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1.
Ergonomics ; : 1-17, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38515318

RESUMO

This paper examines opportunities and challenges of integrating augmented reality (AR) into education and investigates requirements to enable instructors to author AR educational experiences. Although AR technology is recognised for its potential in educational enhancement, it poses challenges for instructors creating AR-based experiences due to their limited digital skills and the complexity of 3D authoring tools. Semi-structured interviews with 17 aviation instructors identified current pedagogical approaches, gaps, and potential applications of AR in aviation weather education. Additionally, results highlighted the benefits of AR and obstacles to its integration into education, followed by outlining design priorities and user needs for educational AR authoring. For AR authoring toolkit development, this study recommended incorporating interactive AR lesson modules, early development of user requirements, and prebuilt AR modules. Findings will guide the development of a 3D authoring toolkit for non-technologist instructors, enabling wider AR use in aviation weather education and other educational fields.


Research interviews with aviation instructors were conducted to derive design implications of AR authoring toolkits for non-technologist instructors. Key findings highlighted gaps in aviation weather education, potential AR applications, and barriers to AR in education. Design recommendations emphasised incorporating interactive AR lesson modules, initial user requirements, and prebuilt AR modules.

2.
J ECT ; 34(1): e5-e9, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28937549

RESUMO

OBJECTIVES: Super refractory status epilepticus (SRSE) is a stage beyond refractory status that requires general anesthesia as management. Electroconvulsive therapy (ECT) is recommended only as a potential treatment option beyond general anesthesia and after all other options have been exhausted. Its effect on aborting status has been minimally researched. We present the largest case series to our knowledge exploring the effect of ECT on SRSE. METHODS: Eight adults hospitalized for SRSE received ECT in an attempt to abort status after other treatment modalities were exhausted. Electroconvulsive therapy consisted of a 504-mC (≈99.4 J) stimulus delivered bifrontotemporally with a constant 0.5-millisecond pulse width. Seizure activity during ECT was monitored visually and correlated to the single-channel recording provided by the apparatus. RESULTS: There was neurotelemetry or clinical evidence of improvement within 24 hours after the full course of ECT treatment in 5 (63%) of the 8 cases. Cases that improved were given an average of 7.8 total ECT stimulations, eliciting an average of 4.2 total seizures. CONCLUSIONS: Although it is difficult to determine the exact role of ECT in the improvement of 63% of our cases, we present a series of patients for whom pharmacotherapy, ketogenic diet, and general anesthesia otherwise did not produce an appreciable effect on status prior to implementation of ECT. These findings suggest that cases of SRSE may benefit from ECT administration.


Assuntos
Eletroconvulsoterapia/métodos , Estado Epiléptico/terapia , Adulto , Idoso , Eletroconvulsoterapia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
3.
J Health Commun ; 19 Suppl 2: 19-28, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25315581

RESUMO

Patients on warfarin therapy need to achieve and maintain anticoagulation control in order to experience the benefits of treatment while minimizing bleeding risk. Low health literacy skills may hinder patients' ability to use and adhere to warfarin in a safe and effective manner. The authors conducted this study to evaluate the relationship between health literacy and anticoagulation control among patients on chronic warfarin therapy. Participants were recruited from 2 diverse anticoagulation clinics in North Carolina. Time in therapeutic range (TTR) for warfarin therapy was used as a measure of anticoagulation control. Health literacy was assessed using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Of the 198 study participants, 51% had limited health literacy (S-TOFHLA score of 0-90) and 33% had poor anticoagulation control (TTR<50%). Participants with limited health literacy were less likely to correctly answer warfarin-related knowledge questions. Limited health literacy was significantly associated with TTR<50% (adjusted odds ratio=2.34, 95% CI [1.01, 5.46]). Findings indicate that limited health literacy is associated with poor anticoagulation control for patients on warfarin therapy. Lack of medication understanding may hinder the safe and effective use of this narrow therapeutic index drug.


Assuntos
Anticoagulantes/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Varfarina/uso terapêutico , Idoso , Anticoagulantes/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Varfarina/efeitos adversos
4.
J Nurs Adm ; 44(7/8): 378-80, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25072226

RESUMO

The director of academic nursing education was created to strengthen the relationship between academic nursing education and clinical practice with goals of advancing nurses' academic education and preparing the future pediatric nursing workforce for 1 organization.


Assuntos
Educação de Pós-Graduação em Enfermagem , Enfermagem Pediátrica/educação , Liderança , Papel do Profissional de Enfermagem
5.
Ethiop Med J ; Suppl 2: 37-44, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25546908

RESUMO

INTRODUCTION: A Twinning Partnership between the University of Wisconsin-Madison (UW) and Addis Ababa University (AAU) in Addis Ababa, Ethiopia was formed to strengthen the development of emergency medical services at AAU's Tikur Anbessa Specialized Hospital (TASHI) through medical education and exchanges. The Twinning philosophy which emphasizes collaboration and joint learning was an ideal program in which QI program was incorporated to maximize success, promote sustainability, and reinforce basic principles for effective healthcare service delivery. This article describes the QI methodology, capacity building strategy, implementation approach, and lessons learned. METHODOLOGY: QI initiative at TASH ED started during EM fellowship in 2010 when Priority problems in the department were identified, and root cause analysis and possible strategies for improvement were devised. Then Baseline and sensitization was undertaken which was followed by Quality Improvement Projects cycles. The Federal Ministry of health key performance indicators (KPI) were used as standard and measurement tool when it was relevant. The findings were analyzed and trends presented to the ED staff and other stakeholders. RESULTS: In the past four years Since QI initiatives started in TASH EM department different achievements have been registered. The main developments were capacity building with QI training of EM fellows, EM residents and EM and critical care nurses. QI Training was also conducted to Tikur Anbessa Hospital and college of health sciences leadership. In addition, various QI projects have been designed and started, while some are finalized and the rest are on implementation. DISCUSSION: The QI experience in the department suggests that a QI program can effectively support, complement, and enhance health system strengthening partnerships, and that establishment of a QI program at the department level is feasible and beneficial, enhancing the adoption and sustainability of health care improvements such as marked improvements in triage, improved infection control and other critical improvements. Therefore, program leaders have determined that scale-up to a hospital-wide QI program is needed to fully realize the potential for increased quality, efficiency and system strengthening.


Assuntos
Medicina de Emergência/organização & administração , Medicina de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Etiópia , Hospitais Especializados , Humanos , Melhoria de Qualidade
6.
BMC Ophthalmol ; 13: 48, 2013 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-24066722

RESUMO

BACKGROUND: Autoimmune retinopathy (AR) and Cancer-Associated Retinopathy (CAR) are associated with a diverse repertoire of anti-retinal autoantibodies (AAbs) but not all antigenic targets have been characterized. Identification of new AAbs may help with clinical diagnosis and prognosis of retinal dysfunction in AR. The goal was to identify frequently targeted retinal autoantigens within the 60-70-kDa molecular weight range. METHODS: Human retinal proteins were separated by SDS-PAGE and 2D gel electrophoresis (2-DE) and sera from AR patients with and without cancer were used to identify immunoreactive proteins by Western blotting. Proteins were identified following separation by electrophoresis, Coomassie staining using in-gel trypsin digestion and mass spectrometric analysis. Circulating serum hsp60 and anti-hsp60 antibody levels were determined by quantitative ELISA. RESULTS: Retrospective evaluation of 819 patients with anti-retinal AAbs showed that 29% patients had AAbs targeted proteins between 60-70-kDa. Shotgun mass spectrometry of human retinal proteins present in 1D-gel found 66 species within this range. To identify the immunoreactive proteins, we performed Western blots of 2-DE gels and showed a group of heat shock proteins (hsps), including hsp60 and CRMP proteins that were frequently recognized by AR patient AAbs, irrespective of cancer status. These results were validated by immunostaining of purified hsp60 and CRMP2 proteins. ELISA results revealed that patients with AR and CAR had significantly increased levels of serum anti-hsp60 antibodies compared to control healthy subjects (p < 0.0001). However, circulating hsp60 protein was not significantly elevated in sera of either patient group. CONCLUSIONS: Different anti-retinal antibodies frequently co-exist in a single patient, creating antibody-arrays related to the syndrome. Hsps and CRMP-2 are newly identified autoantigens in AR. A frequent co-association of anti-hsp antibodies with other anti-retinal AAbs may augment pathogenic processes, leading to retinal degeneration.


Assuntos
Autoanticorpos/sangue , Doenças Autoimunes/imunologia , Proteínas de Choque Térmico/imunologia , Peptídeos e Proteínas de Sinalização Intercelular/imunologia , Proteínas do Tecido Nervoso/imunologia , Doenças Retinianas/imunologia , Adulto , Autoantígenos/imunologia , Western Blotting , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Humanos , Estudos Retrospectivos
7.
Front Public Health ; 10: 1079082, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36793362

RESUMO

Background: Embedding evidenced-based programs (EBPs) like PEARLS outside clinical settings can help reduce inequities in access to depression care. Trusted community-based organizations (CBOs) reach older adults who are underserved; however, PEARLS adoption has been limited. Implementation science has tried to close this know-do gap, however a more intentional focus on equity is needed to engage CBOs. We partnered with CBOs to better understand their resources and needs in order to design more equitable dissemination and implementation (D&I) strategies to support PEARLS adoption. Methods: We conducted 39 interviews with 24 current and potential adopter organizations and other partners (February-September 2020). CBOs were purposively sampled for region, type, and priority older populations experiencing poverty (communities of color, linguistically diverse, rural). Using a social marketing framework, our guide explored barriers, benefits and process for PEARLS adoption; CBO capacities and needs; PEARLS acceptability and adaptations; and preferred communication channels. During COVID-19, interviews also addressed remote PEARLS delivery and changes in priorities. We conducted thematic analysis of transcripts using the rapid framework method to describe the needs and priorities of older adults who are underserved and the CBOs that engage them, and strategies, collaborations, and adaptations to integrate depression care in these contexts. Results: During COVID-19, older adults relied on CBO support for basic needs such as food and housing. Isolation and depression were also urgent issues within communities, yet stigma remained for both late-life depression and depression care. CBOs wanted EBPs with cultural flexibility, stable funding, accessible training, staff investment, and fit with staff and community needs and priorities. Findings guided new dissemination strategies to better communicate how PEARLS is appropriate for organizations that engage older adults who are underserved, and what program components are core and what are adaptable to better align with organizations and communities. New implementation strategies will support organizational capacity-building through training and technical assistance, and matchmaking for funding and clinical support. Discussion: Findings support CBOs as appropriate depression care providers for older adults who are underserved, and suggest changes to communications and resources to better fit EBPs with the resources and needs of organizations and older adults. We are currently partnering with organizations in California and Washington to evaluate whether and how these D&I strategies increase equitable access to PEARLS for older adults who are underserved.


Assuntos
COVID-19 , Depressão , Humanos , Idoso , Depressão/terapia , Pesquisa Qualitativa , Washington , Pobreza
8.
Pilot Feasibility Stud ; 8(1): 77, 2022 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-35366952

RESUMO

BACKGROUND: Progression of dental caries can result in irreversible pulpal damage. Partial irreversible pulpitis is the initial stage of this damage, confined to the coronal pulp whilst the radicular pulp shows little or no sign of infection. Preserving the pulp with sustained vitality and developing minimally invasive biologically based therapies are key themes within contemporary clinical practice. However, root canal treatment involving complete removal of the pulp is often the only option (other than extraction) given to patients with irreversible pulpitis, with substantial NHS and patient incurred costs. The European Society of Endodontology's (ESE 2019) recent consensus statement recommends full pulpotomy, where the inflamed coronal pulp is removed with the goal of keeping the radicular pulp vital, as a more minimally invasive technique, potentially avoiding complex root canal treatment. Although this technique may be provided in secondary care, it has not been routinely implemented or evaluated in UK General Dental Practice. METHOD: This feasibility study aims to identify and assess in a primary care setting the training needs of general dental practitioners and clinical fidelity of the full pulpotomy intervention, estimate likely eligible patient pool and develop recruitment materials ahead of the main randomised controlled trial comparing the clinical and cost-effectiveness of full pulpotomy compared to root canal treatment in pre/molar teeth of adults 16 years and older showing signs indicative of irreversible pulpitis. The feasibility study will recruit and train 10 primary care dentists in the full pulpotomy technique. Dentists will recruit and provide full pulpotomy to 40 participants (four per practice) with indications of partial irreversible pulpitis. DISCUSSION: The Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) study will address the lack of high-quality evidence in the treatment of irreversible pulpitis, to aid dental practitioners, patients and policymakers in their decision-making. The PIP feasibility study will inform the main study on the practicality of providing both training and provision of the full pulpotomy technique in general dental practice. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN17973604 . Registered on 28 January 2021. Protocol version Protocol version: 1; date: 03.02.2021.

9.
J Med Case Rep ; 14(1): 218, 2020 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-33176863

RESUMO

BACKGROUND: Facial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity. It is a rare condition, most commonly reported in barotraumatic environments, in particular scuba diving and high-altitude air travel. We report here an unusual case of highly frequent baroparesis, workup, and successful treatment. CASE PRESENTATION: A 57-year-old Caucasian male frequent commercial airline traveler presented with a 4-year history of recurrent episodes of right-sided facial paralysis and otalgia, increasing in both frequency and severity. Incidents occurred almost exclusively during rapid altitude changes in aircraft, mostly ascent, but also during rapid altitude change in an automobile. Self-treatment included nasal and oral decongestants, nasal corticosteroids, and warm packs. Temporal bone computed tomography (CT) scan revealed possible right-sided dehiscence of the tympanic bone segment; audiogram and magnetic resonance imaging of the internal auditory canals were unremarkable. After a diagnosis of facial nerve baroparesis was made, the patient underwent myringotomy with insertion of a pressure equalization tube (PET) into the right tympanic membrane. Despite re-exposure to altitude change multiple times weekly post-treatment, the patient reported being symptom-free for more than 6 months following intervention. CONCLUSIONS: Prompt PET insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis. Education regarding this rare condition may prevent unnecessary testing and treatment of affected patients. Future studies should explore the pathophysiology and risk factors, compare therapeutic options, and provide follow-up data to optimize the management of affected patients.


Assuntos
Barotrauma , Mergulho , Paralisia Facial , Altitude , Barotrauma/complicações , Nervo Facial , Paralisia Facial/etiologia , Paralisia Facial/terapia , Humanos , Masculino , Pessoa de Meia-Idade
10.
Exp Mol Pathol ; 87(3): 195-203, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19744478

RESUMO

Autoimmune retinopathies (AR) are uncommon retinal degenerations with vision loss associated with unique clinical symptoms and findings and with serum anti-retinal autoantibodies. The experimental and clinical studies corroborate that autoantibodies in high titers can penetrate into the retina affecting function of the target antigens, which leads to retinal dysfunction and degeneration. Anti-recoverin and anti-enolase alpha-enolase autoantibodies were more frequently recognized in AR but autoantibodies with other specificities have also been documented, indicating immunological heterogeneity. Our goal was to examine the associations of anti-retinal autoantibodies with retinopathy in order to identify molecular biomarkers for better diagnosis and prognosis of retinopathies. In these studies we examined 39 patients (10 with cancers) of average age of approximately 57 years old with sudden onset of unexplained progressive vision loss and the presence of circulating serum autoantibodies against 40-kDa retinal protein. The patients presented the retinal phenotype characterized by defects in visual fields and reduced scotopic ERG responses. Anti-40-kDa autoantibodies had specificity to the amino terminus of transducin-alpha. None of the normal subjects' sera had anti-40-kDa autoantibodies. In conclusion, the clinical phenotype of patients with anti-transducin-alpha autoantibodies differed from other phenotypes of AR. These patients, often women at a ratio approximately 2:1, had defects in rod (scotopic) photoreceptor function and typically did not have cancers, whereas the anti-recoverin phenotype is associated with cancer and severe loss of rod and cones function, and anti-enolase retinopathy typically presents with cone dysfunction and is equal in cancer and non-cancer patients. Our studies suggest that anti-transducin autoantibodies can serve as molecular biomarkers for retinal phenotypes and could be used for progression of retinal dysfunction and degeneration.


Assuntos
Autoanticorpos/sangue , Doenças Autoimunes/diagnóstico , Degeneração Retiniana/diagnóstico , Transducina/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/sangue , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Degeneração Retiniana/sangue
11.
Nurs Res ; 58(3): 175-83, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19448521

RESUMO

BACKGROUND: Interventions to increase physical activity among adults with chronic illness are intended to improve quality of life and reduce disease complications or slow disease progression. OBJECTIVE: The aim of this study was to integrate quality-of-life outcomes from primary research studies testing interventions to increase physical activity among adults with chronic illness. METHODS: Extensive literature searching strategies were used to locate published and unpublished primary research testing physical activity interventions. Results were coded for studies that had at least 5 participants with chronic illness. Fixed- and random-effects meta-analytic procedures included moderator analyses. RESULTS: Eighty-five samples from 66 reports with 7,291 subjects were synthesized. The mean quality-of-life effect size for two-group comparisons (treatment vs. control) was.11 (higher mean quality-of-life scores for treatment subjects than for control subjects). The treatment group pre-post comparison effect size was.27 for quality of life. Heterogeneity was modest in two-group comparisons. Most design and sample attributes were unrelated to intervention effects on quality of life. Studies that exclusively used supervised center-based exercise reported larger quality-of-life improvements than did studies that included any educational/motivational content. Effect sizes were larger among unpublished and unfunded studies. The effect size for physical activity did not predict the quality-of-life effect size. DISCUSSION: Subjects experience improved quality of life from exposure to interventions designed to increase physical activity, despite considerable heterogeneity in the magnitude of the effect. Future primary research should include quality-of-life outcomes so that patterns of relationships among variables can be explored further.


Assuntos
Doença Crônica , Terapia por Exercício , Exercício Físico/psicologia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Atitude Frente a Saúde , Doença Crônica/prevenção & controle , Doença Crônica/psicologia , Interpretação Estatística de Dados , Modificador do Efeito Epidemiológico , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Qualidade de Vida/psicologia , Análise de Regressão , Pesquisa , Autocuidado/métodos , Autocuidado/psicologia , Resultado do Tratamento
12.
Ecohealth ; 16(2): 306-316, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31016438

RESUMO

One health emphasizes the interdependent health of humans, animals, and their shared environments and shows promise as an integrated, equitable transdisciplinary approach to important ecohealth issues. Notably, research or programming explicitly examining the intersection of gender and one health is limited, although females represent half of the human population and play important roles in human and animal health around the world. Recognizing these gaps, scholars from the University of Wisconsin-Madison in collaboration with United States Department of Agriculture convened a consultative workshop, "Women and One Health," in 2016. This paper outlines the workshop methods and highlights outcomes toward shared terminology and integration of frameworks from one health, gender analysis, and women in agriculture. Further, recommendations for education, policy, and service delivery at the intersection of women's empowerment and one health are offered as important efforts toward the dual goals of gender equality and sustainable health of humans, animals, and their shared ecosystems.


Assuntos
Ecossistema , Saúde , Saúde Única , Agricultura , Animais , Educação , Feminino , Educação em Saúde , Humanos , Comunicação Interdisciplinar , Masculino , Desenvolvimento Sustentável , Mulheres
13.
Acad Med ; 83(2): 148-53, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18303359

RESUMO

Globalization, migration, and widespread health disparities call for interdisciplinary approaches to improve health care at home and abroad. Health professions students are pursuing study abroad in increasing numbers, and universities are responding with programs to address these needs. The University of Wisconsin (UW)-Madison schools of medicine and public health, nursing, pharmacy, veterinary medicine, and the division of international studies have created an interdisciplinary center for global health (CGH). The CGH provides health professions and graduate students with courses, field experiences, and a new Certificate in Global Health. Educational programs have catalyzed a network of enthusiastic UW global health scholars. Partnerships with colleagues in less economically developed countries provide the foundation for education, research, and service programs. Participants have collaborated to improve the education of health professionals and nutrition in Uganda; explore the interplay between culture, community development, and health in Ecuador; improve animal health and address domestic violence in Mexico; and examine successful public health efforts in Thailand. These programs supply students with opportunities to understand the complex determinants of health and structure of health systems, develop adaptability and cross-cultural communication skills, experience learning and working in interdisciplinary teams, and promote equity and reduce health disparities at home and abroad. Based on the principles of equity, sustainability, and reciprocity, the CGH provides a strong foundation to address global health challenges through networking and collaboration among students, staff, and faculty within the UW and beyond.


Assuntos
Países em Desenvolvimento , Educação Profissionalizante/organização & administração , Saúde Global , Faculdades de Medicina/organização & administração , Equador , Educação Médica , Educação Profissionalizante/tendências , Educação Profissional em Saúde Pública , Humanos , Comunicação Interdisciplinar , México , Faculdades de Medicina/tendências , Tailândia , Uganda , Wisconsin
14.
Patient Educ Couns ; 70(2): 157-72, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18023128

RESUMO

OBJECTIVE: This meta-analysis integrates primary research testing the effect of patient education to increase physical activity (PA) on behavior outcomes among adults with diverse chronic illnesses. METHODS: Extensive literature searching strategies located published and unpublished intervention studies that measured PA behavior outcomes. Primary study results were coded. Fixed- and random-effects meta-analytic procedures included moderator analyses. RESULTS: Data were synthesized across 22,527 subjects from 213 samples in 163 reports. The overall mean weighted effect size for two-group comparisons was 0.45 (higher mean for treatment than control). This effect size is consistent with a difference of 48 min of PA per week or 945 steps per day. Preliminary moderator analyses suggest interventions were most effective when they targeted only PA behavior, used behavioral strategies (versus cognitive strategies), and encouraged PA self-monitoring. Differences among chronic illnesses were documented. Individual strategies unrelated to PA outcomes included supervised exercise sessions, exercise prescription, fitness testing, goal setting, contracting, problem solving, barriers management, and stimulus/cues. PA outcomes were unrelated to gender, age, ethnicity, or socioeconomic distribution among samples. CONCLUSION: These findings suggest that some patient education interventions to increase PA are effective, despite considerable heterogeneity in the magnitude of intervention effect. PRACTICE IMPLICATIONS: Moderator analyses are preliminary and provide suggestive evidence for further testing of interventions to inform practice.


Assuntos
Doença Crônica/reabilitação , Terapia por Exercício , Comportamentos Relacionados com a Saúde , Educação de Pacientes como Assunto/organização & administração , Adulto , Atitude Frente a Saúde , Doença Crônica/psicologia , Interpretação Estatística de Dados , Modificador do Efeito Epidemiológico , Terapia por Exercício/educação , Terapia por Exercício/organização & administração , Retroalimentação Psicológica , Objetivos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Avaliação de Resultados em Cuidados de Saúde , Prescrições , Resolução de Problemas , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Autocuidado/métodos , Autocuidado/psicologia , Apoio Social , Fatores Socioeconômicos
15.
J Patient Saf ; 13(2): 51-61, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28198722

RESUMO

OBJECTIVE: End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus. METHODS: We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine. Each survey asked for code status interpretation of stand-alone Physician Orders for Life-Sustaining Treatment (POLST) and living will (LW) documents in 9 scenarios. Respondents assigned code status and resuscitation decisions to each scenario. For 1 of 2 surveys, a VM was included to help clarify patient wishes. RESULTS: Response rate was 54%, and most were male emergency physicians who lacked formal advanced planning document interpretation training. Consensus was not achievable for stand-alone POLST or LW documents (68%-78% noted "DNR"). Two of 9 scenarios attained consensus for code status (97%-98% responses) and treatment decisions (96%-99%). Adding a VM significantly changed code status responses by 9% to 62% (P ≤ 0.026) in 7 of 9 scenarios with 4 achieving consensus. Resuscitation responses changed by 7% to 57% (P ≤ 0.005) with 4 of 9 achieving consensus with VMs. CONCLUSIONS: For most scenarios, consensus was not attained for code status and resuscitation decisions with stand-alone LW and POLST documents. Adding VMs produced significant impacts toward achieving interpretive consensus.


Assuntos
Comunicação , Compreensão , Consenso , Cuidados Críticos , Testamentos Quanto à Vida , Médicos , Ordens quanto à Conduta (Ética Médica) , Adulto , Estado Terminal , Medicina de Emergência , Medicina de Família e Comunidade , Feminino , Humanos , Medicina Interna , Masculino , Pessoa de Meia-Idade , Segurança , Inquéritos e Questionários , Gravação em Vídeo
17.
Sci Rep ; 6: 34087, 2016 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-27686155

RESUMO

Complex social networks and behaviors are difficult to observe for free-living marine species, especially those that move great distances. Using implanted acoustic transceivers to study the inter- and intraspecific interactions of sand tiger sharks Carcharias taurus, we observed group behavior that has historically been associated with higher order mammals. We found evidence strongly suggestive of fission-fusion behavior, or changes in group size and composition of sand tigers, related to five behavioral modes (summering, south migration, community bottleneck, dispersal, north migration). Our study shows sexually dimorphic behavior during migration, in addition to presenting evidence of a potential solitary phase for these typically gregarious sharks. Sand tigers spent up to 95 consecutive and 335 cumulative hours together, with the strongest relationships occurring between males. Species that exhibit fission-fusion group dynamics pose a particularly challenging issue for conservation and management because changes in group size and composition affect population estimates and amplify anthropogenic impacts.

18.
J Am Geriatr Soc ; 50(6): 1001-11, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12110058

RESUMO

OBJECTIVES: To identify the extent to which inappropriately prescribed medications (IPMs) are administered to older patients in residential care/assisted living (RC/AL) facilities and to describe facility and resident factors associated with receipt of one or more IPMs. DESIGN: Cross-sectional study of a stratified, representative sample of 193 facilities in four states. SETTING: We identified representative geographic regions within Florida, New Jersey, North Carolina, and Maryland and drew from within them a stratified random sample of 193 RC/AL facilities. Three subtypes of facilities were included in the sample: small homes (<16 beds), larger "new-model" homes, and larger "traditional" homes. PARTICIPANTS: Within each larger home, a random sample of residents aged 65 and older was approached for consent; in smaller homes all residents were approached. The overall enrollment rate was 92%; 2,078 residents were enrolled. MEASUREMENTS: Questionnaires and on-site observations were used to gather data on facility administration and staffing and resident characteristics. All prescription and nonprescription medications taken at least 4 of the 7 days before data collection were taken from medication administration records and coded for analysis. IPM designation was based on modification of a list developed by Beers et al. and currently used by nursing home surveyors. RESULTS: The majority of RC/AL patients were taking five or more medications; 16.0% of these patients were receiving IPMs. The most common IPMs were oxybutynin, propoxyphene, diphenhydramine, ticlopidine, doxepin, and dipyridamole. In multivariate analyses, using generalized estimating equations, IPM use was associated with the number of medications received, smaller facility bed size, moderate licensed practical nurse turnover, absence of dementia, low monthly fees, and absence of weekly physician visits. CONCLUSIONS: IPMs remain a problem in long-term care, but rates in these RC/AL settings compare favorably with those reported for other frail older populations, suggesting that use of medications with severe adverse effects may be waning. Regular physician facility visits may improve prescribing, as will attention to high-risk groups such as individuals on multiple medications.


Assuntos
Uso de Medicamentos/normas , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Instituições Residenciais/normas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco
19.
Am J Psychol ; 115(2): 199-209, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12041008

RESUMO

This experiment demonstrated that rating the credibility of nonfamous faces results in a significant increase in rated credibility on a subsequent encounter relative to new nonfamous faces. The degree of credibility enhancement is comparable for both honesty and sincerity ratings and at both short (2-day) and long (14-day) interrating intervals. Furthermore, credibility enhancement was independent of recognition; ratings were significantly higher for repeated faces, regardless of whether they were remembered. Although female faces were rated more credible than male faces, there was no gender difference in the degree of credibility enhancement with repetition. Conditional analyses revealed that actual, rather than perceived, repetition formed the basis of credibility enhancement. Future research should compare repetition effects on both credibility and affect as well as the durability of such effects over time.


Assuntos
Julgamento/fisiologia , Rememoração Mental/fisiologia , Reconhecimento Visual de Modelos/fisiologia , Prática Psicológica , Adulto , Face , Humanos , Fatores Sexuais , Análise e Desempenho de Tarefas
20.
J Law Med Ethics ; 42 Suppl 2: 32-7, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25564708

RESUMO

The experience and lessons to date from the University of Wisconsin-Madison Global Health Institute's global health programs, considered together with more recently published competency frameworks related to global health practice, can provide important insights into the development of a core set of interprofessional competencies for global health that can be used across disciplines and professions.


Assuntos
Currículo , Saúde Global/educação , Saúde Global/normas , Comunicação Interdisciplinar , Competência Profissional/normas , Humanos , Universidades , Wisconsin
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