Dementia Care: Confronting Myths in Clinical Management

Enormous challenges of this pervasive life-changing condition. Seeking help, often grasping at straws, victims, and their care providers are confronted with misinformation and myths when they search the internet or other sources. When Persons with Dementia (PWD) and their caregivers believe and/or act on false information, proper treatment may be delayed, and ultimately damage can be done. In this paper, we review commonly misunderstood issues encountered in caring for PWD. Our goal is to equip Primary Care Practitioners (PCPs) with accurate information to share with patients and families, to improve the outcomes of PWD to the greatest extent possible. While there are innumerable myths about dementia and its causes and treatments, we are going to focus on the most common false claims or misunderstandings which we hear in our Internal Medicine practice at Marshall Health. We offer suggestions for busy practitioners approaching some of the more common issues with patients and families in a clinic setting

Burnout syndrome and nurse-to-patient ratio in the workplace

Introduction: Burnout among Registered Nurses has been a great concern within the U.S. healthcare system and has been reported in many hospitals. Nurse Burnout has been defined as a chronic response to work-related stress comprising three components or dimensions: emotional exhaustion, depersonalization, and personal accomplishment. The purpose of this research was to analyze the nurse-to-patient ratio to determine how it affects the psychological, mental, emotional health and the nurse overall productivity in the workplace. Methodology: The methodology was a review of literatures and a semi-structured interview. There were four primary databases and one website used in this research, and 31 articles were consulted for this literature review. Results: Study on Psychological, Mental, and Emotional Health and Nurse Productivity in Burnout Syndrome Regarding Nurse-to-Patient Ratio Discussion: The expert’s observed causes for nurse dissatisfaction in their position and general fatigue were attributed to mismanagement of personnel and resources, lack of follow through, extended shifts and stretched personal requirements all of which lead to feelings of burnout. Conclusion: The nurse-patient ratio is a direct determinate of the effects of psychological, mental, emotional health and nurse productivity in the workplace which also determines the patients’ overall health

Quantitative and Qualitative Findings and Implications of an Intercultural Sensitivity Assessment Among Employees at a Large Health System

Tuesday, November 10, 2009: 2:45 PM Jarret R. Patton, MD , Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA Jay Baglia, PhD , Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA Lynn M. Deitrick, RN, PhD , Department of Community Health, Health Studies and Education, Lehigh Valley Health Network, Allentown, PA Anthony Nerino, MA , Department of Community Health, Health Studies and Education, Lehigh Valley Health Network, Allentown, PA Eric J. Gertner, MD, MPH , Department of Medicine, Lehigh Valley Health Network, Allentown, PA Judith N. Sabino, MPH , Cultural Awareness, Lehigh Valley Health Network, Allentown, PA MaryKay Grim, BS , Human Resources, Lehigh Valley Health Network, Allentown, PA Debbie Salas-Lopez, MD, MPH , Department of Medicine, Lehigh Valley Health Network, Allentown, PABackground: As our nation welcomes people from many cultures, it is essential that healthcare providers understand the cultural background of their patients. In response to this diversity, community hospitals are systematically strengthening and improving services to address the cultural needs of their multi-cultural patient populations. As part of a multi-faceted, system-wide cultural awareness initiative, our health network conducted a baseline intercultural sensitivity assessment of its employees. Research Objectives: To establish measures of intercultural sensitivity among employees through the use of a validated instrument. Population: 9,000+ physicians, nurses, technicians and non-clinical employees of a large health network in mid-Eastern Pennsylvania. Methods: All employees were invited to complete the IRB-reviewed, web-based Intercultural Sensitivity Scale (Chen and Starosta 2000). The ICS scale measures attitudes about interacting with people from different cultural backgrounds. The five sub-scales include: 1) interaction engagement, 2) respect for cultural differences, 3) interaction confidence, 4) interaction enjoyment, and 5) interaction attentiveness. Three open-ended questions asked how the network could enhance cultural sensitivity. Two other questions asked for learning preferences (i.e., e-learning, Grand Rounds) and topic information (i.e. diet, religious practices). Demographic information (i.e., age, position, years of service hospital) was also acquired. Results and Conclusions: A 35% (n=3446) response rate was achieved. Characteristics of the respondent sample were highly similar across age, length of employment, racial and ethnic status, gender and proportions of staff positions. With regard to two of the five sub-scales, the survey revealed relative strength in interaction enjoyment while respect for cultural differences exposed an interesting bi-modal distribution – with many staff achieving perfect scores in this area and another large contingent scoring well below the mean. Baseline measures informed educational interventions, assessed training needs, enabled evaluation of interventions, and revealed individual and/or institutional factors that impeded or enhanced responses to patient experiences of healthcare disparities. Initial findings suggest general staff preferences for diversity workshops and cultural fact sheets as the preferred mode of instruction. Employees requested information about religion, attitudes about death and dying, and attitudes about health care institutions relevant to cultures represented in our local community. Practice Implications: Baseline results are used to direct network initiatives (i.e. creating health information repository, ensuring language-appropriate services, and strengthening educational programs) and to measure intervention outcomes. Along with obtaining uniform racial/ethnic patient data, this information is essential in comprehensive organizational change regarding culturally-appropriate service delivery and will ensure the delivery of equitable health care. Learning Objectives: 1. Explain how quantitative and qualitative results inform system-wide planning related to cultural competency. 2. List the key findings from this assessment 3. Describe a research methodology to measure the intercultural sensitivity of a health care organization employee population. Keywords:Cultural Competency, Hospitals Presenting author\u27s disclosure statement: Qualified on the content I am responsible for because: I am co-chair of Lehigh Valley Health Network\u27s Cultural Awareness Initiative. The abstract describes a baseline assessment that was part of this initiative. Any relevant financial relationships? No I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation

Understanding innovators' experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: A qualitative study

This article is made available through the Brunel Open Access Publishing Fund - Copyright @ 2011 Barnett et al.Background: Healthcare service innovations are considered to play a pivotal role in improving organisational efficiency and responding effectively to healthcare needs. Nevertheless, healthcare organisations encounter major difficulties in sustaining and diffusing innovations, especially those which concern the organisation and delivery of healthcare services. The purpose of the present study was to explore how healthcare innovators of process-based initiatives perceived and made sense of factors that either facilitated or obstructed the innovation implementation and diffusion. Methods: A qualitative study was designed. Fifteen primary and secondary healthcare organisations in the UK, which had received health service awards for successfully generating and implementing service innovations, were studied. In-depth, semi structured interviews were conducted with the organisational representatives who conceived and led the development process. The data were recorded, transcribed and thematically analysed. Results: Four main themes were identified in the analysis of the data: the role of evidence, the function of inter-organisational partnerships, the influence of human-based resources, and the impact of contextual factors. "Hard" evidence operated as a proof of effectiveness, a means of dissemination and a pre-requisite for the initiation of innovation. Inter-organisational partnerships and people-based resources, such as champions, were considered an integral part of the process of developing, establishing and diffusing the innovations. Finally, contextual influences, both intra-organisational and extra-organisational were seen as critical in either impeding or facilitating innovators' efforts. Conclusions: A range of factors of different combinations and co-occurrence were pointed out by the innovators as they were reflecting on their experiences of implementing, stabilising and diffusing novel service initiatives. Even though the innovations studied were of various contents and originated from diverse organisational contexts, innovators' accounts converged to the significant role of the evidential base of success, the inter-personal and inter-organisational networks, and the inner and outer context. The innovators, operating themselves as important champions and being often willing to lead constructive efforts of implementation to different contexts, can contribute to the promulgation and spread of the novelties significantly.This research was supported financially by the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH)

Diagnostic aids in the screening of oral cancer

The World Health Organization has clearly indentified prevention and early detection as major objectives in the control of the oral cancer burden worldwide. At the present time, screening of oral cancer and its pre-invasive intra-epithelial stages, as well as its early detection, is still largely based on visual examination of the mouth. There is strong available evidence to suggest that visual inspection of the oral mucosa is effective in reducing mortality from oral cancer in individuals exposed to risk factors. Simple visual examination, however, is well known to be limited by subjective interpretation and by the potential, albeit rare, occurrence of dysplasia and early OSCC within areas of normal-looking oral mucosa. As a consequence, adjunctive techniques have been suggested to increase our ability to differentiate between benign abnormalities and dysplastic/malignant changes as well as to identify areas of dysplasia/early OSCC that are not visible to naked eye. These include the use of toluidine blue, brush biopsy, chemiluminescence and tissue autofluorescence. The present paper reviews the evidence supporting the efficacy of the aforementioned techniques in improving the identification of dysplastic/malignant changes of the oral mucosa. We conclude that available studies have shown promising results, but strong evidence to support the use of oral cancer diagnostic aids is still lacking. Further research with clear objectives, well-defined population cohorts, and sound methodology is strongly required

Delocalized single-photon Dicke states and the Leggett- Garg inequality in solid state systems

We show how to realize a single-photon Dicke state in a large one-dimensional array of two- level systems, and discuss how to test its quantum properties. Realization of single-photon Dicke states relies on the cooperative nature of the interaction between a field reservoir and an array of two-level-emitters. The resulting dynamics of the delocalized state can display Rabi-like oscillations when the number of two-level emitters exceeds several hundred. In this case the large array of emitters is essentially behaving like a mirror-less cavity. We outline how this might be realized using a multiple-quantum-well structure and discuss how the quantum nature of these oscillations could be tested with the Leggett-Garg inequality and its extensions.Comment: 29 pages, 5 figures, journal pape

Mammography screening: views from women and primary care physicians in Crete

Background: Breast cancer is the most commonly diagnosed cancer among women and a leading cause of death from cancer in women in Europe. Although breast cancer incidence is on the rise worldwide, breast cancer mortality over the past 25 years has been stable or decreasing in some countries and a fall in breast cancer mortality rates in most European countries in the 1990s was reported by several studies, in contrast, in Greece have not reported these favourable trends. In Greece, the age-standardised incidence and mortality rate for breast cancer per 100.000 in 2006 was 81,8 and 21,7 and although it is lower than most other countries in Europe, the fall in breast cancer mortality that observed has not been as great as in other European countries. There is no national strategy for screening in this country. This study reports on the use of mammography among middleaged women in rural Crete and investigates barriers to mammography screening encountered by women and their primary care physicians. Methods: Design: Semi-structured individual interviews. Setting and participants: Thirty women between 45–65 years of age, with a mean age of 54,6 years, and standard deviation 6,8 from rural areas of Crete and 28 qualified primary care physicians, with a mean age of 44,7 years and standard deviation 7,0 serving this rural population. Main outcome measure: Qualitative thematic analysis. Results: Most women identified several reasons for not using mammography. These included poor knowledge of the benefits and indications for mammography screening, fear of pain during the procedure, fear of a serious diagnosis, embarrassment, stress while anticipating the results, cost and lack of physician recommendation. Physicians identified difficulties in scheduling an appointment as one reason women did not use mammography and both women and physicians identified distance from the screening site, transportation problems and the absence of symptoms as reasons for non-use. Conclusion: Women are inhibited from participating in mammography screening in rural Crete. The provision of more accessible screening services may improve this. However physician recommendation is important in overcoming women's inhibitions. Primary care physicians serving rural areas need to be aware of barriers preventing women from attending mammography screening and provide women with information and advice in a sensitive way so women can make informed decisions regarding breast caner screening