No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Cognitive changes associated with cancer and its treatment have been well documented. However, the majority of research on cognitive symptoms in cancer has been conducted with early-stage breast cancer patients or survivors in remission. Little is known about cognitive symptoms in patients with late-stage or metastatic cancers. To address this gap in the literature, this study examines cognitive and related symptoms among metastatic breast cancer patients enrolled in a parent study of perceptions of symptom importance and interference. Eighty metastatic breast cancer patients were recruited from the Indiana University Simon Cancer Center to participate in this cross-sectional telephone interview study. The interview consisted of self-report measures, including measures of symptom severity, distress, and the importance of seeing improvement in specific symptoms post-treatment. I hypothesized that cognitive complaints would cluster with fatigue, sleep disturbance, depressive symptoms, anxiety, and pain. This hypothesis was tested using cluster analysis and was partially supported. Cognitive complaints were found to cluster with fatigue, sleep disturbance, depressive symptoms, and anxiety, but not pain. In addition, the extent to which ratings of symptom importance for cognitive symptoms differed from those of other symptoms (i.e., pain, fatigue, sleep problems, depressive symptoms, anxiety, nausea, lymphedema, hot flashes, and neuropathy) was explored using ANOVA and Tukey’s HSD tests. Cognitive complaints were rated as significantly more important than anxiety, depressive symptoms, neuropathy, swelling, nausea, and hot flashes. Importance ratings for cognitive complaints, pain, fatigue, and sleep problems were not significantly different. Developing patient-centered treatment approaches that take into account symptom clustering and patients’ treatment priorities may increase treatment adherence and optimize healthcare quality.

In this review, we discuss considerations and successful models for providing decentralized diagnosis, treatment, and prevention services for children and adolescents. Key approaches to building decentralized capacity for childhood TB diagnosis in primary care facilities include provider training and increased access to child-focused diagnostic tools and techniques. Treatment of TB disease should be managed close to where patients live; pediatric formulations of both first-and second-line drugs should be widely available; and any hospitalization should be for as brief a period as medically indicated. TB preventive treatment for child and adolescent contacts must be greatly expanded, which will require home visits to identify contacts, building capacity to rule out TB, and adoption of shorter preventive regimens. Decentralization of TB services should involve the private sector, with collaborations outside the TB program in order to reach children and adolescents where they first enter the health care system. The impact of decentralization will be maximized if programs are family-centered and designed around responding to the needs of children and adolescents affected by TB, as well as their families. / Revisión por pares

No description available.

Background & Purpose: Sustaining an acquired brain injury (ABI) can often lead to admission to an inpatient rehabilitation program. The purpose of inpatient rehabilitation is to provide individualized, patient-centered therapy in order to facilitate community re-integration. Considering the patient perspective is beneficial for informing patient-centered care because clinicians and program administrators may develop greater awareness and understanding of patient needs and preferences. There is a lack of qualitative research investigating patient experiences and perspectives of ABI inpatient rehabilitation, and the majority of existing research was conducted in non-Canadian contexts. The present study was thus designed to describe and interpret patient experiences of an ABI inpatient rehabilitation program in urban Ontario. The purpose was to contribute to a patient lens that inpatient rehabilitation staff could consider in their work. Methods: An interpretive description approach was adopted for this qualitative study. Twelve participants were purposively sampled from a regional ABI rehabilitation program. They completed semi-structured interviews about their experiences. Interviews were transcribed, coded, and analyzed to identify major themes. Results: Three major themes were identified from the analysis and arranged around three time points. At the time point prior to admission to inpatient rehabilitation, the theme was “Life Rerouted,” where participants described their lives being diverted from what was “normal” after sustaining an ABI. Inpatient rehabilitation was seen as a way to return to their pre-injury life. The second theme described experiences within inpatient rehabilitation and was entitled, “Autonomy within Rehab.” Under this theme, participants emphasized the importance of personal autonomy over their choices and abilities while in rehabilitation, with three related sub-themes: interactions with clinicians, perceptions of institutional policy, and the involvement of family members. Under a minor theme, not directly related to aspects of autonomy, entitled “social comparisons,” participants also made comparisons of their recovery progress to other patients. The third and final theme reflected participants experiences just after discharge and was entitled, “Life (and Recovery) Go On.” Under this theme, participants described an ongoing recovery process leading to sentiments of both frustration and hope for the future. Discussion: An overarching key message was developed from these themes: “re-establishing personal identity is important to the recovery process.” Two theories (biographical disruption and relational autonomy) are used to interpret this message and describe the strategies and perspectives adopted by patients during inpatient rehabilitation as they attempted to cope with the psychosocial impacts of ABI on their lives. Conclusions: The findings of this study provide knowledge and a theoretical lens in which program staff can view and understand patients’ experiences, needs and preferences. These findings may enhance patient-centered care within the context of ABI inpatient rehabilitation. / Thesis / Master of Science (MSc)

by Tse Kai Fat, Tsui Ping Tim. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 55-56). / ABSTRACT --- p.ii / TABLE OF CONTENT --- p.vi / LIST OF ILLUSTRATIONS --- p.viii / LIST OF TABLES --- p.ix / CHAPTER / Chapter I. --- INTRODUCTION / The Hong Kong Hospital Authority --- p.1 / What is Quality of Health Care Service? / Four Dimensional Approach --- p.3 / Quality -- Standard Medical Practice(A) --- p.4 / Quality -- Good Medical Outcome(B) --- p.5 / Quality -- Customer Satisfaction(C&D) --- p.6 / Quality and Cost Containment / Trade-off between Quality and Cost --- p.9 / Quality Management Reduces Healthcare Cost --- p.10 / Methodology --- p.11 / Malcolm Baldrige National Quality Award(MBNQA) --- p.12 / Chapter II. --- CORPORATE QUALITY MANAGEMENT IN THE HOSPITAL AUTHORITY / Corporate and Hospital Missions --- p.14 / Strategic Quality Management --- p.15 / Continuous Quality Management --- p.17 / Specific Corporate Quality Improvement Programs --- p.20 / Core Value Success Scheme --- p.21 / Dilemma Faced by the Hospital Authority --- p.23 / Chapter III. --- QUALITY MANAGEMENT IN PRINCESS MARGARET HOSPITAL / Hospital Background --- p.24 / Organisational Structure --- p.24 / Quality Management System --- p.25 / Leadership --- p.26 / Information and Analysis --- p.27 / Strategic Planning --- p.29 / Human Resource Development and Management --- p.31 / Process Management --- p.32 / Organisation Performance Results --- p.34 / Patient Satisfaction --- p.35 / Chapter IV --- QUALITY MANAGEMENT IN SHATIN HOSPITAL / Hospital Background --- p.36 / Quality Management System --- p.36 / Leadership --- p.39 / Information and Analysis --- p.39 / Strategic Planning --- p.40 / Human Resource Development and Management --- p.40 / Process Management --- p.41 / Organisation Performance Results --- p.42 / Patient Satisfaction --- p.43 / Chapter V. --- CRITIQUE AND RECOMMENDATIONS / Princess Margaret Hospital versus Shatin Hospital --- p.44 / The Hong Kong Hospital Authority --- p.46 / Corporate Strategy --- p.46 / Measurement of Quality --- p.47 / Staff Motivation --- p.48 / Total Quality Management and Cost Containment --- p.49 / APPENDIX --- p.50 / BIBLIOGRAPHY --- p.55

This thesis focuses on the role of middle managers in the transfer of a humanistic approach to management, care and services in a physical rehabilitation center.This thesis should interest decision makers and researchers who are paying attention to humanistic approaches to management, care and services. The design of this multi-case qualitative, exploratory and constructivist research includes six cases, representing the six middle managers of the studied organization. The multi-case study allows us to contrast cases of successful middle managers from the ones who were not really able to transfer the humanistic approach in their program. Data production and analysis are done with methods used in grounded theory. Here are the main findings generated by this thesis. Firstly, our analysis reveals that, in spite of top management efforts to disseminate a humanistic approach to management, care and services throughout the organizations the transfer process sometimes clashes against the absorptive capacity of the middle manager within the program. When the middle manager has the capacity to absorb the humanistic approach, often because it is compatible with his profound convictions, this capacity is first expressed through his behavioral exemplarity. In the eyes of his employees, the middle manager primarily represents an embodied example of the humanistic approach through his behavior. Therefore, the behavioral exemplarity of the middle manager came out as a sine qua non condition through which is possible the co-construction of new humanistic care and services practices to be offered to clients of the program. Secondly, our analysis sheds light on the importance, at the beginning of the transfer process, to explain to employees the necessity to adopt a humanistic approach to management, care and services and to recognize existing humanistic practices in the organization. Thirdly, the results bring to the forefront the importance of macro and micro contexts as determinant variables in the transfer of a humanistic approach to management, care and services. Lastly, an intervention model illustrating the key role of middle managers in the transfer of a humanistic approach to management, care and services emerges from the results. The model also includes contextual elements which facilitate the transfer. On a more practical note, the model can guide organizations in the dissemination process of such an approach by providing a rich description of the stages of the dissemination process, the actors involved, the dissemination strategies and the goals of these strategies.

Inledning: Vid en förvärvad hjärnskada är delaktighet i rehabiliteringen en central del för patientens återanpassning till vardagen och eventuellt tillbakabildande av förlorade funktioner. Delaktighet i vårdförloppet leder till en ökad teoretisk förståelse och praktisk insikt hos patienten. Syfte: Syftet med denna studie var att beskriva hur vuxna personer med förvärvad hjärnskada upplever/har upplevt delaktighet under sin vårdtid på en rehabiliteringsavdelning. Metod: Detta är en kvalitativ studie med beskrivande design med semistrukturerade intervjuer som datainsamlingsmetod. Tio patienter som vårdats minst fem arbetsdagar på en rehabiliteringsavdelning intervjuades gällande frågor om delaktighet under vårdtiden på rehabiliteringsavdelningen. En kvalitativ innehållsanalys inspirerad av Graneheim och Lundman (2012) användes för att analysera insamlad data på latentnivå. Resultat: Utifrån temat ”delaktighet” uppstod tre kategorier: kompetent personal, informerad patient, samt självständighet. Temat ”icke-delaktighet” resulterade i två kategorier: bristfällig information och kontrollförlust. Det var flera av informanternas berättelser som liknade varandra i fråga om delaktighet på vårdavdelningen. Samtliga informanter beskrev att de upplevt sig vara delaktiga någon gång under vårdtiden på rehabiliteringsavdelningen. Det handlade bland annat om att de upplevt att de fått tillräcklig information från personalen angående sjukdom och vårdförlopp, att det fanns kompetent personal som anpassade sig efter patienternas individuella behov och önskemål samt möjlighet till självständighet under exempelvis träning. Ett flertal informanter beskrev även upplevelser av att inte vara delaktiga under vårdtiden. Bristfällig information från personalens sida samt en känsla av kontrollförlust var de huvudsakliga anledningarna till detta. Slutsats: Denna studie kan bidra till en ökad förståelse hos vårdpersonal angående delaktighet under rehabiliteringstiden för patienter med förvärvad hjärnskada. Då vårdtiderna kan vara långa på rehabiliteringsavdelningen är det särskilt viktigt med en god kontakt och bra kommunikation med patienterna för delaktighet och en patientcentrerad vård.

Rationale: Chronic diseases represent an important health burden that often involves major adaptations to manage the disease on a daily basis. Health professionals, such as the family physician, can help a person acquire more power over his or her health (enablement). While it would be useful to measure patient perception of enablement by the family doctor with a valid questionnaire, existing tools present important gaps. Aim and objectives: This study aimed at developing a self-administered questionnaire to measure the perception of patients with chronic diseases of enablement by their family physician. The objectives were: 1) To deepen the conceptualization of enablement by validating the proposed conceptual framework with patients presenting with chronic diseases and to specify the relative importance of its dimensions; 2) To operationalise the dimensions by proposing indicators of these dimensions (pool of items); 3) To verify the content validity of the questionnaire. Methods: An exploratory sequential mixed-method research design was chosen. The descriptive qualitative study (objectives 1 and 2) used in-depth interviews with 30 patients aged 35 to 75 presenting with at least one chronic disease, having the same family doctor for at least one year and recruited through maximum variation sampling. Taped interviews were transcribed and analyzed using Miles and Huberman's mixed coding method (2003a). A three-round e-Delphi study (objective 3) involved 15 Canadian experts in family medicine, able to read in French. The experts scored the items proposed on a 9-point scale (1 = Inappropriate to 9 = Very appropriate) and could suggest rewording and additions. Items scored 7-9 by the experts were considered consensual and were not presented in the following round. Items that were not consensual after the third round were decided upon by the team of researchers. Results: The partnership (the trusting relationship and decisions to be taken) that develops over time was found to be a major component of enablement. The enablement role of the physician goes beyond the medical consultation to defend the interests and safety of the patient's journey through the healthcare system. The trusting relationship combined with a good knowledge of the person may help the family physician better understand and legitimize the various feelings experienced while offering realistic hope . The family physician is in a privileged position to help patients develop their own expertise . Sixty-six items classified into six dimensions were submitted to the experts during the first round of the E-Delphi method. The first round was completed by 13 experts: 21 items were consensual; 25 items were resubmitted without any modification; 16 items were modified and four were rejected. Forty-one items were submitted during the second round, completed by 13 experts: eight items were consensual; 20 items were submitted without any modification; 12 items were modified and one item was rejected. Thirty-three items were submitted during the third round completed by nine experts: 29 items remained intact; three items were modified and one item was rejected. Conclusion: An initial 61-item questionnaire is proposed.

Made available in DSpace on 2016-08-10T10:54:54Z (GMT). No. of bitstreams: 1 RENATA MOURA DE CARVALHO.pdf: 1383256 bytes, checksum: 4cef8119d9baa087062d9de6420baf42 (MD5) Previous issue date: 2016-02-24 / Over the years hospitals were turning into places with high technology and infrastructure to serve more efficiently a greater share of the population. This process generated depersonalization due to the technicistic nature that these environments became to have. Many environments have become cold, frightening and ruthless reflecting on the quality of life within these spaces. When health care is focused on a child or teenager the patient centered care s issues should be raised as key points to their well-being during hospital stay being important to understand the perception that users and professionals have about the environment they are in. This study aims to explore the perspectives of users and professionals at a Pediatric Oncology Hospital in Goiânia and of regional architects about the contribution of the architectural physical environment for the process of patient centered care. It had as methodology the qualitative research with the theoretical support in Grounded Theory in Constructivist Data by Kathy Charmaz (2009) where the data was obtained from shared experiences and the relationships with participants. It was used as data collection instrument, semi-structured interviews with ten companions, seven patients, six healthcare professionals and three architects. The results highlight six categories: Attempts to adapt; Wear in the hospital; Quality of the functional structure of the hospital; Failures in quality of the hospital s operation; Quality of hospital s physical structure and failures in the quality of the hospital s physical structure. / Com o passar dos anos os hospitais foram se transformando em espaços com alta tecnologia e infraestruturas para atender com mais eficiência uma maior parcela da população. Esse processo gerou a despersonalização devido ao caráter tecnicista que esses ambientes passaram a ter. Muitos ambientes se tornaram frios, assustadores e desumanos repercutindo na qualidade de vida dentro desses espaços. Quando a atenção em saúde é focada na criança ou no adolescente as questões de humanização devem ser levantadas como pontos-chave para o bem-estar durante a hospitalização sendo importante entender a percepção que os usuários e profissionais têm quanto ao ambiente em que estão. Este trabalho tem como objetivo explorar as perspectivas dos usuários e profissionais de um hospital oncológico pediátrico em Goiânia e de arquitetos regionais quanto à contribuição do ambiente físico arquitetônico para o processo de humanização. Teve como metodologia a pesquisa qualitativa com o suporte teórico na Teoria Fundamentada em Dados Construtivista de Kathy Charmaz (2009), onde os dados foram obtidos a partir de experiências compartilhadas e das relações com os participantes. Foi utilizado como instrumento de coleta de dados, entrevistas semiestruturadas com dez acompanhantes, sete pacientes, seis profissionais da saúde e três arquitetos. Dos resultados emergiram seis categorias: Tentativas de adaptação; Desgaste no hospital; Qualidade da estrutura funcional do hospital; Falhas na qualidade do funcionamento do hospital; Qualidade da estrutura física do hospital e Falhas na qualidade da estrutura física do hospital.