Hearing loss and tinnitus are the two most common service-connected disabilities in Veterans. Patients with a chief complaint of hearing loss and/or tinnitus typically undergo a hearing evaluation to determine the severity and type of hearing loss. The standard treatment for sensorineural hearing loss is the fitting of personal amplification.Up to 95% of tinnitus patients have an underlying hearing loss and could benefit from hearing aids for both improved communication and as an effective treatment to reduce the impact of tinnitus, ((Shargorodsky, Curhan, & Farwell, 2010). It is not uncommon, however, for some of these patients to decline hearing aids although they elect to undergo tinnitus counseling. The observation that some of these patients elected to obtain hearing aids following tinnitus counseling compelled an investigation of tinnitus counseling’s role in the patient’s revised decision to accept hearing aid fitting. An electronic medical records review (2015- 2020) identified Veterans meeting the following criteria: (1) diagnosis of sensorineural hearing loss and tinnitus, (2) declined hearing aids at the time of the hearing evaluation, (3) received tinnitus counseling, (4) elected to obtain hearing aids following tinnitus counseling, and (5) affirmed regular use of the hearing aids for more than one year. 30 qualified veterans provided informed consent to participate. Enrolled participants were interviewed using a brief survey that allowed patients to report a variety of tinnitus and hearing-related challenges. Participants also completed a validated tinnitus intake form, the tinnitus handicap inventory (THI), which reports a patient’s self-assessed tinnitus handicap. A total of six Veterans (white males, average age of 60 years, with bilateral sensorineural hearing loss and bothersome tinnitus) participated. The number of hours of daily hearing aid use was related to the self-perceived benefit of hearing aids for the management of tinnitus, as the 5 participants who wore their hearing aids >5 hours/day reported benefit in contrast to the single participant who wore their hearing aids /day. The reported benefit of tinnitus counseling, however, was not reflected as a significant improvement in the post-counseling THI score. All participants reported the counseling was useful and recommended that other veterans experiencing tinnitus and hearing loss undergo a trial with hearing aids . A narrative analysis of additional information provided by participants was made to identify counseling elements that supported the use of hearing aids for tinnitus management. In general, the analysis indicated that when patients were provided accurate information regarding tinnitus management strategy options, then they might be more likely than uninformed patients to accept and act upon hearing aid recommendations in a timely manner. All participants suggested that the provision of more information regarding tinnitus and management options at the time of the hearing evaluation would have likely expedited hearing aid acceptance. The preliminary findings of this survey suggest that patients with a diagnosis of sensorineural hearing loss and tinnitus might benefit from some form of tinnitus management counseling at the time of the initial hearing evaluation, and that the counseling might facilitate uptake of hearing aids.

No description available.

Sexualitet är en del av att vara människa och berör själva meningen med livet. Den finns med oss i alla åldrar och livssituationer. Vid sjukdom och behandling påverkas sexualiteten på olika sätt och det är därför viktigt att allmänsjuksköterskan uppmärksammar och berör patientens sexualitet i omvårdnadsarbetet. Trots vetskapen om detta väljer många sjuksköterskor att borste från patientens sexualitet, vilket kan orsaka mycket onödigt lidande för patienten. Sexuell dysfunktion kan även vara det enda tecknet på allvarlig sjukdom och det är därför av stor vikt att sjusköterskan införlivar sexualiteten i omvårdnadsarbetet. Syftet med litteraturstudien var att undersöka allmänsjuksköterskans förhållningssätt kring sexualitet i mötet med patienter i olika åldrar. Studien genomfördes som en litteraturstudie där elva vetenskapliga artiklar samlades in och granskades. Både kvalitativa och kvantitativa artiklar inkluderades i studien. Resultatet visade att det fanns ett antal faktorer som påverkade sjuksköterskans förhållningssätt till patientens sexualitet. Många av deltagarna i studierna var medvetna om att det låg inom deras ansvarsområde att uppmärksamma och beröra patientens sexualitet i omvårdnadsarbetet, men få gjorde det. Av de hinder som identifierades, var brist på sexologisk kunskap och utbildning det mest framträdande hindret bland såväl sjuksköterskor som sjuksköterskestudenter. / Sexuality is integral to every person and affects the individual in all developmen-tal stages. Sexuality is affected by both illness and treatments, which is a reason why nurses ought to incorporate sexuality into nursing practice. Despite being aware of the importance of patients’ sexuality, many nurses choose not to address the issue, which could possibly cause the patient unnecessary suffering as sexual dysfunction can be the only symptom indicating severe illness. The aim of this study was to explore nurses’ attitude towards patients’ sexuality throughout life. The study was conducted as a literature review based on eleven scientific articles. Qualitative as well as quantitative articles were included in the study. Results showed that there are a number of barriers that affect nurses’ attitudes towards patients’ sexuality. The majority of all informants were well aware that addressing patients’ sexuality formed part of their duties as nurses, however, only a small number of nurses actually did address the issue. The most prominent barrier iden-tified by both nurses and nursing student was their self-reported lack of education in sexology.

Yes / This article reports the use of a mobile cancer care unit (Cancer Van) to provide continuity of care to patients with cancer who utilise the services of Airedale NHS Foundation Trust. The article contains data that shows the resilience of this service during the Covid19 pandemic and provides evidence that this type of service is beneficial for patient care. / Hope for Tomorrow

The emerging health care culture of accountability for patient outcomes compounds problems for already overwhelmed clinicians struggling to fit everything entailed in complicated office visits into 15-minute appointments. Unprocessed frustrations tempt clinicians to use ineffective and outdated methods for trying to get their patients to comply or adhere to their care plans, undermining effective health care management. The intention of this project was to evaluate whether educating medical assistants in the health coaching method of motivational interviewing can improve the patient care approach while simultaneously assisting clinicians struggling with insufficient time. Several individual scheduling conflicts limited the target population into two primary care medical assistants and two auxiliary primary care office staff who voluntarily chose to learn the new approach. Guided by the adult learning theory, an educational lecture project was designed to capture the spirit of motivational interviewing through basic descriptions and strategies that will assist learners to focus on person-centered conversation skills, helping to balance both the needs of the patient and clinician. Following the education, participants filled out an anonymous post-lecture evaluation questionnaire to provide immediate feedback about learner understanding. Responses indicated the project met its stated objectives, and results showed the versatility of the motivational interviewing method which can be learned and effectively applied by health care workers from a wide range of professional backgrounds. Motivational interviewing is an innovative approach that utilizes therapeutic communication to promote behavior changes that lead to improved health of our communities and country.

Introduktion: Hälften av alla vårdskador uppkommer i samband med operation. Operationsteamet är ett multidisciplinärt samarbete där många människor från flera yrkeskategorier arbetar tillsammans i olika konstellationer med patientsäkerheten som en av de viktigaste delarna. Operationssjuksköterskan och anestesisjuksköterskan ansvarar för patientens omvårdnad före, under och efter operationen. Syfte: Att beskriva hur omvårdnadsteamet arbetar intraoperativt beträffande patientsäkerheten. Metod: En integrerad systematisk litteraturstudie där artiklar söktes i databaserna Cinahl och PubMed. Elva artiklar med kvantitativ, kvalitativ och mixed method valdes ut och analyserades. Resultat: Materialet resulterade i tre kategorier: Att vara förberedd, att utbyta information med varandra och att vara förtrogen med varandras färdigheter. Konklusion: En stor del av resultatet visade på att förberedelser där hela omvårdnadsteamet involveras, kontinuerligt utbyter information med varandra och är förtrogna med varandras yrkesprofessionella färdigheter stärker patientsäkerheten. Resultatet av denna litteraturstudie kan leda till en ökad förståelse för operationsteamets betydelse för patientsäkerheten intraoperativt. / Introduction: Half of all health care-associated injuries occur in conjunction with surgery. The patient care team is a multidisciplinary collaboration where many people from different professions work together in different configurations with patient safety as one of the most important aspects. The operating theatre nurse and the nurse anesthetist are responsible for the patients nursing care before, during and after the surgery. Aim: To describe how the patient care team works intraoperatively regarding the patient safety. Method: An integrated systematic literature study were articles searches where made using the databases Cinahl and PubMed. Eleven articles with quantitative, qualitative and mixed method analysis has been reviewed. Result: The material resulted in three categories: To be prepared, to exchange information with each other and to be familiar with each other’s skills. Conclusion: A large part of the result showed that preparations where the whole patient care team was involved, continuously exchanging information with each other and were familiar with each other’s professional skills enhances the patient safety. The result of this literature study might lead to an increased understanding of the importance of the patient care team for patient safety intraoperatively.

The research is situated in a busy intensive care unit in a tertiary referral centre university hospital in Scotland. To date no research appears to have been done with a focus on handover in intensive care, across the professions involved, examining how handover is enacted. This study makes an original contribution to the practical and pedagogical aspects of handover in intensive care both in terms of the methodology used and also in terms of its findings. In order to study handover a mixed methods approach has been adopted and fieldwork has been done in the ethnographic mode. Data has been audio recorded and transcribed and analysed to explore the clinical handovers of patients by doctors and nurses in this intensive care unit. Texts of both handover, and the artefacts involved, are reviewed. Material from journals, books, lectures and websites, including those for health care professionals, patients and relatives, and those in industry are explicated. This study explores the role of material artefacts and texts, such as the intensive care-based electronic patient record, the whiteboards in the doctors’ office, and in the ward, in the enactment of handover. Through analysis of the data I explore some of the entanglements and ontologies of handover and the multiple things of healthcare: patients, information, equipment, activities, texts, ideas, diseases, staff, diagnoses, illnesses, floating texts, responsibility, a plan, a family. The doing of handover is framed theoretically through the empirical philosophy of Mol’s identification of multiple ontologies in clinical practice (Mol, 2002). Each chapter is prefaced by a poem, each of which has relevant socio-material elements embedded in it. The significance of the findings of the research for both patient care and clinical education and learning is surfaced.

Telecare and especially Mobile Care Systems are getting more and more popular. They have two major benefits: first, they drastically improve the living standards and even health outcomes for patients. In addition, they allow significant cost savings for adult care by reducing the needs for medical staff. A common drawback of current Mobile Care Systems is that they are rather stationary in most cases and firmly installed in patients’ houses or flats, which makes them stay very near to or even in their homes. There is also an upcoming second category of Mobile Care Systems which are portable without restricting the moving space of the patients, but with the major drawback that they have either very limited computational abilities and only a rather low classification quality or, which is most frequently, they only have a very short runtime on battery and therefore indirectly restrict the freedom of moving of the patients once again. These drawbacks are inherently caused by the restricted computational resources and mainly the limitations of battery based power supply of mobile computer systems. This research investigates the application of novel Artificial Intelligence (AI) and Machine Learning (ML) techniques to improve the operation of 2 Mobile Care Systems. As a result, based on the Evolving Connectionist Systems (ECoS) paradigm, an innovative approach for a highly efficient and self-optimising distributed online machine learning algorithm called MECoS - Moving ECoS - is presented. It balances the conflicting needs of providing a highly responsive complex and distributed online learning classification algorithm by requiring only limited resources in the form of computational power and energy. This approach overcomes the drawbacks of current mobile systems and combines them with the advantages of powerful stationary approaches. The research concludes that the practical application of the presented MECoS algorithm offers substantial improvements to the problems as highlighted within this thesis.

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Controversy was observed regarding the opinions of nursing managers on the role of patient care workers (PCWs) in private hospitals. These opinions ranged from praise for their contribution towards patient care to serious concerns about the impact of their role on patient safety. The aim of this study was therefore to explore the role of PCWs in private hospitals in the Cape Metropole, South Africa. A qualitative approach with a descriptive design was applied to explore the role of PCWs as perceived by unit managers, nurses and patient care workers. Purposive sampling was used to select participants from medical and surgical wards from three different private hospitals, one each from the three major private hospital groups in South Africa (n=15). Permission to conduct the study was obtained from the Health Research Ethics Committee of the Stellenbosch University, as well as from the private hospital organisations. Fifteen semi-structured interviews were conducted, transcribed and analysed. Six themes emerged from the data. These included PCW activities, care organisation, position in the patient care team, training, reasons for employment and concerns about the PCW role. The findings indicated strong similarities with the health care asistant role as described in the literature study. The activities of PCWs are focused on direct patient care and they spend much time with patients. They are close observers of the patient’s condition and report to nurses. PCWs seem to be well integrated into the patient care team and are mostly seen as nurses. Yet, there are concerns about their evolving role despite their limited training programmes and the lack of direct supervision. The researcher recommends that the work of PCWs should be regulated, but that the nursing profession should critically evaluate the need for another nursing category in addition to that of the enrolled nurse auxiliary. / AFRIKAANSE OPSOMMING: Teenstrydigheid is waargeneem met betrekking tot die opinies van verpleegbestuurders oor die rol van pasiёntsorgwerkers (PSWs) in privaat hospitale. Hierdie opinies het variëer van waardering vir hul bydrae tot pasiёntsorg tot ernstige besorgdheid oor die impak van hulle rol op pasiënt veiligheid. Die doel van hierdie studie was dus om die rol van PSWs in privaat hospitale in die Kaapse Metropool in Suid Afrika te ondersoek. ‘n Kwalitatiewe benadering met ‘n beskrywende ontwerp is gevolg om die rol van PSWs, soos waargeneem deur eenheidsbestuurders, verpleegsters en PSWs self, te ondersoek. Doelgerigte steekproeftrekking is gebruik om deelnemers van mediese en chirurgiese sale uit drie verskillende privaat hospitale, een uit elk van die drie grootste privaat hospitaal organisasies in Suid Afrika, te kies (n=15). Toestemming om die studie te doen is verkry van die Etiek Komitee vir Gesondheidsorgnavorsing van die Universiteit van Stellenbosch sowel as van die privaat hospitaal organisasies. Vyftien semi-gestruktureerde onderhoude is gevoer, woordeliks getik en ge-analiseer. Ses temas het uit die data na vore gekom. Dit sluit die aktiwiteite van PSWs, die organisering van sorg, plek in die pasiёntsorg span, opleiding, redes vir indiensneming en besorgdheid oor die rol van PSWs. Die bevindinge toon ‘n sterk ooreenkoms met die rol van die gesondheidsorg assistent soos beskryf in die literatuur. PSWs fokus op direkte pasiёntsorg en spandeer baie tyd met pasiёnte. Weens hulle nabyheid aan die pasiёnt, kan hulle die pasiёnt se toestand waarneem en bevindings rapporteer aan verpleegsters. PSWs is oёnskynlik goed geїntegreer in die pasiёntsorgspan en word meesal as verpleegsters beskou. Tog is daar besorgdheid oor die uitbreiding van hulle rol ten spyte van beperkte opleidingsprogramme en ‘n gebrek aan toesighouding. Die navorser stel voor dat die werk van PSWs gereguleer behoort te word, maar ook dat die verpleegprofessie die nodigheid van ‘n addisionele kategorie tot die assistent verpleegster, krities moet evalueer.

Human immunodeficiency virus (HIV) is a worldwide problem, with more than 34 million people infected with HIV/AIDS in 2011. At the end of 2011, in Nigeria, an estimated 3.7% of the adult population were living with HIV/AIDS. HIV services in Nigeria are secondary-care led, involving multidisciplinary teams and access to free antiretroviral. However, evaluations of service provision from both patient and healthcare professional perspectives, especially, pharmacists in Nigeria have never been conducted, and are the aims of this research. This study involved grounded theory methodology, using In-depth semi-structured interviews with adults infected with HIV, pharmacists, and administrators involved in the management and care of those patients at Maitama District Hospital in Abuja. HIV pharmacists working for the NHS in the UK were interviewed for comparative purposes. Thirty-five patients were interviewed. Five concepts were identified that influenced how they accessed hospital services after diagnosis. These include faith in God and antiretroviral, social issues with emphasis on HIV stigma and discrimination, patient journeys at the hospital with delays and repeat visits, obstacles such as ARV unavailability and their expectations. Also, five concepts were identified from the pharmacists’ interviews which include clinical service, impressions of service provided, social issues the patients encountered, the obstacles faced with clinical service provided and expectations for improvement. Ten patients were shadowed on their clinic days to observe the patient journey articulated. Furthermore, the administrators interviewed re-affirmed the opinions of the patients and pharmacists about many patients attending HIV clinic, few staff attending to patients, medicines unavailability, especially ARV drugs, and lack of working space for staff. Delays, few pharmacists/many patients and shortage of ART as barriers to service provision ii emerged as dominant themes across the three groups of interviewees in Nigeria. Also, it has been found that there is a wide gap between HIV patients’ hospital management in the UK and Nigeria as regards availability of antiretroviral, staff strength, number of patients in attendance on clinic days and weekly clinic days. Pharmacy was found to have a substantial role in the management of HIV/AID patients but it appears from this study that service improvements, both human and material resources are needed. Twenty three recommendations, which are further synthesised into six potential areas, are made, which, if implemented, would dramatically improve the service provision for HIV/AIDS patients at Maitama District Hospital.