Measuring health outcomes of a multidisciplinary care approach in individuals with chronic environmental conditions using an abbreviated symptoms questionnaire

The Nova Scotia Environmental Health Centre is a treatment facility for individuals with chronic environmental conditions such as multiple chemical sensitivity, chronic fatigue syndrome, fibromyalgia, chronic respiratory conditions and in some cases chronic pain. The premise of care is to provide a patient-centred multidisciplinary care approach leading to self-management strategies. In order to measure the outcome of the treatment in these complex problems, with overlapping diagnoses, symptoms in many body systems and suspected environmental triggers, a detailed symptoms questionnaire was developed specifically for this patient population and validated. Results from a pilot study in which an abbreviated symptoms questionnaire based on the top reported symptoms captured in previous research was used to measure the efficacy of a multidisciplinary care approach in individuals with multiple chemical sensitivity are presented in this paper. The purpose of this study was to examine the extent, type and patterns of changes over time in the top reported symptoms with treatment measured using the abbreviated symptoms questionnaire. A total of 183 active and 109 discharged patients participated in the study where the health status was measured at different time periods of follow up since the commencement of treatment at the Centre. The findings from this study were successful in generating an initial picture of the nature and type of changes in these symptoms. For instance, symptoms such as difficulty concentrating, sinus conditions and tiredness showed early improvement, within the first 6 months of being in treatment, while others, such as fatigue, hoarseness or loss of voice, took longer while others showed inconsistent changes warranting further enquiry. A controlled longitudinal study is planned to confirm the findings of the pilot study

A controlled study of the effect of a mindfulness-based stress reduction technique in women with multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia

Tara Sampalli1, Elizabeth Berlasso1, Roy Fox1, Mark Petter21Nova Scotia Environmental Health Centre, Fall River, Nova Scotia, Canada; 2Doctoral Candidate, Department of Psychology, Dalhousie University, Halifax, CanadaBackground: The objective of this study was to examine the effect of a mindfulness-based stress reduction (MBSR) program on women diagnosed with conditions such as multiple chemical sensitivity (MCS), chronic fatigue syndrome (CFS), and fibromyalgia (FM). Methods: The intervention group underwent a 10-week MBSR program. Symptoms Checklist Inventory (SCL-90R) was used as outcome measure and was administered before the start of the program (pre-), immediately upon completion (post-) and at three-month follow-up. Women on the wait list to receive treatment at the Nova Scotia Environmental Health Centre were used as control subjects for the study.Results: A total of 50 participants in the intervention group and 26 in the wait-list controls group were recruited for this study. Global scores in the intervention group reached statistical significance pre-post (<0.0001) and at pre-follow-up (<0.0001) while the global scores in the control group remained the same. Five of nine and eight of nine subscales of the SCL-90R showed improvement of statistical significance in MBSR group following treatment and at three-month follow-up.Conclusions: The study showed the importance of complementary interventions such as MBSR techniques in the reduction of psychological distress in women with chronic conditions.Keywords: chronic conditions, multiple chemical sensitivity, mindfulness-based stress reduction, chemical sensitivit

An evaluation of SNOMED CT® in the domain of complex chronic conditions

<p style="margin: 0pt; line-height: 200%; mso-layout-grid-align: none;"><strong>Objective</strong>: To determine the content coverage in SNOMED CT<strong style="mso-bidi-font-weight: normal;">®</strong> to represent the multidisciplinary terms and concepts in the domain for complex chronic conditions</p><p style="margin: 0pt; line-height: 200%; mso-layout-grid-align: none;"><strong>Methods</strong>: An evaluation of the coverage of multidisciplinary health factors in SNOMED CT<strong style="mso-bidi-font-weight: normal;">®</strong> for the complex and chronic condition, Multiple Chemical Sensitivity (MCS) is conducted in the study. The methodology included a retrospective audit of patient charts and feedback from multidisciplinary clinicians in the creation of a controlled vocabulary used in the generation of patient profiles for MCS. Clinicians and experts in the field reviewed and tested the vocabulary for its usefulness (scope, specificity and structure) by re-coding 3 patient profiles using the vocabulary. Cohen's kappa analysis was conducted to determine inter-rater reliability. Cronbach's alpha analysis was conducted to determine the internal reliability of the survey questionnaire.</p><p style="margin: 0pt; line-height: 200%; mso-layout-grid-align: none;"><strong>Results</strong>: One hundred patient charts and 9 clinicians from varying health disciplines participated in the study. SNOMED CT<strong style="mso-bidi-font-weight: normal;">®</strong> was shown to capture nearly 82% of the concepts spanning multidisciplinary areas of health focus. The nutrition area of health focus had the highest level of exact matches Furthermore post-coordination was applied in an attempt to improve coverage of concepts to 75% ( of 45 terms) of the missing terms in SNOMED CT ® . Seventy-five percent (n=9) of the clinicians agreed on the overall usefulness of the vocabulary.</p><p style="margin: 0pt; line-height: 200%; mso-layout-grid-align: none;"><strong>Conclusions</strong>: SNOMED CT® had a reasonable coverage of the multidisciplinary health concepts required to describe a complex and chronic condition. Standardizing the multidisciplinary vocabulary with reference tag to a widely used reference terminology such as SNOMED CT® to discuss the terms and concepts used may improve the understanding across disciplines and communities of practice. Overall, based on the availability of concepts in SNOMED CT® and the feedback from clinicians, the approach looks promising and should be further explored.</p

Myness, Ourness and Otherness: A Heuristic Film-based Exploration of Countertransference with LGBTQ Clients with Internalized Homophobia

This paper utilizes a heuristic arts-based inquiry to explore the author’s countertransference while working as a drama therapist with an LGBTQ group living with internalized homophobia. The paper contains a literature synthesis spanning topics of internalized homophobia, psychotherapy and creative arts therapies with LGBTQI individuals as well as the methodology used by the author to understand his experience of the working with the said group as a drama therapist. The heuristic methodology provides a framework and a context for the arts process in accomplishing the aims of the above inquiry. The research process will be informed by the Moustakas model of heuristic research, which includes the six steps in heuristic methodology. The last step of this research involves a film presentation that captures the author’s experience and ends with some reflections on the process

A security suite for wireless body area networks

Wireless Body Area Networks (WBANs) have gained a lot of research attention in recent years since they offer tremendous benefits for remote health monitoring and continuous, real-time patient care. However, as with any wireless communication, data security in WBANs is a challenging design issue. Since such networks consist of small sensors placed on the human body, they impose resource and computational restrictions, thereby making the use of sophisticated and advanced encryption algorithms infeasible. This calls for the design of algorithms with a robust key generation / management scheme, which are reasonably resource optimal. This paper presents a security suite for WBANs, comprised of IAMKeys, an independent and adaptive key management scheme for improving the security of WBANs, and KEMESIS, a key management scheme for security in inter-sensor communication. The novelty of these schemes lies in the use of a randomly generated key for encrypting each data frame that is generated independently at both the sender and the receiver, eliminating the need for any key exchange. The simplicity of the encryption scheme, combined with the adaptability in key management makes the schemes simple, yet secure. The proposed algorithms are validated by performance analysis.Comment: 20 pages, 10 figures, 3 tables, International Journal of Network Security & its Applications (IJNSA

Mobile IP Address Efficiency

In future wireless networks, Mobile IP will be widely deployed as a general mobility protocol. Currently, in the protocol each mobile node (MN) should have one public home address to identify itself when it is away from home. Unlike the stationary host, the MN cannot simply use private addresses when NAT (Network Address Translation) is enabled. How to assign public addresses among mobile nodes is important to save the already limited IPv4 addresses. Even though Mobile IPv6 can provide a large address space, when communicating with IPv4 based hosts, the MN still needs to use one public IPv4 address. Protocol translation can map between IPv6 and IPv4 addresses; however, it is a NAT-based approach and breaks end-to end communications. From a new perspective, we propose an address-sharing mechanism that allows a large number of MNs to share only one IPv4 public address while avoiding most of the drawbacks of NAT

Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

Background: Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Methods:Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. Results:The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Conclusion: Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions

RFID Mutual Authentication Protocols based on Gene Mutation and Transfer

Radio Frequency Identification (RFID) is a technology that is very popular due to the simplicity in its technology and high adaptability in a variety of areas. The simplicity in the technology, however, comes with a caveat – RFID tags have severe resource restrictions, which make them vulnerable to a range of security attacks. Such vulnerability often results in the loss of privacy of the tag owner and other attacks on tags. Previous research in RFID security has mainly focused on authenticating entities such as readers / servers, which communicate with the tag. Any security mechanism is only as strong as the encryption keys used. Since RFID communication is wireless, critical messages such as key exchange messages are vulnerable to attacks. Therefore, we present a mutual authentication protocol that relies on independent generation and dynamic updates of encryption keys thereby removing the need for key exchange, which is based on the concept of gene mutation and transfer. We also present an enhanced version of this protocol, which improves the security offered by the first protocol. The novelty of the proposed protocols is in the independent generation, dynamic and continuous updates of encryption keys and the use of the concept of gene mutation / transfer to offer mutual authentication of the communicating entities. The proposed protocols are validated by simulation studies and security analysis

Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping

Background: Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Methods: Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. Results: The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Conclusion: Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions