Deconstructing (e)health literacy: aspects that promote and inhibit understanding of health information in breast cancer patient pathways

Purpose: Deconstructing current definitions of “health literacy (HL)” and “eHealth literacy (eHL)”, into the core notion of “understanding health information (HI)”, this study provides insights into what promotes and inhibits the understanding of HI for breast cancer patients during cancer patient pathways (CCP) in Norway. Methods: Seven well-educated women were interviewed. Through a stepwise deductive-inductive analysis of the transcribed interviews, the following topics were identified: 1) explanations accompanied by drawings, 2) individualized knowledge-based information, 3) information processing capacity, and 4) ambiguity in medical information. Results: The women's understanding of HI increased when spoken communication was accompanied by visual illustrations, which served as roadmaps throughout the CPP. Even if HI should be targeted to the patients’ individual needs, some HI can be generalized if it refers to established knowledge about the health phenomena. The women described their changing mental and physical status during the CPP and how these changes influenced their understanding of HI. Conclusion: The results challenge the idea that HL and eHL are fixed, stable, personal characteristics. On the contrary, HL/eHL, in this case particularly the understanding of HI, depends on the individual (temporary) physical and cognitive capacity of the patient and adaptation in the institutional and private contexts.publishedVersio

Configuring Secretarial Workflows in the Epic EHR Suite

The primary goal of large-scale electronic health record (EHR) suites is to meet the needs of a broad range of users in healthcare institutions. EHR suites are extensively configurable, which makes it possible to tailor them to diverse professional practices and users. However, while users such as physicians and nurses may have clearly defined responsibilities, clerical personnel (i.e. secretaries) conduct “in-between” or invisible work that is not as easily defined. Therefore, it may be more difficult to tailor EHR suites to their needs. Moreover, because secretaries are quite low in the hospital hierarchy, it is difficult for them to obtain satisfactory solutions. In this paper, we explore the challenges of configuring the EHR suite for secretary workflows in the Health Platform program in central Norway

Effects of intrauterine exposure to synthetic glucocorticoids on fetal, newborn, and infant hypothalamic-pituitary-adrenal axis function in humans : a systematic review

BACKGROUND: Synthetic glucocorticoids are commonly used in reproductive medicine. Fetal organ systems are highly sensitive to changes in the intrauterine environment, including overexposure to glucocorticoids. Structural and functional alterations resulting from such changes may persist throughout life and have been associated with diverse diseases. One system that could be particularly sensitive to fetal glucocorticoid overexposure is the hypothalamic-pituitary-adrenal (hpa) axis. Many human studies have investigated this possibility, but a systematic review to identify consistent, emergent findings is lacking. METHODS: We systematically review 49 human studies, assessing the effects of intrauterine exposure to synthetic glucocorticoids on fetal, neonate, and infant hpa function. RESULTS: Study quality varied considerably, but the main findings held true after restricting the analyses to higher-quality studies: intrauterine exposure to synthetic glucocorticoids reduces offspring hpa activity under unstimulated conditions after pain but not pharmacological challenge. Although reduced unstimulated hpa function appears to recover within the first 2 wk postpartum, blunted hpa reactivity to pain is likely to persist throughout the first 4 months of life. There is some evidence that the magnitude of the effects is correlated with the total amount of glucocorticoids administered and varies with the time interval between glucocorticoid exposure and hpa assessment. CONCLUSIONS: This systematic review has allowed the demonstration of the way in which intrauterine exposure to various regimens of synthetic glucocorticoids affects various forms of hpa function. As such, it guides future studies in terms of which variables need to be focused on in order to further strengthen the understanding of such therapy, whilst continuing to profit from its clinical benefits

Determining the Level of Knowledge of UND College Women in Their Childbearing Years Regarding Exercise during Pregnancy

With an increase in the number of pregnant women exercising, there is an increased need for patient education and the distribution of updated guidelines to promote appropriate exercise activities. PURPOSE: The purpose of this study was to determine the level of knowledge in English-speaking, college women in their childbearing years attending the University of North Dakota regarding the risks, precautionary measures and recommended modes of exercise during pregnancy. SUBJECTS & METHODS: Eighty-four women between the ages of 18 and 40 enrolled in the summer school session completed a thirty-one question survey. The survey was used to gather information about the training needs of college women regarding their understanding of risk factors associated with participating in exercise during pregnancy. RESULTS: It was found that the women had a significantly low level of knowledge of the risks, precautionary measures, and modes of exercise during pregnancy. It was also found that the women had a significantly lower amount of knowledge ofthe risks (X=32.59 +/ -20.44, p\u3c.OOI), as compared to the precautionary measures (X=49.7 +/ -20.90, p\u3c.OOI) or modes of exercise (X=45.54 +/-24.75, p\u3c.OOI). CONCLUSION: College women between the ages of 18 and 40 do not have a good understanding concerning the risks of exercise, precautionary measures to be implemented, and recommended modes of exercise associated with pregnancy. DISCUSSION: The low scores may be contributed to factors such as no previous experience( s) of pregnancy or the size of city in which the participants had lived the longest. The information obtained from this study may guide the development of appropriate educational tools and instructional protocols, and may serve as a precursor for future research

Kan revisor være til nytte ved konkursprediksjon?

I denne avhandlingen har vi undersøkt hvilke faktorer som kan være med på å forklare en konkurs. Vi har sett på økonomiske variabler, i form av nøkkeltall, og revisors vurdering av fortsatt drift-forutsetning. Vår problemstilling er som følger: "I hvilken grad kan revisors vurdering av fortsatt drift-forutsetningen være til nytte ved konkursprediksjon?" For å undersøke revisors vurdering av fortsatt drift-forutsetning studerte vi merknader i revisjonsberetningen. Under revisjon skal revisor ta stilling til ledelsens vurdering av fortsatt drift, og om denne er korrekt

Patient experiences of waiting times in standardised cancer patient pathways in Norway – a qualitative interview study

Objective - Standardised cancer patient pathways (CPP) are implemented within cancer care with an aim to ensure standardised waiting times for diagnosis and treatment. This article investigates how patients in Norway experience waiting times within a CPP. Methods - Qualitative semi-structured interviews with 19 patients who had been through CPP for breast cancer, prostate cancer or malignant melanoma in Norway. Results - Few patients knew about the term CPP but trusted that waiting times were standardised to decrease mortality. Their experiences of waiting depended on their expectations as much as the period they waited. Patients generally felt safe about the timing of treatment, but not all expectations of a rapid response from health services were met. Short waiting times were interpreted as a sign of urgency, and a change of pace between urgent action and prolonged periods of waiting were disturbing. Conclusions - Patients are comforted by knowing they are within a structured CPP that ensures rapid diagnosis and start of treatment. CPPs still need to be improved to avoid delays, allow for adaptions to patient needs, and include more information to avoid stress

Deconstructing (e)health literacy: aspects that promote and inhibit understanding of health information in breast cancer patient pathways

Purpose Deconstructing current definitions of “health literacy (HL)” and “eHealth literacy (eHL)”, into the core notion of “understanding health information (HI)”, this study provides insights into what promotes and inhibits the understanding of HI for breast cancer patients during cancer patient pathways (CCP) in Norway. Methods Seven well-educated women were interviewed. Through a stepwise deductive-inductive analysis of the transcribed interviews, the following topics were identified: 1) explanations accompanied by drawings, 2) individualized knowledge-based information, 3) information processing capacity, and 4) ambiguity in medical information. Results The women's understanding of HI increased when spoken communication was accompanied by visual illustrations, which served as roadmaps throughout the CPP. Even if HI should be targeted to the patients’ individual needs, some HI can be generalized if it refers to established knowledge about the health phenomena. The women described their changing mental and physical status during the CPP and how these changes influenced their understanding of HI. Conclusion The results challenge the idea that HL and eHL are fixed, stable, personal characteristics. On the contrary, HL/eHL, in this case particularly the understanding of HI, depends on the individual (temporary) physical and cognitive capacity of the patient and adaptation in the institutional and private contexts