The relationship between medical literacy and trust in healthcare in Romania

The paper discusses the issue of patients’ trust in Romanian healthcare system, from the point of view of the information they get from the internet. Using cross-tabulations, correlations, and factorial analysis, based on data from the European Values Survey, we track the influence that internet literacy may have on healthcare related behaviour, choice, and trust. Further research should include primary data collection, in order to ensure a better focus on the niche we are interested in, and investigate adjacent factors which may interfere with healthcarerelated information retrieval and formation of patients’ trust in the healthcare system.healthcare system, Romania, trust, patients, internet, healthcare literacy.

Sicherheit in der häuslichen Intensivpflege - eine qualitative Studie zur Perspektive von häuslich beatmeten Menschen und ihren pflegenden Angehörigen

Background: The discourse about patient safety focuses traditionally on inpatient settings and objectively measurable outcomes, specifically the avoidance of any adverse events. The aim of this thesis is to explore safety in advanced home care and, in the spirit of person-centred care, to pay special attention to the experiences and perspectives of severely ill and technology-dependent people and their relatives. Methods: Problem-centred interviews with (non)-invasive mechanically ventilated people (n = 21) and family caregivers (n = 15) have been conducted as part of a larger multiphase qualitative health services research project. The iterative research process was based on the grounded theory methodology. In addition, a qualitative secondary analysis was carried out to explore the interpersonal trust in this context further. Results: Particularly, trusting interpersonal relationships with their nurses enhance safety for people receiving home mechanical ventilation (HMV). They feel safe when nurses are familiar with their needs and situation, and when they can rely on, inter alia, their professional abilities. Additionally, the possibility of communicating their needs and being noticed by nurses is important for them. Other themes are the continuity and feeling the presence of trustful nurses or relatives. Critical situations occur when the nurse-patient communication and interaction are strained or when patient- or technology-related monitoring tasks are neglected. Further problems occur when co-ordination and co-operation are lacking and if the negotiation process, education and supervision is neglected. Family caregivers make a decisive contribution to patient safety by fostering mutual information sharing, co-ordinating informal health care and undertaking compensation for nurses’ qualification deficits and organisational shortcomings. Discussion: From the perspective of people receiving HMV, safety is far more than the absence of adverse events. The main finding is that those receiving HMV have a relational approach to safety. In addition, it could be shown that nurses can make an essential contribution to safety when they build a trustful and needs-oriented nurse-patient relationship (NPR). If this is not successful, critical situations might occur. Family caregivers’ substantial contribution to safety deserves to be acknowledged but also constitutes potential risks. Needs-based, professional support and education should be offered which focus on joint decision-making and targeted promotion of their expertise. Conclusion: Trustful NPRs are of central importance for the feeling of safety of people receiving HMV. Developing a trustful NPR is, therefore, an essential component of nursing practice in advanced home care. Patient safety should remain the responsibility of the nurses and requires appropriate preconditions and framework conditions.Hintergrund: Der Diskurs zum Thema Patientensicherheit ist vorwiegend auf stationäre Einrichtungen und objektiv messbare Parameter ausgerichtet, wobei der Fokus auf der Vermeidung sog. „unerwünschter Ereignisse“ liegt. Ziel dieser Arbeit ist es daher, Patientensicherheit in der häuslichen Intensivpflege ins Blickfeld zu rücken. Dabei wird im Sinne einer personenzentrierten Versorgung besonderes Augenmerk auf die Erfahrungen und Sichtweisen von schwerstkranken und technikabhängigen Menschen und ihren Angehörigen gelegt. Methodik: Im Rahmen eines mehrphasigen, qualitativen Versorgungsforschungsprojekts wurden problemzentrierte Interviews mit (non-)invasiv beatmeten Menschen (n = 21) und deren Angehörigen (n = 15) durchgeführt. Der iterativ angelegte Forschungsprozess orientierte sich an den Prinzipien der Grounded Theory. Zudem wurde im Rahmen einer qualitativen Sekundärdatenanalyse eine zusammenfassende Inhaltsanalyse durch-geführt, um das Phänomen des interpersonalen Vertrauens in gegebenem Kontext näher zu untersuchen. Ergebnisse: Aus der Sicht der häuslich beatmeten Menschen werden v. a. vertrauens-volle zwischenmenschliche Beziehungen zu den Pflegefachpersonen als sicherheits-relevant angesehen. Sie fühlen sich sicher, wenn personelle Kontinuität gegeben ist, die Pflegefachpersonen mit ihren Bedürfnissen und ihrer Situation vertraut sind und sie ihnen u.a. bezogen auf Ihre Kompetenzen vertrauen können. Bedeutsam sind ferner ihre Möglichkeiten sich mitteilen zu können, das Gefühl mit ihren Bedürfnissen von den Pflegefachpersonen wahrgenommen zu werden sowie die Gewissheit, dass vertrauenswürdige Pflegefachpersonen oder Angehörige anwesend sind. Gestaltet sich die Kommunikation und Interaktion als schwierig oder werden patienten- oder technikbezogene Überwachungsaufgaben vernachlässigt, können risikobehaftete Situationen entstehen. Wenn Kooperations- und Abstimmungserfordernisse unterschätzt sowie Aushandlungs-, Edukations- und Supervisionsaufgaben vernachlässigt werden, leisten Angehörige einen entscheidenden Beitrag zur Sicherheit der beatmeten Personen, indem sie z. B. sicherheitsrelevante Informationen mit den professionellen Akteuren teilen, die Versorgung koordinieren und qualifikatorische und organisatorische Defizite kompensieren. Diskussion: Aus Sicht beatmeter Menschen ist Sicherheit in der häuslichen Intensiv-pflege weitaus mehr als lediglich die Abwesenheit „unerwünschter Ereignisse“. Die zentrale Erkenntnis ist, dass beatmete Menschen einem relationalen, subjektiven Sicherheitsverständnis folgen. Zudem konnte gezeigt werden, dass Pflegefachpersonen einen wesentlichen Beitrag zum subjektiven Sicherheitsgefühl leisten können, wenn sie die Pflegebeziehung vertrauensvoll und bedürfnisorientiert gestalten. Gelingt dies nicht, können Risikosituationen entstehen. Der wesentliche Beitrag involvierter Angehöriger verdient Anerkennung, birgt jedoch auch Sicherheitsrisiken. Es bedarf an dieser Stelle daher einer bedarfsgerechten, professionellen Unterstützung, die auf partnerschaftlichen Einbezug und gezielte Förderung ihrer Expertise setzt. Fazit: Vertrauensvolle Pflegebeziehungen sind für das subjektive Sicherheitsgefühl häuslich beatmeter Menschen von zentraler Bedeutung. Sie verantwortlich zu gestalten stellt eine pflegerische Kernaufgabe in der häuslichen Intensivpflege dar. Die Gewährleistung von Patientensicherheit liegt im pflegerischen Verantwortungsbereich. Entsprechende Voraussetzungen und Rahmenbedingungen bedürfen gezielter Entwicklung

Finding my ground in public health research: lessons from my Grandmother’s kitchen

<p>Abstract</p> <p>Background</p> <p>Research has a 'bad name' in Aboriginal communities. Too often, researchers have come, gathered information and taken it away from Aboriginal people, with no benefit for the communities taking part in the research. This history has implications for Aboriginal and non-Aboriginal researchers planning research with Aboriginal communities. An in depth interview study will be conducted in one region of Victoria. Participants will be Aboriginal women who have had a baby within the previous five years. Processes that have been used in preparing to 'step out' into the community to conduct this research are the focus of the paper.</p

Case Studies in Industry: What We Have Learnt

Case study research has become an important research methodology for exploring phenomena in their natural contexts. Case studies have earned a distinct role in the empirical analysis of software engineering phenomena which are difficult to capture in isolation. Such phenomena often appear in the context of methods and development processes for which it is difficult to run large, controlled experiments as they usually have to reduce the scale in several respects and, hence, are detached from the reality of industrial software development. The other side of the medal is that the realistic socio-economic environments where we conduct case studies -- with real-life cases and realistic conditions -- also pose a plethora of practical challenges to planning and conducting case studies. In this experience report, we discuss such practical challenges and the lessons we learnt in conducting case studies in industry. Our goal is to help especially inexperienced researchers facing their first case studies in industry by increasing their awareness for typical obstacles they might face and practical ways to deal with those obstacles.Comment: Proceedings of the 4th International Workshop on Conducting Empirical Studies in Industry, co-located with ICSE, 201

Double osseous flaps for simultaneous midfacial and mandible reconstruction: Automation in surgical complexity within an entirely computerized workflow

Introduction: Broad maxillofacial surgical resections involving both the midface and the mandible represent a challenge in terms of reconstruction. Although several papers have explored the possibility of simultaneously using two microsurgical flaps, reports on the implementation of a dual osseous flap strategy are limited, and mainly addressed to static anatomical reconstruction, regardless of functional implications. In particular, there is a lack in the literature of a unifying protocol which illustrates how technology including virtual planning, statistical shape modeling, virtual occlusion, 3D-printing and patient-specific implants can address the functional and accuracy needs required for an optimal reconstruction. Materials and methods: In this paper, the Authors present their preliminary experience in a two-center study, showing how broad maxillofacial defects, requiring a simultaneous reconstruction in both the mandible and the midface, can be successfully reconstructed using the combination of two osseous flaps in an automated sequence in which all steps are anticipately defined in a virtual plan, accounting for the optimal alignment of temporomandibular joint, predicting the final occlusion and defining a mandibular shape according to a statistical shape model. Results: Average RMSE for the iliac bone crest flap was of 3.2 ± 0.36 mm; for the fibula flap, RMSE value was of 2.3 ± 0.65 mm, for patient-specific implants, for mandibular prostheses the average RMSE was 2.46 mm with 0.76 mm standard deviation. Temporomandibular joint function increased when a TMJ prosthesis was placed. Conclusions: Double bone free flap is a valuable resource to reconstruct wide defects that simultaneously involve two thirds of the cranio-maxillo-facial skeleton, but a careful virtual planning study should be always performed before approaching this surgical option

2 P2P or Not 2 P2P?

In the hope of stimulating discussion, we present a heuristic decision tree that designers can use to judge the likely suitability of a P2P architecture for their applications. It is based on the characteristics of a wide range of P2P systems from the literature, both proposed and deployed.Comment: 6 pages, 1 figur