Patient Evaluation of Emotional Comfort Experienced (PEECE): Developing and testing a measurement instrument

Objectives: The Patient Evaluation of Emotional Comfort Experienced (PEECE) is a 12-item questionnaire which measures the mental well-being state of emotional comfort in patients. The instrument was developed using previous qualitative work and published literature. Design: Instrument development. Setting: Acute Care Public Hospital, Western Australia. Participants: Sample of 374 patients. Interventions: A multidisciplinary expert panel assessed the face and content validity of the instrument and following a pilot study, the psychometric properties of the instrument were explored. Main outcome measures: Exploratory and confirmatory factor analysis assessed the underlying dimensions of the PEECE instrument; Cronbach’s α was used to determine the reliability; κ was used for test–retest reliability of the ordinal items. Results: 2 factors were identified in the instrument and named ‘positive emotions’ and ‘perceived meaning’. A greater proportion of male patients were found to report positive emotions compared with female patients. The instrument was found to be feasible, reliable and valid for use with inpatients and outpatients. Conclusions: PEECE was found to be a feasible instrument for use with inpatient and outpatients, being easily understood and completed

The Impact of Insurance and a Usual Source of Care on Emergency Department Use in the United States

Background. Finding a usual source of care (USC) is difficult for certain populations. This analysis determines how insurance type and having a USC affect the settings in which patients seek care. Methods. In this cross-sectional study of the 2000–2011 Medical Expenditure Panel Surveys, we assessed the percentage of low-income persons with half or more of their ambulatory visits to the emergency department (ED). Respondents were stratified based on insurance type and presence of a USC. Results. In 2011, among Medicaid enrollees without USCs, 21.6% had half or more of their ambulatory visits to EDs compared to 8.1% for those with USCs. Among the uninsured without USCs, 24.1% went to an ED for half or more of their ambulatory visits compared to 8.8% for those with USCs in 2011. Among the privately insured without USCs, 7.8% went to an ED for half or more of their ambulatory visits compared to 5.0% for those with USCs in 2011. These differences remained in multivariate analyses. Conclusions. Those who lack USCs, particularly the uninsured and Medicaid enrollees, are more likely to rely on EDs

Low-Intensity Continuous Ultrasound for the Symptomatic Treatment of Upper Shoulder and Neck Pain: A Randomized, Double-Blind Placebo-Controlled Clinical Trial

Purpose: Low-intensity continuous ultrasound (LICUS) is an emerging high-dosimetry ultrasound-based therapy for accelerated tissue healing and the treatment of myofascial pain. In this study, LICUS treatment is clinically evaluated for chronic upper neck and shoulder pain in a randomized, multi-site, double-blind, placebo-controlled study. Patients and Methods: CONSORT guidelines were followed in conducting and reporting the clinical trial. Thirty-three participants with upper trapezius myofascial pain were randomized for treatment with active (n=25) or placebo (n=8) devices. Investigators and subjects were blinded to treatment groups. Participants self-reported pain daily, rating from 0– 10 on the numeric rating scale. If pain rating was more significant than or equal to 3, the LICUS (3MHz, 0.132W/cm 2, 1.3W, 4 hours) was self-applied for total energy dosimetry of 18,720 Joules per treatment. During the 4-week study, daily pain rating was recorded. If LICUS treatment was delivered, pain before, during, and after treatment were recorded as well as the global rate of change (GROC). Independent t-tests were used to assess change from baseline and differences between treatment groups. ClinicalTrials.gov: NCT02135094. Results: There was a 100% completion rate for participants enrolled in the study and no significant differences between the groups regarding demographic variables or baseline outcome measures. Participants treated with active therapy observed a significant mean pain reduction from baseline of 2.61 points for active (p\u3c 0.001), compared to 1.58 points decrease from baseline for placebo (p=0.087), resulting in a 1.03 points significant decrease in the active group over placebo (p=0.003). The total GROC was significantly higher in the active group at 2.84 points compared to the placebo group at 0.46 points (p\u3c 0.001). Conclusion: Low-intensity continuous ultrasound treatment significantly reduced pain in patients with upper trapezius myofascial pain of the neck and shoulder. LICUS treatment showed a clinically meaningful improvement in the GROC scores for patients. The results from this clinical trial indicate that the LICUS treatment of 18,720 Joules can effectively be used to treat clinical pain related to upper trapezius myofascial pain. Further research could investigate varying dosimetry to improve efficacy and/or reduce the dose

Characteristics and quality of life of patients presenting to cancer support centres: Patient rated outcomes and use of complementary therapies

Background: In order to effectively target and provide individualised patient support strategies it is crucial to have a comprehensive picture of those presenting for services. The purpose of this study was to determine the characteristics and patient rated outcomes of individuals presenting to SolarisCare cancer support centres and their choices regarding complementary and integrated therapies (CIT).Methods: A cohort with a current or previous cancer diagnosis aged 18 - 87 years presenting to a SolarisCare centre during a 5-day period completed a questionnaire. Four SolarisCare centres participated in the trial including regional and metropolitan locations. Outcomes included medical and demographic characteristics, CIT variables and patient rated outcomes (PROs) including quality of life (QoL).Results: Of the 95 participants (70.3%) who completed the survey, the mean age was 60.5 years with 62% currently receiving treatment. Eighty percent of the sample had at least one other comorbid condition, with the most popular CIT being relaxation massage. Of the PROs, QoL was significantly lower than norms for the Australian population and other mixed cancer populations. No notable differences were seen between genders, however significantly poorer outcomes were found for the younger age group. Fifty percent of the population did not meet physical activity recommendations, and musculoskeletal symptoms explained between 25-27% of variance in QoL.Conclusions: A greater understanding of the health profiles of patients presenting to supportive care centres and their use of CIT, provides Western Australian health professionals with key information to ensure the safety of supportive care practices, as well as fosters optimal patient outcomes and enhances the integration of supportive care strategies within mainstream medical care

Positive patient experiences in an Australian integrative oncology centre

Background: The purpose of this study was to explore the experiences of cancer patients\u27 utilising complementary and integrative therapies (CIT) within integrative oncology centres across Western Australia.Methods: Across four locations 135 patients accessed CIT services whilst undergoing outpatient medical treatment for cancer. Of the 135 patients, 66 (61 ± 12 y; female n = 45; male n = 21) agreed to complete a personal accounts questionnaire consisting of open-ended questions designed to explore patients\u27 perceptions of CIT. All results were transcribed into nVivo (v9) and using thematic analysis, key themes were identified.Results: Of the 66 participants, 100% indicated they would recommend complementary therapies to other patients and 92% stated CIT would play a significant role in their future lifestyle . A mean score of 8 ± 1 indicated an improvement in participants\u27 perception of wellbeing following a CIT session. Three central themes were identified: empowerment, support and relaxation. Fourteen sub-themes were identified, with all themes clustered into a framework of multifaceted views held by cancer patients in relation to wellbeing, role of significant others and control.Conclusions: Exploration of patients\u27 experiences reveals uniformly positive results. One of the key merits of the environment created within the centres is patients are able to work through their cancer journey with an increased sense of empowerment, without placing them in opposition to conventional medical treatment. In order to effectively target integrative support services it is crucial to explore the experiences of patients in their own words and use those forms of expression to drive service delivery

Why Disaster Subcultures Matter: A Tale of Two Communities: How and Why the 2007 Western Solomon Islands Tsunami Disaster Led to Different Outcomes for Two Ghizo Communities

At 07:45 a.m. on 2 April 2007, a tsunami hit Ghizo Island, western Solomon Islands in the south-west Pacific. Thirty-three people died on Ghizo, of whom 31 originated from a relatively small migrant Gilbertese community (transmigrated in the 1950s–1970s from Kiribati), while only two were from the majority Melanesian community. This paper documents an extensive 4-year study that addresses the potential core reasons for this asymmetrical casual impact. Community-participatory social science research was undertaken in two Gilbertese villages and two Melanesian villages. The four villages had similar spatial vulnerabilities due to their coastal location, although they had variable access to the safer higher ground. Gilbertese villages had less diverse ocean-reliant livelihoods, a limited knowledge of hinterland bush resource utilisation, uncertainties regarding land rights, and perceived ethnic discrimination. Melanesian villages had strong wantok and kastom social reciprocity cultures, a diverse set of livelihoods, wider social capital with other Melanesian communities, and greater security regarding land rights. This paper argues that these key factors—linked to the lower status as a migrant community of the Gilbertese, a limited sharing of knowledge between communities, government blind spots and power hierarchies—explain both the disproportionate impacts of the disaster and issues that impact longer-term aid intervention and social cohesion

From Top to Bottom - the Multiwavelength Campaign of V824 Ara (HD 155555)

A great deal of progress has been made in recent years in decomposing the 2-D structure in the atmospheres of late-type stars. Doppler images of many photospheres single stars, T Tauri stars, Algols, RS CV(sub n) binaries to name a few - are regularly published (Strassmeier 1996; Richards and Albright 1996; Rice and Strassmeier 1996; Kuerster et al. 1994). Ultraviolet spectral images of chromospheres appear in the literature (e.g., Walter et al. 1987; Neff et al. 1989) but are less common owing to the difficult nature of obtaining complete phase coverage. Zeeman doppler images of magnetic fields are now feasible (e.g., Donati et al. 1992). Performing Doppler imaging of the same targets over many seasons has also been accomplished (e.g, Vogt et al. 1997). Even when a true image reconstruction is not possible due to poor spectral resolution, we can still infer a great deal about spatial structure if enough phases are observed. However, it is increasingly apparent that to make sense of recent results, many different spectral features spanning a range of formation temperature and density must be observed simultaneously for a coherent picture to emerge. Here we report on one such campaign. In 1996, we observed the southern hemisphere RS CV(sub n) binary V824 Ara (P=1(sup d).68, G5IV+K0V-IV-IV) over one complete stellar rotation with the Hubble Space Telescope and EUVE. In conjunction, radio and optical photometry and spectroscopy were obtained from the ground. Unique to this campaign is the complete phase coverage of a number of activity proxy indicators that cover source temperatures ranging from the photosphere to the corona

An NMR and Quantum Mechanical Investigation of Solvent Effects on Conformational Equilibria of Butanedinitrile

Vicinal proton−proton NMR couplings and ab initio quantum mechanics have been used to investigate solvent effects on conformational equilibria of butanedinitrile. The trans and gauche conformations are about equally favored at room temperature in solvents of low dielectric constant while the equilibrium is essentially the statistical proportions of one-third trans and two-thirds gauche in water with a high dielectric constant. The coupling assignments were confirmed with the aid of stereospecific deuterium-labeled (R,R or S,S)-1,2-dideuteriobutanedinitrile. The calculations support the observed trends. Similar results were observed for 1,2-dibromo- and dichloroethanes

Avaliação da resiliência em mulheres masctectomizadas e diagnosticadas com câncer atendidas no Centro de Atenção Integral à Saúde da Mulher (CAISM)/ Assessment of resilience in women with masctectomized and diagnosed with cancer attended at the Center for Integral Attention to Women's Health (CIAWH)

Estudo transversal com 82 pacientes do Centro de Atenção Integral à Saúde da Mulher, a fim de avaliar a resiliência em mulheres diagnosticadas com câncer e mastectomizadas. O instrumento utilizado foi a Escala dos Pilares da Resiliência da Vetor Editora®. Na comparação das médias entre pacientes diagnosticadas e mastectomizadas, podemos afirmar que as amostras não têm diferenças significativas, ou seja, são consideradas iguais. O impacto da mastectomia sobre a qualidade de vida, somado ao preconceito que a paciente enfrenta, pode ser minimizado por uma rede de apoio, que suscitará a capacidade de resiliência, a fim de minimizar efeitos adversos provocados pelo câncer e procedimento cirúrgico

Crop Updates - 2003 Lupins

This session covers twenty one papers from different authors LUPIN ISSUES AND R & D DIRECTIONS Mark Sweetingham, Department of Agriculture ACKNOWLEDGEMENTS VARIETIES AND BREEDING New lupin line for release – WALAN2141, Bevan J, Buirchell, Mark Sweetingham, Geoff Thomas, Amelia McLarty, Harmohinder Dhammu and CVT and Lupin Breeding teams, Department of Agriculture Lupin variety trial, Martin Harries and Wayne Parker, Department of Agriculture Herbicide tolerance of new lupins, Harmohinder S. Dhammu, Terry Piper and David Nicholson, Department of Agriculture YELLOW AND ALBUS LUPINS Selection for high lupin yield under terminal drought, Jairo A. Palta1&2, Neil C. Turner1&2 Bob French2&3 and Bevan Buirchell2&3 , 1CSIRO Plant Industry, Floreat, WA, 2CLIMA, University of Western Australia, Crawley, WA, 3Department of Agriculture Outcrossing and isolation distance in yellow lupins, Kedar Adhikari, Bevan Buirchell and Katia Stefanova, Department of Agriculture Development of aphid tolerant yellow lupins in Western Australia, Kedar Adhikari, Bevan Buirchell, Mark Sweetingham and Françoise Berlandier, Department of Agriculture ESTABLISHMENT Development of anthracnose resistant albus lupins for Western Australia, Kedar Adhikari, Bevan Buirchell, Mark Sweetingham and Geoff Thomas, Department of Agriculture Lupin sowing methods for improved yields, Glen Riethmuller, Department of Agriculture Moisture delving = more reliable lupin establishment, Paul Blackwell and Wayne Parker, Department of Agriculture Effect of time of sewing, plant density and row orientation on lupins at various row spacings, Geoff Fosbery, Farm Focus Consultants, Bill Crabtree, Crabtree Consulting and Tracy Gilham, WANTFA Influence of row spacing on water stress and water use of lupins, Bob French and Laurie Wahlsten, Department of Agriculture AGRONOMY Effect on lupin protein and yield from variety, planting time and seed rate, Pierre Fievez, Pierre Fievez and Associates Lupin row cropping: herbicides to band, shield design and economics, Mike Collins, WANTFA and John Holmes, 4 Farmers Harvest options for narrow leaf lupins, Martin Harries and Dirranie Kirby, Department of Agriculture NUTRITION Additional nutrients on lupin yield and protein, Pierre Fievez, Pierre Fievez and Associates Demonstrating the effect of phosphorous placement on yields of narrow leaf lupin and yellow lupin on high phosphorus retention soils, Martin Harries and Wayne Parker, Department of Agriculture PESTS AND DISEASES How far are anthracnose spores spread by rain splash? Geoff Thomas, Mark Sweetingham and Ken Adcock, Department of Agriculture Height of cereal stubble affects spread of lupin anthracnose, Geoff Thomas, Bill MacLeod and Ken Adcock, Department of Agriculture Controlling non-necrotic strains of bean yellow mosaic virus in lupins by cultural methods, Roger Jones and Rohan Prince, Department of Agriculture, and Centre for Legumes in Mediterranean Agriculture MARKET DEVELOPMENT Australian sweet lupin – is it the next human health food? Stuart Johnson, Deakin University; Ramon Hall, ARC SPIRT PhD Scholar; Madeleine Ball, University of Tasmania; Sofia Sipsas and David Petterson; Department of Agriculture CONTACT DETAILS FOR PRINCIPAL AUTHOR