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1.
Sarah E. Reedman Roslyn N. Boyd Stewart G. Trost Catherine Elliott Leanne Sakzewski 《Archives of physical medicine and rehabilitation》2019,100(4):676-686
Objective
To determine the efficacy of a participation-focused therapy (ParticiPAte CP) on leisure-time physical activity goal performance and satisfaction and habitual physical activity (HPA) in children with CP.Design
Randomized waitlist-controlled trial.Setting
Home and community.Participants
Children classified at Gross Motor Function Classification System (GMFCS) levels I-III were recruited (n=37; 18 males; mean age ± SD, 10.0±1.4y) from a population-based register.Interventions
Participants were randomized to ParticiPAte CP (an 8-wk goal-directed, individualized, participation-focused therapy delivered by a physical therapist) or waitlist usual care.Main Outcome Measures
The primary outcome was Canadian Occupational Performance Measure. Accelerometers were worn for objective measurement of HPA (min/d moderate-to-vigorous physical activity [MVPA], sedentary time). Barriers to participation, community participation, and quality-of-life outcomes were also collected. Data were analyzed by intention-to-treat using generalized estimating equations.Results
ParticiPAte CP led to significant improvements in goal performance (mean difference [MD]=3.58; 95% confidence interval [95% CI], 2.19-4.97; P<.001), satisfaction (MD=1.87; 95% CI, 0.37-3.36, P=.014), and barriers to participation (MD=26.39; 95% CI, 6.13-46.67; P=.011) compared with usual care at 8 weeks. There were no between-group differences on minutes per day of MVPA at 8 weeks (MD=1.17; 95% CI, ?13.27 to 15.61; P=.874). There was a significant difference in response to intervention between participants who were versus were not meeting HPA guidelines at baseline (MD=15.85; 95% CI, 3.80-27.89; P<.0061). After ParticiPAte CP, low active participants had increased average MVPA by 5.98±12.16 minutes per day.Conclusion
ParticiPAte CP was effective at increasing perceived performance of leisure-time physical activity goals in children with CP GMFCS I-III by reducing modifiable barriers to participation. This did not translate into change in HPA on average; however, low active children may have a clinically meaningful response. 相似文献2.
Jessica L. Mckee Ian A. Mckee Melanie D. Bouclin Dennis F. Filips Ian J. Atkinson Chad G. Ball Paul B. McBeth Major Andrew W. Kirkpatrick 《The Journal of emergency medicine》2019,56(4):363-370
Background
Penetrating neck wounds are common in the civilian and military realms. Whether high or low velocity, they carry a substantial morbidity and mortality rate.Objectives
We endeavored to ascertain whether the iTClamp is equivalent to direct manual pressure (DMP) and Foley catheter balloon tamponade (BCT).Methods
Using a perfused cadaver, a 4.5-cm wound was made in Zone 2 of the neck with a 1-cm carotid arteriotomy. Each of the hemorrhage control modalities was randomized and then applied to the wound separately. Time to apply the device and fluid loss with and without neck motion was recorded.Results
There was no significant difference between the fluid loss/no movement (p > 0.450) and fluid loss/movement (p > 0.215) between BCT and iTClamp. There was significantly more fluid lost with DMP than iTClamp with no movement (p > 0.000) and movement (p > 0.000). The iTClamp was also significantly faster to apply than the Foley (p > 0.000).Conclusions
The iTClamp and BCT were associated with significantly less fluid loss than DMP in a perfused cadaver model. The iTClamp required significantly less time to apply than the BCT. Both the iTClamp and the BCT were more effective than simple DMP. The iTClamp offers an additional option for managing hard-to-control bleeding in the neck. 相似文献3.
Rosemary Frey Deborah Balmer Jackie Robinson Merryn Gott Michal Boyd 《Journal of pain and symptom management》2019,57(3):545-555.e1
Context
In most resource-rich countries, a large and growing proportion of older adults with complex needs will die while in a residential aged care (RAC) facility.Objectives
This study describes the impact of facility size (small/large), ownership model (profit/nonprofit) and provider (independent/chain) on resident comfort, and symptom management as reported by RAC staff.Methods
This retrospective “after-death” study collected decedent resident data from a subsample of 51 hospital-level RAC facilities in New Zealand. Symptom Management at the End-of-Life in Dementia and Comfort Assessment in Dying at End of life with Dementia (SM-EOLD and CAD-EOLD, respectively) scales were used by RAC staff who were closely associated with 217 deceased residents. Data collection occurred from January 2016 to February 2017.Results
Results indicated that residents of large, nonprofit facilities experienced greater comfort at the end of life (CAD-EOLD) as indicated by a higher mean score of 37.21 (SD = 4.85, 95% CI = 34.4, 40.0) than residents of small for-profit facilities who recorded a lower mean score of 31.56 (SD = 6.20, 95% CI = 29.6, 33.4). There was also evidence of better symptom management for residents of chain facilities, with a higher mean score for symptom management (SM-EOLD total score) recorded for residents of chain facilities (mean = 28.07, SD = 7.64, 95% CI = 26.47, 29.66) than the mean score for independent facilities (mean = 23.93, SD = 8.72, 95% CI = 21.65, 26.20).Conclusion
Findings suggest that there are differences in the quality of end-of-life care given in RAC based on size, ownership model, and chain affiliation. 相似文献4.
Aasha I. Hoogland Hailey W. Bulls Brian D. Gonzalez Brent J. Small Lianqi Liu Joseph Pidala Heather S.L. Jim Asmita Mishra 《Journal of pain and symptom management》2019,57(5):952-960.e1
Context
Quality of life (QoL) is increasingly recognized as an important outcome of cancer treatment. Previous studies have examined clinical predictors of QoL, but with the increasing prevalence of wearable sensors that monitor sleep and activity patterns, further investigation into whether these behaviors are predictive of post-treatment QoL is now feasible. Among patients receiving aggressive cancer treatment such as hematopoietic cell transplantation (HCT), analysis of circadian rhythms (24-hour patterns of sleep and activity) via wearable sensors is limited.Objective
To evaluate the relationship between overall QoL and circadian rhythms in patients receiving allogeneic HCT.Methods
Patients wore an ActiGraph GT3X (Pensacola, FL) activity monitor for at least 72 hours before the initiation of conditioning chemotherapy and transplantation and completed a QoL (Functional Assessment of Cancer Therapy-General [FACT-G]) assessment. QoL assessments were also completed 1, 3, and 6 months after HCT.Results
Patients (n = 45, M age = 55) were mostly male (66%) with a total FACT-G score of 80.96 (SD = 16.05) before HCT. Mixed models revealed robust cross-sectional associations between overall QoL and multiple circadian rhythmicity parameters, including durations of high physical activity, overall circadian rhythmicity, and earlier starts of daily activity (P's < .01). Recovery of QoL after transplant was predicted by longer pre-transplant durations of high physical activity (P = .04) and earlier evening retirement (P = .04).Conclusion
Our findings suggest that wearable sensor information is a promising method of predicting recovery of QoL after HCT. Additional studies are needed to confirm these findings in a larger sample. 相似文献5.
Objective
To determine whether prehospital point-of-care lactate (pLA) is associated with mortality, admission, and duration of hospital stay.Design
A retrospective clinical audit, where elevated lactate was defined as ≥2 mmol/L.Setting
The ambulance service and primary referral hospital in the Australian Capital Territory from 1st July 2014 to 30th June 2015.Participants
Adult patients (≥18 years) who had pLA measured and were transported to the primary referral hospital.Main outcome measures
Mortality, admission, and duration of hospital stay.Results
Two hundred fifty-three patients with a median pLA of 2.5 mmol/L (interquartile range [IQR]: 1.5–3.7) were analysed. Overall mortality was 8.3%; 68% were admitted to the hospital; 8.3% to the intensive care unit (ICU). pLA was non-significantly higher in those who died compared to survivors (3.5 [IQR: 2.75–5.85] vs 2.4 [1.5–3.6]; W = 1631.5; p = 0.053). pLA was higher for those admitted to the hospital (2.9 [1.9–3.9] vs 2.0 [1.4–3.1]; W = 5094.5, p = 0.001) and the ICU (3.2 [2.4–5.7] vs 2.4 [1.5–3.6]; W = 1578.5; p = 0.008). There was no relationship between pLA and duration of stay. Considered as a screening tool, at a cut-off of 2.5 mmol/L, pLA had a likelihood ratio+ of 1.61 for mortality and 1.44 for ICU admission; the odds ratio for mortality was 3.76 (95% confidence interval = 1.30, 13.89).Conclusions
Elevated prehospital lactate was associated with significantly increased ICU and hospital admissions. There may be value in pLA as a screening tool. 相似文献6.
Neda Tadayon Hassan Yousefnia Ali Ramazani Samaneh Zolghadri Behrooz Alirezapour Amir Reza Jalilian Hossein Afarideh Mahdokht Vaez-Tehrani 《Journal of Medical Imaging and Radiation Sciences》2019,50(1):142-148
Introduction
In this study, 68Ga-PDTMP was introduced as a novel agent for PET bone scanning.Methods
68Ga-PDTMP was prepared with radiochemical purity of higher than 98% at the optimized conditions.Results
Stability tests showed no decrease in radiochemical purity, even after 120 min. The capacity binding of 76.3% ± 0.7% after 10 min incubation for 68Ga-PDTMP was observed.Conclusion
Biological studies in normal mice demonstrated that most of the remained activity is transmitted from blood into bones. The results show that 68Ga-PDTMP can be considered as a potential radiolabelled complex for PET bone scanning. 相似文献7.
Background
Despite the evidence and available guidelines about endotracheal suction (ETS), a discrepancy between published guidelines and clinical practice persists. To date, ETS practice in the adult intensive care unit (ICU) population across New Zealand and Australia has not been described.Objective
To describe ICU nurses' ETS practice in New Zealand and Australia including the triggers for performing endotracheal suction.Methods
A single day, prospective observational, binational, multicentre point prevalence study in New Zealand and Australian ICUs. All adult patients admitted at 10:00 on the study day were included.Main outcome measures
In addition to patient demographic data, we assessed triggers for ETS, suction canister pressures, use of preoxygenation, measures of oxygenation, and ETS at extubation.Results
There were 682 patients in the ICUs on the study day, and 230 were included in the study. Three of 230 patients were excluded for missing data. A total of 1891 ETS events were performed on 227 patients during the study day, a mean of eight interventions per patient. The main triggers reported were audible (n = 385, 63%) and visible (n = 239, 39%) secretions. Less frequent triggers included following auscultation (n = 142, 23%), reduced oxygen saturations (n = 140, 22%), and ventilator waveforms (n = 53, 9%). Mean suction canister pressure was ?337 mmHg (standard deviation = 189), 67% of patients received preoxygenation (n = 413), and ETS at extubation was performed by 84% of nurses.Conclusion
Some practices were inconsistent with international guidelines, in particular concerning patient assessment for ETS and suction canister pressure. 相似文献8.
Lauren R. Klein Brian E. Driver Gabriella Horton Sarah Scharber Marc L. Martel Jon B. Cole 《The Journal of emergency medicine》2019,56(5):484-490
Background
Rapid treatment of agitation in the emergency department (ED) is critical to avoid injury to patients and providers. Treatment with intramuscular antipsychotics is often utilized, but there is a paucity of comparative effectiveness evidence available.Objective
The purpose of this investigation was to compare the effectiveness of droperidol, olanzapine, and haloperidol for treating agitation in the ED.Methods
This was a retrospective observational study of adult patients who received intramuscular medication to treat agitation. Patients were classified based on the initial antipsychotic they received. The primary effectiveness outcome was the rate of additional sedation administered (rescue medication) within 1 h. Secondary outcomes included rescue sedation for the entire encounter and adverse events.Results
There were 15,918 patients included (median age 37 years, 75% male). Rescue rates at 1 h were: 547/4947 for droperidol (11%, 95% confidence interval [CI] 10–12%), 988/8825 olanzapine (11%, 95% CI 10–12%), and 390/2146 for haloperidol (18%, 95% CI 17–20%). Rescue rates for the entire ED encounter were: 832/4947 for droperidol (17%, 95% CI 16–18%), 1665/8825 for olanzapine (19%, 95% CI 18–20%), and 560/2146 for haloperidol (26%, 95% CI 24–28%). Adverse events were uncommon: intubation (49, 0.3%), akathisia (7, 0.04%), dystonia (5, 0.03%), respiratory arrest (1, 0.006%), and torsades de pointes (0), with no significant differences between drugs.Conclusions
Olanzapine and droperidol lead to lower rates of rescue sedation at 1 h and overall, compared with haloperidol. There were no significant differences in major adverse events. 相似文献9.
Sydney E.S. Brown Ryan M. Antiel Thane A. Blinman Susanna Shaw Mark D. Neuman Chris Feudtner 《Journal of pain and symptom management》2019,57(5):971-979
Context
Do-not-resuscitate (DNR) orders are common among children receiving palliative care, who may nevertheless benefit from surgery and other procedures. Although anesthesia, surgery, and pediatric guidelines recommend systematic reconsideration of DNR orders in the perioperative period, data regarding how clinicians evaluate and manage DNR orders in the perioperative period are limited.Objectives
To evaluate perioperative management of DNR orders at a tertiary care children's hospital.Methods
We reviewed electronic medical records for all children with DNR orders in place within 30 days of surgery at a tertiary care pediatric hospital from February 1, 2016, to August 1, 2017. Using standardized case report forms, we abstracted the following from physician notes: 1) patient/family wishes with respect to the DNR, 2) whether preoperative DNR orders were continued, modified, or suspended during the perioperative period, and 3) whether life-threatening events occurred in the perioperative period. Based on data from these reports, we created a process flow diagram regarding DNR order decision-making in the perioperative period.Results
Twenty-three patients aged six days to 17 years had a DNR order in place within 30 days of 29 procedures. No documented systematic reconsideration took place for 41% of procedures. DNR orders were modified for two (7%) procedures and suspended for 15 (51%). Three children (13%) suffered life-threatening events. We identified four time points in the perioperative period where systematic reconsideration should be documented in the medical record, and identified recommended personnel involved and important discussion points at each time point.Conclusion
Opportunities exist to improve how DNR orders are managed during the perioperative period. 相似文献10.
Elke Pucks-Faes Heinrich Matzak Gabriel Hitzenberger Eleonora Genelin Lucas-Michael Halbmayer Elena Fava Josef Fritz Leopold Saltuari 《Archives of physical medicine and rehabilitation》2019,100(5):837-843
Objective
To report our experience using continuous intrathecal baclofen (ITB) administration prior to a possible ITB device implantation.Design
Retrospective open label study. Mean duration of follow-up 64 months.Setting
Primary-care and referral center, ambulatory and hospitalized care.Participants
Patients (N=116) undergoing continuous ITB trials between 2006 and 2017.Interventions
Continuous application of baclofen via a temporary intrathecal catheter connected to an external pump.Main Outcome Measures
Assessment of the modified Ashworth Scale and range of movement prior versus end of ITB trial. According to the Barthel Index, definition of high-level patients (60-100 scoring points) and low-level patients (0-55 scoring points). Calculation of the Rivermead Mobility Index in high-level patients prior versus end of ITB trial. Evaluation of occurring adverse events.Results
A total of 119 ITB trials were performed in 116 patients (78 men, mean age 41±16), 113 patients completed the trials (31 of 113 high level, 82 of 113 low level). The median modified Ashworth scale improved from 4 (interquartile range [IQR] 3-4) to 2 (IQR 1-2; P≤.001), the range of movement from 2 (IQR 1-3) to 3 (IQR 3-3; P≤.001). The Rivermead Mobility Index increased from 9 (IQR 6-12) to 10 (IQR 7-12.5; P=.004) in high-level patients. Eighty-eight out of 113 patients (78%) were appropriate candidates for ITB device surgery, 75 of 88 (85%) proceeded to an implantation. A total of 69 adverse events occurred in 57 of 119 trials (48%), 37 of 69 (54%) were drug related, 32 of 69 (46%) were procedure related, and 42 of 69 (61%) were minor. The ITB device was implanted in 69 of 75 patients (92%) at last follow-up.Conclusions
Continuous administration of ITB is an effective and useful alternative to ITB bolus application during ITB screening period. Half of the patients experienced adverse events; the majority were minor events. 相似文献11.
Tessa Hart John Whyte Monica Vaccaro Amanda R. Rabinowitz 《Archives of physical medicine and rehabilitation》2019,100(5):987-989
Objective
Determine agreement between self-reported dose and dose reflected in administrative records of outpatient physical, occupational, and speech therapies at 6 and 12 months after severe traumatic brain injury (TBI), for the purpose of examining accuracy and predictors of accuracy of self-reported health care utilization in this population.Design
Secondary analysis of survey used in a larger study; participants were queried about therapy doses using a structured interview, either alone or assisted by relatives if they so chose, with responses compared to administrative records.Setting
Rehabilitation center providing outpatient TBI therapies.Participants
Sixty-five people with severe TBI living in the community provided 6-month data (N=65); 54 provided 12-month data.Interventions
Not applicable.Main Outcome Measures
Degree of agreement with administrative records of scheduled and billed therapy appointments, measured using intraclass correlation coefficients (ICCs), with linear regression used to predict accuracy from demographic variables and cognitive status.Results
ICCs were in the moderate range at 6 months, but were more variable, with some in the poor range, at 12 months. Agreement was higher for scheduled than for billed (attended) appointments. Assisted and unassisted patients provided comparable agreement with records. No demographic factors were associated with accuracy, but lower cognitive FIM scores, as hypothesized, tended to predict lower agreement at 6 months.Conclusions
People with severe TBI can provide reasonable estimates of commonly prescribed outpatient therapy doses at 6 months postinjury. Accuracy may be improved by inviting patients to request assistance from relatives and by asking them to consider attended (vs scheduled) sessions. 相似文献12.
Trisha Benish Danny Villalobos Sue Love Monica Casmaer Curtis J. Hunter Shane M. Summers Michael D. April 《The Journal of emergency medicine》2019,56(3):248-257.e1
Background
Headache is a common chief complaint in the emergency department (ED) setting.Objectives
To compare analgesia with metoclopramide and diphenhydramine vs. intranasal ketamine among ED patients with primary headache.Methods
We enrolled a convenience sample of adults with a primary headache in a randomized, single-blind, placebo-controlled trial. We randomized patients to either a control arm (intravenous metoclopramide and diphenhydramine) or intranasal ketamine. The primary outcome was change in pain 0–100 mm visual analog scale (VAS) score measured at study start and 30 min post completion of initial medication administration. Secondary outcomes included side effects, hospital admission, and return to care within 48–72 h.Results
All 53 enrolled subjects completed the study, 26 of whom were allocated to the control arm and 27 to intranasal ketamine. The mean change in pain VAS score at 30 min post intervention was 22.2 mm in the control arm vs. 29.0 in the intranasal ketamine arm (effect size difference 6.8 mm, 95% confidence interval ?5.8–19.4). The incidence of reported side effects was 65.4% in the control arm vs. 66.7% in the ketamine arm. Three patients (11.5%) allocated to the control arm required admission for headache pain control vs. 1 patient (3.7%) in the intranasal ketamine arm. Three (11.5%) additional patients in the control arm returned to the ED within 48–72 h for headache pain vs. none in the ketamine arm.Conclusions
In this small randomized study, intranasal ketamine was not superior to standard therapy among ED patients with primary headache syndromes. 相似文献13.
14.
Jessica M. Jarvis Karen Choong Mary A. Khetani 《Archives of physical medicine and rehabilitation》2019,100(4):703-710
Objective(s)
Determine the associations between having participation-focused strategies and receiving rehabilitation services in the pediatric intensive care unit (PICU) with caregiver stress over 6 months post-PICU discharge.Design
Substudy of a data from Wee-Cover, a prospective cohort study.Setting
Two PICU sites.Participants
Caregivers (N=168) of children 1-17 years old admitted into a PICU for ≥48 hours.Main Outcome Measures
Data were collected from caregivers at enrollment and 3 and 6 months post-PICU discharge. Caregiver stress was assessed using the Pediatric Inventory for Parents. Having strategies to support their child’s participation in home-based activities was assessed using the Participation and Environment Measure (PEM). In PEM, caregivers report on strategies used to support their child’s participation in home-based activities. Data were dichotomized (yes, no) to denote having participation-focused strategies and if their child received PICU rehabilitation services. Additional covariates were history of a preexisting condition, child age, length of PICU stay, and change in functional capacities at PICU discharge.Results
History of a preexisting condition, time, and change in functional capacities significantly predicted caregiver stress frequency and difficulty. The interaction of having strategies-by-rehabilitation-by-time significantly predicted caregiver stress frequency and difficulty.Conclusion(s)
Results highlight the role of early rehabilitation and the importance of working with caregivers to develop participation-focused strategies to support their child’s functioning post-PICU. Families of children with a preexisting condition or those who experience a decrease in function during a PICU stay are susceptible to higher levels of stress and may be a priority population to target for rehabilitation services. 相似文献15.
Eric D. Hansen Mary M. Mitchell Dulce M. Cruz Oliver Fahid A. Alghanim Michelle Walter Amy A. Case Tom Smith Amy R. Knowlton 《Journal of pain and symptom management》2019,57(5):961-965
Context
In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV from a universally fatal disease to a serious chronic illness, warranting discussions between patients and their loved ones about advance care planning (ACP). Evidence is needed on factors associated with patients' likelihood to discuss ACP with loved ones.Objectives
To further characterize factors associated with successful ACP in PLWHAs with their loved ones, we examined associations between patients having ACP discussions with the need for assistance with personal care, chronic pain, life satisfaction, prior family disagreements over health care decisions, sex, age, and interference in daily routines due to memory problems.Methods
Data were from the Affirm Care study (N = 370), which examined social and environmental factors associated with health outcomes among PLWHAs and their informal caregivers.Results
Slightly more than half of respondents discussed ACP with loved ones (57%). In adjusted analysis, higher levels of chronic pain (odds ratio [OR] = 2.09, P = 0.045), needing assistance with personal care (OR = 1.63, P = 0.023), greater life satisfaction (OR = 1.02, P = 0.002), prior family arguments over health care decisions (OR = 2.80, P < 0.001), and female sex (OR = 2.22, P = 0.001) were associated with higher odds of discussing ACP with loved ones, whereas age, drug use, education level, depression, and memory problems were nonsignificant.Conclusion
These results suggest that interventions to increase ACP among PLWHAs and their loved ones should target males. The findings also suggest PLWHAs with chronic pain, the need for assistance with personal care, and those with a history of prior family arguments over health care decisions may be primed for ACP. 相似文献16.
Amy Hammerich Julie Whitman Paul Mintken Thomas Denninger Venu Akuthota Eric E. Sawyer Melissa Hofmann John D. Childs Joshua Cleland 《Archives of physical medicine and rehabilitation》2019,100(5):797-810
Objective
To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).Design
Randomized clinical trial.Setting
Orthopedic spine clinics.Participants
A total of 390 individuals were screened with 60 eligible and randomly selected to receive ESI and education with or without PT (N=54).Interventions
A total of 54 individuals received 1-3 injections and education in a 10-week intervention period, with 31 receiving injections and education only (ESI) and 23 additionally receiving 8-10 sessions of multimodal PT (ESI+PT).Main Outcome Measures
Disability, pain, quality of life, and global rating of change were collected at 10 weeks, 6 months, and 1 year and analyzed using linear mixed model analysis.Results
No significant difference was found between ESI and ESI+PT in the Oswestry Disability Index at any time point, although the sample had significant improvements at 10 weeks (P<.001; 95% confidence interval [CI], ?18.01 to ?5.51) and 1 year (P=.01; 95% CI, ?14.57 to ?2.03) above minimal clinically important difference. Significant differences in the RAND 36-Item Short Form Health Survey 1.0 were found for ESI+PT at 10 weeks with higher emotional role function (P=.03; 95% CI, ?49.05 to ?8.01), emotional well-being (P=.02; 95% CI, ?19.52 to -2.99), and general health perception (P=.05; 95% CI, ?17.20 to ?.78).Conclusions
Epidural steroid injection plus PT was not superior to ESI alone for reducing disability in individuals with LSS. Significant benefit was found for the addition of PT related to quality of life factors of emotional function, emotional well-being, and perception of general health. 相似文献17.
18.
Joseph J. Gallo Martha Abshire Seungyoung Hwang Marie T. Nolan 《Journal of pain and symptom management》2019,57(3):556-565
Context
Stability of preferences for life-sustaining treatment may vary depending on personal characteristics.Objective
We estimated the stability of preferences for end-of-life treatment over 12 years and whether advance directives and medical conditions were associated with change in preferences for end-of-life treatment.Design
Mailed survey of older physicians.Methods
Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University. Eight hundred ninety eight physicians who completed the life-sustaining treatment questionnaire anytime in 1999, 2002, 2005, and 2011 (mean age 68.2 years at baseline). Preferences for life-sustaining treatment were assessed using a checklist questionnaire in response to a standard “brain injury” scenario and considered as a package using the latent class transition model.Results
End-of-life preferences grouped into three classes: most aggressive (wanting most interventions; 14% of physicians), least aggressive (declining most interventions; 61%), and an intermediate class (declining most interventions except intravenous fluids and antibiotics; 25%). Physicians without an advance directive were more likely to desire more treatment and were less likely to transition out the most aggressive class. Transition probabilities from class to class did not vary over time. Persons with cancer expressed preference for the least aggressive treatment, whereas persons with cardiovascular disease and depression had preferences for more aggressive treatment.Conclusion
Transitions in end-of-life preferences and the factors influencing change and stability suggest that periodic reassessment for planning end-of-life care is needed. 相似文献19.
Purpose
Adverse health effects of smoking could be made worse by worker's tobacco use, and combining tobacco use with occupational hazards could enhance the likelihood of occupational disease and injury. This study was aimed to develop a workplace smoking cessation program based on self-determination theory (SDT) and then to examine the effectiveness of the program.Methods
A quasi-experimental design with nonequivalent control group pretest–posttest design was used. An intervention group (n = 30) received a smoking cessation program using individual counseling and tailored text messaging based on SDT during 12 weeks. Participants in the control group (n = 30) received a smoking cessation leaflet and telephonic follow-up for 3 times.Results
At 6 and 12 weeks, there were significant differences between the two groups on autonomous regulation, perceived competence, nicotine dependence, tobacco abstinence rate, and exhaled carbon monoxide concentration. At 12 weeks, the abstinence rate in the intervention group was 96.7%, whereas that in the control group was 12.9%.Conclusion
SDT-based workplace smoking cessation program using individual counseling and tailored text messaging is effective in encouraging autonomous regulation and competence for workers. 相似文献20.
Shin-ichiro Ohmura Taio Naniwa Shin-ya Tamechika Toshiaki Miyamoto Daisuke Shichi Nobukata Kazawa Shiho Iwagaitsu Shinji Maeda Jun-ichi Wada Akio Niimi 《Journal of infection and chemotherapy》2019,25(4):253-261