportunities and potentially the satisfaction of older patients in training practices. This cross-sectional study was undertaken to investigate this concern in the Australian context and develop models of older patient-GPR interaction that are acceptable to patients.

The Effect Of Heart Failure Education On Intermediate Care Unit Nursing Staff's Knowledge Of Heart Failure, Self-Care, And Best Practice Guidelines, Carol Budgin

Evidence-Based Practice Project Reports

Heart failure (HF) is a chronic disease affecting nearly six million people in the United States with an annual cost of nearly 33 billion dollars. If nurses are inadequately prepared to care for and/or educate patients with HF, evidence-based (EB) nursing care will be suboptimal and hospital readmission rates with the subsequent increased costs for care will continue to soar. To address their higher-than-national average HF readmission rates, an EB nursing project was implemented at a local, urban community hospital to assess intermediate care unit (IMCU) nursing staff’s knowledge of HF, selfcare, and best practice guidelines. The Rossworm & Larrabee …

Pain Management In Triage And Reducing Percentage Of Left Without Being Seen In An Overcrowded Ed, Christina Ballejos-Campos Phd

Dissertations

Although in most emergency rooms, the patient is seen first by a highly trained triage nurse, the ED physician is trained to determine if the patient can safely leave the ED prior to in-depth exam, treatment and diagnosis. The goal is to keep the left without being seen by a physician percentage low, since a high number would indicate poor quality, additionally patients who present with pain, and then leave the ED prior to being seen can pose a greater risk. This study examined the association of nurse-initiated triage pain protocol on the LWOBS percentage rate of patients who present …

Relationship Between Delirium And Night-Time Interruptions In Icu, Amy R. Stuck Phd, Rn

Dissertations

Background: This dissertation examined the phenomenon of delirium in the intensive care unit (ICU) setting. Delirium is a form of cognitive disturbance with a physiologic etiology and complex, multifactorial mechanisms of causation and risk. Delirium in the ICU patient presents a significant risk for adverse outcomes including increased mortality, length of stay, falls, and restraint use. ICU delirium can lead to persistent cognitive impairment beyond discharge and frequent skilled nursing placement. Identifying delirium requires accurate diagnosis that is optimized when validated instruments are used. Sleep deprivation has been linked to adverse health consequences including delirium. Previous studies investigating the relationship …

Assessing The Quality, Suitability And Readability Of Internet-Based Health Information About Warfarin For Patients, Sayeed Nasser, Judy Mullan, Beata Bajorek

Graduate School of Medicine - Papers (Archive)

Background
Warfarin is a high-risk medication where patient information may be critical to help ensure safe and effective treatment. Considering the time constraints of healthcare providers, the internet can be an important supplementary information resource for patients prescribed warfarin. The usefulness of internet-based patient information is often limited by challenges associated with finding valid and reliable health information. Given patients’ increasing access of the internet for information, this study investigated the quality, suitability and readability of patient information about warfarin presented on the internet.
Method
Previously validated tools were used to evaluate the quality, suitability and readability of patient information …

'If My Arms And Legs Aren't Dropping Off I'Ll Wait To See My Usual Gp!' An Analysis Of Older Patients' Attitudes To Registrars Informed By Agency Theory, Andrew D. Bonney, Sandra C. Jones, Donald C. Iverson, Christopher A. Magee

Graduate School of Medicine - Papers (Archive)

Continuity of care and trust are important in older patient-doctor relationships which impacts older patient willingess to consult registrars for chronic disease management.

Gender Differences In Cognitive Function Of Patients With Chronic Schizophrenia, Mei Han, Xu-Feng Huang, Da Chun Chen, Mei Hong Xiu, Li Hui, Haibo Liu, Thomas R. Kosten, Xiang Yang Zhang

Faculty of Science, Medicine and Health - Papers: part A

Schizophrenic patients have cognitive impairments, but gender differences in these cognitive deficits have had limited study. This study assessed cognitive functioning in 471 subjects including 122 male and 78 female schizophrenic patients and 141 male and 130 female healthy controls. We found that immediate memory, language, delayed memory and total RBANS scores were significantly decreased in schizophrenia compared with healthy controls for both genders. Male patients had significant lower immediate memory, delayed memory and total RBANS scores than female patients, and healthy controls showed a similar gender difference. The RBANS showed modest correlations with PANSS scores, duration of illness and …

Nutrition Status Of Primary Care Patients With Depression And Anxiety, Adrienne K. Forsyth, Peter G. Williams, Frank P. Deane

Faculty of Health and Behavioural Sciences - Papers (Archive)

The objective of this study was to evaluate the nutrition status of people referred to a nutrition and physical activity program for the management of mental health in a general practice.

Needs Assessment Of Emergency Department Social Workers In Southwestern Minnesota In Relation To Emergency Department Expansion, Gina Marie Njugunah

All Graduate Theses, Dissertations, and Other Capstone Projects

Expansion of a hospital emergency department will affect the role of the emergency department social worker. This research project was conducted to assess the needs, concerns, and strengths of the social workers working in the emergency department of a regional medical center. The study included 13 participants who completed an on-line survey. Results showed that participants were concerned with the increase in patient volume as well as the possible increase in wait time for patients. Participants also expressed how concerns could be addressed. The most common solution was to track information about the cases, including wait times for patients, in …

Stroke Rehabilitation, Length-Of-Stay, And Re-Admission Rates: A Literature Review, Morgen Hagedorn

All Graduate Theses, Dissertations, and Other Capstone Projects

Stroke is shown to be a significant U.S. health problem with a profound impact on the nation’s rising healthcare costs (Hall, Levant, & DeFrances, 2012). Longer patient length-of-stay [LOS] and higher re-admission rates have brought consequences to healthcare systems as institutional budgets are unable to reconcile the additional services and the influx of healthcare demands. Through a comprehensive literature review, the author illustrates the general knowledge available on the stroke experience, on stroke care and rehabilitation, and on patient LOS and re-admission rates. The literature review is based on general medical research with a focus on the stroke population. The …

Survey Of Emergency Department Patients' Perceived Barriers To Accessing Services And Community Resource Utilization, Kelsey Ann Wilke

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this project is to describe the patients being served by Avera McKennan’s emergency department (ED) and to explore perceived barriers to accessing services and current community resource utilization in order to prevent further non-emergent visits.

Research Questions: 1) What are the demographic characteristics of emergency department patients that are referred to the emergency department social worker? 2) What are the perceived barriers that emergency department patient’s encounter when trying to access services and community resources?

Educate Your Patients About Hpv, Constance R. Sharuga, Tabitha Price, Deborah Dotson

ETSU Faculty Works

Excerpt: According to the United States Centers for Disease Control and Prevention (CDC), approximately 20 million Americans are currently infected with human papillomavirus (HPV), and another 6 million will become newly infected each year.

Bridging Tactics: Parental Support Systems: A Proposal For A Psycho-Educational Parent Group, Emily F. Thompson

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this Capstone project is to design and present a new intervention program for increasing supportive services to the parents of clients being served through the infant/early childhood mental health program at CSSM. The goal of this project is to provide CSSM with a culturally-­responsive, theoretically grounded, evidence-­based proposal for the development of a psycho-educational group that includes a clear rationale for why this intervention is needed and how it will help the agency achieve the outcomes of infant/early childhood mental health program.

Risk Of Road Traffic Accidents In Patients Discharged Following Treatment For Psychotropic Drug Overdose: A Self-Controlled Case Series Study In Australia, Tharaka L. Dassanayake, Alison L. Jones, Patricia Michie, Gregory Carter, Patrick Mcelduff, Barrie J. Stokes, Ian Whyte

Graduate School of Medicine - Papers (Archive)

Background: Use of psychotropic drugs is known to impair driving and increase the risk of road traffic accidents. They are also the most common drugs taken in overdose in hospital-treated episodes of self-poisoning. Most patients who take psychotropic drug overdoses are discharged within 48 hours, while they still have possible subclinical drug effects. Objective: Using a self-controlled case series design, we aimed to determine whether patients with psychotropic drug overdose are at a higher risk of a traffic accident in the period following discharge compared with a control period not associated with hospital-treated drug overdose. Methodology: Using the New South …

Educating Patients About Warfarin Theray Using Information Technology: A Survey On Healthcare Professionals' Perspectives, Sayeed Nasser, Judy Mullan, Beata Bajorek

Graduate School of Medicine - Papers (Archive)

Objective: To explore healthcare professionals’ views about the benefits and challenges of using information technology (IT) resources for educating patients about their warfarin therapy.

Methods: A cross-sectional survey of both community and hospital-based healthcare professionals (e.g., doctors, pharmacists and nurses) involved using a purpose-designed questionnaire. The questionnaires were distributed using a multi-modal approach to maximise response rates.

Results: Of the total 300 questionnaires distributed, 109 completed surveys were received (43.3% response rate). Over half (53.2%) of the healthcare participants were aged between 40-59 years, the majority (59.5%) of whom were female. Fifty nine (54.1%) participants reported having …

Care Of Patients With A Diagnosis Of Chronic Obstructive Pulmonary Disease: A Cluster Randomised Controlled Trial, Nicholas Zwar, Oshana Hermiz, Elizabeth J. Comino, Sandy Middleton, Sanjyot Vagholkar, Wei Xuan, Stephen F. Wilson, Guy B. Marks

Faculty of Science, Medicine and Health - Papers: part A

Objective: To evaluate a partnership model of care for patients with a diagnosis of chronic obstructive pulmonary disease (COPD). Design, setting and participants: Cluster randomised controlled trial with blinded outcome assessment of 44 general practices in south-western Sydney comprising 451 people with a diagnosis of COPD, conducted between 2006 and 2009. Intervention: Participants from intervention group practices were visited at their home by a registered nurse with specific training in COPD care who worked with the general practitioner, the patient and other health professionals to develop and implement an individualised care plan based on best-practice guidelines. Participants from control group …

The Impact Of Cannabis Use On Cognitive Functioning In Patients With Schizophrenia: A Meta-Analysis Of Existing Findings And New Data In A First-Episode Sample, Murat Yücel, Emre Bora, Daniel I. Lubman, Nadia Solowij, Warrick J. Brewer, Sue M. Cotton, Phillipe Conus, Michael J. Takagi, Alex Fornito, Stephen J. Wood, Patrick D. Mcgorry, Christos Pantelis

Faculty of Health and Behavioural Sciences - Papers (Archive)

Cannabis use is highly prevalent among people with schizophrenia, and coupled with impaired cognition, is thought to heighten the risk of illness onset. However, while heavy cannabis use has been associated with cognitive deficits in long-term users, studies among patients with schizophrenia have been contradictory. This article consists of 2 studies. In Study I, a meta-analysis of 10 studies comprising 572 patients with established schizophrenia (with and without comorbid cannabis use) was conducted. Patients with a history of cannabis use were found to have superior neuropsychological functioning. This finding was largely driven by studies that included patients with a lifetime …

An Indoor Localisation And Motion Monitoring System To Determine Behavioural Activity In Dementia Afflicted Patients In Aged Care, Matthew D'Souza, Montserrat Ros, Mohanraj Karunanithi

Faculty of Health and Behavioural Sciences - Papers (Archive)

Dementia is highly prevalent among the older population. Most patients with dementia are admitted to an aged care facility due to wandering behaviour which tends to result in dangerous scenarios such as straying away from the facility and being seriously injured. Due to the decreasing availability of carers in aged care, there is a need to prioritise monitoring of patients that have a severe case of wondering. The challenge is to allow carers to monitor the status of such patients in terms of position localisation and motion behavioural status, in real-time. The long term behavioural analysis of such patients would …

Physical Activity And Energy Expenditure In Haemodialysis Patients: An International Survey, Carla Maria Avesani, Stanislas Trolonge, Patrik Deleaval, Flavia Baria, Denise Mafra, Gerd Faxen-Irving, Phillipe Chauveau, Daniel Teta, Maria Ayako Kamimura, Maria Chan, Lilian Cuppari, Olof Heimburger, Denis Fouque

Faculty of Health and Behavioural Sciences - Papers (Archive)

Background. The assessment of physical activity and energy expenditure is relevant to the care of maintenance haemodialysis (MHD) patients. In the current study, we aimed to evaluate measurements of physical activity and energy expenditure in MHD patients from different centres and countries and explored the predictors of physical activity in these patients. Methods. In this cross-sectional multicentre study, 134MHD patients from four countries (France, Switzerland, Sweden and Brazil) were included. The physical activity was evaluated for 5.0 6 1.4 days (mean 6 SD) by a multisensory device (SenseWear Armband) and comprised the assessment of number of steps per day, activity-related …

Recent Peritonitis Associates With Mortality Among Patients Treated With Peritoneal Dialysis, Neil Boudville, Anna Kemp, Philip Clayton, Wai Lim, Sunil V. Badve, Carmel M. Hawley, Stephen P. Mcdonald, Kathryn J. Wiggins, Kym M. Bannister, Fiona G. Brown, David W. Johnson

Illawarra Health and Medical Research Institute

Peritonitis is a major complication of peritoneal dialysis, but the relationship between peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of peritonitis with 27% of patients having ≥2 …