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No description available.

People with dementia account for a growing number of patients requiring end-of-life medical care each year in the United States. The clinical application of bioethical principles is rarely more important than in the context of end-of-life decision making, and determining the appropriate clinical treatment plan can be difficult and complex for clinicians, patients, and medical proxies. While the current bioethical literature offers a wealth of information on the principles underlying ethical medical practice, real-world clinical scenarios are often fraught with confusion, complexity, and conflicting understandings of best practices. There is a need for clinical decision-making tools that are both comprehensive yet simple, and broadly-applicable enough to be clinically useful. This thesis explores the cultural factors that necessitate further discussion and understanding of the issues surrounding end-of-life care for people with dementia, uses a clinical case to demonstrate a real-world approach to the ethical complexities surrounding such care, and proposes a basic ethical decision-making algorithm with the potential for broad application by students and clinicians encountering complex ethical scenarios. / Urban Bioethics

This study attempted to determine the relation between womens' anticipation of Esteem-Threat, their level of satisfaction, and their utilization of prenatal care services in the public assistance setting. One-hundred twenty-six women completed a battery of questionnaires during an initial clinic visit. Measures of patient datisfaction were completed after a minimum of four clinic visits. Results showed a significant linear relation between womens' anticipation of Esteem-Threat and satisfaction with services. No relations were found between Esteem-Threat and the timing of entry into prenatal care. A small, statistically significant relation was found between Esteem-Threat and the number of appointments kept. Results are discussed in the context of the limitations of the sample and the psychometric properties of the measures. Future applications of the Esteem-Threat model are also discussed. / Ph. D.

Bakgrund: Akutsjukvård är den del av sjukvården som tar hand om patienter som har behov att skyndsamt få hjälp. Eftersom patienten är i en utsatt situation och kan sväva mellan liv och död, kan akutsjukvården anses vara en krävande arbetsplats för sjuksköterskan. Genom att undersöka och förstå patienters upplevelser av att vårdas inom akutsjukvård kan omhändertagandet av dessa patienter utvecklas och förbättras för att minska patientens lidande. Syfte: Undersöka patienters upplevelser av att vårdas inom akutsjukvård. Metod: Litteraturöversikt med kvalitativ ansats baserad på nio vetenskapliga artiklar. Resultat: Tre teman identifierades: Bemötandets betydelse, Informationens Betydelse och Trygghetens betydelse. Konklusion: När patienter blir akut sjuka eller skadade och hamnar i akutsjukvården är det viktigt att patienterna blir bemötta på ett bra sätt av sjukvårdspersonalen. Patienterna har även ett behov av att känna sig trygga och av information som är tydlig. Förbättringsarbeten inom dessa områden kan bidra till mer positiva upplevelser av att vårdas inom akutsjukvården. / Background: Emergency care is the part of medical care that is responsible for taking care of patients who need urgent help. Due to the reason the patient is in a vulnerable situation, emergency care can be considered a demanding workplace for the nurse. By investigating and understanding patients' experiences of being cared for in emergency healthcare, the care of these patients can be developed and improved to reduce the patients' suffering. Aim: To explore patients' experience of being cared for by emergency medical care. Method: A literature review with qualitative design based on nine scientific articles. Findings: Three themes were identified: Importance of being met, Importance of information and Importance of feeling safe. Conclusion: When patients become acutely ill or injured and end up in emergency medical care, it is important that they are treated well by the healthcare staff. Patients also have a need to feel safe and to receive clear information. Work of improvement within these areas can result in a more positive experience of being treated within emergency medical care.

The utilization of ambulatory services by the health maintenance organization of Florida (HMO), independent practice association (IPA) model, was compared to a fee-for-service population. Each randomly selected group consisted of 250 patients being cared for by the same providers, at the same clinic, during the calendar year 1986. Demographic and clinical data was gathered from the office charts. Frequencies were evaluated by the Statistical Package for the Social Sciences and t-tests were run to substantiate variance at the 0.05 level of confidence. The HMO group is a younger population (t = 0.017), and the males are responsible for the increased utilization of ambulatory services (t = 0.001). Trends of increased utilization are noted across the age groups and the variables. The rate of hospitalization is insignificantly higher for the HMO population and covers a broader range of age groups. Consequently, this HMO IPA model increases the rate of ambulatory service utilization in a younger population without reducing the rate of hospitalization. Cost effectiveness studies and organizational management evaluations are needed.

In Study 1, 280 undergraduate students (177 female, 103 male) were administered a battery of questionnaires assessing functional somatic symptoms, psychosocial variables, and behavioral responses to health-related situations. Significant predictors of functional somatic symptoms differed for females and males. The amount of stress experienced, perceived susceptibility to illness, perceived barriers to health care and level of pain tolerance were significant predictors for males. Significant predictors for females included perceived susceptibility to illness, amount of stress experienced, and not responding to health-related situations by seeking medical attention. A discriminant analysis correctly classified 21.25% of these groups. / Master of Science

The purpose of this study was to examine variations in the surgical rates among the elderly population of hospital service areas of southwest and central Virginia in order to assess whether these variations were influenced by physicians and hospitals. Procedures analyzed were specific to the elderly. Considerable variations in the rates of the selected surgical procedures were found. Some areas were found to be surgically more active than others. The variables that proved to be determinants of surgical rates were availability of general physicians and specialists and hospital occupancy rate. The impact of availability of hospital beds, per capita expenditure and ownership status of facilities were found to be mixed and inconsistent. / Master of Urban Affairs

Bakgrund - ambulanssjukvården representerar ofta det inledande mötet mellan vårdpersonal och patient, där det första intrycket kan ha en avgörande inverkan på hela sjukvårdserfarenheten för patienten. När en patient känner behov av sjukvård kan starka känslor som ensamhet, rädsla, nervositet och hjälplöshet uppstå. Inom ambulanssjukvården ställs höga krav, om det brister i bemötandet mellan patienten och vårdpersonalen kan det ha negativa konsekvenser på patientsäkerheten och den fortsatta vårdkedjan. Brister i bemötandet mellan patient och personal kan leda till försämrad kommunikation och information, vilket i sin tur kan påverka patientsäkerheten, denna holistiska syn på vårdmötet kan ytterligare stärka kvalitén och säkerheten inom ambulanssjukvården, vilket i slutändan gynnar såväl patienter som vårdpersonal. Syfte - syftet var att beskriva patienternas upplevelse av ambulanspersonalens bemötande i Sverige. Metod - för att besvara studiens syfte utfördes en litteraturöversikt med systematiska ansats och med integrerad analys. Femton artiklar hittades som besvarade syftet, artiklar som togs med i studien var av kvantitativ, kvalitativ och mixad studiedesign. Resultat - när ambulanspersonalen bekräftade patienterna, hade förmågan att bemöta individuella behov, gav information och kommunicerade med patienterna beskrevs bemötandet som positivt. Bristande kommunikation och information och då patienterna kände sig objektifierade av ambulanspersonal beskrevs som negativa aspekter i bemötandet. Slutsats - kommunikation och information framhölls av patienterna som avgörande betydelse. Missnöje uttrycktes när patienter inte erhöll tillräckligt tydlig och adekvat information. En förmåga att etablera en känsla av välbefinnande genom en konstruktiv dialog fysisk beröring och förmåga att integrera empati medicinska expertis identifierades som central faktorer för att patienterna skall uppleva ett tillfredställande bemötande. / Background - emergency medical care often represents the initial encounter between healthcare professionals and patients, where the first impression can have a crucial impact on the entire healthcare experience for the patient. When a patient feels the need for medical care, strong emotions such as loneliness, fear, nervousness, and helplessness may arise. High demands are placed within emergency medical care, as deficiencies in the interaction between the patient and the healthcare personnel can have negative consequences on patient safety and the continuity of care. Deficiencies in the interaction between patient and staff can lead to impaired communication and information flow, which in turn can affect patient safety. This holistic view of the healthcare encounter can further strengthen the quality and safety within emergency medical care, ultimately benefiting both patients and healthcare professionals. Aim - aim of this study was to describe the patients' experience of the ambulance staff's treatment in Sweden Method - to answer the purpose of the study, the authors chose to conduct a literature review with a systematic approach and with integrated analysis. Fifteen articles were found that answered the purpose, articles that were included in the study were of quantitative, qualitative and mixed study design. Results - when the ambulance staff acknowledged the patients, had the ability to respond to individual needs, provided information and communicated with the patients, the response was described as positive. Lack of communication and information and when patients felt objectified by ambulance staff were described as negative aspects of the treatment. Conclusion - communication and information were emphasized by the patients as of crucial importance. Dissatisfaction was expressed when patients did not receive sufficiently clear and adequate information. The ability to establish a sense of well-being through constructive dialogue, physical touch, and the ability to integrate empathy with medical expertise were identified as central factors for patients to experience satisfactory treatment