Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research

<b>Background</b> Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.<p></p> <b>Methods and findings</b> The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.<p></p> <b>Conclusions</b> Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems

University admission based on tests and interviews : Implementation and assessment

Admission to higher education has far-reaching implications and an impact not only on individuals, but also on society. In most developed countries, admission to university studies remains a key issue in higher education: the admissions system determines who will have access to higher education and raises the issue of equal opportunity, in terms of e.g. age, gender, and social class. Traditionally, admission to university studies in Sweden has been centralised, but in recent decades, universities have been permitted to reserve a specified number of undergraduate places for individual admission of selected students. Such a system was introduced to the dental course at the Dental School, Karolinska Institutet, in 1993. The main objective is to seek out, from a pool of applicants with good academic standards, highly motivated students with the potential to become good dentists. The overall aim of the thesis was to assess the relationship between individual student selection adopted at the Dental School and subsequent student achievement, including professional competence. It also presents an overall impression of the selection procedures, as perceived by successful applicants and by members of the selection committee. The specific aims of the thesis were to assess the outcome of an individualised admissions system for dental undergraduates in terms of. student drop-out rates, academic performance during the preclinical years and professional competence of dental students in their final undergraduate year. Students admitted through traditional modes served as a control group. The results are based on data from the first three rounds of admission using the system. During the first years of the undergraduate course, the results of three major integrated examinations, designed to disclose both comprehension and academic ability were analysed to give an early indication of students' potential to become 'good dentists'. The individually selected students achieved better results than those accepted through traditional modes. After three intakes, there have been few or no dropouts among the individually selected students. With respect to professional competence, faculty members who were clinical supervisors in the comprehensive care clinic and knew the students well assessed all the final-year students from the same three rounds of admission. The assessors were uninformed of the means by which the students had originally been admitted to the undergraduate course. Assessment by means of a specially designed protocol comprised seven different criteria and one overall - global - rating. Students originally admitted by individual selection seem to be more professionally competent than students admitted by traditional means. With respect to the relationship between student selection procedures and academic achievement, both interviewed students and the admissions committee are of the same opinion: that the individualised admissions procedure has a positive influence on students' academic achievement and professional competence. The students feel specially selected for their potential to become good dentists and the committee members agree that this awareness lead the students to aspire to higher achievements. It is concluded that motivation and commitment are important determinants of student achievement and that these criteria are more readily disclosed through tests and interview than through traditional modes such as matriculation grades and aptitude tests