Patient

Despite 1.2 billion ambulatory visits in 2005, from a health care quality and safety perspective, the ambulatory setting has been less subject to research and scrutiny, compared to high-risk inpatient areas like surgery, perioperative and perinatal care, and the emergency department (ED). The ambulatory environment is prone to problems and errors that include missed/delayed diagnoses, delay of proper treatment or preventive services, medication errors/adverse drug events, and ineffective communication and information flow. Once there is clarity about the nature of outpatient errors, evidence-based teamwork tools, strategies, behaviors, and principles can be implemented as countermeasures to elements of the error chain. From the resources of the TeamSTEPPS™ initiative, six effective and evidence-based tools and strategies are offered for use by clinicians in the ambulatory setting to improve the quality and safety of patient care by improving teamwork and communication.

Health care in Nigeria as in many other countries is confronted with growing demand for medical treatment and services. The medical records must appropriately have all of the patients' medical history. Physicians must maintain flawless records, because this document serves a number of purposes. This study on hospital patient datable management system was design to transform the manual way of searching, sorting, keeping and accessing patient medical information (files) into electronic medical record (EMR) in order to solve the problem associate with manual method. The existing system (manual) has been studied and hence a computer based application was provided to replace this manual method. These computer based systems generate the patient report as the patient register in and out of the hospital. This paper generally looks for a more accurate, reliable and efficient method of computer to facilitate patient record's keeping in General Hospitals to ensure efficient outcome that will lessen time consuming. The study proposed that the design of hospital patient database record will be a solution to the problem being experienced by the current manual method of keeping patient medical record.

Diabetes is the most common disease in the world which will lead to death when there is no proper health care. Failure to control the disease not only results in long-term complications but also affects the life of the patients. If the glucose level is monitored day-by-day, it will help the patient to manage their health properly. The feedback information regarding their sugar level is helpful for the patient to take care of the health daily. In this paper we discuss about the system that is designed to monitor the glucose level, blood pressure and temperature of the person. By making the data available in cloud, it can be used by the doctors to get the historical data. This will help better health care management of their patients. This system is implemented by using the Raspberry Pi for reading data from the user. The ADC is also used to convert the analog signal into the digital signals. The project implementation details are discussed in this paper.

Son dönemlerde, şiddet özellikle de sağlık çalışanlarına yönelik şiddet
eğiliminde artış gözlenmektedir. Bu eğilimde özellikle hastaların şiddet uyguladığı
genel görüşü hâkim olsa da, yapılan araştırmalar hasta yakınlarının daha çok şiddete
başvurduğu, şiddete başvuranların ise fiziksel şiddetten çok sözel şiddete yöneldiği
bulgulanmıştır.
Sağlık alanında hasta ve sağlık çalışanlarının yaşadıklarını bir problem haline
dönüştüren faktörlerin tespiti problemin çözümü için önemlidir. Bu nedenle sağlıkta
şiddeti tetikleyen nedenlerin tespiti hem sağlık çalışanları, hem de hasta ve hasta
yakınları çerçevesinde empatik bir yaklaşımla tasarlanan araştırmada tarafları şiddete
yönelten sebepleri ve uygun ortamı hazırlayan nedenlerin ortaya çıkartılması
amaçlanmıştır. Araştırma çerçevesinde Burdur İli’nde bulunan sağlık tesislerinde şiddet
olaylarına karışmış, yer almış, (şiddet uygulayan ya da uygulanan) adli makamlara
intikal etmiş, 8 sağlık çalışanı ve 7 hasta ve hasta yakını olmak üzere toplam 15 kişi ile
yüz yüze derinlemesine görüşmeler yapılmıştır. Elde edilen veriler nitel araştırma
yöntemlerden biri olan tematik analiz yöntemi kullanılarak değerlendirilmiştir. Görüşme
esnasında katılımcılardan sağlık çalışanlarına demografik, çalışma koşulları, sağlık
çalışanlarının hasta ve yakınlarını algılama düzeyi, olay örgüsüyle ilgili bilgiler, şiddeti
tetikleyenler sebepler; hasta ve hasta yakınlarına da demografik, olayın gelişimi, bilgi
düzeyi, olayın nasıl algıladığı, şiddete yol açan sebepler ile ilgili sorular yöneltilerek
veriler toplanmıştır.
Toplanan verilerin değerlendirilmesi sonucunda hem sağlık çalışanları, hem de
hasta ve hasta yakınlarının karşılıklı iletişimleri esnasındaki sorunları bağlamında yanlış
anlaşılmalar neticesinde şiddete başvurulduğu; medyanın olayları sunumundan
etkilendikleri; sağlık çalışanlarının çalışma saatleri, alınan ücret ve yönetim kaynaklı
problemler yaşadığı; hasta ve yakınlarından şiddet olaylarına karışan kişilerin bir
sonraki sağlık ihtiyacı için aynı kuruma tekrar başvurma konusunda tedirginlik
hissettikleri; hasta ve hasta yakınlarının sağlık tesislerinden hizmet alımında kendi
haklarının ihlal edildiğini düşündükleri ve bunu düşünmelerine yol açan nedenin, hasta
haklarına ve hasta önceliklerine yönelik bilgi eksikliklerinden kaynaklandığı
bulgulanmıştır.
Sonuç olarak sağlık çalışanların için motivasyon araçlarındaki eksiklikler, hasta
ve yakınlarıyla aralarındaki iletişim eksiklikleri, yönetimden kaynaklı aksaklıklar hasta
ve yakınlarıyla etkileşiminde; hasta ve yakınlarına ise hasta öncelikleri ve hasta hakları
iv
konusundaki bilgi eksiklikleri, medyada yer alan sağlıkta şiddet içerikli haber ve
programlardan etkilenmeleri, bireysel çıkarları için kurallara uygun olmayan istekleri,
iletişim eksikliği veya yanlış anlamlandırmalar, olayın kendileri için taşıdığı önem ve
gelişim hızı kaynaklı etkileri, ekonomik ve psikolojik durumlarından dolayı sağlık
çalışanları ile etkileşimlerinde gergin ortamın ortaya çıkışını etkileyen faktörler olarak
belirtilebilir.
Anahtar Kelimeler: Sağlıkta şiddet, hasta ve hasta yakını, nitel araştırma tematik analiz, sağlık çalışanları,
Recently an increasing tendency to violence, especially towards healthcare
professionals, has been observed. Although the opinion that it is patients that exert
violence is widely held, research has found that relations of patients resort to violence
more than patients themselves, and that violence is often verbal rather than physical.
To arrive at a solution, it is essential to determine the factors which turn the
experiences of both patients and healthcare professionals into problems. Therefore,
adopting an empathetic approach, the study aims to reveal the factors contributing to the
formation of an environment which leads both patients and their relations as well as
healthcare professionals to violence. Within the framework of the study, face-to-face
interviews were done with 15 individuals - 8 healthcare professionals and 7 patients and
relations - all of whom were involved in violent incidents at health centers (either as the
doer or the receiver) and were brought to the judicial authorities. The data were
evaluated by means of Thematic Analysis Method, a qualitative research method.
During the interviews, the healthcare professionals were asked questions about their
demographic background, working conditions, level of perceiving patients and patients’
relations, details about the incidents, and factors triggering violence, whereas the
patients and their relations were asked questions about their demographic background,
how the incident occurred, their level of knowledge, how they perceived the incident,
and factors triggering violence.
As a result of the analysis of the data, it has been found that both parties resorted
to violence due to misunderstandings in their communication, that they were affected by
the media’s presentation of the events, that healthcare professionals have problems
related to their working hours, salaries and management, that patients and their relations
who previously experienced a problem feel nervous about consulting the same
institution again, that patients and their relations feel their rights are being violated
while getting service from the health institutions and the reason why they feel so is due
to their lack of knowledge.
To conclude, the factors triggering violence can be listed for healthcare
professionals as lack in motivational tools, lack of communication with patients and
their relations, management-related problems, whereas the list for patients and their
relations include factors such as lack of information about patient-priority and patient
rights, the effect of media coverage of violent incidents in health centers, unlawful
vi
demands regarding their self-interest, lack of communication, misunderstanding, the
effects of the incident related to the level of importance and how fast the incident came
to pass, and their economic and psychological conditions.
Keywords: Violence in health sector, patient, patient’s relations, qualitative research thematic analysis, healthcare professionals.

Statistical information from cancer studies show that the Philippines has the highest incidence rate of breast cancer in Asia. Efforts on creating awareness are being spearheaded by the country's health department, local governments, and cancer-interest organizations. Despite these, discussions on the issue remain a forbidden topic among many Filipinos, particularly the patients and their families themselves. This study aims to know the central discourses behind the prevailing treatment of Filipinos on female breast cancer as taboo and the correlation to the slow development of awareness on the illness. A quality circle was conducted on three middle-aged women from General Santos City, southern Philippines. All of the respondents were breast cancer survivors. A discourse analysis on the data figured that there are two central and interconnected discourses hindering the awareness and acceptance of breast cancer: (i) fear and denial due to financial instability, and (ii) folk belief. The researchers suggest that instead of coursing breast cancer treatment budget through the Philippine government's health insurance provider, it should be directly allocated to the country's health services program. They concluded that beyond creating awareness, it is with the accessibility of treatment that the Filipino people will be liberated from the prevailing central discourses on breast and any type of cancer.

The diagnosis of mania largely depends on the quality of information the physician is provided with. Often, the patient cannot give an accurate account of the symptom development and thus information from relatives and friends is required. No systematic rating instrument is available, however, to facilitate this.
In this study, the psychometric properties of the 49-item Observer-Rated Scale for Mania (ORSM) are reported.
The scale was used in 113 inpatients and the following psychometric aspects were assessed: reliability, test-retest reliability, construct validity (factor analysis, discriminant analysis, comparison of means), extreme-group validity, prognostic validity, sensitivity, specificity, positive and negative predictive values.
The ORSM proved highly valid and reliable. Factor analysis revealed three factors which were labelled euphoric mania, instable mania and psychotic mania.
The ORSM is a useful instrument to help non-professionals who are in regular contact with the patient diagnosed a manic/mixed episode. It thus complements existing rating scales for mania, which are either designed for professionals or are self-rating instruments.

Primary health care involves a sustained partnership between patients and providers that addresses the majority of a population's health needs over time. Lengthy waiting time, poor access, lack of information and healthy relationship with healthcare workers in outpatient clinics remain a challenge to quality care. The objective of the study is to assess patient satisfaction and factor of importance on the service they receive at the primary health care facility in Botswana. The study was a cross sectional study in which 360 systematically selected participants completed 5 point likert scale self-administered questionnaire to rate their satisfaction level as well as factors of importance where best service was provided. Results showed that pharmacy received the highest satisfaction level with a mean rating of 4.1 while the nurse got the least level of satisfaction with a mean rating of 3.4 in terms of services rendered. 14.4% of participants still think time is not important to them as factor for as long as they got what they wanted. Majority (63.9%) were most displeased with the time spent at the facility. Participants mentioned that increase in manpower (36%) and staff training (15%) stood out as areas that need to be significantly considered for improvement. Time spent in the facility is a great source of dissatisfaction to participants. There is a need for interventions in terms of increased manpower, training of staffs with regard the areas which participants indicated as displeased with.

This web based application was developed with MySQL as data storage and Gammu as SMS Gateway. The purpose of this application is to improve the hospital service by helping patients to remind their taking medication schedule. There are some steps included in the development of the application, which begin with collecting data, design and implementation of the application, and end with the evaluation process. The methods consisting of the observation at the hospital, interview with the doctor, the patients, and the hospital management, literature study, and distributing the questionnaire. Several diagrams involved in helping the design process, some of them are flowchart, hierarchical structure, Use Case and sequence diagram. By using the reminder application, patients can remember their medication schedule better than before. The delivering information to the patient was designed to be clear, simple, and direct. This make patients feel that the hospital gives more attention to them and it could enhance the hospital's value.

Remote health care monitoring system (RHCMS) has drawn considerable attentions for the last decade. As the aging population are increasing and at the same time the health care cost is skyrocketing there has been a need to monitor a patient from a remote location.  Moreover, many people of the World are out of the reach of existing healthcare systems. To solve these problems many research and commercial versions of RHCMS have been proposed and implemented till now. In these systems the performance was the main issue in order to accurately measure, record, and analyze patients’ data. With the ascent of wireless network RHCMS can be widely deployed to monitor the health condition of a patient inside and outside of the hospitals. In this work we present a ZigBee based wireless healthcare monitoring system that can provide real time online information about the health condition of a patient. The proposed system is able to send alarming messages to the healthcare professional about the patient’s critical condition. In addition the proposed system can send reports to a patient monitoring system, which can be used by the healthcare professionals to make necessary medical advices from anywhere of the World at any time.

Objectives: There are international calls for improving education for health care workers around certain core competencies, of which patient safety and quality are integral and transcendent parts. Although relevant teaching programs have been developed, little is known about how best to assess their effectiveness. The objective of this work was to develop and implement an objective structured clinical examination (OSCE) to evaluate the impact of a patient safety curriculum.

Patient counseling were intended to improve adherence and maintaining quality of life. Antiretroviral adherence is the second strongest predictor of progression to AIDS and death, after CD4 count. Incomplete adherence to ART is common in all groups of treating individuals. The commonest cause of ART failure is poor adherence. Several factors associated with poor adherence include a poor patient-clinician relationship, high pill burden, forgetfulness, mental depression, lack of patient education, inability of patients to identify their medications, drug toxicity, beliefs about treatment and the impression of being too ill for treatment. Counseling steps include establishing the rapport between the patient and pharmacist, developing individual treatment plan and using of information sheets, compliance aids, leaflets can be helpful in better understanding about the ART regimen they are taking. The key to successful is educating the patient before the initiation of therapy, supporting ART initiation as the patient first starts taking medications, and continuously monitoring and supporting adherence. Using of adherence devices like pill boxes, reminders and visual medication schedules can improve the adherence towards the antiretroviral drugs and can improve the outcome in HIV patient receiving ART.

The discourses and practices of genetics surround us today as never before, and have become a major component of our ideas of personhood and identity. In contemporary biomedicine, many illnesses and pathologies have been reorganized along a genetic axis. The growing use of predictive genetic diagnostics and genome analysis–now offered by private companies directly to the public–and the new dimension of “genetic risk” they introduce, have contributed to the emergence of a new “genetically responsible subject”–a ...

With unremitting change and intense competition, nowadays companies in Turkey are increasingly turning to be users of M&A as a tool to grow, build synergy, attain local/global presence, enter into new sectors, or achieve economies of scale and scope. However, it is too bad that they are usually not very good at wielding this tool successfully. Previous research yielded that good management of change related with human side of M&As, particularly the culture factor, has deterministic role in achievement of post-M&A success. Based on this backdrop, the major aim of the current study is to examine the effects of post-M&A culture change on individual and organizational performance outcomes. Survey method was used to gather responses of a purposeful convenience sample of employees (N=154), which went through an M&A process. An organizational culture inventory (DOCS), a personality inventory (NEO), a political skills inventory, and questions assessing perceptions of employees about pre and...

Objective: This paper explores physician perceptions of the ways professional and family interpreters affect their performance of doctorcommunication tasks described in the Calgary-Cambridge Framework. Methods: Physicians' (19) encounters with patients (24) accompanied by an interpreter were videotaped. Stimulated recall was used to elicit each of the participants' perceptions of the clinical encounter. We analyzed transcriptions of the physician interviews using Atlas-ti software. Results: Physicians perceived all communication tasks to be more difficult using an interpreter than when one was not needed. Physicians perceived family interpreters to be less skilled translators than professional interpreters. Physicians expected professional interpreters to serve as culture brokers at least some of the time. Although only some family interpreters were also caregivers, physicians assumed that all of them fulfilled caregiver roles. Conclusion: With professional interpreters, physicians follow communication rules they were taught. In contrast, physicians act as though these rules are not relevant with family interpreters who they treat as caregivers. Practice implications: Guidelines to working with an interpreter should include directives on working with both professional and family interpreters, describing the similarities and differences with each type, and modifying the clinical encounter process to correspond to those attributes. #

In this Paper the main objective is how to reduce the waiting time. As it is commonly known that in the hospital minimum you need to wait for half an hour to one hour, which is a sheer waste and also the doctor is very busy who does not like to wait for his patients, since he will run out of his schedule if one of them fails to show up in time. The objective of this paper is to optimize balance between the patients' waiting time, the doctor's idle time and the overtime. The initial problem is to find an optimal appointment system for the hospital on per day basis. We suppose that there are eight types of patient. They all have a lognormal service time and their actual arrival time is drawn from a triangular distribution. A different type of patients is described. In the second column the average service time for every patient is shown. The next column shows the standard deviation of the service times. Column four and five give the parameters inserted in the lognormal distribution to achieve the values in the first two columns. Since the lognormal distribution has no upper bound it is truncated to a maximum service time of one hour.

"This chapter presents findings of ethnographic work in a neuro-oncology
clinic in Israel. It is claimed that patients, close-ones and physicians
engage in creating metaphorical visions of the brain and brain tumours
that reaffirm Cartesian dualism. The ‘brain talk’ involved visible and
spatial terms and results in a particular kind of objectification of the
organ of the self. The overbearing presence of visual media (i.e., magnetic
resonance imaging, computed tomography, angiographic studies) further
gave rise to particular forms of interactions with patients and physicians
where the ‘imageable’ (i.e., the image on the screen) became the
‘imaginable’ (i.e., the metaphor). The images mostly referred to a domain
of mundane objects: a meatball in a dish of spaghetti, a topping of olives
over a pizza, the surface of the moon, a stone, an egg, an animal, a dark
cloud. Furthermore, conversations with family members showed that
formal facts and informed compassion were substituted by concrete
representations. For them, and especially for the patient, these
representations redefined an ungraspable situation, where a tumour – an object – can so easily affect the organ of their subjectivity, into something
comprehensible through the materialistic, often mechanistic actions of
most mundane objects. This, however, also created alienated objects
within the boundaries of their own embodied selves. Patients, on the one
hand, did not reject their own sense of ‘own-ness’, of having a lifeworld
(lebenswelt) as subjective agents, but on the other, did talk about their
own interiors as being an ‘other’: an object visible, observable and
imaginable from a third-person standpoint – a standpoint drawing its
authority from biomedical epistemology and practice."

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS™) is a systematic approach developed by the Department of Defense (DoD) and the Agency for Healthcare Research and Quality (AHRQ) to integrate teamwork into practice. It is designed to improve the quality, safety, and the efficiency of health care. TeamSTEPPS is based on 25 years of research related to teamwork, team training, and culture change. As a direct outcome of the 1999 Institute of Medicine (IOM) report, To Err is Human, TeamSTEPPS introduces tools and strategies to improve team performance in health care. This article describes the evolution of the TeamSTEPPS program and its research foundation, development, and implementation. To date, the DoD has taught TeamSTEPPS at over 68 facilities, creating approximately 1,500 trainers/coaches, who have trained over 5,000 staff members. Beginning with the public release of TeamSTEPPS resources in November 2006, AHRQ began its effort to disseminate TeamST...

ÖZET Son dönemlerde, özellikle sağlık çalışanlarına yönelik şiddet eğiliminde artış gözlenmektedir. Bu eğilimde özellikle hastaların şiddet uyguladığı genel görüşü hâkim olsa da, yapılan araştırmalar hasta yakınlarının daha çok şiddete başvurduğu, şiddete başvuranların ise fiziksel şiddetten çok sözel şiddete yöneldiği bulgulanmıştır. Sağlık alanında hasta ve sağlık çalışanlarının yaşadıklarını bir problem haline dönüştüren faktörlerin tespiti problemin çözümü için önemlidir. Bu nedenle sağlıkta şiddeti tetikleyen nedenlerin tespiti hem sağlık çalışanları, hem de hasta ve hasta yakınları çerçevesinde empatik bir yaklaşımla tasarlanan araştırmada tarafları şiddete yönelten sebepleri ve uygun ortamı hazırlayan nedenlerin ortaya çıkartılması amaçlanmıştır. Araştırma çerçevesinde Burdur İli'nde bulunan sağlık tesislerinde şiddet olaylarına karışmış, yer almış, (şiddet uygulayan ya da uygulanan) adli makamlara intikal etmiş, 8 sağlık çalışanı ve 7 hasta ve hasta yakını olmak üzere toplam 15 kişi ile yüz yüze derinlemesine görüşmeler yapılmıştır. Elde edilen veriler nitel araştırma yöntemlerden biri olan tematik analiz yöntemi kullanılarak değerlendirilmiştir. Görüşme esnasında katılımcılardan sağlık çalışanlarına demografik, çalışma koşulları, sağlık çalışanlarının hasta ve yakınlarını algılama düzeyi, olay örgüsüyle ilgili bilgiler, şiddeti tetikleyenler sebepler; hasta ve hasta yakınlarına da demografik, olayın gelişimi, bilgi düzeyi, olayın nasıl algıladığı, şiddete yol açan sebepler ile ilgili sorular yöneltilerek veriler toplanmıştır. Sonuç olarak sağlık çalışanlarının için motivasyon araçlarındaki eksiklikler, hasta ve yakınlarıyla aralarındaki iletişim eksiklikleri, yönetimden kaynaklı aksaklıklar ile hasta ve yakınlarıyla etkileşim kaynaklı faktörler; hasta ve yakınlarının ise hasta öncelikleri ve hasta hakları konusundaki bilgi eksiklikleri, medyada yer alan sağlıkta şiddet içerikli haber ve programlardan etkilenme, bireysel çıkarları için kurallara uygun olmayan istekler, iletişim eksikliği veya yanlış anlamlandırmalar, olayın kendileri için taşıdığı önem ve gelişim hızından kaynaklı etkiler, ekonomik ve psikolojik durumlarını içeren faktörler gergin ortamın ortaya çıkışını tetikleyen faktörler olarak bulgulanmıştır.

Evaluating quality of care through peer review is a challenge for physicians. Rural physicians have the added burden of close personal relationships and conflicts of interest. The Rural Physician Peer Review Model © presents an innovative solution to these problems that involves utilizing simple information technology to share HIPAA-compliant information, a systems approach to review, principles of patient safety/quality of care, and continuing education. The process involves network hospitals submitting patient cases to the central staff, deidentifying patient information, e-transmitting the cases, meeting by teleconference, and report writing by the physician moderator. Over 3 years, 934 patient cases have been reviewed in 209 teleconferences. Participating physicians report high levels of satisfaction with the objectivity of the reviews and new learning. Written evaluations of the teleconferences document that this impartial process promotes the inclusion of quality improvement and patient safety in peer review. Anecdotal evidence indicates increased use of system improvements.

Use of patient safety reporting systems (PSRS) to identify and mitigate risks to patients who are harmed by medical care has been a national priority for nearly a decade. Yet, most reporting systems are still new and focus on reporting events. To improve the value of PSRS, we must use the data to identify safety hazards, prioritize where to focus resources, develop interventions to mitigate these hazards, and evaluate whether the interventions reduced harm. We developed and implemented a Web-based PSRS and discuss in this paper the benefits, limitations, and challenges we encountered. First, we discuss the benefits of PSRS as part of a patient safety learning community. The remainder of the paper focuses on the challenges we faced that still need to be resolved to improve the value of reporting systems. We address these challenges as follows: what to report, how to minimize reporting burden and costs, how to conduct expert reviews and prioritize safety efforts, how to place incidents into taxonomies, how to know that the reporting system actually improved patient safety, and who should be responsible for attempting risk mitigation.

This article is concerned with the important issue of communication between doctors and patients. A patient's agreement to proposed therapy, his or her cooperation, and engagement in the therapeutic process to a large extent depend on the communicative skills of a doctor or therapist. This article stems from the survey carried out among the patients of the Clinical Hospital of the University Medical Centre in Gdansk, and, thereby, it attempts to evaluate the aforementioned skills.

Objective: this study aimed to assess of self-care activities among diabetic patients' type II and to find out the relationship between self-care activities and their demographic and clinical data. Methodology:Descriptive Cross-Sectional Design was adopted in the current study in order to assess of self-care activities among diabetic patient type II. A Non-Probability (Purposive Sample) of (200) Diabetes Mellitus patients with type II. Data collected through using of a well-designed questionnaire consist of three parts, part I consists of demographic data , part II consists of clinical data , and part III consists of self-care activities , Data collected by direct interview method with diabetic patients'. Data was analyzed by using descriptive and Inferential Data Analysis. Results: The findings indicate that the patients' responses are high at medications domain. Poor at the exercise and monitoring domains. In addition, moderate at the remaining domains. also there is a highly significant relationship between the patients (self-care activities) and their (levels of education, treatment, health education, sources of health education, complications). while there is a non-significant relationship with remaining demographic and clinical data.Conclusion: The study conclude that moderate self-care activities is the main level for most of the patients. Also study concludes that large number of the patient with TIIDM have cardiovascular diseases as a complication that can affect their self-care activities. Recommendation: The study recommends an education program should be designed and implemented to increase patient's information about self-care regimen for diabetes mellitus in order to reduce or prevent complications.

One of the most important issues in the medical and health field of the Iranian society, during the second half of the Qajar era, was the relationship between patient and physician. The nature of these relationships at that time was one of the most important things that could have a great impact on how people were health-wise examined and treated; individually and generally. Regarding the patient-physician relationship, a number of sociologists around the world have offered a theoretical model, one of which is the American sociologist Talcott Parsons. In this article, using a descriptive-analytical research method facilitating first-hand sources such as memoirs and travelogues, the relationship between upper-class patients and European physicians based on the Parsons role-oriented model is investigated. The research questions are: Did the patients of the upper classes during the second half of the Qajar era have the conditions to play the social role of the patient? Did European physicians in this era have the conditions to play the social role of the doctor? Findings indicate that in the second half of the Qajar era, both the upper class patient and the European physician were able to play their social role in the cycle of patient-physician relations. However, issues such as patients' malingering were among the influential factors that could disrupt the normal course of patient-physician relationships during this period.

Purpose-Clear and complete communication between health care providers is a prerequisite for safe patient management and is a major priority of the Joint Commission's 2008 National Patient Safety Goals. The goal of this study was to describe nurses' perceptions of nurse-physician communication in the long-term care (LTC) setting.

Abstract: The use of" triggers," or clues, to identify adverse events (AEs) during manual chart review has been found to be a useful method for measuring the overall level of harm in a health care organization. The Institute of Healthcare Improvement Global Trigger Tool for ...

Background: Nurses work environment has been recognized as a major factor affecting both nurses' and patients' outcomes. Objective: To assess nurses' work environment, concerning the five work environment aspects that emanate from the study instrument. Methodology: A cross sectional study was conducted in a 536-bed Greek general hospital of the capital city of Greece, Athens. One hundred seventy four randomly selected nurses and assistant nurses were participated (response rate 91.6%). The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to assess nurses work environment. Results: The participants assessed their work environment as non favorable. They rated low ( 2.5) both the total PES-NWI (mean=2.16, SD=0.38) and 4 of the 5 the work environment aspects. In particularly, participants rated Staffing and resource adequacy lower of all aspects (mean=1.79, SD=0.44), Nurses participation in hospital affairs rated mean=1.97 (SD=0.48), Nursing foundations of quality scored mean=2.14 (SD=0.42) and Nurse manager ability, Leadership and support of Nurses rated mean=2.49 (SD=0.63). The only favorable aspect of nurses' work environment was Nurse-Physician collegial relations (mean=2.69, SD=0.55). Nurses' participation in continuous educational programs (CEP) was found as a statistical significant demographic characteristic (p=0.001) that is correlated with the work environment. Nurses that participated in CEP rated higher the overall PES-NWI, compared with those that didn't. Also, participation in CEP was significantly associated with the subscales Nurses participation in hospital affairs (p=0.001), Quality foundation (p=0.005) and Nurse manager ability (p=0.04). Conclusions: Hospitals' administration and nurse leaders have to assess nurses work environment, recognize weaknesses and non favorable aspects and centre their efforts on its improvement, if they wish to establish and sustain safe and quality health services provision.

This article analyzes Squid Ink and C Plan, two animation short films which are used as a therapeutic tool of artistic mediation to promote positive social values. The idea of animation is to provide abstraction and symbolization of motion pictures. In this sense, the visual metaphor will have a great rhetoric relevance and will be emphasized on both cases of study. The use of animation as a form of art and as mediation has a dual purpose. Firstly, it helps to have a better understanding of those who are affected by Crohn's disease and Hepatitis C, and secondly, it familiarizes chronic patients and health personnel with language and artistic values of animated images.

Background: Discrete-choice experiments are based on the premise that any good or service can be described by its characteristics (or attributes), and the extent to which an individual values a good or service depends on the levels of these characteristics. Little is known about patient preferences for treatment of chronic musculoskeletal pain such as Achilles tendinopathy. Methods: A discrete-choice experiment was conducted in 58 adults with a history of Achilles tendon pain at the conclusion of a three-arm randomized clinical trial. Participants were asked to complete a questionnaire consisting of ten hypothetical treatment scenarios and some sociodemographic questions. For each scenario, participants were asked to choose which option they would prefer if seeking treatment for their painful Achilles tendon. A mixed logit model was estimated to quantify subject preferences and marginal willingness to pay for the treatment attributes. Results: A response rate of 62% was achieved. A significant positive impact on utility was observed for chance of treatment success. A significant negative impact on utility was observed for cost, weeks before exercise can be completed free of pain, chance of side effects (p = 0.06), and injections as a stand-alone treatment. Respondents were willing to pay Australian dollars ($A)238 (95% CI -312, 788) for a 10% increase in the chance of treatment success. Conclusions: Study participants with Achilles tendon pain who had either participated or expressed an interest in participating in a randomized trial prefer a treatment that costs less, has a greater chance of success, has a shorter duration before being able to exercise free of pain, and has less likelihood of side effects. On average, participants preferred exercises over injections as a stand-alone treatment. Further research is required to confirm the findings in patients outside of the trial setting. Nevertheless, this study contributes to an area that is deficient in research by identifying priorities and marginal willingness to pay for attributes related to Achilles tendinopathy.

Cancer is a potentially fatal and chronic disease that is diagnosed with negative emotions such as anger. The purpose of this study was to investigate the effectiveness of mindfulness training on improving the experience of anger and self-compassion in cancer patients. This was a semi-experimental study with a control group. The statistical population of this study was cancer patients referred to health centers in Tehran in 1977. Samples were selected by convenience sampling method and randomly assigned to experimental and control groups. The experimental group was trained in mindfulness. The Self-Compassion Scale (SCS) and Multidimensional Anger Inventory (MAI) were used for data collection. Results of the statistical analysis of anger scores (P< 0.01) and self-compassion (P< 0.001) in the experimental group showed that their condition was better than the control group. Mindfulness can be used to reduce mental health problems and thus to achieve better therapeutic outcomes.
Keywords: Cancer, Mindfulness, Anger, Self Compassion

How did I learn to understand that there can never ever be any acceptable alternative to immortality and living indefinitely forever young?

Is there any better way to learn and permanently remember the understanding that any possibly imaginable alternative to reverse all adverse effects of aging and happily live indefinitely forever young, healthy and energetic would have the same long-term negative consequences as intentionally committing suicide than I have described in this authentic experience report?

When I was only 6 years old, I went through an emotional trauma, from which I am still suffering today and that has led me to come here and be the only one working in the EIT building during Christmas break. On October 2nd, 1980, only one day before my daddy’s birthday, my aunt Frieda, who I liked a lot because she paid lots of attention to my long stories and actually took them serious, suffered from a sudden heart attack. My daddy succeeded to bring her back to life with CPR and my mom called the emergency doctor in the mean time. The doctor was a quiet man from Romania. He had short back hear and looked like being around 30 years old. His voice was very quiet and emotionally detached when he asked my grandma about the age of my aunt. My grandma replied: "She is 83 years old." And then something happened, which I never expected, i.e. the doctor went on in his empathy-lacking quiet voice to say the few German words, which I still remember as if my aunt had died yesterday. He said “Ich denke, wir hoeren auf.” In English this means, “I think, we are going to quit.” He meant going to quit any efforts and even medical interventions at our disposal to bring my aunt Frieda back to live and to make sure she’ll stay alive. When the doctor said this, it was spooky quiet, as if a ghost would kill my aunt. I felt like screaming into the face of the doctor, YOU MUST DO YOUR JOB AS EMERGENCY DOCTOR, TO DO EVERYTHING IN YOUR POWER TO MINIMIZE MY AUNT’S RISK TO DIE FROM THIS PARTIAL HEART ATTACK REGARDLESS OF HER AGE!!!! But I was only six. I was scared and confused. It was my first real encounter with death. I helplessly looked at my parents and looked at my grandma. I wanted them to demand from the doctor not to use my aunt Frieda’s advanced age against her. Although I was only six years old I strongly felt that no medical provider has the moral right and should be punished harshly when using his patient’s age as a shallow absolutely unjustified excuse for refusing to save their lives. But it was so quiet this time, which I recall must have been around 7.30 p.m. on October the 2nd, 1980, when my aunt laid diagonally across the carpet on the floor of the children’s room. Neither my mom nor my daddy nor my grandma nor my 2 younger siblings opened their mouth.

Although I was furious beyond anyone’s imagination, the fact that my otherwise very confident parents and even my grandma, who was best friends with my dying aunt, i.e. all three adults in the room, who’d I expect to fight for my life if I ever needed urgent medical care, and who’d otherwise readily expressed their opposition to anything they did not agree with or considered unfair, did not even attempt to pressure the doctor on a mental, emotional emphatic, moral, medical or legal level, to take his job seriously regardless how he personally felt about my aunt’s advanced age. When something totally unexpected like this happens, i.e. in case of such kind of second degree murder due to medical neglect and intentionally withholding readily available medical interventions without any apparent rational reason for not even trying to save my aunts life, when we still had a chance, I became speechless. I felt like screaming to my parents to not allow the doctor to let my aunt die, after my daddy had brought her back to life already. My daddy is very good in CPR. He’ll fight for everyone’s life as if it was his own. My daddy waited for the doctor’s instructions on how to proceed after restoring my aunts consciousness to the point where she had her eyes opened and could hear every single word, which was spoken by anyone in the children’s room. When all this happened I stood about 4 feet away from my aunt. I was afraid to move any closer because I was worried of accidentally bump into something I could not see but which would kill here. Now something happened that I can never forget. My daddy got up from the carpet and stopped CPR! I felt like screaming “NOOOOOOOOOOOOO!!!!!!!!!” “WHYYYYYYYYYY???” “DON’T!!!!!!” “KEEP BREATHING MORE AIR IN HER MOUTH!!!!! Don’t listen to this evil doctor. He has no respect for life! He does not deserve to be an emergency doctor!!! What if she were his aunt???? She is conscious and will most likely fully come back to life if you’ll just give her enough time to get over this medical crisis!!!! Actually, she was already over the hump because apparently her heart was beeping already independently and all my daddy was still doing, was breathing air in my aunt’s mouth. I wanted my mom to call another doctor. I wanted him to be a German doctor, who treats our aunt as if she was his aunt. I felt that this Rumanian doctor had no empathy for Germans because when my entire family looked up to him for help, he indirectly killed by neglect.

Even if is negative medical intuition should turn out to be true and all of our medical interventions were doomed to fail this evening, I felt he should at least try anyways or else there would have been no point in the doctor making the trip to our home. Then he could have stayed in his killer-hospital. At least that way he would not have had the opportunity to encourage my daddy from reviving my aunt with CPR. When I was six, my daddy was still very powerful. He would have kept performing CPR for hours to save my aunt’s life, if this disguised killer-doctor, would not have instructed him to stop and let her die, just because he felt no old people deserve resources intensive medical care, unless they are his own relatives. Would he let his aunt or grandmother dies like that if he had good chances to prevent or at least postpone death? This I felt would have certainly give my aunt enough time to get over the fear, which is an inherent feature of anyone surviving a heart attack, especially when the doctor is instructing my daddy to stop keeping her alive. I felt like being in a madhouse. I could not speak. My otherwise very attentive parents and grandmother did not seem to be aware that I felt so much emotional pain with such a mental intensity that I almost felt as if I was the one dying instead of my aunt. This god dam Rumanian doctor! Why did he have to be on duty when my aunt needed dedicated professional medical help to get over her heart attack? Why did the hospital not send a German doctor with a strong voice, who’d be much more assertive in his speech and actions to instruct my parents to do everything in their power to save my aunt’s life? Why did my aunt deserve such an indecisive foreign doctor, who lacks the kind of strong loud confidence inducing voice, patients and their relatives need in their struggle of succeeding in overcoming any medical crisis? Why did this stupid hospital send us this absolutely useless and even counterproductive foreign physician, who refused to even say a single word when my parents and grandma looked up to him and expected rational life-saving medical advice? What was he thinking when he condemned my aunt with the only very ambiguous sentence, I still remember verbatim from this cursed Rumanian doctor, “I think we are going to quit.”? Was he asking my parents, whether they’d approve his proposal to quit saving my aunt’s life? Did he order my daddy to quit CPR and let my aunt die? This doctor showed lack of leadership when everyone is expecting him to take charge of the medical crisis at hand and to maximize the odds for the best possible medical outcome.

I remember not being able to feel anything that evening. My aunt laid dead diagonally across the carpet in the children’s room when I started to understand that everyone expects me to go to sleep as usual. I hid under my blanket and wanted to die. I cried so hard. What if I had a heart attack? Would my parents and grandma follow the medical advice of the doctor, if he told them that he thinks, we should quit saving my life? Luckily, I only was 6 and no doctor would even dream about using my age as an excuse for letting me die. But, what about 80 years from now? From then onward, I wanted to become strong, innovative, energetic and knowledge to defeat death before it would inevitably kill me only about 80 years later. That is why I came to America.

The use of art for healing is not a new phenomenon and the history of human life has been familiar with the subject of art in healing for thousands of years. "Artistic elements in the form of paintings and drama have been used in the first civilizations for several centuries BC to reduce fear and anxiety, to create power and strength, and to convey information. "Aristotle and other philosophers have used poetry and drama for the health and purification of the soul. To this day, painting, drama, and music are used in creative art therapy to rehabilitate all diseases and for all ages from childhood to old age. Accordingly, the impact of art on human life has been studied from an architectural point of view in the design of medical centers. Some of the human concerns in the realm of healthcare have always been the strict, cold, and lifeless forms of health centres, as well as the lack of accessibility to them. With the admission to these institutions and the escalation of stressors induced by disease and therapy, the mental state of patients has increasingly gained more attention. Medication, which has been a necessary part of human life since ancient times, is classified into two categories: Physical and mental. Persons' physical improvement was influenced by the first dimension, while individuals' readiness to cope with the treatment process was influenced by the second dimension. Every medical facility was made up of distinct but interconnected units that combined to form the two components. With the rising relevance of this issue, the shape of these buildings and their access were the key problems discussed in these centres, so that they could complete treatment by conducting patients in a simple and quick manner, in a more comfortable setting, with the least amount of time spent, and away from any type of environmental stress imposing in this complex. Finally, different investigations and scientific advances have revealed that the more environmental pressures are reduced in physical and mental dimensions, and the more the psychological dimensions of patients are analysed, the improvement of patients would be faster. This study has also investigated these components in the interaction with art and art therapy and their impacts on each other. Physical studies, data gathering, and data interpretation and analysis were all regarded initial principles in this study. This study is a qualitative-quantitative study in which the field technique and content analysis were utilised in two sections, with qualitative studies and survey study in the qualitative studies and analysis portion. In this area, all written and oral references are studied and collected, and their contents are utilised to extract the principles, the basis, and the best solutions for designing an effective medical and health centre that meets the treatment and psychological needs of patients, as well as the application of art features.

Background: Discrete-choice experiments are based on the premise that any good or service can be described by its characteristics (or attributes), and the extent to which an individual values a good or service depends on the levels of these characteristics. Little is known about patient preferences for treatment of chronic musculoskeletal pain such as Achilles tendinopathy. Methods: A discrete-choice experiment was conducted in 58 adults with a history of Achilles tendon pain at the conclusion of a three-arm randomized clinical trial. Participants were asked to complete a questionnaire consisting of ten hypothetical treatment scenarios and some sociodemographic questions. For each scenario, participants were asked to choose which option they would prefer if seeking treatment for their painful Achilles tendon. A mixed logit model was estimated to quantify subject preferences and marginal willingness to pay for the treatment attributes. Results: A response rate of 62% was achieved. A significant positive impact on utility was observed for chance of treatment success. A significant negative impact on utility was observed for cost, weeks before exercise can be completed free of pain, chance of side effects (p = 0.06), and injections as a stand-alone treatment. Respondents were willing to pay Australian dollars ($A)238 (95% CI -312, 788) for a 10% increase in the chance of treatment success. Conclusions: Study participants with Achilles tendon pain who had either participated or expressed an interest in participating in a randomized trial prefer a treatment that costs less, has a greater chance of success, has a shorter duration before being able to exercise free of pain, and has less likelihood of side effects. On average, participants preferred exercises over injections as a stand-alone treatment. Further research is required to confirm the findings in patients outside of the trial setting. Nevertheless, this study contributes to an area that is deficient in research by identifying priorities and marginal willingness to pay for attributes related to Achilles tendinopathy.

Abstract Background and Objective: Patients with life threatening diseases have to deal with the death issue. One of the common psychological problem is anxiety esp. death anxiety . This study aimed to determine the level of death anxiety in hemodialysis patients. Material and Methods: This cross-sectional study was conducted on all 150 patients admitted to Panj-azar teaching hospital for hemodialysis, 2013. The data was collected by demographic checklist and Templer Death Anxiety questionnaire scoring 0 to 15 (0-6 for low, 7-9 for moderate and 10-15 for high anxiety). We analyzed the data by independent t-test, ANOVA and Pearson correlation coefficient (P<0.05).
Results: Twenty-four point seven percent of the patients had low , 10% average and 65.3% of them had high death anxiety. Average scores of death anxiety in men and in women were 8.21±4.82 and 11.95±3.81, respectively. The relationship of death anxiety with sex (P<0.001), employment status (P<0.001), and age (P<0.002) was significant.
Conclusion: Bases on the results, the death anxiety is high in more than half of the patients with hemodialysis.
Keywords: Death Anxiety, Hemodialysis, Patient, Iran, Anxiety

Ce qui fait la spécificité de la décision médicale consiste non seulement dans le fait qu’elle est décision pour autrui, mais également en ce qu’elle doit être prise de manière collégiale et partagée en faisant intervenir toutes les personnes concernées. Cette décision doit le plus souvent se prendre rapidement, ce qui réduit considérablement le temps de la délibération préalable. Il est donc indispensable que les médecins et les soignants qui y participent constituent une « base de données » de l’ensemble de leurs décisions antérieures afin de nourrir à leur sujet une réflexion susceptible d’éclairer leurs décisions à venir, principalement dans le but de ne pas se laisser emporter par leurs émotions lorsqu’ils se trouvent dans une situation d’urgence.

While people aspire to more direct participation in decision-making concerning them, individually and collectively, and while the health system is still undergoing intense debate, this doctoral reseach offers a better understanding of chronic patients' empowerment, together individual and collective. Individual empowerment reminds an initiatory journey that changes a vulnerable patient into a resilient person, aware of his weakness, but able to overcome it by acquiring knowledge and adapting his behavior. This individual or psychological empowerment is, according to this thesis, the first level of a much broader process that expands through membership in a group of peer and extends into collaborative dynamic and societal transformations. The multidisciplinary literature review conducted in social sciences clarifies the notion of empowerment and shows that its collective dimensions has long been evaded by marketing. However, the two qualitative exploratory studies confirm the expansive and multilevel nature of empowerment. The first study, based on four experts' interviews, identifies the unmet needs of patients and their communities strategies. It delivers a first model of empowerment process. The following study, a netnography of an online community of patients with thyroid deseases improve the first analysis. The focus on twenty-one of them reveals the individual characteristics that promote patient's commitment and the community resources that increase the group power. Their progression on the forum shows also the existence of an intermediate level, in which a troubled and stressed applicant becomes an altlruistic patient, helping his peers. Finally, a comparison of results between the two studies provides a systemic understanding of the process. The result is a new conceptual and theoretical model of empowerment as a trajectory in four phases, individual, community, collaborative and societal. This research will inspire health actors wishing to revisit democracy based on patients and communities' needs and abilities. This renewal can take several forms, such as the creation of new social listening spaces, new collaborative expertises, or the introduction of participative co-design projects and shared governance mechanisms with trained professionals

With unremitting change and intense competition, nowadays companies in Turkey are increasingly turning to be users of M&A as a tool to grow, build synergy, attain local/global presence, enter into new sectors, or achieve economies of scale and scope. However, it is too bad that they are usually not very good at wielding this tool successfully. Previous research yielded that good management of change related with human side of M&As, particularly the culture factor, has deterministic role in achievement of post-M&A success. Based on this backdrop, the major aim of the current study is to examine the effects of post-M&A culture change on individual and organizational performance outcomes. Survey method was used to gather responses of a purposeful convenience sample of employees (N=154), which went through an M&A process. An organizational culture inventory (DOCS), a personality inventory (NEO), a political skills inventory, and questions assessing perceptions of employees about pre and...

Brian Jack, MD;Jeffrey Greenwald, MD;Shaula Forsythe; Julie O&#x27;Donnell; Anna Johnson; Lynn Schipelliti, RN; Mary Goodwin, RN; Gail M. Burniske, PharmD, BCPS; Caroline Hesko; Michael Paasche-Orlow, MD, MPH; Christopher Manasseh, MD; David Anthony, MD, MSc; ...

Objective: This study aimed to examine the utility of using color and shape to differentiate drug strength information on over-the-counter medicine packages. Medication errors are an important threat to patient safety, and confusions between drug strengths are a significant source of medication error.

Non-invasive prenatal testing (NIPT) via fetal DNA in maternal blood has been publicly funded in Ontario, Canada, for high-risk women since 2014. We solicited women’s experiences and values related to this new health technology to describe how this test is currently being used in Ontario and to provide information about patient priorities to inform future policy decisions about the use of NIPT. Guided by constructivist grounded theory methodology, we interviewed 38 women who had diverse personal experiences with NIPT. Participants’ accounts of their values for decision making about NIPT heavily relied on three mutually modulating factors: timing, accuracy, and risk. The values expressed by women conflict with the way that publicly funded NIPT has typically been implemented in Ontario. We offer recommendations for how NIPT might be integrated into prenatal care pathways in a way more consistent with women’s values.