Functional outcomes associated with adaptive seating interventions in children and youth with wheeled mobility needs.

OBJECTIVE: To determine the parent-reported functional outcomes associated with adaptive seating devices for wheeled mobility devices used by young people aged 1 to 17 years. DESIGN: Longitudinal case series. SETTING: Homes of participating parents. PARTICIPANTS: Parents (N=70, 63 mothers, 6 fathers, 1 grandmother) who had children with adaptive seating needs. INTERVENTION: Adaptive seating system for wheeled mobility devices. MAIN OUTCOME MEASURE: Family Impact of Assistive Technology Scale for Adaptive Seating (FIATS-AS). RESULTS: All parents completed the FIATS-AS 4 times-2 times before and 2 times after their child received a new adaptive seating system. Mixed-design analysis of variance did not detect significant mean differences among the FIATS-AS scores measured at baseline and 2 and 8 months after receiving the seating system (F2,134=.22, P=.81). However, the FIATS-AS detected a significant interaction between age cohort and interview time (F4,134=4.5, P<.001, partial η(2)=.16). Post hoc testing confirmed that 8 months after receiving the seating system was associated with a large improvement in child and family functioning for children <4 years, maintenance of functioning for children between 4 and 12 years, and a moderate decline in functioning for youth between 13 and 17 years. CONCLUSIONS: Adaptive seating interventions for wheeled mobility devices are associated with functional changes in the lives of children and their families that interact inversely with age. Future controlled longitudinal studies could provide further empirical evidence of functional changes in the lives of children and their families after the introduction and long-term use of specific adaptive seating interventions.

Effect of anesthesia and sedation on pediatric MR imaging patient flow.

PURPOSE: To determine the effect of sedative and anesthetic administration on the duration and costs of pediatric magnetic resonance (MR) imaging. MATERIALS AND METHODS: This prospective study was approved by the institutional research ethics board; informed consent and/or assent was obtained from all participants or their parents. A patient flow study was conducted in a pediatric MR imaging clinic in which research assistants tracked participants' progress through the clinic. Demographic, visit process, and medication information was collected for 237 participants, categorized as awake, sedated, or anesthetized. The data were analyzed to (a) determine total visit duration differences, (b) investigate variations in visit stage durations according to patient type, and (c) estimate visit costs on the basis of human resource and medication use. Linear regression, the Shapiro-Wilk test, the two-tailed t test, and the nonparametric Mann-Whitney test were used. RESULTS: Complete data sets were obtained for 148 awake, 28 sedated, and 27 anesthetized participants. Data revealed 12 stage sequences among patient visits; dominant sequences differed according to patient category. An awake patient's average visit duration (2 hours 21 minutes) differed significantly from that of sedated (3 hours 38 minutes, P < .001) and anesthetized (4 hours 7 minutes, P < .001) patients; sedated and anesthetized visit durations did not differ significantly (P < .073), although this finding may be attributable to the small sample sizes. Variation in stage durations was also evident within and among patient types. Visit costs for sedated and anesthetized patients were 3.24 and 9.56 times higher, respectively, than those for awake patients. Costs for anesthetized patients were 2.95 times higher than those for sedated patients. CONCLUSION: Visit durations were significantly longer for anesthetized and sedated patients. Anesthetized patients incurred the highest costs, followed by sedated patients.

Hitting home: a survey of housing conditions of homes used for long-term care in Ontario.

A telephone survey of a random sample of 811 long-term home care clients from three geographically distinct regions in Ontario was conducted to illuminate the living and working conditions in households receiving long-term care services. The median age of clients was 77 years and 75 percent were female. The majority had not completed high school. Almost half were widowed, had income levels of dollar 20,000 (Canadian) or less, and lived alone. Approximately one-third needed help with most basic activities of daily living. The vast majority could not bathe or dress themselves. More than three-quarters needed help with preparing meals, housekeeping, and shopping. Few clients could perform yardwork and home repairs. Many clients' homes required major and minor repairs, were not suitable in size, were not affordable, and lacked important household amenities. More than 30 percent required modifications to enable clients to live and be cared for comfortably and safely, and half the clients had not completed these because of exorbitant costs. Overall, many clients were living in homes less than optimal for domestic life and long-term care provision. These results highlight significant gaps in care provision and a need to link housing to health and social service policies.

Children's experiences of parental mental illness: a literature review.

AIM: This paper provides a review of published qualitative research on children's experiences of parental mental illness. METHODS: We undertook a comprehensive search of Medical Literature Analysis and Retrieval System Online, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts and Applied Social Sciences Index and Abstracts databases, as well as citation searches in Web of Science and manual searches of other relevant journals and reference lists of primary papers. RESULTS: Although 20 studies met the search criteria, only 10 focused exclusively on children's descriptions of their experience--the remainder elicited adults' perspectives on children's experiences of parental mental illnesses. Findings are organized under three themes: the impact of illness on children's daily life, how children cope with their experiences and how children understand mental illness. CONCLUSIONS: Despite references to pervasive knowledge gaps in the literature, significant information has been accumulated about children's experiences of parental mental illness. Considerable variability in research findings and tensions remain unresolved. For example, evidence is mixed as to children's knowledge and understanding of mental illnesses and how best to deploy resources to help them acquire optimal information. Furthermore, children's desire to be recognized as important to their parents' well-being conflicted with adults' perceptions that children should be protected from too much responsibility. Nevertheless, the cumulative evidence remains a key reason for advocating for psychoeducation and peer-support group interventions for children, which are endorsed by child and adult study participants alike.

Understanding the meaning of satisfaction with treatment outcome.

OBJECTIVE: Although satisfying patients is an important goal in health care, what is meant by satisfaction in relation to treatment outcome is not clear. The objective of this study was to explore patients' perspectives on the meaning of satisfaction with treatment outcome. DESIGN: We conducted a qualitative exploratory study. SETTING: This study was conducted at an adult tertiary care hospital. PATIENTS: Individuals who had undergone elective hand surgery were included in this study. INTERVENTION: In-depth, open-ended interviews in which 31 participants described their experience of a hand condition, how they evaluated the outcome of surgical interventions, and what it meant to be satisfied or dissatisfied with these outcomes were examined. ANALYSIS: : Interview transcripts were analyzed using Gadow's conceptualization of embodiment states: "object body" (disunity between the affected hand and the self) or "cultivated immediacy" (harmony between the hand and the self). RESULTS: Eight of 9 dissatisfied individuals were categorized as "object body" and 15 of 19 satisfied individuals were in, or in transition to, "cultivated immediacy". These states fluctuated and were also dependent on context (eg, social setting) and time since surgery. CONCLUSION: In relation to the outcome of hand surgery, satisfaction was experienced as a relative lack of tension between the patient's sense of self and the affected hand (ie, satisfaction was having a hand that could be lived with unself-consciously). Emotional and social effects of interventions and the influence of context should be considered in future measures of satisfaction with treatment outcome. Finally, interventions directed toward facilitating patients' experience of body-self unity could promote satisfaction with treatment outcome.

Testing a new theory of patient satisfaction with treatment outcome.

OBJECTIVES: Theories of patient satisfaction with treatment outcome have not been developed and tested in healthcare settings. The objectives of this study were to test a new theory linking patient satisfaction and embodiment (body--self unity) and examine it in relation to other competing theories. DESIGN: We conducted a prospective cohort study. SETTING: This study was conducted at a tertiary care hospital. PATIENTS: We studied 122 individuals undergoing elective hand surgery. METHODS: Satisfaction with treatment outcome approximately 4 months after surgery was examined against the following factors (representing 7 theories of satisfaction): 1) overall clinical outcome, 2) patients' a priori self-selected important clinical outcomes, 3) foresight expectations, 4) hindsight expectations, 5) psychologic state, 6) psychologic state in those with poor outcomes, and 7) embodiment. ANALYSIS: Seven hypotheses were tested first using univariate analyses and then multivariable regression analysis. RESULTS: Satisfaction with treatment outcome was significantly associated with embodiment. Three confounders--the extent to which surgery successfully addressed patients' most important reason for surgery, hindsight expectations, and workers' compensation--were also significant. The final model explained 84% of the variance in a multidimensional measure of satisfaction with treatment outcome. CONCLUSION: This research suggests that satisfaction with treatment outcome could be facilitated by developing strategies to improve body--self unity, and eliciting and addressing the patient's most important reason for undergoing treatment.