The lived experience of nonpsychiatric hospitalization for persons with severe mental illness

textPeople with severe mental illness experience medical comorbidities to a greater extent than the general population. When hospitalized in general hospital settings, they experience poorer outcomes and are experienced as difficult by nurses. An understanding of the experience of hospitalization from the patient's perspective is important to improving care and outcomes for this population. The purpose of this study was to explore the lived experience of nonpsychiatric hospitalization for persons with severe mental illness. Heideggarian phenomenology provided the philosophical underpinning and informed the methodology employed. Participants were recruited through mental health providers. Ten individuals with severe mental illness participated in minimally structured interviews and described their experience of hospitalization on a medical-surgical unit. Data, including transcribed interviews and field notes, were analyzed within the hermeneutic tradition as described by Cohen et al. (2000). The lived experience of nonpsychiatric hospitalization was expressed in four themes: taking care of me (subthemes: being cared for, not being cared for), it's my life, on my toes (subthemes: needing an advocate, managing my mental health), and being a good patient. Care providers' comportment, perception of the patient's illness, attentiveness, responsiveness, and personalized caring behaviors characterized the participant experience of being cared for or not being cared for. It's my life reflected participants' desire to be informed and involved so they could contribute to their recovery. Participants felt the need to be on my toes in order to look out for and advocate for themselves. The need to be on my toes extended to the management of a chronic illness while hospitalized for an unrelated acute condition. The final theme reflected the perceived patient role obligation to be a "good patient". Findings were consistent with the literature regarding experiences of hospitalization from the perspective of persons without mental illness. Identified themes emphasize the critical importance of the nurse-patient relationship to the patient experience. There are significant implications for how nurses come to know their patients in medical-surgical settings so that they can effectively personalize care. Reflective practices may empower nurses to solicit assistance and support to improve caring practicesNursin

Firm Level Behavior in Repeated R&D Races

This paper contains an analysis of a quality ladders growth model with firm-level decreasing returns R&D technology. This analysis explains the relationship between competition in R&D races and firm R&D efforts. While competition proves to have a positive effect on industry growth rates, the relationship between competition and individual firm R&D effort is negative and dominated by intertemporal effects. The analysis also demonstrates that differences between the socially optimal and free market growth rates increase as the economy's resource endowment increases.Firm Level; Firm; Firms; Quality; R&D; Technology

Analysis of Prescriptions of Alpha-Blockers and Phosphodiesterase 5 Inhibitors from the Urology Department and Other Departments

PurposeWe analyzed the prescriptions of alpha-blockers and phosphodiesterase 5 inhibitors (PDE5Is) in the urology department as well as in other departments of the general hospital.MethodsWe investigated the frequency of prescription of alpha-blockers and PDE5Is from 3 general hospitals from January 1, 2007 to December 31, 2009. For alpha-blockers, data were collected from patients to whom alpha-blockers were prescribed from among patients recorded as having benign prostatic hyperplasia according to the 5th Korean Standard Classification of Diseases. For PDE5Is, data were collected from patients to whom PDE5Is were prescribed by the urology department and by other departments. Alpha-blockers were classified into tamsulosin, alfuzosin, doxazosin, and terazosin, whereas PDE5Is were classified into sildenafil, tadalafil, vardenafil, udenafil, and mirodenafil.ResultsAlpha-blockers were prescribed to 11,436 patients in total over 3 years, and the total frequency of prescriptions was 68,565. Among other departments, the nephrology department had the highest frequency of prescription of 3,225 (4.7%), followed by the cardiology (3,101, 4.5%), neurology (2,576, 3.8%), endocrinology (2,400, 3.5%), pulmonology (1,102, 1.6%), and family medicine (915, 1.3%) departments in order. PDE5Is were prescribed to 2,854 patients in total over 3 years, and the total frequency of prescriptions was 10,558. The prescription frequency from the urology department was 4,900 (46.4%). Among other departments, the endocrinology department showed the highest prescription frequency of 3,488 (33.0%), followed by the neurology (542, 5.1%), cardiology (467, 4.4%), and family medicine (407, 3.9%) departments in order.ConclusionsA high percentage of prescriptions of alpha-blockers and PDE5Is were from other departments. For more specialized medical care by urologists is required in the treatment of lower urinary tract symptoms and erectile dysfunction

Understanding and meeting information needs following unintentional injury: comparing the accounts of patients, carers and service providers

Objective. To explore information needs of unintentional injury patients and their carers over time, across services, and how such needs are met from the perspectives of patients, carers and service providers

Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial

Background A better therapeutic relationship predicts better outcomes. However, there is no trial-based evidence on how to improve therapeutic relationships in psychosis. Aims To test the effectiveness of communication training for psychiatrists on improving shared understanding and the therapeutic relationship (trial registration: ISRCTN94846422). Method In a cluster randomised controlled trial in the UK, 21 psychiatrists were randomised. Ninety-seven (51% of those approached) out-patients with schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the sample recruited at baseline) were followed up after 5 months. The intervention group received four group and one individualised session. The primary outcome, rated blind, was psychiatrist effort in establishing shared understanding (self-repair). Secondary outcome was the therapeutic relationship. Results Psychiatrists receiving the intervention used 44% more self-repair than the control group (adjusted difference in means 6.4, 95% CI 1.46–11.33, P<0.011, a large effect) adjusting for baseline self-repair. Psychiatrists rated the therapeutic relationship more positively (adjusted difference in means 0.20, 95% CI 0.03–0.37, P = 0.022, a medium effect), as did patients (adjusted difference in means 0.21, 95% CI 0.01–0.41, P = 0.043, a medium effect). Conclusions Shared understanding can be successfully targeted in training and improves relationships in treating psychosis

Miscommunication in Doctor-Patient Communication

The effectiveness of medical treatment depends on the quality of the patient–clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a shared understanding of illness and treatment. Here, we use the tools of conversation analysis (CA) to explore this idea in the context of psychiatric consultations. The CA “repair” framework provides an analysis of the processes people use to deal with problems in speaking, hearing, and understanding. These problems are especially critical in the treatment of psychosis where patients and health care professionals need to communicate about the disputed meaning of hallucinations and delusion. Patients do not feel understood, they are frequently non‐adherent with treatment, and many have poor outcomes. We present an overview of two studies focusing on the role of repair as a mechanism for producing and clarifying meaning in psychiatrist–patient communication and its association with treatment outcomes. The first study shows patient clarification or repair of psychiatrists’ talk is associated with better patient adherence to treatment. The second study shows that training which emphasizes the importance of building an understanding of patients’ psychotic experiences increases psychiatrists’ self‐repair. We propose that psychiatrists are working harder to make their talk understandable and acceptable to the patient by taking the patient's perspective into account. We conclude that these findings provide evidence that repair is an important mechanism for building shared understanding in doctor–patient communication and contributes to better therapeutic relationships and treatment adherence. The conversation analytic account of repair is currently the most sophisticated empirical model for analyzing how people construct shared meaning and understanding. Repair appears to reflect greater commitment to and engagement in communication and improve both the quality and outcomes of communication. Reducing potential miscommunication between psychiatrists and their patients with psychosis is a low‐cost means of enhancing treatment from both the psychiatrist and patient perspective. Given that misunderstanding and miscommunication are particularly problematic in psychosis, this is critical for improving the longer term outcomes of treatment for these patients who often have poor relationships with psychiatrists and health care services more widely

EMR documentation of physician–patient communication following genomic counseling for actionable complex disease and pharmacogenomic results

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136350/1/cge12820.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136350/2/cge12820_am.pd

The challenges of communicating research evidence in practice: perspectives from UK health visitors and practice nurses

&lt;p&gt;Background: Health practitioners play a pivotal role in providing patients with up-to-date evidence and health information. Evidence-based practice and patient-centred care are transforming the delivery of healthcare in the UK. Health practitioners are increasingly balancing the need to provide evidence-based information against that of facilitating patient choice, which may not always concur with the evidence base. There is limited research exploring how health practitioners working in the UK, and particularly those more autonomous practitioners such as health visitors and practice nurses working in community practice settings, negotiate this challenge. This research provides a descriptive account of how health visitors and practice nurses negotiate the challenges of communicating health information and research evidence in practice.&lt;/p&gt; &lt;p&gt;Methods: A total of eighteen in-depth telephone interviews were conducted in the UK between September 2008 and May 2009. The participants comprised nine health visitors and nine practice nurses, recruited via adverts on a nursing website, posters at a practitioner conference and through recommendation. Thematic analysis, with a focus on constant comparative method, was used to analyse the data.&lt;/p&gt; &lt;p&gt;Results: The data were grouped into three main themes: communicating evidence to the critically-minded patient; confidence in communicating evidence; and maintaining the integrity of the patient-practitioner relationship. These findings highlight some of the daily challenges that health visitors and practice nurses face with regard to the complex and dynamic nature of evidence and the changing attitudes and expectations of patients. The findings also highlight the tensions that exist between differing philosophies of evidence-based practice and patient-centred care, which can make communicating about evidence a daunting task.&lt;/p&gt; &lt;p&gt;Conclusions: If health practitioners are to be effective at communicating research evidence, we suggest that more research and resources need to be focused on contextual factors, such as how research evidence is negotiated, appraised and communicated within the dynamic patient-practitioner relationship.&lt;/p&gt

Octupolar ordering of Gamma8 ions in magnetic field

We study f-electron lattice models which are capable of supporting octupolar, as well dipolar and quadrupolar, order. Analyzing the properties of the Gamma8 ground state quartet, we find that (111)-type combinations of the Gamma5 octupoles Tbeta(111)=Tbeta(x)+Tbeta(y)+Tbeta(z) are the best candidates for octupolar order parameters. Octupolar ordering induces Gamma5-type quadrupoles as secondary order parameter. Octupolar order is to some extent assisted, but in its basic nature unchanged, by allowing for the presence of quadrupolar interactions. In the absence of an external magnetic field, equivalent results hold antiferro-octupolar ordering on the fcc lattice. In this sense, the choice of our model is motivated by the recent suggestion of octupolar ordering in NpO2. The bulk of our paper is devoted to a study of the effect of an external magnetic field on ferro-octupolar ordering. We found that octupolar order survives up to a critical magnetic field if the field is lying in specific directions, while for general field directions, the underlying symmetry of the model is destroyed and therefore the phase transition suppressed even in weak fields. Field-induced multipoles and field-induced couplings between various order parameters are discussed on the basis of a group theoretical analysis of the Helmholtz potential. We also studied the effect of octupolar ordering on the non-linear magnetic susceptibility which satisfies Ehrenfest-type relations at continuous octupolar transitions.Comment: 29 pages, 10 figures LaTeX In its contents, the present version agrees with the published one (see Journal Reference below). Essential additions to the text in Sec. III, otherwise some change of wording, and minor correction