Decision aids for respite service choices by carers of people with dementia: development and pilot RCT

<p>Abstract</p> <p>Background</p> <p>Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options. However, they are rarely utilised to help those with chronic or age related conditions to make decisions about care services. Decision aids should also be useful for carers of people with decreased decisional capacity. These carers' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns, while relying on information from health professionals. This paper reports on a study that both developed and pilot tested a decision aid aimed at assisting carers to make evaluative judgements of community services, particularly respite care.</p> <p>Methods</p> <p>A mixed method sequential study, involving qualitative development and a pilot randomised controlled trial, was conducted in Tasmania, Australia. We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid. For the randomised control trial we randomly assigned 31 carers of people with dementia to either receive the service decision aid at the start or end of the study. The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid. Pilot data was collected from carers using interviewer-administered questionnaires at the commencement of the project, two weeks and 12 weeks later.</p> <p>Results</p> <p>The qualitative data strongly suggest that the intervention provides carers with needed decision support. Most carers felt that the decision aid was useful. The trial data demonstrated that, using the mean change between baseline and three month follow-up, the intervention group had less increase in burden, a decrease in decisional conflict and increased knowledge compared to control group participants.</p> <p>Conclusions</p> <p>While these results must be interpreted with caution due to the small sample size, all intervention results trend in a direction that is beneficial for carers and their decisional ability. Mixed method data suggest the decision aid provides decisional support that carers do not otherwise receive. Decision aids may prove useful in a community health services context.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN32163031">ISRCTN32163031</a></p

Water Supply Planning: Middle Illinois Assessment of Water Resources for Water Supply-Final Report

Illinois Department of Natural Resourcespublished or submitted for publicationis peer reviewedOpe

An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study

Purpose: To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR). Methods: This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11&nbsp;months but was extended in a minority of cases up to 7&nbsp;years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement. Results: One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1&nbsp;month) was favoured by age &lt;60&nbsp;years (p&nbsp;&lt;&nbsp;0.005), no previous observation (p&nbsp;&lt;&nbsp;0.0002), duration less than 3&nbsp;months (p&nbsp;&lt;&nbsp;0.0001), absence of CSCR in the fellow eye (p&nbsp;=&nbsp;0.04), leakage outside of the arcade (p&nbsp;=&nbsp;0.05) and fluid height &gt;500&nbsp;\u3bcm (p&nbsp;=&nbsp;0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1&nbsp;month was favoured by first episode (p&nbsp;=&nbsp;0.04), height of subretinal fluid &gt;500&nbsp;\u3bcm (p&nbsp;&lt;&nbsp;0.0001) and short duration of observation (p&nbsp;=&nbsp;0.02). Finally, there was no statistically significant difference among the treatments at 12&nbsp;months. Conclusion: Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification

Urban futures and the code for sustainable homes

Copyright © 2012 ICE Publishing Ltd. Permission is granted by ICE Publishing to print one copy for personal use. Any other use of these PDF files is subject to reprint fees.A 6?6 ha (66 000 m2) regeneration site, commonly referred to as Luneside East, is to be turned from a run down, economically under-achieving area of Lancaster, UK, into a new, distinctive, vibrant, sustainable quarter of the city. As a result several aspects of water planning for 350 new homes and 8000 m2 of workspace needed to be considered before any infrastructure investment was undertaken. This included assessment of the future capacity requirements (i.e. inflows and outflows) for water infrastructure (i.e. mains water supply, wastewater disposal, rainwater storage and stormwater disposal) much of which will be located underground. This paper looks at the implications of various water management strategies on the Luneside East site (e.g. water-efficient appliances, greywater recycling and rainwater harvesting) in line with current policy measures that focus on technology changes alone (e.g. the code for sustainable homes). Based on these findings this paper outlines some basic implications for technological resilience discussed in the context of four ‘world views’ – that is, the urban futures scenarios considered in this special issue. Conclusions are drawn as to how far this can take engineers, planners and developers in understanding and planning for resilient water infrastructure within a development like Luneside East

Elasticity of furniture elements glue by layers

Соответствующие исследования охватывали послойно склеиваемую буковую древесину предназначенную на выбранные конструкционные мебельные элементы. Целью исследований было определение упругостных свойств этих элементов совместно с определением зависимости между модулями упругости послойно склеиваемых элементов с различным числом слоев, их толщины и направления сгиба. Для достижения указанной цели проводились теоретические исследования с последующей проверкой на основании результатов экспериментальных изысканий. Проведенные анализы показали, что модуль упругости элементов из буковой древесины склеиваемой послойно не зависит от числа слоев ни от вида используемого клея. Примерно так же представляются прочность и деформации.The respective investigations comprised the beech wood glued by layers, designed for selected constructional furniture elements. The aim of the investigations was to determine elastic properties of the wooden elements jointly with datermination of relationships between the elasticity modules of the by-layer glued elements of different number of layers, their thickness and bending direction. To attain this aim, theoretical investigations were carried out with their subselent verification on the basis of the experimental investigation results. The investigations have proved that the elasticity module of beech wood elements glued by layers does not depend on the number of layers and the glue kind used. Strength and deformations are formed similarly

Eye Movement Desensitization And Reprocessing (Emdr) As A Time-Limited Treatment Intervention For Body Image Disturbance And Self-Esteem: A Single Subject Case Study Design

This single subject case study implemented in the private practice setting examined body-image disturbance and self-esteem. Eye movement desensitization and reprocessing (EMDR) is the treatment modality. The Self-Esteem Rating Scale and the Body Image Avoidance Questionnaire are pre and post tested. A self-developed Daily Body Satisfaction Log is used throughout the 43-day observation period. Scores on subjects\u27 self-esteem and body image avoidance showed clinical improvement over the treatment period. Based on this clinical examination, eye movement desensitization and reprocessing appears to be a promising time-limited treatment intervention that merits further research for application to eating disorder symptoms such as body image disturbance and low self-esteem. Suggestions for future research are provided

Student Utilization Of Health Services At A University Hospital In Turkey

This paper gives the results of the first pilot study of health care utilization by Turkish university students who receive much of their student health-related services from an affiliated university hospital. The survey was distributed to 393 students and a response rate of 59.8% was obtained. In general students did not report satisfaction with the health services they received. This finding is significant because the hospital concerned is considered \u27state of the art\u27 in Turkey. Significant levels of dissatisfaction were noted across several treatment and provider variables, and comparisons with American health services are made. Suggestions for improving the student health services in the country are generated and future research recommendations are highlighted