Patients Reasons for Choosing Office-based Buprenorphine: Preference for Patient-Centered Care

Objectives - To explore HIV-infected patients\u27 attitudes about buprenorphine treatment in office-based and opioid treatment program (OTP) settings. Methods - We conducted in-depth qualitative interviews with 29 patients with co-existing HIV infection and opioid dependence seeking buprenorphine maintenance therapy in office-based and OTP settings. We used thematic analysis of transcribed audiorecorded interviews to identify themes. Results - Patients voiced a strong preference for office-based treatment. Four themes emerged to explain this preference. First, patients perceived the greater convenience of office-based treatment as improving their ability to address HIV and other healthcare issues. Second, they perceived a strong patient-focused orientation in patient-provider relationships underpinning their preference for office-based care. This was manifest as increased trust, listening, empathy, and respect from office-based staff and providers. Third, they perceived shared power and responsibility in officebased settings. Finally, patients viewed office-based treatment as a more supportive environment for sobriety and relapse prevention. This was partly due to strong therapeutic alliances with office-based staff and providers who prioritized a harm reduction approach, but also due to the perception that the office-based settings were safer for sobriety, compared with increased opportunities for purchasing and using illicit opiates in OTP settings. Conclusions - HIV-infected patients with opioid dependence preferred office-based buprenorphine because they perceived it as offering a more patient-centered approach to care compared with OTP referral. Office-based buprenorphine may facilitate engagement in care for patients with co-existing opioid dependence and HIV infection

Training older adults to use automatic teller machines.

The present study assessed the success of several instructional programs in teaching the use of automatic teller machines (ATMs). Fifty-six older adults (aged 61 to 81) participated in the study, randomly assigned to each of four, 14-member groups. The description group received only a general overview of an ATM; the text guide group received written instructions for performing various transactions on an ATM; the pictorial guide group received written instructions accompanied by pictures of corresponding ATM screens; and the online tutorial group completed a step-by-step tutorial on a simulated ATM. Participants practiced on an ATM simulator. They were tested after a 24-h interval on their ability to perform familiar transactions on an unfamiliar ATM simulator and to perform completely novel transactions. Accuracy was best for the online tutorial group, intermediate for the text and pictorial guide groups, and worst for the description group. These data demonstrate both the importance of providing older adults with ATM training and the fact that the type of training influences the level of performance. The online tutorial, which provided specific practice on the task components, best facilitated acquisition and transfer performance

Design Considerations for Technology Interventions to Support Social and Physical Wellness for Older Adults with Disability

Social and physical wellness are important considerations for maintaining one’s health into older age and remaining independent. However, some segments of the older adult population, such as those aging with disability, are at increased risk for loneliness and reduced physical activity, which could result in negative health consequences. There is a critical need to understand how to deploy social and physical wellness interventions for people aging with disability. We provide an overview of constructs related to social and physical wellness, as well as evidence-based interventions effective with older populations. Our review yields considerations for how interventions may need to be developed or modified to be efficacious for this population segment. Technology may be a key component in adopting interventions, particularly tele-technologies, which we define and discuss in depth.<br /

Promoting patient engagement with self-management support information: a qualitative meta-synthesis of processes influencing uptake

<p>Abstract</p> <p>Background</p> <p>Patient information has been viewed as a key component of self-management. However, little attention has been given to methods of dissemination or implementation of effective information strategies. Previous problems identified with the use and implementation of patient information point to the need to explore the way in which patients engage with and use information to support self-management for chronic conditions.</p> <p>Methods</p> <p>Four published qualitative studies from a programme of research about self-management were analysed as a group; these included studies of the management of inflammatory bowel disease (IBD); self-help in anxiety and depression (SHADE); menorrhagia, treatment, information, and preference (MENTIP) study; and self-help for irritable bowel syndrome (IBS). For the analysis, we used an adapted meta-ethnographic approach to the synthesis of qualitative data in order to develop an evidence base.</p> <p>Results</p> <p>The ontological status and experience of the condition in everyday life was the most dominant theme to emerge from this synthesis. This, coupled with access to and experience of traditional health services responses, shaped the engagement with and use of information to support self-management. Five key elements were found which were likely to influence this: the perception and awareness of alternative self-management possibilities; the prior extent and nature of engagement with information; the extent of and ability to self-manage; opportunities for use of the information and the stage of the illness career; and congruence and synergy with the professional role.</p> <p>Conclusion</p> <p>People with chronic conditions need support from providers in both supply and engagement with information, in a way which gives legitimacy to the person's own self-management strategies and possible alternatives. Thus, a link could usefully be made between information offered, as well as patients' past experiences of self-management and engagement with services for their condition. The timeliness of the information should be considered, both in terms of the illness career and the type of condition (<it>i.e</it>., before depression gets too bad or time to reflect on existing knowledge about a condition and how it is to be managed) and in terms of the pre-existing relationship with services (<it>i.e</it>., options explored and tried).</p> <p>More considered use of information (how it is provided, by whom, and at what point it should be introduced) is key to facilitating patients' engagement with and therefore use of information to support self-management.</p

Higher carbohydrate intake is associated with increased risk of allâ cause and diseaseâ specific mortality in head and neck cancer patients: results from a prospective cohort study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145268/1/ijc31413.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145268/2/ijc31413-sup-0001-suppinfo01.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145268/3/ijc31413_am.pd

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program