Patient Experiences of Structured Heart Failure Programmes

Objectives. Patient experiences of structured heart failure rehabilitation and their views on the important components of heart failure services were examined. Methods. Focus groups were conducted with fifteen participants (men, n = 12) attending one of two heart failure rehabilitation programmes. Sessions were guided by a semistructured interview schedule covering participants' experiences of the programme, maintenance, and GP role. Focus group transcripts were analysed qualitatively. Results. Participants indicated that rehabilitation programmes substantially met their needs. Supervised exercise sessions increased confidence to resume physical activity, while peer-group interaction and supportive medical staff improved morale. However, once the programme ended, some participants' self-care motivation lapsed, especially maintenance of an exercise routine. Patients doubted their GPs' ability to help them manage their condition. Conclusion. Structured rehabilitation programmes are effective in enabling patients to develop lifestyle skills to live with heart failure. However, postrehabilitation maintenance interventions are necessary to sustain patients' confidence in disease self-management

Communication skills training in undergraduate medicine.

Good communication with patients is now recognised as the cornerstone in effective medical practice. Medical students do not automatically acquire the art of good communication through clinical training. A new course to promote the development of communication skills at undergraduate level is described. The course was provided at the juncture between pre-clinical and clinical training. Course evaluation illustrated the value of the course as perceived by students themselves and highlighted the areas of greatest need for students in communication skills training

Secular trends in child and adult sexual violence--one decreasing and the other increasing: a population survey in Ireland.

BACKGROUND: Sexual violence is a worldwide problem affecting children and adults. Knowledge of trends in prevalence is essential to inform the design and evaluation of preventive and intervention programmes. We aimed to assess the prevalence of lifetime sexual violence for both sexes and to document the prevalence of adult and child abuse by birth year in the general population. METHODS: National cluster-randomized telephone interview study of 3120 adults in Ireland was done. RESULTS: Child sexual abuse involving physical contact was reported by 20% of women and 16% of men. In adulthood, figures were 20% and 10% for women and men, respectively. Prevalence of any form of sexual violence across the lifespan was 42% (women) and 38% (men). Analysis by year of birth indicated a curvilinear pattern for child sexual abuse with lower prevalence in the oldest and youngest participants. Sexual violence in young adulthood showed a linear pattern with higher prevalence in the youngest participants. CONCLUSION: The trend of lower rates of experience of child sexual abuse in younger adults in the sample is in keeping with findings from other countries. The trend of higher rates of adult sexual violence in younger adults is worrying, particularly since the same participants reported less experience of child sexual abuse than the preceding generations. There is a paucity of international data addressing the issue of cohort differences in exposure to sexual violence. Within-study analysis, and follow-up studies designed to maximize replicability, are needed to inform discussion about societal trends in different types of sexual violence

Promoting Healthy Behaviour Choices: Understanding Patient Challenges by Undertaking a Personal Behaviour Change Task

INTRODUCTION: Unhealthy behaviours such as poor diet, smoking and physical inactivity contribute significantly to chronic disease. Our first year medical school project aims to increase student awareness of: the importance of these behaviours and their systematic measurement; recommended behaviour targets in health professional guidelines; challenges in achieving patient behaviour change; and psychological theories which aid behaviour change. METHODS: Students are provided with evidence-based health behaviour guidelines for prevention of heart disease. Students select whichever behaviour they would personally like to achieve improvement in, systematically record behaviour for one week (baseline), and then try to implement (healthy) behaviour change for the next two weeks, using psychological theory as an aide. Students report their results and discuss outcomes reflecting on explanations for the success or otherwise of their behaviour attempts. A virtual learning environment (Moodle) ensures project engagement and completion during the relevant timeframes. RESULTS: This assignment has been successfully completed by students over previous academic years. The use of deadlines for uploading sections of coursework to Moodle (e.g. baseline data) has increased the quality and completeness of the projects. Students learn to use standard instruments such as the Fagerstrom Test for Nicotine Dependence and also learn recommended professional guidelines on diet and physical activity at an early point in a medical training. Also, self-reported health behaviours improved over the course of the assignment. CONCLUSIONS: This project allows students to test the difficulty of adhering to professional advice they themselves will give to future patients. The assignment combines knowledge (e.g. education on chronic conditions, on the role of behaviour change and on professional guidelines), skills (e.g. documenting behaviours, planning and implementing change) and attitudes (e.g. on understanding the difficulties encountered by individuals when making and sustaining recommended behaviour change). The novel use of a virtual learning environment ensures high participation

Communication skills training in undergraduate medicine: attitudes and attitude change.

The importance of communication skills training in undergraduate medical education is now widely accepted. However little is known about student attitudes towards their own communication skills and whether their attitudes changes as a result of participating in communication skills courses. The aim of the present study was to identify these attitudes prior to commencing such a course and to further evaluate changes in these attitudes on completion of the course. Results demonstrated an improvement in perceived confidence regarding a number of specific communication skills. The study provides further evidence of the value of such courses in undergraduate medical training

Assessing the quality of life of the individual: the SEIQoL with a healthy and a gastroenterology unit population

Current methods of measuring quality of life (QoL) impose an external value system on individuals, rather than allowing them to describe their lives in terms of those factors which they consider important. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) was developed to overcome such limitations. The QoL of 42 healthy attenders at an international immunization clinic was assessed using SEIQoL. Judgement reliability was high (r = 0·74) and individuals' judgement policies accounted for a large percentage of the variance in overall QoL (R2 = 0·75) demonstrating the construct validity of judgement analysis in this context. In a second study of QoL of out-patients suffering from irritable bowel syndrome (IBS) (N = 20) or peptic ulcer disease (PUD) (N = 20) was assessed using SEIQoL. Judgement reliability was lower (r = 0·54) although statistically highly significant (P < 0·01), and the variance in overall QoL judgements explained was high (R2 = 0·74). SEIQoL is an acceptable, reliable and valid technique for measuring individual QoL that takes greater account of individual perspectives than traditional measurement approache

Recruitment using mobile telephones in an Irish general population sexual health survey: challenges and practical solutions

BACKGROUND: Non-coverage of households without a landline telephone is a major concern of telephone survey researchers. Sampling mobile telephone users in national surveys is vital in order to gain access to the growing proportion of households that use mobile telephones extensively or exclusively. The complex logistics of conducting surveys with mobile telephones have been discussed in the literature. This paper outlines the actual challenges encountered during a recent national sexual health survey in Ireland, which utilized a mobile telephone sampling frame to recruit approximately half of the sample. METHOD: The 2010 Irish Contraception and Crisis Pregnancy Survey (ICCP-2010) is a nationally representative sample of adults aged 18-45 years living in Ireland (n = 3002; 1416 recruited by landline telephone and 1586 recruited by mobile telephone). The overall response rate for the survey was 69% (79% for the landline telephone strand; 61% for the mobile telephone strand). All interviews were conducted using computer-assisting telephone interviewing. RESULTS: During the 18-week fieldwork period, five main challenges relating to the use of mobile telephones were encountered: (1) explaining to respondents how random digit dialling works in relation to mobile telephones; (2) establishing the respondent\u27s eligibility; (3) calling the respondent with the Caller ID blocked or withheld; (4) calling the respondent when they are in any number of locations or situations; and (5) explaining to respondents the importance of refusal conversion calls for the response rate calculation. Details of how the survey protocols and procedures were monitored and adapted throughout the study to ensure a high response rate are outlined. CONCLUSION: It is undeniably more challenging to recruit respondents using mobile telephones as opposed to landline telephones. Respondents are generally not familiar with being contacted on their personal mobile telephone for the purposes of being recruited for a research study. The main challenge for survey methodologists and interviewers is to devise simple protocols to explain to respondents why they are being contacted on a mobile telephone. Recommendations for survey researchers interested in using this methodological approach in the future are discussed

Cross-sectional validation of the Aging Perceptions Questionnaire: a multidimensional instrument for assessing self-perceptions of aging

<p>Abstract</p> <p>Background</p> <p>Self-perceptions of aging have been implicated as independent predictors of functional disability and mortality in older adults. In spite of this, research on self-perceptions of aging is limited. One reason for this is the absence of adequate measures. Specifically, there is a need to develop a measure that is theoretically-derived, has good psychometric properties, and is multidimensional in nature. The present research seeks to address this need by adopting the Self-Regulation Model as a framework and using it to develop a comprehensive, multi-dimensional instrument for assessing self-perceptions of aging. This study describes the validation of this newly-developed instrument, the Aging Perceptions Questionnaire (APQ).</p> <p>Methods</p> <p>Participants were 2,033 randomly selected community-dwelling older (+65 yrs) Irish adults who completed the APQ alongside measures of physical and psychological health. The APQ assesses self-perceptions of aging along eight distinct domains or subscales; seven of these examine views about own aging, these are: timeline chronic, timeline cyclical, consequences positive, consequences negative, control positive, control negative, and emotional representations; the eighth domain is the identity domain and this examines the experience of health-related changes.</p> <p>Results</p> <p>Mokken scale analysis showed that the majority of items within the views about aging subscales were strongly scalable. Confirmatory factor analysis also indicated that the model provided a good fit for the data. Overall, subscales had good internal reliabilities. Hierarchical linear regression was conducted to investigate the independent contribution of APQ subscales to physical and psychological health and in doing so determine the construct validity of the APQ. Results showed that self-perceptions of aging were independently related to physical and psychological health. Mediation testing also supported a role for self-perceptions of aging as partial mediators in the relationship between indices of physical functioning and physical and psychological health outcomes.</p> <p>Conclusion</p> <p>Findings support the complex and multifaceted nature of the aging experience. The good internal reliability and construct validity of the subscales suggests that the APQ is a promising instrument that can enable a theoretically informed, multidimensional assessment of self-perceptions of aging. The potential role of self-perceptions of aging in facilitating physical and psychological health in later life is also highlighted.</p

Nine-year comparison of presentation and management of acute coronary syndromes in Ireland: a national cross-sectional survey

BACKGROUND: Shorter time to treatment is associated with lower mortality in acute coronary syndromes (ACS). A previous (1994) survey showed substantial delays for acute myocardial infarction (AMI) in Ireland. The present study compared current practice with 1994 and surveyed acute coronary syndromes as a more complete contemporary evaluation of critical cardiac care than assessing AMI alone. METHODS: Following ethics committee approval, all centres (N = 39) admitting acute cardiac patients to intensive/coronary care unit provided information on 1365 episodes. A cross-sectional survey design was employed. RESULTS: Since 1994, median hospital arrival to thrombolysis time was reduced by 41% (76 to 45 minutes). Thrombolysis was delivered more often in the emergency department in 2003 (48% vs 2%). Thrombolysis when delivered in the emergency department was achieved faster than thrombolysis delivered in intensive/coronary care (35 mins v 60 mins; z = 5.62, p < .0001). Suspected AMI patients who did not subsequently receive thrombolysis took longer to present to hospital (5 h vs 2 h 34 mins; z = 7.33, p < .0001) and had longer transfer times to the intensive/coronary care unit following arrival (2 h 17 mins vs 1 h 10 mins; z = 8.92, p < .0001). Fewer confirmed AMI cases received thrombolysis in 2003 (43% vs 58%). There was an increase in confirmed cases of AMI from 1994 (70% to 87%). CONCLUSIONS: Substantial improvements in time to thrombolysis have occurred since 1994, probably relating to treatment provision in emergency departments. Patient delay pre-hospital is still the principal impediment to effective treatment of ACS. A recent change of definition of AMI may have precluded an exact comparison between 1994 and 2003 data