User satisfaction in PFI and non- PFI hospitals in the UK: in particular the outpatients’ department reception/waiting areas

A thesis submitted for the degree of Doctor of Philosophy of the University of BedfordshireFew studies have been undertaken which examine the correlation between design of the receptionl/waiting areas of the outpatients' departments and the implications for Private Finance Initiative (PFI) and non-PFI hospitals, in particular the interior environment with reference to user satisfaction. This study investigates to what degree user satisfaction has been achieved in the design of the receptionlwaiting areas in PFI and non-PFI hospitals. The aim of the investigation is to determine whether user satisfaction can be achieved in PFI or non-PFI hospital environments, particular in the outpatients' department. To ascertain whether hospital environments facilitate user friendly and therapeutic characteristics/attributes conducive to user satisfaction, two strands of investigation were undertaken; a) investigation and analysis of PFI and non-PFI hospital design; b) the study of users (PFI and non-PFI) via questionnaire surveys and analysis of their perceptions. The research methods utilised combinations of qualitative information from interviews, discussions with hospital end users, architects/designers and Consortium executives. The surveys undertaken with patients, hospital staff and NHS Trust Managers provided quantitative data to measure the degree to which user satisfaction had been achieved. The main findings of the design analysis identify the strengths and weaknesses in the design of the 'main' and 'sub' reception/waiting areas respectively. The results of the patient surveys, discussions and interviews revealed more positive perceptions of the hospital facilities for PFI hospitals and a general acceptance of the hospital facilities in the non-PFI hospitals. However, the other comments section of the questionnaires reveals some psychological needs of the user were not being met. The hospital staff surveys, discussions and interviews revealed the spatial planning was not ideal for their functional needs. The survey of NHS Trust Managers, Architects/Designers and Building Contractors revealed the difficulties associated with the collaborative process and the implications for the design development process, when reflecting upon 'cost effectiveness' and 'value for money' issues. The conclusions drawn from the study suggest that there is a case for the standardisation of therapeutic environments in the development of 'new build' hospital projects via the design development and collaborative process. The recommendation (see p. 313) provides a design protoeo/that enhance and aids the design development process via selective expertise, which addresses the functional and psychological needs of the hospital end user

TESTING A MODEL OF HEALTH-RELATED QUALITY OF LIFE IN PERSONS WITH HIV AND LIVER DISEASE

Persons living with human immunodeficiency virus (HIV) are living longer and therefore are more likely to suffer significant morbidity due to potentially treatable liver diseases. Liver diseases alone have been shown to have a significant negative effect on one's health-related quality of life (HRQOL). Clinical evidence suggests that persons living with HIV and liver disease, a growing number of individuals, may have a poorer HRQOL than persons living with HIV who do not have liver disease. Thus, this study examined the multiple components of HRQOL by testing Wilson and Cleary's model in persons with HIV and in persons living with HIV and liver disease using structural equation modeling. This secondary analysis used de-identified baseline and medical record review data from a parent study testing interventions to improve medication adherence in persons living with HIV (R01 NR04749). The Wilson and Cleary model components include: biological/physiological factors (HIV viral load, CD4 counts), symptom status (Beck Depression Inventory II, Medical Outcomes Study HIV Health Survey [MOS-HIV] mental function), functional status (missed appointments, MOS-HIV physical function), general health perceptions (Perceived burden visual analogue scale, MOS-HIV health transition), and overall QOL (Satisfaction with Life Scale, MOS-HIV overall QOL). Characteristics of the individual and environment were also explored. The Wilson and Cleary (1995) model was found to be useful in linking clinical indicators to patient-related outcomes. The findings provide the foundation for development and future testing of a targeted bio-behavioral nursing intervention to improve HRQOL in persons living with HIV and liver disease

A Study Of The Impact Of Discharge Information For Surgical Patients

AIM OF THE STUDY: To establish whether the routine information surgical patients receive about the management of pain and wound care during their hospitalization is sufficient for them to care for themselves without seeking assistance from a health professional or health care agency. BACKGROUND: While there has been considerable evidence suggesting cost benefits of discharge information the health care environment is constantly changing. Contemporary issues such as increased patient participation, extensive use of technology, reduction in health care expenditure, and greater awareness of consumer rights necessitate further inquiry into the appropriateness of discharge information. METHOD: One hundred and fifty-eight adult patients discharged within a week of their operation participated in the study. A written questionnaire was distributed within 24 hours prior to discharge and a telephone interview conducted 1 to 2 weeks after discharge. At the time of discharge the majority of patients had received information. FINDINGS: Those patients who had received information were less likely to access a health facility than those who had not received information. However, the telephone interview, revealed that there was no evidence that patients who believed they were well informed within 24 hours of discharge about the management of their wound, still felt well informed 1 to 2 weeks later. CONCLUSION: Nurses need to be aware that patients who leave the hospital with little or no discharge information may not be confident in the management of their health condition and therefore may access a health facility, if even just for reassurance

Teaching units on Magabala Books: useful resources from Reading Australia's website

This article discusses the useful resources available for teachers from the Reading Australia website that was set up by the Copyright Agency. In particular, it highlights the teaching units developed around books published by Magabala Books. These units are linked to the Australian Curriculum: English and the NSW English K-10 Syllabus and introduce the work of Indigenous authors and illustrators to middle years students

Profound reduction in tamoxifen active metabolite endoxifen in a breast cancer patient treated with rifampin prior to initiation of an anti-TNFα biologic for ulcerative colitis: A case report

Background: Tamoxifen, a common anti-estrogen breast cancer medication, is a prodrug that undergoes bioactivation via cytochrome P450 enzymes, CYP2D6 and to a lesser degree, CYP3A4 to form the active metabolite endoxifen. With an increasing use of oral anti-cancer drugs, the risk for drug-drug interactions mediated by enzyme inhibitors and inducers may also be expected to increase. Here we report the first case demonstrating a potent drug-drug interaction in a real-world clinical setting between tamoxifen and rifampin in a breast cancer patient being treated concurrently for ulcerative colitis. Case presentation: We describe a patient on adjuvant tamoxifen therapy for breast cancer that was prescribed rifampin for TB prophylaxis prior to initiation of an anti-tumor necrosis factor (TNF)-α agent due to worsening ulcerative colitis. This 39 year old Caucasian woman had been followed by our personalized medicine clinic where CYP2D6 genotyping and therapeutic monitoring of tamoxifen and endoxifen levels had been carried out. The patient, known to be a CYP2D6 intermediate metabolizer, had a previous history of therapeutic endoxifen levels. Upon admission to hospital for a major flare of her ulcerative colitis a clinical decision was made to initiate an anti-TNFα biological agent. Due to concerns regarding latent TB, rifampin as an anti-mycobacterial agent was initiated which the patient was only able tolerate for 10 days. Interestingly, her plasma endoxifen concentration measured 2 weeks after cessation of rifampin was sub-therapeutic at 15.8 nM and well below her previous endoxifen levels which exceeded 40 nM. Conclusion: Rifampin should be avoided in patients on tamoxifen therapy for breast cancer unless continued tamoxifen efficacy can be assured through endoxifen monitoring. Drug-drug interactions can pose a significant risk of sub-therapeutic benefit in tamoxifen patients

Profound reduction in tamoxifen active metabolite endoxifen in a breast cancer patient treated with rifampin prior to initiation of an anti-TNFα biologic for ulcerative colitis: A case report

Background: Tamoxifen, a common anti-estrogen breast cancer medication, is a prodrug that undergoes bioactivation via cytochrome P450 enzymes, CYP2D6 and to a lesser degree, CYP3A4 to form the active metabolite endoxifen. With an increasing use of oral anti-cancer drugs, the risk for drug-drug interactions mediated by enzyme inhibitors and inducers may also be expected to increase. Here we report the first case demonstrating a potent drug-drug interaction in a real-world clinical setting between tamoxifen and rifampin in a breast cancer patient being treated concurrently for ulcerative colitis. Case presentation: We describe a patient on adjuvant tamoxifen therapy for breast cancer that was prescribed rifampin for TB prophylaxis prior to initiation of an anti-tumor necrosis factor (TNF)-α agent due to worsening ulcerative colitis. This 39 year old Caucasian woman had been followed by our personalized medicine clinic where CYP2D6 genotyping and therapeutic monitoring of tamoxifen and endoxifen levels had been carried out. The patient, known to be a CYP2D6 intermediate metabolizer, had a previous history of therapeutic endoxifen levels. Upon admission to hospital for a major flare of her ulcerative colitis a clinical decision was made to initiate an anti-TNFα biological agent. Due to concerns regarding latent TB, rifampin as an anti-mycobacterial agent was initiated which the patient was only able tolerate for 10 days. Interestingly, her plasma endoxifen concentration measured 2 weeks after cessation of rifampin was sub-therapeutic at 15.8 nM and well below her previous endoxifen levels which exceeded 40 nM. Conclusion: Rifampin should be avoided in patients on tamoxifen therapy for breast cancer unless continued tamoxifen efficacy can be assured through endoxifen monitoring. Drug-drug interactions can pose a significant risk of sub-therapeutic benefit in tamoxifen patients

The Relationship of Anti-Mullerian Hormone Levels and Urine Cortisol in Women with Chronic Abdominal Pain

Context: Persistent and intense stress leads to chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis, placing an individual at increased risk for the development of disease. HPA activity inhibits ovarian functioning, and may contribute to female infertility. Objective: The objective of the study was to explore the association of HPA activity with ovarian functioning in female participants with and without chronic abdominal pain (CAP). Design/setting/and subjects: A secondary data analysis was performed using data from female participants in a natural history protocol at the National Institutes of Health. A total of 36 females (19–39 years, mean 27.11) were included in the study. Main outcome measurements: Whole blood was drawn for determination of serum levels of anti-Mullerian hormone (AMH), luteinizing hormone, follicle stimulating hormone, and cortisol. Urine samples were collected over a five hour period for determination of cortisol levels. CAP was defined as presence or absence of chronic abdominal pain for \u3e6 months and was determined via self-report. Results: AMH concentrations declined significantly with age as expected. When AMH levels were dichotomized as normal or abnormal (defined as higher or lower than age-specific normative ranges), there were significant associations between abnormal AMH levels and CAP and urine cortisol levels. Subjects with CAP or low urine cortisol levels were significantly more likely to have abnormal AMH levels. Conclusions: Results suggest that chronic pain and HPA dysregulation may be associated with abnormal AMH levels

Integrated programs for mothers with substance abuse issues: A systematic review of studies reporting on parenting outcomes

<p>Abstract</p> <p>Background</p> <p>Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, dysfunctional parenting, and poor outcomes for mothers and children, yet there has been no systematic review of studies of parenting outcomes.</p> <p>Objectives</p> <p>As part of larger systematic review to examine the effectiveness of integrated programs for mothers with substance abuse issues, we performed a systematic review of studies published from 1990 to 2011 with data on parenting outcomes.</p> <p>Methods</p> <p>Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline, the treatment program included at least one specific substance use treatment and at least one parenting or child service, and there were quantitative data on parenting outcomes. We summarized data on parenting skills and capacity outcomes.</p> <p>Results</p> <p>There were 24 cohort studies, 3 quasi-experimental studies, and 4 randomized trials. In the three randomized trials comparing integrated programs to addiction treatment-as-usual (<it>N </it>= 419), most improvements in parenting skills favored integrated programs and most effect sizes indicated that this advantage was small, <it>d</it>s = -0.02 to 0.94. Results for child protection services involvement did not differ by group. In the three studies that examined factors associated with treatment effects, parenting improvements were associated with attachment-based parenting interventions, children residing in the treatment facility, and improvements in maternal mental health.</p> <p>Conclusions</p> <p>This is the first systematic review of studies evaluating the effectiveness of integrated programs on parenting. The limited available evidence supports integrated programs, as findings suggest that they are associated with improvements in parenting skills. However, more research is required comparing integrated programs to addiction treatment-as-usual. This review highlights the need for improved methodology, study quality, and reporting to improve our understanding of how best to meet the parenting needs of women with substance abuse issues.</p