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61.
Becoming tobacco‐free: Changes in staff and patient attitudes and incident reports in a large academic mental health and addictions hospital
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62.
Pamela J. Morgan MD CCFP FRCPC Stephen Halpern MD FRCPC MSc Jenny Lam-McCulloch BSc MSc 《Journal canadien d'anesthésie》2000,47(10):956-961
PURPOSE: Epidural anesthesia was a commonly used technique for elective Cesarean section. Recently, because of the availability of non-cutting spinal needles, many institutions have changed from epidural to spinal anesthesia. The purpose of this study was to compare maternal satisfaction between epidural and spinal anesthesia for elective Cesarean section with a new satisfaction tool. METHODS: We studied healthy parturients in a randomized, double-blinded pilot study in which patients were assigned to receive either epidural (n = 13) or spinal (n = 14) anesthesia for elective Cesarean section. Two and 24 hr postoperatively, patients completed a validated 22-point maternal satisfaction questionnaire and a 10-cm visual analog score (VAS) for satisfaction. Maternal satisfaction scores were compared between groups. RESULTS: There was no difference in demographics, complications or technical failures between groups. Mean satisfaction scores on the questionnaire (0-154) at two and 24 hr were 130.23 +/- 11.36 and 129.54 +/- 16.70 for the epidural group and 116.92 +/- 18.47 and 115.92 +/- 15.71 for the spinal group (P = 0.04 and P = 0.03 respectively). No difference in VAS scores was noted. The presence of minor side effects including pruritus contributed to the lower satisfaction in the spinal group at 24 hr. CONCLUSION: This pilot study demonstrated higher maternal satisfaction with epidural than with spinal anesthesia for elective Cesarean section. This may be related to the increased side effects caused by neuraxial morphine. The satisfaction questionnaire was able to elucidate differences not detected with a global VAS for satisfaction. Further study with a larger patient population is required to confirm these data. 相似文献
63.
Madeline McCoy BSc MSc Taylor Shorting BA Vinay Kumar Mysore MSc CAAP BA Edward Fitzgibbon MD MSc CCFP Jill Rice MD MHSc CCFP Meghan Savigny MDes BDes Marianne Weiss DNSc RN Daniel Vincent MD MSc CCFP FRCPC Meaghen Hagarty MD CCFP Krystal Kehoe MacLeod PhD Natalie C. Ernecoff PhD MPH Rex Pattison Mona Kornberg PhD Adrianna Bruni MD MSc CCFP Shirley H. Bush MBBS MRCGP FAChPM Kerry Kuluski MSW PhD Valerie Fiset RN PhD Cecilia Li MDCM CCFP FRCPC Henrique A. Parsons MD MSc Geneviève Lalumière RN BScN MN Tara Connolly BEd MA RP Colleen Webber PhD Sarina R. Isenberg MA PhD 《Health expectations》2024,27(2):e14002
64.
Ellen Warner MD FRCPC FACP Vivek Goel MD FRCPC Nancy Ondrusek MSc Elaine C. Thiel BScN Lavina Lickley MD PhD FRCSC FACS Pamela L. Chart MD MDCM Wendy S. Meschino MD FRCPC FCCMG Brian D. Doan PhD June C. Carroll MD CCFP FCFP & Kathryn M. Taylor PhD 《Health expectations》1999,2(2):118-128
Objective
To develop and pilot study an information aid for women with a family history of breast cancer.Design, setting and participants
The information aid, consisting of a booklet and audiotape, was developed by a multi-disciplinary team of health care professionals, breast cancer survivors and their relatives. Women with no personal history of breast cancer, on the waiting list for a familial breast cancer clinic at either of two centres, who could read English, were eligible for the pilot study which consisted of three sets of mailed questionnaires.Main outcome measures
The baseline questionnaires included: demographic information: the Breast Cancer and Heredity Knowledge Scale (BCHK); psychological measures (the State-Trait Anxiety Inventory [STAI], Centre for Epidemiologic Studies Depression Scale [CES-D] and an item about breast cancer worry), and an item about breast cancer risk perception. Immediately after reviewing the information aid, participants completed a satisfaction survey, the risk perception and cancer worry items and a checklist about their personal family history. The third set of questionnaires, completed 2–4 weeks after reviewing the aid, was identical to the first. Patients then attended their scheduled clinic visit and an objective hereditary breast cancer risk assessment was made by the genetic counselling team.Results and conclusions
Of 97 eligible women who were contacted, 67 completed all three sets of questionnaires. Overall, women were very satisfied with the aid and 96% would recommend it to other women. There was a highly significant improvement in their knowledge scores after they reviewed the aid. Anxiety and depression did not change and there was a decline in breast cancer worry. Risk perception did not change significantly. Ninety per cent of women completed their personal family history checklist accurately. Several important improvements have been made in the information aid and it will now be evaluated in the community.65.
It ‘makes you feel more like a person than a patient’: patients’ experiences receiving home‐based primary care (HBPC) in Ontario,Canada
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Tracy Smith‐Carrier PhD RSW Samir K. Sinha MD DPhil FRCPC Mark Nowaczynski PhD MD CCFP FCFP Sabrina Akhtar MD CCFP Gayle Seddon BScN MHS RN Thuy‐Nga Pham MD CCFP 《Health & social care in the community》2017,25(2):723-733
The lack of effective systems to appropriately manage the health and social care of frail older adults – especially among those who become homebound – is becoming all the more apparent. Home‐based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in‐depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office‐based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care – which the office‐based alternative provides little guarantee – and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population. 相似文献
66.
67.
A mixed methods study of the work patterns of full‐time nurse practitioners in nursing homes
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Ruth Martin‐Misener PhD RN‐NP Faith Donald PhD NP‐PHC Abigail Wickson‐Griffiths PhD Student RN MN Noori Akhtar‐Danesh PhD Jenny Ploeg PhD RN Kevin Brazil PhD Sharon Kaasalainen PhD RN Carrie McAiney PhD Nancy Carter PhD RN Lori Schindel Martin PhD RN Alan Taniguchi MD CCFP FCFP 《Journal of clinical nursing》2015,24(9-10):1327-1337
68.
Historical thinking in clinical medicine: lessons from R.G. Collingwood's philosophy of history
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Benjamin H. Chin‐Yee BSc Ross E.G. Upshur BA MA MD MSc CCFP FRCPC 《Journal of evaluation in clinical practice》2015,21(3):448-454
The aim of this article is to create a space for historical thinking in medical practice. To this end, we draw on the ideas of R.G. Collingwood (1889–1943), the renowned British philosopher of history, and explore the implications of his philosophy for clinical medicine. We show how Collingwood's philosophy provides a compelling argument for the re‐centring of medical practice around the patient history as a means of restoring to the clinical encounter the human meaning that is too often lost in modern medicine. Furthermore, we examine how Collingwood's historical thinking offers a patient‐centred epistemology and a more pluralistic concept of evidence that includes the qualitative, narrative evidence necessary for human understanding. We suggest that clinical medicine can benefit from Collingwood's historical thinking, and, more generally, illustrates how a philosophy of medicine that draws on diverse sources from the humanities offers a richer, more empathetic clinical practice. 相似文献
69.
Brian H. Rowe MD MSc CCFP Cristina Villa-Roel MD MSc Alex Guttman MD Scott Ross MD CCFP Duncan Mackey MD CCFP Marco L. A. Sivilotti MD MSc FRCPC FACMT rew Worster MD MSc CCFP Ian G. Stiell MD MSc FRCPC Virginia Willis RN Bjug Borgundvaag MD PhD CCFP 《Academic emergency medicine》2009,16(4):316-324
Objectives: The objective was to examine predictors of hospital admission among adults presenting to Canadian emergency departments (EDs) for acute exacerbations of chronic obstructive pulmonary disease (COPD). Current acute treatment approaches and outcomes 2 weeks after the ED visit are also described. Methods: Subjects, aged ≥35 years presenting with COPD exacerbations to 16 EDs across Canada, underwent a structured in‐ED interview and a telephone interview 2 weeks later. Results: Of 501 study patients, 247 (49.3%; 95% confidence interval [CI] = 44.9% to 53.6%) were admitted. Admitted patients were older, were more often former smokers, and had more admissions for COPD during the past 2 years. They also reported more days of activity limitation and use of inhaled beta2‐agonists in the previous 24 hours. Canadian Triage and Acuity Scale (CTAS), respiratory rate (RR), and airflow obstruction were more severe in the hospitalized group. Most of the patients received inhaled beta2‐agonists, anticholinergics, oral corticosteroids (CS), and antibiotics; hospitalized patients received more aggressive treatments. The median ED length of stay (LOS) of admitted patients was 13.1 hours (interquartile range [IQR] = 7.4‐23.0) compared to 5.6 hours (IQR = 4.2‐8.4) in discharged patients. Admission was associated with at least two COPD admissions in the past 2 years (odds ratio [OR] = 2.10; 95% CI = 1.24 to 3.56), receiving oral CS for COPD (OR = 1.72; 95% CI = 1.08 to 2.74), having a CTAS score of 1–2 (OR = 2.04; 95% CI = 1.33 to 3.12), and receiving adjunct ED treatments (OR = 3.95; 95% CI = 2.45 to 6.35). Use of EDs for usual COPD care was associated with a reduced risk of admission (OR = 0.43; 95% CI = 0.28 to 0.66). Conclusions: Exacerbations of COPD in Canadian EDs result in prolonged ED stays and approximately 50% hospitalization despite aggressive acute treatment approaches. Historical, severity, and treatment‐related factors were strongly associated with hospital admission. Validation of these results should be completed prior to widespread use. 相似文献
70.