Goal setting dynamics that facilitate or impede a client-centered approach

Background: Client-centred goal setting is central to the process of enabling occupation. Yet, there are multiple barriers to incorporating client-centred goal setting in practice. We sought to determine what might facilitate or impede the formation of client-centred goals in a context highly supportive of client-centred goal setting

Methods: We used conversational analysis to examine goal-setting conversations that took place during a pilot trial of Occupational Performance Coaching for stroke survivors. Twelve goal-setting sessions were purposively selected, transcribed, and analyzed according to conventions for conversation analysis.

Results: Two main types of interactions were observed: introductory actions and goal selection actions. Introductory actions set the context for goal setting and involved sharing information and seeking clarification related to goal requirements and clients’ occupational performance competencies. Goal selection actions were a series of interactions whereby the goals were explored, endorsed or dropped.

Conclusion: Client-centred occupational performance goals may be facilitated through placing goal-setting in the context of life changes and lifelong development of goals, and through listening to clients’ stories. Therapists may improve consistency in adoption of client-suggested goals through clarifying meaning attached to goals and being attuned to power dynamics and underlying values and beliefs around risk and goal attainability.     

精神分裂症住院病人用药性别差异情况调查分析

目的:为了解男女精神分裂症患者住院用药情况.方法:对我院精神科封闭病房住院接受抗精神病药物治疗的233例精神分裂症患者不同性别用药进行回顾性分析,其中男性117例,女姓116例.结果:男、女患者精神药物使用频率居首的为氯氮平,居前五位的均为氯氮平,舒必利,利培酮,氯丙嗪,奋乃静;单一抗精神病药物为主;非典型抗精神病药物的使用率超过典型抗精神病药物;服用前五位抗精神病药物的日平均最大剂量女性高:精神药物联合治疗男性高于女性.结论:住院精神分裂症病人在抗精神病药联合治疗上及部分药物的日平均最大剂量有性别差异.     

精神分裂症住院费用的影响因素分析

目的探讨精神分裂症患者住院费用的各种影响因素。方法采用自编的《精神分裂症患者住院费用影响因素调查表》进行调查研究,对调查所得资料采用多元逐步回归分析。结果在各项住院费用中,比例最高的是治疗费,占42．23％,其次为床位费、药费和检查费。住院天数、病程、联用一、二代药物、合并其他疾病和家庭经济对住院费用影响较大,其中,住院时间长、病程长、联用一、二代药物、合并其他疾病是住院费用增加的主要因素,而家庭经济较宽裕可能相应增加辅助治疗的投入。结论精神分裂症患者住院费用受多种因素的影响,其中包括可控因素和不可控因素,我们要从可控因素入手,从加强医院管理,提高医务人员的医疗技术水平等方面去控制那些可控因素（如缩短住院天数,加快病床周转）,从而进一步降低病人的住院费用,减轻病人的经济负担,这样既能提高社会效益,又能提高医院的经济效益。     

住院康复期精神分裂症患者心理健康状况与社会支持的调查

目的:探讨住院康复期精神分裂症患者心理健康状况与社会支持的相关性。方法:采用症状自评量表和社会支持量表对住院康复期137例精神分裂症患者进行问卷调查。结果:患者的心理健康状况较常模差;患者的社会支持度较常模低(P<0.01)。结论:社会支持与住院康复期精神分裂症患者的心理健康密切相关,护士在患者住院治疗的同时,应充分评估和利用患者的社会支持,促进身心康复。     

Factors that affect influenza vaccine uptake among staff of long-term care facilities.

A survey of directors and employees of 36 long-term care facilities in Hesse, Germany, revealed that influenza vaccine uptake among staff was less than 30% in 30 and greater than 50% in 6. The study identified policies and practices associated with vaccination uptake at long-term care facilities and factors associated with the decision of staff to get vaccinated.     

Effects of lithium addition on daily activity and psychiatric symptoms in schizophrenic inpatients

Lithium addition to neuroleptic treatment brought about some improvement in 6 schizophrenic inpatients. In 3 of them, however, enhancement of daily activity did not parallel improvement in psychiatric symptoms. This suggests that lithium addition may enhance daily activity independently of psychiatric symptoms, and that lithium effects should also be assessed from the viewpoint of daily activity.     

Questioning the "big assumptions". Part II: recognizing organizational contradictions that impede institutional change

BACKGROUND: Well-designed medical curriculum reforms can fall short of their primary objectives during implementation when unanticipated or unaddressed organizational resistance surfaces. This typically occurs if the agents for change ignore faculty concerns during the planning stage or when the provision of essential institutional safeguards to support new behaviors are neglected. Disappointing outcomes in curriculum reforms then result in the perpetuation of or reversion to the status quo despite the loftiest of goals. Institutional resistance to change, much like that observed during personal development, does not necessarily indicate a communal lack of commitment to the organization's newly stated goals. It may reflect the existence of competing organizational objectives that must be addressed before substantive advances in a new direction can be accomplished. OBJECTIVE: The authors describe how the Big Assumptions process (see previous article) was adapted and applied at the institutional level during a school of medicine's curriculum reform. Reform leaders encouraged faculty participants to articulate their reservations about considered changes to provided insights into the organization's competing commitments. The line of discussion provided an opportunity for faculty to appreciate the gridlock that existed until appropriate test of the school's long held Big Assumptions could be conducted. CONCLUSIONS: The Big Assumptions process proved useful in moving faculty groups to recognize and questions the validity of unchallenged institutional beliefs that were likely to undermine efforts toward change. The process also allowed the organization to put essential institutional safeguards in place that ultimately insured that substantive reforms could be sustained.     

Questioning the "big assumptions". Part I: addressing personal contradictions that impede professional development

BACKGROUND: The ultimate success of recent medical curriculum reforms is, in large part, dependent upon the faculty's ability to adopt and sustain new attitudes and behaviors. However, like many New Year's resolutions, sincere intent to change may be short lived and followed by a discouraging return to old behaviors. Failure to sustain the initial resolve to change can be misinterpreted as a lack of commitment to one's original goals and eventually lead to greater effort expended in rationalizing the status quo rather than changing it. OBJECTIVE: The present article outlines how a transformative process that has proven to be effective in managing personal change, Questioning the Big Assumptions, was successfully used in an international faculty development program for medical educators to enhance individual personal satisfaction and professional effectiveness. This process systematically encouraged participants to explore and proactively address currently operative mechanisms that could stall their attempts to change at the professional level. CONCLUSIONS: The applications of the Big Assumptions process in faculty development helped individuals to recognize and subsequently utilize unchallenged and deep rooted personal beliefs to overcome unconscious resistance to change. This approach systematically led participants away from circular griping about what was not right in their current situation to identifying the actions that they needed to take to realize their individual goals. By thoughtful testing of personal Big Assumptions, participants designed behavioral changes that could be broadly supported and, most importantly, sustained.     

Factors delaying discharge of psychiatric patients

The reliable identification of patients at high risk of experiencing delays in discharge is an important objective of social workers in psychiatric settings. This study discovered a number of factors associated with excessive hospital stays, marking an initial step in the development of a list of high-risk indicators to be used to achieve more timely and appropriate transitions for psychiatric patients no longer in need of inpatient care.     

某医院住院人数长期趋势模型的建立和预测

目的用时间序列建立住院人数线性回归模型,预测2014、2015、2016、2017年的住院人数。方法用最小二乘法建立线性模型,并对模型进行回归分析。结果回归模型Y=13 067.28+2 511.04X,方差分析结果 P=0.0025,按?=0.05水准,P0.05,可以认为住院人数与年次有直线回归关系。某院2014、2015、2016、2017年的住院人数点预测值分别为33 156.60、35 666.64、38 177.68、40 688.72;区间预测为27 314.59~38 996.61、29 825.63~41 507.65、32 336.67~44 018.69、34 847.71~46 529.73。结论通过预测住院人数为医院的工作计划和决策提供依据,使卫生资源得到合理应用。     

Factors in long-term marriages

"The present study involves a nonrandom sample of 351 [U.S.] couples who have been married 15 years or more. Differences were found in the reported reasons for staying together between happy, unhappy, and mixed (one partner happy and one unhappy) marriages. For happy couples, the most frequently mentioned reasons for staying together was the perceived nature of the relationship, then the belief in marriage as a long-term commitment. Among the mixed and unhappy marriages, the most frequently named reason was the belief that marriage is a long-term commitment. Nineteen percent of those in mixed marriages and 47% in unhappy marriages said the children kept the marriage together."     

Factors related to the provision of hospital discounts for HMO inpatients.

Using 1986 AHA hospital survey data, we analyzed hospital-HMO contract provisions, hospital operating characteristics, and market conditions for a national sample of 801 hospitals with HMO contracts to determine the factors related to provision of a discount and the magnitude of the discount if present. Seventy-eight percent of the hospitals reported that at least one of their HMO contracts provided a discount for inpatient services. Risk-sharing provisions, the number of hospitals within a five-mile radius, the proportion of the population enrolled in HMOs, and the number of HMOs operating in the metropolitan statistical area (MSA) were directly related to provision of discounts. Public hospitals were less likely than other facilities to provide discounts. For the magnitude of the discounts, risk-sharing provisions and the number of hospitals within a five-mile radius were again related, as was the number of HMOs operating in the MSA--but this time the number-of-HMOs variable had an inverse relationship. The results suggest that increased HMO market activity does result in price competition for hospital services but that hospital discounting strategies are extremely complex and may not follow conventional market theories. Hospitals appear to be using contracts both to stabilize their relationships with HMOs and increase market share, and they are increasingly giving discounts to achieve those ends.     

Factors that affect the occurrence of fumonisin

The two important Fusarium ear rots of corn, Gibberella ear rot (Fusarium graminearum, formally F. moniliforme and allied species) and Fusarium ear rot (F. verticillioides and allied species) grow under different environmental conditions. F. graminearum grows well only between 26 and 28 degrees C and requires rain both at silking and during disease progression. F. verticillioides grows well at higher temperatures, and ear rot and fumonisin accumulation are associated with drought and insect stress and growing hybrids outside their areas of adaptation. In southern Transkei, where esophageal cancer has been associated with the consumption of F. verticillioides and fumonisin-contaminated corn, environmental conditions favor this fungus in most years. In the nearby areas where the soils, crops, food consumption, and populations are the same and where esophageal cancer is low, temperatures are cooler and F. graminearum is favored. Although F. verticillioides is associated with a disease of corn, it may be that this fungus is a mutualistic endophyte of the plant. Perhaps because of this, breeding for resistance to Fusarium ear rot has produced inconclusive results to date. The best available strategies for reducing the risk of fumonisin contents of maize are to ensure that hybrids are adapted to the environment and to limit drought stress and insect herbivory. It may also be necessary to make use of alternative strategies such as producing hybrids that contain enzymes to degrade fumonisin as it is produced.     

Employee discharge liability: the straw that broke the camel's back

Employers are frequently confronted with workers who do not perform adequately. It is important to document and communicate dissatisfaction with an employee's performance as failings become evident. Efforts at remediation of the deficiencies must also be recorded. This article outlines the pitfalls of employee discharge without such documentation and strategies to avoid litigation and achieve an equitable outcome for both parties.     

Workplace violence on workers caring for long-term institutionalized schizophrenic patients in Taiwan

It has been noted that workplace violence most frequently occurs in psychiatric settings. The purpose of this study was to explore the workplace violence, including violence situation, victims' feeling, and the prevention strategies, on workers caring for long-term institutionalized schizophrenic patients in Taiwan. We conducted a face-to-face, in-depth, and semi-structured interview with 13 health care workers suffering from physical violence and/or sexual harassment by patients in 2002. First, the interviews were taped and/or paper-notes recorded, then transcribed, organized, and analyzed. Results found that all of the victims alleged they did not receive enough post-incident support, and more than a half of the victims could not call others for help during the violence. To avoid further attack, most victims offered prevention strategies which were considered valuable for establishing guidelines. However, some victims regarded workplace violence as inevitable and part of the job. The most common situations of workplace violence were during routine ward inspections, especially when the victims were alone. The most serious psychological harm was post-traumatic stress disorder (PTSD). In conclusion, we recommended a re-engineering of the organization to a supportive and safe working environment for prevention of workplace violence in the study hospital.     

A minimal-contact intervention for cardiac inpatients: long-term effects on smoking cessation

BACKGROUND: This study examined the 1-year effects of a minimal-contact smoking cessation intervention for cardiac inpatients. METHODS: The multicenter study included cardiac inpatients who had smoked prior to hospitalization. A pretest-posttest quasi-experimental design was used. Patients' experimental condition depended on the hospital they were assigned to. The design was partially randomized: 4 of the 11 hospitals selected the experimental condition themselves (2 experimental, 2 control), while the remaining 7 hospitals were randomly assigned. The experimental group consisted of patients of 5 hospitals (N = 388). Patients of 6 other hospitals served as the control group (N = 401). The intervention included stop-smoking advice by the cardiologist, brief counseling by the nurse, the provision of self-help materials, and aftercare by the cardiologist. RESULTS: Logistic regression analyses controlling for baseline differences and covariates did not show significant intervention effects on point prevalence and continuous abstinence. The study also showed that the outcomes were not significantly related to the way hospitals were assigned to the experimental condition. CONCLUSIONS: While short-term effects were found, the minimal-contact intervention did not result in significant effects after 12 months, at least if patients lost to follow-up were treated as posttest smokers. Efforts should be made to improve the intervention, especially the aftercare.     

Nicotine dependence and smoking cessation after hospital discharge among inpatients with coronary heart attacks

This study focuses on the predictability of two alternative questionnaires for nicotine dependence, i.e., the Fagerstrom Tolerance Questionnaire (FTQ) and the Tobacco Dependence Screener (TDS), each of which represents a different aspect of dependence, among patients with coronary heart disease (CHD). Twenty-nine male inpatients that had been newly diagnosed as CHD were followed up for 30 weeks after hospital discharge. The baseline information included age, number of cigarettes per day, years of smoking, disease type (angina pectoris [AP] or acute myocardial infarction [AMI), whether they had received a briefing on smoking cessation, the FTQ, and the TDS. At 30 weeks after hospital discharge, 19 (66%) were abstainers. The group with a high TDS score (of 6 or greater) was significantly less likely to quit smoking than the group with a low TDS score (p=0.046). The FTQ score was not significantly different between the abstainers and non-abstainers. The subjects with AP were significantly less likely to quit smoking than those with AMI (p=0.021). Multiple logistic regression analysis showed that belonging to the high-TDS group and being diagnosed as AP were significantly associated with failure in smoking cessation (p<0.05). The present study suggests that the TDS may have higher predictability than the FTQ concerning smoking cessation among CHD inpatients.