The Effects Of Two Teaching Methodologies On Knowledge Of Insulin Administration Practices In An Older Adult Group

Approximately 11 million people are affected with acute and chronic complications of diabetes. An estimated $20 billion is spent annually on the diagnosis and management of diabetes. Client adherence to self-care practice is essential to the control of diabetes. The self-care practice of injecting insulin is imperative for the management of both patients with type 1 and type 2 diabetes. Teaching modalities which effectively increase patient knowledge about insulin administration need to be developed and implemented. Therefore, the purpose of this study was to determine whether individualized instructions or audiovisual instructions increased the knowledge of insulin administration practices in older adults. Knowles\u27 Theory of Adult Learning and King\u27s Theory of Goal Attainment were used as frameworks to guide this study. Data were collected using a researcher-designed tool. Eleven participants were selected from two metropolitan hospitals located in either an inpatient or outpatient educational setting. The majority of the sample were female (72.7%), African American (63.6%), between the ages iii of 61 and 70 years (63.6%), and all were diagnosed with type 2 diabetes. This quasi-experimental design utilized a pretest-posttest model. The researcher-designed tool was used to collect data. The two teaching interventions used in the study were individualized and audiovisual instructions. Both interventions included learning objectives with structured content, return demonstrations, and immediate evaluations. Data were analyzed using a two- tailed independent t test. There was no statistical significance in posttest scores between participants provided with individualized and audiovisual instructions (p = .301) . There were excellent return demonstrations by the participants with an average of 10 out of 11 on the performance checklist. Regardless of the teaching modalities implemented during the study, participants achieved increased knowledge levels about insulin administration evidenced by increase in knowledge (posttest) scores (p = .009). Results indicate that teaching intervention does improve knowledge level about insulin administration and performance skills for older adults. Identifying learning needs of older adults can facilitate their responses in collaborating with the I V physician and adhering to treatment plans. This study should be replicated with a larger sample size and multiple teaching modality options for older adults

"24 Hour Care – 14 Days Not At Home"

Diese Arbeit thematisiert die Auswirkungen von Pendelmigration slowakischer PersonenbetreuerInnen auf deren Familienverhältnisse. Die Legalisierung der Personenbetreuung im Rahmen des Hausbetreuungsgesetzes (2007) hat wenig daran geändert, dass es weiterhin fast ausschließlich Migrantinnen sind, die den Betreuungsmangel in Österreich lindern. Speziell für diese Diplomarbeit ausgewertete Daten der WKO geben Aufschluss über gender- und herkunftsspezifische Details zu PersonenbetreuerInnen, die ein selbstständiges Gewerbe angemeldet haben. Diese zeigen, dass es mehrheitlich Slowakinnen sind, die für gewöhnlich im zwei-wöchigen-Turnus zwischen ihrem Herkunftsland und Österreich ‚pendeln‘. Methodischer Pluralismus (intensive Literaturrecherche, Datenauswertung, eine multi-sited-ethnography in Österreich und der Slowakei) ermöglichten es mir, die transnationalen Netzwerke slowakischer PersonenbetreuerInnen und deren/dessen Angehörige zu erforschen. In dieser Arbeit werden die sozio-kulturellen sowie polit-ökonomischen Migrationsmotive slowakischer PersonenbetreuerInnen sowie die Auswirkungen dieser Arbeitsmigration auf Familienverhältnisse analysiert. Dabei zeigt sich, dass sich Haushaltsstrukturen und Geschlechterrollen, die sich über Jahrhunderte in der Slowakei etabliert haben, durch die Pendelmigration eines (weiblichen) Familienmitglieds temporär transformieren. Darüber hinaus argumentiere ich, dass Verwandtschaft im transnationalen Raum als emotionales, ökonomisches sowie soziales Netz fungiert. Ich komme zu dem Schluss, dass slowakische PersonenbetreuerInnen und deren/dessen Familien im transnationalen Raum Strategien entwickeln, um trotz geographischer Distanz emotionale Nähe leben zu können.This Thesis deals with the effects of circular migration of Slovak homecare workers on their family circumstances. Little has changed since the legalization of homecare work in Austria through the homecare worker law (2007). It is still nearly only female migrants that work in this sector. The WKO has especially generated data for this thesis on gender and ethnic details concerning home care workers that are self-employed. These show that it is mostly female Slovaks that usually work in two-week-rotations between their homeland and Austria. Pluralism of methods (intensive literature research, data evaluation, and a multi-sited-ethnography in Austria and Slovakia) made it possible to analyze the transnational networks of Slovak homecare workers and their families. In this thesis the socio-cultural, political and economic Migration motives of Slovak home care workers are explained. Furthermore the effects of working migration on their family conditions are analyzed. It shows that the structure of the households and gender roles that have been established over hundreds of years in Slovakia change temporally through the migration of a (female) family member. Furthermore I explain that kinship in transnational space affects the emotional, economic and social network. I come to the conclusion that Slovak home care workers and their families in transnational space develop strategies to overcome geographical distance and to come to terms with emotional bonds

overview and meta-analysis of neuroimaging studies on motor conversion disorder

Background Conversion Disorders (CD) are prevalent functional disorders. Although the pathogenesis is still not completely understood, an interaction of genetic, neurobiological, and psychosocial factors is quite likely. The aim of this study is to provide a systematic overview on imaging studies on CDs and investigate neuronal areas involved in Motor Conversion Disorders (MCD). Methods A systematic literature search was conducted on CD. Subsequently a meta-analysis of functional neuroimaging studies on MCD was implemented using an Activation Likelihood Estimation (ALE). We calculated differences between patients and healthy controls as well as between affected versus unaffected sides in addition to an overall analysis in order to identify neuronal areas related to MCD. Results Patients with MCD differ from healthy controls in the amygdala, superior temporal lobe, retrosplenial area, primary motor cortex, insula, red nucleus, thalamus, anterior as well as dorsolateral prefrontal and frontal cortex. When comparing affected versus unaffected sides, temporal cortex, dorsal anterior cingulate cortex, supramarginal gyrus, dorsal temporal lobe, anterior insula, primary somatosensory cortex, superior frontal gyrus and anterior prefrontal as well as frontal cortex show significant differences. Conclusions Neuronal areas seem to be involved in the pathogenesis, maintenance or as a result of MCD. Areas that are important for motor-planning, motor-selection or autonomic response seem to be especially relevant. Our results support the emotional unawareness theory but also underline the need of more support by conduction imaging studies on both CD and MCD

Chronic Pain and Sleep Disorders in Primary Care.

BACKGROUND: Chronic pain (CP) and sleep disorders (SD) are highly prevalent in the general population. However, comprehensive data regarding the prevalence and characteristics of pain and SD in primary care are rare. METHODS: From N = 578 patients N = 570 were included within 8 weeks (mean age: 50.8 ± 18.7 years, females: 289). Sociodemographic data, Insomnia Severity Index (ISI), and parts of a self-report questionnaire for pain (Multidimensional German Pain Questionnaire) were recorded and additional medical information (pain medication, sleep medication) was gathered from the patient charts. RESULTS: Of the total sample, 33.2% (n = 189) suffer from CP (pain ≥ 6 months) and 29.1% (n = 166) from SD. 45.5% of the CP patients suffer from SD and 26.5% from clinical insomnia (ISI ≥ 15). SD (β = 0.872, SE = 0.191,  t = 4,572, p < 0.001, CI [0.497; 1.246]) and older age (β = 0.025, SE = 0.005, t = 5.135, p < 0.001, CI [0.015; 0.035]) were significantly associated with pain experience. CONCLUSION: About a quarter of CP patients suffer from clinical insomnia. The suggested bidirectional relation should be considered during comprehensive assessment and treatment of patients

A Randomized Controlled Trial on Functional Relaxation as an Adjunct to Psychoeducation for Stress

This randomized controlled trial investigated whether adding the psychodynamically based body-oriented psychotherapy “Functional Relaxation” (FR) to psychoeducation (PE) is more effective than PE alone to reduce stress and stress-associated complaints. Eighty-one participants with elevated stress-levels, ≥50 points on the global scale of the Perceived Stress Questionnaire (PSQ), received either 10 sessions of manualized FR + PE (n = 42) or two sessions of manualized PE alone (n = 39) in a group setting. Six FR trainers took part in this study. Stress-level (PSQ) was the primary outcome and secondary outcomes were depression (PHQ-9) and somatization (PHQ-15). Multilevel models for discontinuous change revealed that FR + PE was more helpful to reduce stress-levels than PE from pre-treatment to post-treatment (t0 → t1) as well as from pre-treatment to 6-month follow-up (t0 → t2) (both p &lt; 0.05) with effect sizes (d) being medium for PE (dt0 → t1 = 0.57; dt0 → t2 = 0.67) and large for FR + PE (dt0 → t1 = 1.57; dt0 → t2 = 1.39). Moreover, FR + PE affected depression and somatization more positively than did PE from t0 to t1 as well as from t0 to t2 (all p &lt; 0.05). Effect sizes for depression were small to medium for PE (dt0 → t1 = 0.52; dt0 → t2 = 0.37) and large for FR + PE (dt0 → t1 = 1.04; dt0 → t2 = 0.95). Effect sizes for somatization were small for PE (dt0 → t1 = 0.18; dt0 → t2 = 0.19) and medium to large for FR + PE (dt0 → t1 = 0.73; dt0 → t2 = 0.93). In summary, the combination of FR and PE was more effective than PE alone. The results of the present trial provide first evidence of FR as a potent component of stress interventions. Adding FR to such interventions might better help prevent clinically relevant disorders such as depression or somatization

Development and Initial Validation of a Brief Questionnaire on the Patients’ View of the In-Session Realization of the Six Core Components of Acceptance and Commitment Therapy

Background: Assessing in-session processes is important in psychotherapy research. The aim of the present study was to create and evaluate a short questionnaire capturing the patients’ view of the in-session realization of the six core components of Acceptance and Commitment Therapy (ACT). Method: In two studies, psychotherapy patients receiving ACT (Study 1: n = 87) or Cognitive-Behavioral Therapy (CBT) (Study 2, Sample 1: n = 115; Sample 2: n = 156) completed the ACT session questionnaire (ACT-SQ). Therapists were n = 9 ACT therapists (Study 1) and n = 77 CBT trainee therapists (Study 2). Results: Factor structure: Exploratory factor analyses suggested a one-factor solution for the ACT-SQ. Reliability: Cronbach’s alpha of the ACT-SQ was good (Study 1: α = .81; Study 2, Sample 1: α = .84; Sample 2: α = .88). Convergent validity: The ACT-SQ was positively correlated with validated psychotherapeutic change mechanisms (p \u3c .05). Criterion validity: Higher ACT-SQ scores were associated with better treatment outcomes (p \u3c .05). Conclusion: The study provides preliminary evidence for the reliability and validity of the ACT-SQ to assess the in-session realization of the six core components of ACT in the patients’ view. Further validation studies and ACT-SQ versions for therapists and observers are necessary

Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy

Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function

Neural correlates of somatoform disorders from a meta-analytic perspective on neuroimaging studies.

Somatoform disorders (SD) are common medical disorders with prevalence rates between 3.5% and 18.4%, depending on country and medical setting. SD as outlined in the ICD-10 exhibits various biological, social, and psychological pathogenic factors. Little is known about the neural correlates of SD. The aims of this meta-analysis are to identify neuronal areas that are involved in SD and consistently differ between patients and healthy controls. We conducted a systematic literature research on neuroimaging studies of SD. Ten out of 686 studies fulfilled the inclusion criteria and were analyzed using activation likelihood estimation. Five neuronal areas differ between patients with SD and healthy controls namely the premotor and supplementary motor cortexes, the middle frontal gyrus, the anterior cingulate cortex, the insula, and the posterior cingulate cortex. These areas seem to have a particular importance for the occurrence of SD. Out of the ten studies two did not contribute to any of the clusters. Our results seem to largely overlap with the circuit network model of somatosensory amplification for SD. It is conceivable that functional disorders, independent of the clinical impression, show similar neurobiological processes. While overlaps do occur it is necessary to understand single functional somatic syndromes and their aetiology for future research, terminology, and treatment guidelines

Neural correlates of conversion disorder: overview and meta-analysis of neuroimaging studies on motor conversion disorder.

BACKGROUND: Conversion Disorders (CD) are prevalent functional disorders. Although the pathogenesis is still not completely understood, an interaction of genetic, neurobiological, and psychosocial factors is quite likely. The aim of this study is to provide a systematic overview on imaging studies on CDs and investigate neuronal areas involved in Motor Conversion Disorders (MCD). METHODS: A systematic literature search was conducted on CD. Subsequently a meta-analysis of functional neuroimaging studies on MCD was implemented using an Activation Likelihood Estimation (ALE). We calculated differences between patients and healthy controls as well as between affected versus unaffected sides in addition to an overall analysis in order to identify neuronal areas related to MCD. RESULTS: Patients with MCD differ from healthy controls in the amygdala, superior temporal lobe, retrosplenial area, primary motor cortex, insula, red nucleus, thalamus, anterior as well as dorsolateral prefrontal and frontal cortex. When comparing affected versus unaffected sides, temporal cortex, dorsal anterior cingulate cortex, supramarginal gyrus, dorsal temporal lobe, anterior insula, primary somatosensory cortex, superior frontal gyrus and anterior prefrontal as well as frontal cortex show significant differences. CONCLUSIONS: Neuronal areas seem to be involved in the pathogenesis, maintenance or as a result of MCD. Areas that are important for motor-planning, motor-selection or autonomic response seem to be especially relevant. Our results support the emotional unawareness theory but also underline the need of more support by conduction imaging studies on both CD and MCD