bluuebunny/crossref_metadata_2025 huggingface dataset:
Bikker, A.P., Cotton, P & Mercer, R.W. (2014). Embracing Empathy in Healthcare. London: Radcliffe Publishing. ISBN 978190936-818-7
Authors: Lindsay Margot
Published: October 2016

No abstract
Documentation of nursing home residents' preferences regarding end-of-life care in Japan: Does the documentation serve as an advanced directive in care planning?
Authors: Nakanishi Miharu , Miyamoto Yuki
Published: October 2016

Rationale, aims and objective: In 2006, the public long-term care insurance system in Japan introduced a documentation of a nursing home resident’s preferences regarding end-of-life care. However, it is unclear whether the documentation of preferences serves as an advanced directive in care planning. The aim was to examine the association between documentation of a nursing home resident’s preferences regarding end-of-life care and (1) preferences on place of death, (2) comfort at end-of-life in facilities and (3) death of residents in hospitals.Methods: A retrospective study design was used to collect data regarding decedents in long-term care facilities across 3 prefectures in Japan in August 2014. A total of 211 decedents from 62 facilities were included in the analysis. The Managing Director provided information on each resident’s and relative’s preferred place of death, comfort during the last 7 days of life in the facility and actual place of death. The Comfort around Dying End-of-Life in Dementia scale (CAD-EOLD) was used to assess comfort.Results: Residents’ preferences regarding place of death was unable to be determined regardless of completion of routine documentation. Relatives of residents in facilities that completed routine documentation were more likely to prefer that death occurred at the facility. The comfort and likelihood of hospital death did not vary according to the completion of routine documentation.Conclusion: Routine documentation may have confirmed the preferences of relatives instead of residents themselves. Communication strategies should be established as part of the documentation of nursing home resident’s preferences to ensure quality of end-of-life care in accordance with the resident’s preferences.
Can a Discrete Choice Experiment contribute to person-centred healthcare?
Authors: Kaltoft Mette Kjer , Neilsen Jesper Bo , Salkeld Glenn , Dowie Jack
Published: October 2016

In person-centred decision making the relative importance of the considerations that matter to the person is elicited and combined, at the point of decision, with the best estimates available on the performance of the available options on those criteria. Whatever procedure is used to implement this in a clinical decision, average preferences emerging from group or subgroup research cannot contribute directly, since they can have only a statistical relationship with the preferences of the individual person. The precise relationship is knowable by eliciting those of the individual concerned, but there would be little point consulting the averages if this is done. A scan of recent Discrete Choice Experiment (DCE) publications reveals frequent claims that the group-level results can somehow contribute to, or facilitate, better clinical decision making. Typically there are only vague or ambiguous indications of how this could happen, the ambiguity often arising from the use and positioning of the apostrophe in the words persons and patients. Only when the person opts out of preference provision and asks to be treated as ‘average’, can the results of a DCE have clinical relevance in genuinely person-centred healthcare. One cannot derive an ought from an is and one cannot derive an I from a they. DCE researchers should refrain from implying that their results could, let alone should, have any impact on person-centred clinical decisions. Group-level DCE results are clearly conceptually appropriate for health system or service decisions, but the suggestion that they have clinical relevance is a serious deterrent to the development and provision of effective means of individual preference elicitation and specification at the point of decision. Those who wish to foster person-centred care should be alert to the dangers of claims based on group-level analyses such as DCEs.
Development of a communication skills based workshop for Shared Decision-Making (SDM)
Authors: Kelly-Blake Karen , Olomu Adesuwa , Dwamena Francesca , Dontje Katherine , Henry Rebecca , Rovner David R , Rothert Marilyn L , Holmes-Rovner Margaret
Published: October 2016

Rationale, aims and objectives:Shared Decision-Making (SDM) is increasingly recommended to improve patient-centered care. Implementation of SDM in routine practice has been challenging.  Our aim was to develop and evaluate a brief SDM workshop based on a communication skills approach for primary care physicians (PCPs). The clinical problem chosen was one in which over-treatment is a concern: screening and treatment options in stable coronary artery disease (CAD) following a mildly abnormal stress test.  Method: Essential training tasks were identified from existing communication skills and shared decision-making skills. A 90-minute workshop was developed for use with a patient decision aid. Didactic content and role plays featuring 3 case scenarios with interactive feedback formed the approach. Participants were academic internal and family medicine PCPs. Retrospective pre-post surveys evaluated self-reported effectiveness in actual clinic encounters. Results: Seventy-two percent (21/29) of PCPs in the 2 clinics participated in the Communication-Shared Decision Making (COMM-SDM) Training Program. Providers reported increased confidence in doing shared decision-making with CAD patients. Decreases in confidence occurred in the specific task of “setting the stage for the encounter”. Some PCPs were uncomfortable with counseling patients making decisions about optimal medical therapy or percutaneous coronary intervention (PCI), preferring the cardiologist to discuss the options.Conclusions: SDM as an extension of a communication approach appears logistically feasible. The essential tasks of this training approach may be applicable to other clinical decisions where shared decision-making is appropriate, either because the decisions are preference sensitive or because testing and treatment patterns are frequently inconsistent with scientific evidence.
Prediction of treatment outcome in daily generalized mental health care practice: first steps towards personalized treatment by clinical decision support
Authors: Tiemens Bea , Bocker Koen , Kloos Margot
Published: October 2016

Rationale, aims and objectives: Results from prediction studies are often of limited value because potential predictors are measured with instruments that are not routinely used, the results are presented in terms that are difficult to translate to individual patients and the relations between predictors and outcome are complex. These problems were faced by deriving decision trees for classification using information routinely accessed in generalized mental healthcare for intake purposes and treatment monitoring.Method: Positive treatment outcome was defined as symptom improvement, measured with the symptom distress scale of the Outcome Questionnaire (OQ-45.2). The analysis process consisted of 3 phases, derivation of a possible decision tree, selection of the best 10 trees and assessment of classification performance after integration of these 10 trees. This analysis was performed 3 times, for all patients without any missing data, for the full set of patients and for the patients in which intermediate outcome data were available.Results: The prediction performance of the 3 integrated classifiers varied from poor (AUC 0.68) in the complete sample including patients with missing variables, to good (AUC 0.83) including early response as predictor. Complex interactions between variables were found.Conclusion: The present study shows the need for registration of clinical and sociodemographic variables and outcome monitoring in a systematic way to prevent missing variables and automated decision support systems to use complex interactions between variables for outcome prediction.
Inhabiting the interspaces within emergency care
Authors: Elmqvist Carina
Published: October 2016

Aim: To describe and develop an understanding of the patient’s first encounter with different professionals at the scene of an accident and at the emergency department (ED), with a special focus on describing the meaning of emergency care of patients in these care contexts. Design and Methods: The study, having a descriptive design, was carried out with a reflective lifeworld (RLR) approach founded on phenomenological philosophyResults: The general structure revealed that emergency care is characterized by a hand-over of responsibility, which is characterized by life-saving medical actions and constitutes a doing. Those life-saving actions need a conscious presence, which at the same time means an existential support for the patient that is constituted by a being. The responsibility then intertwines the doing and the being and all persons involved are brought together into a mutual space. When the patient’s condition allows for increased physical distance from the professionals, a gap or an interspace in the intertwining between doing and being arises as well as an interspace in the patient's understanding of the encounter. For the patient and next-of-kin, this interspace means an empty space with paradoxical feelings of being interesting and at the same time uninteresting - a paradox of care. For the professionals, this interspace provides a needed  breathing space, but also feelings of being split between the high demands of efficiency and the patient's need for existential support and a meaningful encounter - an ethical dilemma.Discussion: Knowledge of the temporal meaning ofthe encounter, to be here andnow,can give professionals an opportunityto fillthe interspacedespite increasingphysical distance as patient health improves. Furthermore, it will also give professionals an opportunity toreflect on howthe available timeis used.
The Swedish version of the Sheehan Disability Scale - a valid and brief measure of functioning
Authors: Horberg Niklas , Kouros Ioannis , Ekselius Lisa , Ramklint Mia
Published: October 2016

Rationale, aims and objective: The Sheehan Disability Scale (SDS) is a brief instrument used to measure functional disability, but the Swedish translation has not been psychometrically evaluated. The aim of this paper is to test the psychometric properties of the Swedish translation and to further examine concurrent and external validity.Method: In this cross-sectional study, 160 young psychiatric patients from an open care unit in Sweden, were recruited based on a clinical diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder (BD) and/or Borderline Personality Disorder (BPD) and re-diagnosed for confirmation. Participants were interviewed concerning socio-demographic data and a socio-demographic index (SDI) was constructed. Reliability of SDS was measured as internal consistency and an exploratory factor analysis was performed. Level of functioning was measured by SDS scores and Global Assessment of Functioning (GAF). SDS, both self-assessed and expert rated and GAF scores were compared to measure concurrent validity, while SDS and the SDI were compared to measure external validity.Results: The Swedish SDS had a Cronbach’s alpha coefficient of 0.77. An exploratory factor analysis showed that the SDS-items loaded on a single factor with an eigenvalue of 2.06. Self-assessed SDS-scores correlated with expert rated GAF-scores (r = -0.606) and, to some extent, with SDI scores (r = 0.280). Patients with an SDI score ≥ 1 had higher SDS-scores (t=2.70, p=0.008).Conclusions: The Swedish SDS has similar psychometric properties as the English and Spanish versions. It showed both concurrent and external validity, but external validity was weaker
How do we know we do what it says on the tin? Ensuring adherence to a person centered approach within Occupational Therapy Mental Health Services in Higher Education.
Authors: Creaner Brian , Nolan Clodagh
Published: October 2016

Current Irish mental health policy demands a shift towards person centred service delivery. Occupational therapy is well placed to implement and develop services in line with this policy as it has person centred care at the core of its theoretical constructs.  This study examines the use of person centred models in an occupational therapy service for students with mental health disabilities in higher education that is, the Person Environment Occupation (PEO) and Recovery models.   As documentation offers the best insight into the integration of theory to practice, the aim of this study was to examine if documentation adhered to its theoretical underpinnings.    Thus 195 Electronic case files were reviewed and 47 in a re-assessment process. Results demonstrated adherence to the recovery model was an area of strength for the service as was alignment to international best practice standards. However, recording of goals and interventions in line with the PEO model was lacking. Following a period on consultation with senior therapists and the clinical director changes were made to further embed the models into the documentation processes.  Following this consultation re-assessment demonstrated greater adherence to person centred models in all interactions with the students with mental health disabilities.  This research demonstrates that it is necessary not only to examine ones practice but to develop context specific tools to ensure person centred care signifying integration of theory to practice.
Perceived changes to quality of life indicators following a physical activity intervention for recovering cancer patients: A qualitative study.
Authors: Queen Martyn , Bloxham Saul , Brown Phil , Coyle Melissa , Jane Ben
Published: October 2016

The aim of this study was to examine the perceived changes to the quality of life (QoL) for a group of recovering cancer patients, following 6 months of physical activity.Background Evidence suggests that physical activity can improve the QoL of recovering cancer patients, reducing many of the side-effects of cancer and its related treatments, including depression, anxiety, chronic fatigue and improve physical and psychological health. Method A qualitative study with 14 mixed site cancer patients aged 43-70 (12 women, 2 men). The intervention was in 2 parts the first part was an 8-week physical activity programme, the second part related to a period of non-supervised, physical activity for 4 months (6 months in total). The Programme took place at a university in the South West of England. Semi-structured interviews with patients took place 3 times over 6 months. A grounded theory approach was used to analyse the data.Results We found that prior to the 6-month physical activity intervention many of the patients were anxious about being able to complete the initial 8 week programme. Anxieties related to low self-esteem and the chronic fatigue resulting from their cancer treatment. Consequently several patients expressed concerns about their ability to help themselves self-manage their recovery through physical activity. On completion of the intervention the majority of patients reported improvements in their perceived QoL relating to their ability to self-manage, their self-efficacy, energy levels, along with decreases in chronic fatigue.Conclusion Our study has provided valuable insights into how the perceived QoL of a group of recovering cancer patients can be improved through a combined 6-month period of supervised and independent physical activity. These findings serve as further evidence of the effectiveness of a person centred healthcare approach for recovering cancer patients.
How does residents’ experiences with community health service affect their utilization wishes? A population-based survey in China
Authors: Wang Fang , Zhang Liuyi , Cheng Yao , Zhang Ping , Liang Yuan
Published: October 2016

Objectives: Although the number of community health services (CHS) agencies in China has increased rapidly, they are not well used by residents. The aim of this study was to explore residents’ experiences of CHS and their effects on residents’ utilization wishes.Methods: We conducted a cross-sectional door-to-door survey in Wuhan City, in central China. Five indicators (use convenience, environment, attitudes, degree of seriousness and medical costs) were selected as independent variables to reflect residents’ experiences of CHS. Control variables included age, gender, marital status, education level, self-perceived economic status, duration of residence, doctor-diagnosed hypertension and health insurance.Results: Among the five indexes of experiences, the results were as follows: use convenience (91.96%), attitudes (82.12%), degree of seriousness (79.53%), environment (71.94%) and medical costs (60.33%). After adjusting for the potential confounding variables, environment, degree of seriousness and medical costs were the most meaningful influences on residents’ utilization wishes (OR: 2.11, 95% CI: 1.11-4; OR: 2.19, 95% CI: 1.03-4.64; OR: 2.71, 95% CI: 1.46-5.03, respectively).Conclusion: The effects of degree of seriousness and medical costs appear to indicate that residents’ use of CHS is rational. However, the effect of environment may reveal that residents’ use of CHS is partly perceptual (‘judging a book by its cover’). The sustainable development of CHS should take account of these factors.
Opinions of women from deprived communities on the NHS stop smoking service in England - person-centered perspectives.
Authors: Memon Anjum , Barber John , Rumsby Emma , Parker Samantha , Mohebati Lisa , De Visser Richard , Venables Susan , Fairhurst Anna , Lawson Kate , Sundin Josefin
Published: October 2016

Background In most European countries, women are relatively more susceptible to smoking-related diseases, find it more difficult to quit and more likely to relapse than men. With the aim to improve understanding of women’s needs from smoking cessation services, this qualitative study examines perceptions of women from deprived communities on the National Health Service Stop Smoking Service in England.Methods A qualitative study of 11 women, smokers and ex-smokers, who had used Stop Smoking Services located in disadvantaged communities in East Sussex, England. Data were collected through focus group and semi-structured interviews, and were subjected to thematic analysis.Results Women felt that services tailored to their needs would improve cessation rates. They expect smoking cessation facilitators to be non-judgemental and to offer psychological insight into addiction. However, women’s opinions differed on the importance for facilitators to be female or ex-smokers, and on the preference of group or one-to-one services, some women expressed a preference for women only groups. The women praised the continuity of care, capacity for peer support, flexibility of time and location and free cessation aids offered. Conversely, the women felt that services were poorly advertised, that access was not universally good, and that services at work place and drop-in groups would improve access for working women and women with young children.Conclusion Flexible services that are tailored towards the needs of individual smokers and better dissemination of information regarding the range of services available could facilitate greater uptake of smoking cessation services for women in deprived communities.
Patient attractiveness reduces the likelihood of a missed diagnosis: implications for person-centered healthcare
Authors: Tsiga Evangelia , Panagopoulou Efharis , Benos Alexios
Published: October 2016

Objective: No study has so far examined the biases associated with the physical attractiveness stereotype during the process of medical decision making. This study assessed the impact of patients' attractiveness on the diagnosis of kidney or bladder stones.Methods: A computer-based, within-subjects experimental design was used. 34 male family physicians were presented with the same clinical scenario of a 25-year old woman presenting with dysuria complaints. Participants were then presented with facial photos of attractive and unattractive female patients interchangeably. Each photo was followed by a KUB X-ray of kidney or bladder stones. Participants were asked to describe the X-rays.Results: Controlling for the effect of clinical experience, doctors were 3.67 times more likely to miss the diagnosis of kidney or bladder stones on the X-rays of unattractive patients compared to the X-rays of attractive patients (B=1.299, p = .020, Exp(B)=3.667).Conclusion: This study highlights the cognitive biases associated with patient attractiveness during the diagnostic process. It shows that patient attractiveness interferes with physicians' information processing when reading an X-ray, and decreases the likelihood of a missed diagnosis.Practice Implications: The results of this study have severe implications in patient safety and the improvement of the delivered quality of care.
“An MRI reveals the truth about my back”: a qualitative study about patients’ expectations and attitudes toward the value of MRI in the assessment of back pain.
Authors: Petersen Lisbeth , Birkelund Regner , Ammentorp Jette , Schiøttz-Christensen Berit
Published: October 2016

Background: Patients with back pain increasingly demand MRIs to be part of their assessment. However, in most back pain patients, MRI does not appear to have diagnostic value. Nevertheless, it has been shown that patients who receive an MRI are more satisfied with their treatment even though the imaging may not facilitate their return to well-being.  Aim: To explore back pain patients’ expectations of and attitudes towards the value of MRI and to understand the relationship between their expectations and patient satisfaction.Methods: A qualitative study using observations and informal interviews with 62 back pain patients was conducted. Data were analysed according to Malterud’s systematic text condensation method.Results: Patients perceived MRIs to be an objective visual image of the body that could show them where their back pain was originating. Patients expected MRIs to provide them with a biomedical diagnosis; they considered MRIs to be the ‘true objective’ diagnosis, which would allow them to access various services and support and would lead to legitimization of their pain. The patients’ perceived value of MRI was very high; MRIs gave patients a feeling of being understood and taken seriously. Patients and clinicians had different ideas about the diagnosis of back pain, which could challenge how patients experience the benefits of treatment.Conclusion: For patients with back pain, the MRI is a valuable tool that leads to their 'real' diagnosis and enables recognition and legitimisation of their experienced pain. To meet patients' expectations, a better understanding of how MRIs are used in diagnosis and treatment must be achieved. Based on our study, we suggest that information about symptoms and the additional information an MRI can provide be clarified to the patient before assessment of back pain.
Alternative, Complementary or Orthodox: What is real medicine?
Authors: Newell Dave , Lewith George
Published: October 2016

The division between orthodox and CAM approaches to musculoskeletal (MSK) problems is blurred. Manipulative medicine and acupuncture are recognized treatment options for some MSK conditions. These therapies are increasingly evidence based with well-defined mechanisms and are provided by a number of registered professional practitioners, whose ethics and practice is overseen and ultimately regulated, by the Professional Standards Authority. Some practitioners may be considered historically as CAM providers (Osteopaths, Chiropractors and Acupuncturists) and some orthodox practitioners (Physiotherapists and Doctors). If both CAM and orthodox practitioners are providing the same therapies for the same conditions, we believe that this represents good evidence based medical practice. Consequently in this situation, the historical and artificial boundaries between CAM and orthodox medicine cease to be meaningful either clinically or ethically.  We should reasonably assume that CAM and orthodox practitioners, in this context, are practicing ethically.
A Delphi study on the multimodal therapeutic approach to breast cancer; what we know and what we can learn.
Authors: Tassinari Mariateresa , Iseppato Ilaria , Bace Denita , Fossati Maria Elena , Roberti di Sarsina Paolo
Published: October 2016

Background & Aims: Breast cancer is the most common cancer among women in over 140 countries and it is also the major cause of death of women if we include the so-called “least-developed” countries. If, in the view of Evidence-based Medicine (EBM), data regarding the treatment deemed as the most effective is widely available (although still subject to improvement, updating or disagreement), results regarding research input conducted on patients from the person-centered medical perspective are still lacking (where knowing how to give the same importance in all stages and all the actors of the disease is fundamental). In consideration of this lack of attention regarding the centrality of the patient in the therapeutic path, the aim of this study was to understand the considerations that underlie the management of breast cancer between the members of a non-profit organization designed to promote the humanization of medicine by means of sustainable treatments and therapy and to infer how these findings can be implemented. Methods: We conducted a Delphi survey among the members of the Charity Association for Person Centered Medicine-Moral Entity. Participants completed an open-ended questionnaire to answer various questions on female breast cancer with a specific focus on Traditional, Complementary and Alternative Medicine (TCAM) issues. Results and Discussion: The attribution of meaning to the concept of “Embodiment” itself both in relation to culture, environment, lifestyle and psychological sphere as well as the attribution of meaning to the concept of care and its practical implications was heterogeneous. It is extremely significant that all the sample responded that a multimodal and multidisciplinary approach that includes not only the biomedical approach is more effective. Conclusion: The urgency for the implementation of a multi-modal and multi-factorial method in breast cancer therapies is the most crucial conclusion, the starting point to rethinking a medical practice which is centered on the patient.
Updating the descriptive biopsychosocial approach to fit into a formal person-centered dynamic coherence model
Authors: Frölich Thomas , Bevier F F , Babakhani A , Chisholm H H , Henningsen P , Miall D S , Sandberg S , Schmitt A
Published: October 2016

No abstract
Updating the descriptive biopsychosocial approach to fit into a formal person-centered dynamic coherence model - Part III: Personhood, salutogenesis and further topics
Authors: Frölich Thomas , Bevier F F , Babakhani A , Chisholm H H , Henningsen P , Miall D S , Sandberg S , Schmitt A
Published: October 2016

In the present paper the approach, as outlined in our previous articles, is applied to a range of subjects. Its main goal is to understand how human specifics such as use of language, cultural creativity, rational thinking and the use of abstractive terms interfere with human beings basic organic processes. This necessitates an examination at the level of semantics. The latter is referred to as the relationship of produced states to a meaning so that from a sender’s side they are meant to transport meaning from a receiver. Since an interaction of two distinct entities is at issue here, we have to describe the interaction in formal terms, so we talk about the hypostasising of a triggering contact of one entity’s change of states initiating a change of states of another entity. This contact can be accepted as a trigger or not as a trigger, a decision that corresponds to the most primitive form of (possibly also mutual) interpretation. With this model in mind, we can interpret different communicative settings, as the monomeric self-efficacy interpretation, or mutual interpretations in families. To interpret needs a physically memorised categorisation. Only this allows for fast and set-related attributions. Such categorisations can go wrong, especially in fast changing environments. If a higher resolution is needed, additional distinctions are implemented into the heuristic interpretative procedures. Human beings have additional tools for higher resolution in differentiation: practical segmentation and speaking. Afterwards, the products of material and logical discretisation may be re-combined into a new arrangement. The corresponding accessory potential helps to generate a world of its own, as a full-grown personhood. Human uniqueness hence is based on the individuality of each person’s material basis, as well as on its individual type of differentiation and corresponding attribution. Being aware of this, the also mental individuality allows to understand self-interpretative processes that support salutogenesis and an experience of being self-efficient, or not.
Are the arguments for CAM really legitimate in the context of modern healthcare? A commentary on Newell and Lewith (2016): “Alternative, Complementary or Orthodox: What is real medicine?”
Authors: Brown Richard
Published: October 2016

No abstract
Factors associated with body image dissatisfaction in Portuguese adolescents: obesity, sports activity and TV watching
Authors: Coelho Eduarda Maria Rocha Teles de Castro , Fonseca Sandra Celina Fernandes , Pinto Graça Sofia Monteiro , Mourão-Carvalhal Maria Isabel Martins
Published: October 2016

This cross-sectional study intended to determine the prevalence of body image dissatisfaction and associated factors in Portuguese adolescents (N=529, 10-18 years, 53.7% male and 46.3% female). The prevalence of body dissatisfaction (estimated through Collins's silhouettes) was 58%. Multivariate logistic regression analyses showed that the variables associated were: obesity, watch TV over 2 hours/day and practice sport activities 4 or more days/week. In male, obesity and watch TV over 2 hours/day were related to body dissatisfaction and among female only obesity had statistical significance. It is necessary to considered different public health interventions for men and women in order to reduce this high body image dissatisfaction.
Metabolic control in patients with type 2 diabetes mellitus in a public hospital in Peru: a cross-sectional study in a low-middle income country
Authors: Huayanay-Espinoza Irma Elizabeth , Guerra-Castañon Felix , Lazo-Porras María , Castaneda-Guarderas Ana , Thomas Nimmy Josephine , Garcia-Guarniz Ana-Lucia , Valdivia-Bustamante Augusto A. , Málaga Germán
Published: October 2016

Objective

The objective of this study was to assess patients’ achievement of ADA (American Diabetes Association) guideline recommendations for glycosylated hemoglobin, lipid profile, and blood pressure in a type 2 diabetes mellitus (T2DM) outpatient clinic in a low-middle income country (LMIC) setting.

Methods

This is a descriptive cross-sectional study with 123 ambulatory T2DM patients who are being treated at a public hospital in Lima, Peru. Data was gathered via standardized interviews, clinical surveys, and anthropomorphic measurements for each patient. Blood samples were drawn in fasting state for measures of glucose, glycosylated hemoglobin (HbA1c), and lipid profile. Laboratory parameters and blood pressure were evaluated according to ADA recommendations.

Results

Of the 123 patients, 81 were women and the mean age was 61.8 years. Glycemic control was abnormal in 82 (68.33%) participants, and 45 (37.50%) were unable to control their blood pressure. Lipid profile was abnormal in 73 (60.83%) participants. Only nine (7.50%) participants fulfilled ADA recommendations for glycemic, blood pressure, and lipid control.

Conclusions

Amongst individuals with type 2 diabetes, there was poor attainment of the ADA recommendations (HbA1c, blood pressure and LDL-cholesterol) for ambulatory T2DM patients. Interventions are urgently needed in order to prevent long-term diabetic complications.
Exclusions for resolving urban badger damage problems: outcomes and consequences
Authors: Ward Alastair I. , Finney Jason K. , Beatham Sarah E. , Delahay Richard J. , Robertson Peter A. , Cowan David P.
Published: October 2016

Increasing urbanisation and growth of many wild animal populations can result in a greater frequency of human-wildlife conflicts. However, traditional lethal methods of wildlife control are becoming less favoured than non-lethal approaches, particularly when problems involve charismatic species in urban areas. Eurasian badgers (Meles meles) excavate subterranean burrow systems (setts), which can become large and complex. Larger setts within which breeding takes place and that are in constant use are known as main setts. Smaller, less frequently occupied setts may also exist within the social group’s range. When setts are excavated in urban environments they can undermine built structures and can limit or prevent safe use of the area by people. The most common approach to resolving these problems in the UK is to exclude badgers from the problem sett, but exclusions suffer a variable success rate. We studied 32 lawful cases of badger exclusions using one-way gates throughout England to evaluate conditions under which attempts to exclude badgers from their setts in urban environments were successful. We aimed to identify ways of modifying practices to improve the chances of success. Twenty of the 32 exclusion attempts were successful, but success was significantly less likely if a main sett was to be excluded in comparison with another type of sett and if vegetation was not completely removed from the sett surface prior to exclusion attempts. We recommend that during exclusions all vegetation is removed from the site, regardless of what type of sett is involved, and that successful exclusion of badgers from a main sett might require substantially more effort than other types of sett.
Histological variability in the limb bones of the Asiatic wild ass and its significance for life history inferences
Authors: Nacarino-Meneses Carmen , Jordana Xavier , Köhler Meike
Published: October 2016

The study of bone growth marks (BGMs) and other histological traits of bone tissue provides insights into the life history of present and past organisms. Important life history traits like longevity or age at maturity, which could be inferred from the analysis of these features, form the basis for estimations of demographic parameters that are essential in ecological and evolutionary studies of vertebrates. Here, we study the intraskeletal histological variability in an ontogenetic series of Asiatic wild ass (Equus hemionus) in order to assess the suitability of several skeletal elements to reconstruct the life history strategy of the species. Bone tissue types, vascular canal orientation and BGMs have been analyzed in 35 cross-sections of femur, tibia and metapodial bones of 9 individuals of different sexes, ages and habitats. Our results show that the number of BGMs recorded by the different limb bones varies within the same specimen. Our study supports that the femur is the most reliable bone for skeletochronology, as already suggested. Our findings also challenge traditional beliefs with regard to the meaning of deposition of the external fundamental system (EFS). In the Asiatic wild ass, this bone tissue is deposited some time after skeletal maturity and, in the case of the femora, coinciding with the reproductive maturity of the species. The results obtained from this research are not only relevant for future studies in fossilEquus, but could also contribute to improve the conservation strategies of threatened equid species.
Long-Term Functional Outcome After Stapled and Excisional Hemorrhoidectomy
Authors: Zahid Assad , Austin Kirk K. S. , Young Christopher J. , Young Jane M. , Merlino Christine L. , Garibotto Natalia
Published: October 2016

Stapled hemorrhoidectomy (SH) as described by Longo is a recently added option for hemorrhoid surgery. Interest in SH has been principally driven by the fact that conventional excision hemorrhoidectomy (EH) has been an extremely painful procedure because it involves excision of hemorrhoidal tissue along the extremely sensitive anoderm. SH, on the other hand, has been shown to be associated with decreased postoperative pain because it does not involve the sensate anal mucosa below the dentate line. To date there have been many randomized controlled studies comparing circular SH with traditional excision techniques. Despite proven early postoperative advantages for SH, the long-term benefits and effect on patient quality of life (QOL) compared with EH still remain to be debated. This study aimed to evaluate long-term patient outcomes via a validated health-related QOL survey. QOL measures were satisfactory in both groups across all subscales of physical health summary measures and mental health summary measures. This coincided with Wexner continence scores, which were also satisfactory, with a median of 0 in both groups. QOL, continence scores, and long-term symptom follow-up are similar in patients who undergo SH or EH.
Estresse no cotidiano universitário: estratégias de enfrentamento de docentes da saúde Everyday stress in the university: coping strategies of helth teachers’
Authors: Araújo Luana Marcelly Nogueira de , Santos Viviane Euzébia Pereira , Martins Cláudia Cristiane Filgueira , Dantas Marta Silvânere Pereira , Dos Santos Natally Pereira , Alves Kisna Yasmin Andrade
Published: October 2016

Objetivo: investigar as estratégias de enfrentamento ao estresse desenvolvidas pelos professores do Centro de Ciências da Saúde de Universidade Federal do Rio Grande do Norte. Método: estudo exploratório, descritivo, com abordagem qualitativa. A coleta de dados ocorreu no período de abril de 2012 a maio de 2013 com 37 docentes a partir de entrevista semiestruturada, sendo os dados analisados através da Análise de Conteúdo, utilizando a modalidade da análise temática. Resultados: a partir das falas dos docentes foram estruturadas as categorias Atividades de lazer; Atividades de lazer reconhecidamente escassas; Enfrentamento às situações estressantes no ambiente universitário; e Percepção da necessidade de mudança. Conclusão: foi possível perceber que os docentes identificam situações estressantes relacionadas ao trabalho e elencaram atividades de lazer para redução das tensões, que no entanto não realizam. Sugere-se maior apoio institucional e comprometimento individual na elaboração de estratégias que promovam o bem estar do trabalhador docente.
Cotidiano de pacientes renais crônicos submetidos à hemodialise: expectativas, modificações e relações sociais Chronic renal patients everyday on hemodialysis: expectations, modifications and social relations
Authors: Araújo Juliana Barbosa de , Neto Vinicius Lino de Souza , Anjos Elvira Uchoa dos , Silva Bárbara Coeli Oliveira da , Rodrigues Iellen Dantas Campos Verdes , Costa Cristiane da Silva
Published: October 2016

Objetivos: conhecer a percepção de pacientes renais crônicos submetidos à hemodiálise sobre a doença, elencar as expectativas, modificações e relações sociais após o estabelecimento do diagnóstico. Método: Trata-se de uma pesquisa descritiva de abordagem qualitativa desenvolvida em uma unidade de hemodiálise no Nordeste do Brasil com 39 pacientes acometidos por IRC. Para a coleta de dados, utilizou-se um roteiro de entrevista semiestruturado. O estudo foi provado no Comitê de Ética em Pesquisas CAAE: nº 14153513.2.0000.5180, processo nº 147/431. Os dados foram analisados com base conceituais do Discurso do Sujeito Coletivo (DSC). Resultados: As categorias que emergiram do próprio discurso dos entrevistados foram: Rim paralisado; Falta de conhecimento; Limitações; Otimismo; Desesperança; Apoio; Preconceito e isolamento. Conclusão: cotidiano dos  pacientes em hemodiálise requer mudança de hábitos alimentares, restrições hídricas, impossibilidade de viagens devido à periodicidade das sessões, privação do trabalho e das atividades da vida diária devido à debilidade imposta pelo tratamento.
Percepção de gestantes sobre a organização do serviço/ assistência em um pré-natal de baixo risco de Recife Perceptions of pregnant women about the organization of the service/ assistance in prenatal low risk in Recife
Authors: Cardoso Mirian Domingos , Ribeiro Cleideane Meireles da Silva , Oliveira Isadora Batista de , Andrade Priscila Maria da Cruz , Santos Taciana Mirella Batista
Published: October 2016

Objetivo: Descrever o perfil epidemiológico e a percepção da assistência de gestantes de baixo risco atendidas em uma maternidade do Recife-PE. Metodologia: Estudo descritivo com 94 gestantes atendidas no pré-natal de baixo risco, de abril a maio de 2014. Os dados foram coletados dos sujeitos e do Cartão da Gestante, utilizando questionário. Resultados: 71% eram pardas/negras, 17% baixa escolaridade, 26% solteira/divorciada, 49% desempregada e 48% tinha renda familiar menor que um salário mínimo. 28% multigesta e 17% referiu no mínimo um aborto. Entretanto, das 69 (73,4%) que haviam realizado exames, 46% estavam pouco satisfeitas/insatisfeitas com o tempo de entrega dos exames. Conclusão: Conhecer o perfil e a satisfação das gestantes traz contribuições para enfermagem, uma vez que compete ao enfermeiro realizar as consultas de pré-natal das gestantes consideradas de baixo risco, sendo de sua responsabilidade assegurar uma assistência pré-natal qualificada de maneira integral.
O banho no leito na óptica de estudantes de graduação em enfermagem The bed bath according to the undergraduate nursing students’ perspective
Authors: Dias Joana Angélica Andrade , Souza Deusélia Moreira de , Azevedo Bruno Del Sarto , Andrade Isis Souza , Nery Pablo Ian Gonçalves
Published: October 2016

OBJETIVO: Identificar os significados do banho no leito para estudantes de enfermagem, assim como seus sentimentos ao realizá-lo. MÉTODO: Estudo descritivo, de abordagem qualitativa, que teve como cenários um hospital público e uma universidade estadual e como informantes 14 discentes. As informações foram coletadas por meio de um questionário e tratadas conforme a Técnica de Análise de Conteúdo, modalidade Temática. RESULTADOS: Diversos foram os significados do banho no leito para os informantes, tais como: “cuidado”, “relacionamento interpessoal”, “avaliação do estado geral”, “invasão de privacidade” e “identificação/atendimento das necessidades humanas básicas”, causando sentimentos/sensações tanto positivos, quanto negativos. CONCLUSÃO: O banho no leito necessita ser realizado por pessoas capacitadas e dotadas de sensibilidade, não se caracterizando em uma prática mecanicista, mas em uma ação terapêutica que promove bem estar e uma mais rápida recuperação do cliente. DESCRITORES: Banhos, Higiene, Estudantes de enfermagem, Cuidados de enfermagem.
Procedimento operacional padrão no ambiente hospitalar: percepção de enfermeiros Standard operating procedure in the hospital context: the nurses’ perception
Authors: Da Rosa Walter Rossana , Gahlen Maria Helena , Ilha Silomar , Zamberlan Claudia , Barbosa de Freitas Hilda Maria , Weiss Pereira Fabiani
Published: October 2016

Objetivo: Conhecer a percepção de enfermeiros acerca do desenvolvimento do Procedimento Operacional Padrão no ambiente hospitalar. Métodos: Pesquisa exploratória, descritiva de caráter qualitativo, desenvolvida entre os meses de março a abril de 2011, com cinco enfermeiros que trabalham nas unidades de internação de um hospital de médio porte, localizado em uma cidade da região central do Rio Grande do Sul. Os dados foram coletados por meio de entrevista semiestruturada e foram submetidos a análise de conteúdo. Resultados: Emergiram duas categorias: Procedimento Operacional Padrão no cotidiano da práxis do enfermeiro: uma realidade a ser construída; Da visibilidade do Procedimento Operacional Padrão à organização do cuidado de enfermagem. Conclusão: Evidencia-se a importância de uma equipe qualificada à implementação do Procedimento Operacional Padrão, por meio de protocolos dentro das unidades, diminuindo, dessa forma, os problemas existentes com relação ao cuidado do paciente, priorizando a qualidade do atendimento.
Clarifying the biological significance of the CHK2 K373E somatic mutation discovered in The Cancer Genome Atlas database
Authors: Higashiguchi Masayoshi , Nagatomo Izumi , Kijima Takashi , Morimura Osamu , Miyake Kotaro , Minami Toshiyuki , Koyama Shohei , Hirata Haruhiko , Iwahori Kota , Takimoto Takayuki , Takeda Yoshito , Kida Hiroshi , Kumanogoh Atsushi
Published: October 2016

We identified CHK2 K373E as a recurrent mutation in The Cancer Genome Atlas (TCGA) database. In this study, we demonstrate that the K373E mutation disrupts CHK2 autophosphorylation as well as kinase activity, thus leading to impairment of CHK2 functions in suppressing cell proliferation and promoting cell survival after ionizing radiation. We propose that K373E impairs p53‐independent induction of p21WAF1/CIP1 by CHK2. Our data implicate the K373E mutation of CHK2 in tumorigenesis.
Origin of ultra rear‐arc magmatism at Rishiri Volcano, Kuril Arc
Authors: Kuritani Takeshi , Nakagawa Mitsuhiro
Published: October 2016

The Rishiri Volcano is located at the very rear of the Kuril Arc at its junction with the NE Japan Arc, and its 300 km depth to the slab surface is one of the deepest among the active arc volcanoes in the world. In this study, the origin of this ultra rear‐arc magmatism was investigated by analyzing the basaltic lavas from the volcano. The lavas consist of low‐K and high‐K groups, with the low‐K lavas predating the high‐K lavas. Since it is unlikely that the high‐K magmas are derivatives of the low‐K magmas, the two magmas are thought to be derived from different source mantle materials. Analyses using multicomponent thermodynamics suggest that these magmas were both generated through the ∼2% melting of a source mantle with 0.04–0.11 wt.% H2O at 1280–1340°C and ∼2.3 GPa. The temperatures at the surface of the subducting Pacific slab, from which the slab fluids were released, were estimated to be 860–960°C for the low‐K magmas and 930–1040°C for the high‐K magmas. These temperatures of the slab surface are remarkably higher than those predicted by thermal models. The estimated high temperatures of the slab surface and the latest detailed seismic tomography results suggest that the low‐K and high‐K magmatism resulted from the progressive production of fluids at the slab surface due to heating by the injection of hot mantle materials into a relatively large‐scale fracture in the distorted portion of the subducting Pacific plate.
New method of estimating temperatures near the mesopause region using meteor radar observations
Authors: Lee Changsup , Kim Jeong‐Han , Jee Geonhwa , Lee Wonseok , Song In‐Sun , Kim Yong Ha
Published: October 2016

We present a novel method of estimating temperatures near the mesopause region using meteor radar observations. The method utilizes the linear relationship between the full width at half maximum (FWHM) of the meteor height distribution and the temperature at the meteor peak height. Once the proportionality constant of the linear relationship is determined from independent temperature measurements performed over a specific period of time by the Microwave Limb Sounder (MLS) instrument on board the Aura satellite, the temperature can be estimated continuously according to the measurements of the FWHM alone without additional information. The temperatures estimated from the FWHM are consistent with the MLS temperatures throughout the study period within a margin of 3.0%. Although previous methods are based on temperature gradient or pressure assumptions, the new method does not require such assumptions, which allows us to estimate the temperature at approximately 90 km with better precision.