Ratings of physical and mental health in the older bereaved

Subjective and objective ratings of mental and physical health were compared, using data from a larger study of older bereaved persons. Variation by age, race, and sex of subjects also was investigated. Sixty widowed individuals, aged 58-83, whose spouses died within the previous three months were identified through death certificates. Subjects were interviewed in their homes using a modification of the older Americans' Resources and Services, Multidimensional Functional Assessment Questionnaire (OARS), which provides objective and subjective ratings of mental and physical health. The Zung Self-Rating Depression Scale was used to quantify intensity of depression. Subjective ratings of physical health are primarily positive and significantly better than the objective ratings, particularly for women. In general, subjective and objective ratings of mental health do not differ. Interviewer ratings of physical health show significant variation by age of subjects rated. Findings are discussed in terms of reference group comparisons and of implications for design and interpretation of morbidity studies of widowed.     

Baptist Memorial Hospital for Women: quality lifelines for a lifetime

OVERALL APPROACH TO QUALITY AND SAFETY: At Baptist Women's, a not-for-profit, 140-bed free-standing hospital, the Institute of Medicine's six quality dimensions are embedded into the quality blueprint and strategic plan. Quality initiatives and dashboards are shared through an established shared drive, which is accessible for all employees, to track performance on identified dashboards. IMPROVING MAMMOGRAPHY CYCLE TIME AT THE WOMEN'S HEALTH CENTER: Cycle time (arrival to departure) for mammography was identified as the top improvement priority. Increasing the percentage of patients who had preregistered reduced admission time, and process changes were made to move the patient through the center more efficiently. For example, patients with orders for additional films were flagged to ensure that these exams were completed before a new patient's exam. The ultrasound schedule was blocked during peak times to ensure that add-on exams could be performed in a timely manner. The cycle time was reduced for screening mammography (from 2 hours in 2003 to 30 minutes in April 2006) and diagnostic screenings, including review of films and reports with radiologist at departure, decreased from > 3 hours in 2003 to 2.5 hours in April 2006. CONCLUSION: Expectations of teamwork, proactive problem resolution, communication on all levels, and customer service are the cornerstone of Baptist Women's culture of quality.     

Do students falsify information in clinical notes?

BACKGROUND: If students report information in a post-encounter note that was allegedly not obtained from the patient, they may be suspected of serious professional misconduct, ie, deliberate falsification of patient data. Over-reporting during a clinical assessment may result in accusations of cheating and even lead to failure of a high-stakes examination. Despite these serious implications, the prevalence and reasons for over-reporting are not clear. We investigated every detected incident of false reporting during our high-stakes clinical skills assessment (CSA) at the end of the third year. Of 73 alleged incidents, 69 were attributed to errors in standardized patient (SP) performance, note scoring, data management, or the design of cases or scoring instruments. The four instances of over-reporting by students were more compatible with mistakes and lack of specificity than deliberate falsification. We conclude that all potential sources of error must be excluded before over-reporting incidents are attributed to deliberate falsification of data by students.     

Health Status and Resources of Recently Bereaved Older Persons

This prospective, comparative study investigated variables in 60 recently widowed older men and women at three to four months and nine to 10 months after bereavement and compared them with an age-matched of nonbereaved. Major sections of the Duke University Older Americans' Resources and Services multidimensional functional assessment questionnaire were used to measure physical and mental health and social and economic resources. The Zung self-rating depression. scale (ZSDS) was used to evaluate the amount of depression. Subjects' scores were compared at Times 1 and 2 with scores of the comparison group. The bereaved were most impaired on physical health and economic resources: 18 percent were classified as moderately to severely depressed by the ZSDS and at both Times 1 and 2 they had significantly poorer scores than nonbereaved on all variables except social resources. For both groups, social and economic resources correlated highly with physical and mental health. Only for nonbereaved did age show a relationship to physical health and depression. Further research should focus on specific components of social resources and on evaluating interventions to reestablish social networks and mobilize social resources.     

A Dialectical and Dialogical Approach to Health Policies and Programs: The Case of Open Defecation in India

ABSTRACT

A multi-pronged approach to health policy and programs related to open defecation (OD) is proposed via a qualitative study conducted in rural India. A dialogic and dialectic perspective is employed to interpret the key findings from nine focus groups, highlighting the dialectical views toward OD and latrines. Findings indicate that current policy may be too narrow as it does not fully deal with the multiple reasons, including social communication as well as gender, cultural, health and work identity issues, for OD. The results suggest that OD is more complicated than it appears and a multi-pronged, poly-vocal approach to health communication campaigns and policy should be considered.