Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study

Objective To explore physicians' thoughts and considerations of participation in medical decision making by hospitalised elderly patients. Design A qualitative study using focus group interviews with physicians interpreted with grounded theory and completed with a questionnaire. Setting and participants The setting was three different hospitals in two counties in Sweden. Five focus groups were conducted with physicians (n=30) in medical departments, with experience of care of elderly patients. Results Physicians expressed frustration at not being able to give good care to elderly patients with multimorbidity, including letting them participate in medical decision making. Two main categories were found: ‘being challenged’ by this patient group and  ‘being a small part of the healthcare production machine’. Both categories were explained by the core category ‘lacking in time’. The reasons for the feeling of ‘being challenged’ were explained by the subcategories ‘having a feeling of incompetence’, ‘having to take relatives into consideration’ and ‘having to take cognitive decline into account’. The reasons for the feeling of ‘being a small part of the healthcare production machine’ were explained by the subcategories ‘at the mercy of routines' and ‘inadequate remuneration system’, both of which do not favour elderly patients with multimorbidity. Conclusions Physicians find that elderly patients with multimorbidity lead to frustration by giving them a feeling of professional inadequacy, as they are unable to prioritise this common and rapidly growing patient group and enable them to participate in medical decision making. The reason for this feeling is explained by lack of time, competence, holistic view, appropriate routines and proper remuneration systems for treating these patients

Weight reduction is not a major reason for improvement in rheumatoid arthritis from lacto-vegetarian, vegan or Mediterranean diets

OBJECTIVES: Several investigators have reported that clinical improvements of patients with rheumatoid arthritis (RA), from participating in therapeutic diet intervention studies, have been accompanied by loss of body weight. This has raised the question whether weight reduction per se can improve RA. In order to test this hypothesis, three previously conducted diet intervention studies, comprising 95 patients with RA, were pooled. Together with Age, Gender, and Disease Duration, change during the test period in body weight, characterised dichotomously as reduction or no reduction (dichoΔBody Weight), as well as Diet (dichotomously as ordinary diet or test diet), were the independent variables. Dependent variables were the difference (Δ) from baseline to conclusion of the study in five different disease outcome measures. ΔESR and ΔPain Score were both characterised numerically and dichotomously (improvement or no improvement). ΔAcute Phase Response, ΔPhysical Function, and ΔTender Joint Count were characterised dichotomously only. Multiple logistic regression was used to analyse associations between the independent and the disease outcome variables. RESULTS: Statistically significant correlations were found between Diet and three disease outcome variables i.e. ΔAcute-Phase Response, ΔPain Score, and ΔPhysical Function. Δ Body Weight was univariately only correlated to ΔAcute-Phase Response but not significant when diet was taken into account. CONCLUSION: Body weight reduction did not significantly contribute to the improvement in rheumatoid arthritis when eating lacto-vegetarian, vegan or Mediterranean diets

They do what they think is the best for me : Frail elderly patients' preferences for participation in their care during hospitalization.

OBJECTIVE: To deepen the knowledge of frail elderly patients' preferences for participation in medical decision making during hospitalization. METHODS: Qualitative study using content analysis of semi-structured interviews. RESULTS: Patient participation to frail elderly means information, not the wish to take part in decisions about their medical treatments. They view the hospital care system as an institution of power with which they cannot argue. Participation is complicated by barriers such as the numerous persons involved in their care who do not know them and their preferences, differing treatment strategies among doctors, fast patient turnover in hospitals, stressed personnel and linguistic problems due to doctors not always speaking the patient's own language. CONCLUSION: The results of the study show that, to frail elderly patients, participation in medical decision making is primarily a question of good communication and information, not participation in decisions about medical treatments. PRACTICE IMPLICATIONS: More time should be given to thorough information and as few people as possible should be involved in the care of frail elderly. Linguistic problems should be identified to make it possible to take the necessary precautions to prevent negative impact on patient participation.Original Publication:Anne Ekdahl, Lars Andersson and Maria Friedrichsen, They do what they think is the best for me: Frail elderly patients' preferences for participation in their care during hospitalization., 2010, Patient Education and Counseling, (80), 2, 233-240.http://dx.doi.org/10.1016/j.pec.2009.10.026Copyright: Elsevier Science B.V., Amsterdam.http://www.elsevier.com

Evaluation of material models and element types for sheet metal formning of titanium

In the last decades, the growing competitiveness of the market has continuously driven the forming companies to highly optimize their products regarding offered performance at minimum cost. In order to achieve better products, studies where conducted with different material models when simulating the forming process of titanium. The material is often used in heat exchanger applications. Titanium has a HCP structure which results in high anisotropy in rolled sheet metal. It is of importance to be able to simulate the sheet metal forming process of titanium in a more precise way both regarding formability and springback. In this work different material models for titanium where used and evaluated against experimental work in special test module tools (TMT). The evaluation is made by comparing results of simulations with pressed test parts in titanium. This paper describes FE-analysis of springback using the YLD 2000 model compared to the anisotropic-viscoplastic material model. Different element types were also analysed. It has been shown that material model YLD 2000 and elements with through thickness stretch gives the most accurate results in the performed simulations

Long-term effectiveness of basic body awareness therapy in psychiatric outpatient care. A randomized controlled study

The long-term effects of Basic Body Awareness Therapy (BBAT) in addition to treatment as usual (TAU) were studied in a randomized, controlled design in psychiatric outpatient care. Seventy-seven patients with mood, stress-related somatoform, behavioural or personality disorders were studied at baseline, after a 3-month treatment period and at a 6-month follow-up. The use of psychiatric healthcare and social services were studied during 12 months, starting with baseline. The study comprised a control group (n=39) that received TAU and a treatment group (n=38) that in addition to TAU also received 12 sessions of BBAT. The aim was to study the effects of BBAT in addition to TAU compared with TAU only, regarding: body awareness, health-related factors and coping strategies as well as the use of the social services and psychiatric healthcare. Analysis of variance (ANOVA) repeated-measures analysis of the intention-to-treat population (n=77) revealed that the BBAT group had a significantly improved body awareness (p<0.001), attitude to the body fewer symptoms (p<0.001) and improved self-efficacy (p<0.05), from baseline to 6 months after the termination of treatment, compared with the control group. The treatment group also had a significantly less use of psychiatric treatment from healthcare professionals other than the psychiatrist (p<0.05) during 1 year after baseline and a significantly less total use of social services (p<0.05). The evidence of the positive effects as well as the lower costs for psychiatric healthcare and social services for the group that had received BBAT in addition to TAU is discussed, and it is concluded that BBAT seem an effective intervention in psychiatric outpatient care also in the long term for patients who in addition to psychiatric disorders also present somatic symptoms

Validity of the Body Awareness Scale-Health (BAS-H).

Quality of movement assessment using the Body Awareness Scale–Health (BAS-H) was validated against the following self-rating tests: Nottingham Health Profile (NHP); Arthritis Self-Efficacy Scale (ASES); Psychological General Well-Being (PGWB); Sense of Coherence (SoC); Sivic Psychosomatism test (SPS); Symptom Check List 90-R (SCL 90-R); and Visual Analogue Scale for pain intensity (VAS-pain). In total, 75 persons were included, divided into three groups: psychiatric outpatients (n = 25), chronic pain patients (n = 25) and healthy controls (n = 25). The highest significant correlations were obtained between the BAS-H total index and the sub-indices of grounding/stability to the centre line, centering/breathing and flow on the one hand, and the NHP, the ASES, and the PGWB on the other, with r ranging from 0.36 to 0.73. Multiple regression analysis revealed the NHP to explain 50% and ASES a further 5% of the variance in the BAS-H total index. Significant differences for both the BAS-H total index and the sub-indices were obtained between the two patient groups and the healthy controls. It is concluded that the construct validity of the BAS-H was found to be in accordance with theoretical expectations

Outcome of Basic body awareness therapy. A randomized controlled study of patients in psychiatric outpatient care

The aim was to study the outcome of Basic Body Awareness Therapy (Basic BAT) added to treatment as usual (TAU) compared to TAU only, for patients with mood, somatoform or personality disorders in psychiatric outpatient services. Seventy-seven patients were randomized to Basic BAT and TAU (n=38) or TAU only (n=39). Patients were assessed at baseline and after 12 sessions of Basic BAT, 3 months after baseline. At the termination of Basic BAT sessions, patients receiving Basic BAT in addition to TAU showed significant improvements concerning the quality of movements using the Body Awareness Scale-Health (BAS-H), and psychiatric symptoms and attitudes towards body and movement using the Body Awareness Scale interview, compared to the TAU-only patients. A significant improvement in favour of the patients receiving Basic BAT was also shown with regard to self-efficacy, physical coping resources and sleep. Age and sex showed no significant influence on outcome. The results indicate that Basic BAT in addition to TAU, in a relatively short intervention period improves the body awareness and attitude towards the body as well as self-efficacy, sleep and physical coping resources compared to TAU only. This study indicates a positive short-term outcome of the Basic BAT treatment. However, studies of the long-term outcome remain to be undertaken