Nurses' Attitudes Towards Geriatric Behavior Problems in Long-Term Care Settings

We examined the attitudes of 101 geriatric nurses toward behavior problems in 5 long-term care facilities. The survey consisted of two sections. Section 1 assessed nurses' attitudes about the significance and treatment of behavior problems, and their current abilities in managing these problems. In section 2, nurses were asked to rate 22 behavior problems in terms of their frequencies of occurrence in their facility. Results indicate that nurses consider behavior problems to be of great significance, although they were uncertain whether their training had adequately prepared them to manage these problems. Nurses were also uncertain about the efficacy of psychotropic medications in managing behavior problems, but were more agreeable with the statement that behavioral procedures could be used effectively to manage these problems. Twenty of the 22 behavior problems were reported to occur at least occasionally, with 6 problems occurring frequently to all-the-time and 9 problems occurring at the high end of occasionally to frequently. Comparisons of RN/LPN responses were examined, and implications of the results for geriatric nurses' training were discussed.     

The Attitudes of Medical Students Towards Careers in Geriatric Medicine

When designing a geriatric medical curriculum, it is important to understand the attitudes that medical students have towards the elderly and careers in geriatric medicine. Therefore, attitudes of senior medical students at the University of Queensland towards a career with the elderly were assessed using a questionnaire. Very few students were considering pursuing a career in geriatric medicine and most students excluded the elderly from the age groups that they would prefer to treat This appeared to be secondary to a perception that geriatric medicine is a ‘low tech’ specialty concerned with psychosocial and placement issues and rarely with cure.     

Clinical Approaches to the Patient with a Failing Fontan Procedure

The Fontan operation has been nothing short of revolutionary in its influence on the modern management of patients born with functionally univentricular hearts. The vast majority of these individuals are now surviving well into adulthood. In the 45 years since its introduction, however, there has been increasing recognition of Fontan survivors as a vulnerable population with an altered physiology that has remarkably broad, adverse impact on their long-term health. In this review, the authors discuss the varied manifestations, both cardiac and extracardiac, of the failing Fontan circulation and potential therapeutic options. In addition, a general clinical approach to the patient presenting with Fontan failure is proposed. Ultimately, the key to improving our care and understanding of the Fontan population lies in multi-institutional collaboration and partnership between subspecialty cardiologists and specialists in other organ systems.     

Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

Background

Heart surgery has developed with increasing patient complexity.

Objective

To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS).

Method

All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups.

Results

Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata.

Conclusion

Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.     

Attitudes Towards Couples-Based HIV Testing Among MSM in Three US Cities

Couples-based voluntary HIV counseling and testing (CVCT)—in which couples receive counseling and their HIV test results together—has been shown to be an effective strategy among heterosexual sero-discordant couples in Africa for reducing HIV transmission by initiating behavioral change. This study examined attitudes towards CVCT among men who have sex with men (MSM) in three US cities. Four focus group discussions (FGD) were held with MSM in Atlanta, Chicago, and Seattle. Although initially hesitant, participants reported an overwhelming acceptance of CVCT. CVCT was seen as a sign of commitment within a relationship and was reported to be more appropriate for men in longer-term relationships. CVCT was also seen as providing a forum for the discussion of risk-taking within the relationship. Our results suggest that there may be a demand for CVCT among MSM in the United States, but some modifications to the existing African CVCT protocol may be needed.     

Public Attitudes Toward Long-Term Care Arrangements for the Elderly in Taiwan

This study aimed to examine public attitudes toward three types (institutional, community-based and home-based) of long-term care arrangements, as well as the factors associated with these attitudes. Data were collected from the 1994 Social Image Survey in Taiwan, which involved a representative nation-wide random sample with 1,556 respondents aged 20–64. The results revealed that 58.2% of the respondents would choose home-based care to assist dependent elderly in their families. Community-based care and institutional care were selected by 31.8% and 10.1% of the respondents respectively. Polytomous logistic regression analyses were carried out to examine how respondents' socioeconomic status, health status, care resources and perception of government responsibility for the elderly were associated with the selection of long-term care for their elderly. We concluded that a large portion of the study participants anticipate the development of institution-based and community-based care by the government     

Health Professional Attitudes Towards Ageing and Older People: Preliminary report of the Reactions to Ageing Questionnaire

The rationale, development and preliminary findings are outlined for the Reactions to Ageing Questionnaire (RAQ). The first version of the instrument was developed following a content analysis of open ended responses. Subsequent administrations to nurses and members of the general population resulted in revisions, producing a 30-item questionnaire. Results are reported of psychometric analyses following administration of the final version to 531 health professionals. Assessments of item homogeneity, use of factor analysis and assessment of associations with other measures of attitudes support the instrument's reliability and validity.     

Clinical Geropsychology: Approaches to Older Adults With Disability

With advancing old age comes increased risk of chronic physical or mental impairment and resulting disability, with many potential paths to adaptation. An understanding of the types of resources older adults may utilize to adapt to disability, and how they move through disablement and adjustment processes, can assist professionals as they work with disabled older adults to achieve optimal outcomes. This article reviews characteristics and disability trends in older adults, research and treatment issues in disability, and both clinical and public policy implications regarding disability. The example of dealing with vision loss due to age-related eye disease is used to exemplify chronic impairment, which can be accompanied by comorbid depression with resulting functional disability, and the types of resources available. Disability is considered in the context of older adults’ health, personal factors, and external factors representing their life circumstances.     

Development and validation of the Attitudes Towards Smoking Scale (ATS-18)

Aim. To develop and test the validity of a scale measuring attitudes towards smoking in current and former cigarette smokers. Design and participants. In a first mail survey, we collected qualitative data from 616 smokers. In a second mail survey, we collected quantitative data from 529 smokers and ex-smokers. We conducted a 16-month follow-up survey among 93 participants in the second survey. Setting. Geneva, Switzerland, 1995–98. Findings. The study resulted in a three-dimensional, 18-item scale: the "Attitudes Towards Smoking Scale" (ATS-18). The scale was validated with reference to criteria of content-, construct and predictive validity. The three subscales measure perceptions of adverse effects of smoking (10 items), psychoactive benefits (four items) and pleasure of smoking (four items). Internal consistency coefficients (0.85, 0.88 and 0.81) and test–retest correlations were high (0.90, 0.75, 0.89, respectively). Differences in attitude scores between smokers in the pre-contemplation and preparation stages of change were - 0.83, 0.71 and 1.23 standard deviation units, respectively. A differential score (advantages minus disadvantages of smoking) predicted smoking cessation in baseline smokers and relapse in baseline ex-smokers. Conclusion. ATS-18 is a valid and reliable instrument which can be used in both research and clinical settings.     

基层医院临床药学工作探讨

探讨基层医院如何开展临床药学工作。通过分析基层医院开展临床药学重要性并结合基层医院的现状,对开展临床药学工作内容及面临的问题进行分析。基层医院开展临床药学工作必要而且可行,同时尚需更广泛的支持,以推动临床药学事业的发展。     

Laboratory Approaches to the Diagnosis of Adenovirus Infection Depending on Clinical Manifestations

Abstract Background: While commercial enzyme immunoassays (EIA) intended for the detection of adenovirus in fecal specimens are widely used, there are no rapid, convenient, and sensitive commercial tests available for the detection of adenoviruses in respiratory and conjunctival specimens. The applicability of EIA for the detection of adenovirus in stool and throat samples was investigated. One-day rapid culture assay (RCA) for the detection of adenovirus in respiratory and conjunctival specimens was developed and evaluated. Patients and Methods: Stool samples from patients with gastroenteritis were tested by adenovirus EIA and by cell culture using human embryonic lung cells (HEL) and Graham 293 cells. Blood and stool samples from two BMT patients were also tested for adenovirus by PCR for at least 6 months. Throat specimens from patients with respiratory infections and conjunctival specimens were used for the evaluation of 1-day RCA compared with conventional adenovirus isolation in Graham 293 cells. Results: A total of 3,860 stool samples were tested by EIA Ridascreen^?, 8,169 by Novitec™, and 2,218 by ProSpectT^? yielding 135 (3.5%), 308 (3.7%), and 77 (3.5%) positive results, respectively. From 305 Ridascreen^?- and 340 Novitec™-negative stool samples, adenoviruses were isolated in three (0.9%) and eight (2.4%) cases, respectively, including two patients undergoing BMT. Multiple sequential stool samples from one BMT patient were repeatedly negative by EIA, but positive by PCR and cell culture. Graham 293 cells were better suited for isolation of adenovirus than HEL. EIA proved unreliable for detecting adenovirus in throat swabs. The sensitivity and specificity of RCA in throat swabs were 90% (37/41) and 100% (64/64), respectively, and 76% (16/21) and 100% (132/132) in conjunctival specimens, respectively. Conclusions: Generally, EIA is sufficiently sensitive for the diagnosis of adenovirus-associated diarrhea. However, it may not be sensitive enough to detect adenovirus in immunocompromised patients undergoing BMT and shedding very few viral particles in stools. Thus, in such cases, a more sensitive assay, such as PCR, is recommended. Furthermore, EIA is not sufficiently sensitive for the reliable detection of adenoviruses in throat swabs. One-day RCA may be useful for the detection of adenoviruses in respiratory and conjunctival specimens.     

Attitudes of Employees and Employers Towards Older Workers in a Climate of Anti-discrimination

Attitudes and practices towards older workers were surveyed in Brisbane with 525 employees randomly sampled from the electoral roll and executives of 104 companies obtained by stratified random sampling from the Register of Workplaces (response rates, 60% and 80% respectively). The results indicated that “older workers” are young in terms of contemporary life expectancy, and younger for employers than employees; they have some desirable personal qualities (eg. loyalty), but are not perceived as adaptable; workers aged 25–39 were preferred on qualities held to be important in the workplace and there was minimal interest in recruiting anyone over 45 years.