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Gainey J, Brecthtel L, Blum B, Keels A, Madeline L, Lowther E, Nathaniel T. Functional Outcome Measures of Recombinant Tissue Plasminogen Activator-Treated Stroke Patients in the Telestroke Technology. J Exp Neurosci 2018; 12:1179069518793412. [PMID: 30245570 PMCID: PMC6144501 DOI: 10.1177/1179069518793412] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/12/2018] [Indexed: 11/16/2022] Open
Abstract
The efficiency of telestroke programs in improving the rates of recombinant
tissue plasminogen activator (rtPA) in stroke patients has been reported.
Previous studies have reported favorable treatment outcomes with the use of
telestroke programs to improve the use of rtPA, but functional outcomes are not
fully understood. This study investigated the effect of telestroke technology in
the administration of rtPA and related functional outcomes associated with
baseline clinical variables. Retrospective data of a telestroke registry were
analyzed. Univariate analysis was used to compare demographic and clinical
variables in the rtPA group and the no rtPA group and between the improved
functional ambulation group and the no improvement group. A stepwise binary
logistic regression identified factors associated with improved functional
outcome in the total telestroke population and in the subset of the telestroke
population who received rtPA. In adjusted analysis and elimination of any
multicollinearity for patients who received rtPA in the telestroke setting,
obesity (odds ratio [OR] = 2.138, 95% confidence interval [CI], 1.164-3.928,
P < .05), higher systolic blood pressure at the time of
presentation (OR = 1.015, 95% CI, 1.003-1.027, P < .05), and
baseline high-density lipoprotein at the time of admission (OR = 1.032, 95% CI,
1.005-1.059, P < .05) were associated with improved
functional outcomes. Increasing age (OR = 0.940, 95% CI, 0.916-0.965,
P < .0001) and higher calculated National Institutes of
Health Stroke Scale (OR = 0.903, 95% CI, 0.869-0.937) were associated with a
poorer outcome in rtPA-treated patients. Telestroke technology improves
functional outcomes at spoke stations where neurological expertise is
unavailable. Further studies are necessary to determine how telestroke
technology can be optimized, especially to improve contraindications and
increase eligibility for thrombolysis therapy.
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Affiliation(s)
- Jordan Gainey
- School of Medicine, University of South Carolina, Greenville, SC, USA
| | - Leanne Brecthtel
- School of Medicine, University of South Carolina, Greenville, SC, USA
| | - Brice Blum
- School of Medicine, University of South Carolina, Greenville, SC, USA
| | - Aaliyah Keels
- School of Medicine, University of South Carolina, Greenville, SC, USA
| | | | | | - Thomas Nathaniel
- School of Medicine, University of South Carolina, Greenville, SC, USA
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Abstract
Part 1 of this paper (Harries and Harries 2001) examined the reasoning studies of the 1980s and 1990s and critiqued the ethnographic and information-processing approaches, based on stated information use. The need for an approach that acknowledged the intuitive nature of experienced thinkers' reasoning was identified. Part 2 describes such an approach ± social judgement theory ± and presents a pilot application in occupational therapy research. The method used is judgement analysis. The issue under study is that of prioritisation policies in community mental health work. The results present the prioritisation policies of four occupational therapists in relation to managing community mental health referrals.
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Redelmeier DA, Dickinson VM. Judging whether a patient is actually improving: more pitfalls from the science of human perception. J Gen Intern Med 2012; 27:1195-9. [PMID: 22592355 PMCID: PMC3515001 DOI: 10.1007/s11606-012-2097-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/22/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
Abstract
Fallible human judgment may lead clinicians to make mistakes when assessing whether a patient is improving following treatment. This article provides a narrative review of selected studies in psychology that describe errors that potentially apply when a physician assesses a patient's response to treatment. Comprehension may be distorted by subjective preconceptions (lack of double blinding). Recall may fail through memory lapses (unwanted forgetfulness) and tacit assumptions (automatic imputation). Evaluations may be further compromised due to the effects of random chance (regression to the mean). Expression may be swayed by unjustified overconfidence following conformist groupthink (group polarization). An awareness of these five pitfalls may help clinicians avoid some errors in medical care when determining whether a patient is improving.
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Meijer R, van Limbeek J, Kriek B, Ihnenfeldt D, Vermeulen M, de Haan R. Prognostic social factors in the subacute phase after a stroke for the discharge destination from the hospital stroke-unit. A systematic review of the literature. Disabil Rehabil 2009; 26:191-7. [PMID: 15164952 DOI: 10.1080/09638280310001636437] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The objective of our study was to identify prognostic social factors in the subacute phase after stroke for the discharge destination from the hospital stroke-unit. METHODS A systematic literature search was performed, designed in accordance with the Cochrane Collaboration criteria. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria. RESULTS Characteristics of the social situation that proved to be important for prediction of the discharge destination are marital status and social support. Quantity and methodological quality of the research studies were insufficient, and the number of possible social prognostic factors investigated was limited by the absence of a conceptual framework of social subdomains in the studies, including an unambiguous definition of the prognostic social factors within these subdomains. CONCLUSIONS A great need exists for research into the prognostic qualities of the following social factors: the ability to provide support, presence, and readiness of the homefront; the availability of professional care, personal financial means, membership of societies and clubs, frequency of contacts with close relatives and friends; the quality of the patient's residence with regard to the adaptation to the needs and abilities of the patient. A commitment about the aforementioned conceptual framework is mandatory.
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Affiliation(s)
- Ronald Meijer
- Department of Rehabilitation Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
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Cameron KA. A practitioner's guide to persuasion: an overview of 15 selected persuasion theories, models and frameworks. PATIENT EDUCATION AND COUNSELING 2009; 74:309-317. [PMID: 19136229 DOI: 10.1016/j.pec.2008.12.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 12/03/2008] [Accepted: 12/05/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To provide a brief overview of 15 selected persuasion theories and models, and to present examples of their use in health communication research. RESULTS The theories are categorized as message effects models, attitude-behavior approaches, cognitive processing theories and models, consistency theories, inoculation theory, and functional approaches. CONCLUSIONS As it is often the intent of a practitioner to shape, reinforce, or change a patient's behavior, familiarity with theories of persuasion may lead to the development of novel communication approaches with existing patients. PRACTICE IMPLICATIONS This article serves as an introductory primer to theories of persuasion with applications to health communication research. Understanding key constructs and general formulations of persuasive theories may allow practitioners to employ useful theoretical frameworks when interacting with patients.
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Affiliation(s)
- Kenzie A Cameron
- Division of General Internal Medicine and Center for Communication in Healthcare at the Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Sheehan D, Robertson L, Ormond T. Comparison of language used and patterns of communication in interprofessional and multidisciplinary teams. J Interprof Care 2007; 21:17-30. [PMID: 17365371 DOI: 10.1080/13561820601025336] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Can the language used and the patterns of communication differentiate a multidisciplinary team from an interprofessional team? This research question arose from an unexpected outcome of a study that investigated clinical reasoning of health professional team members in the elder care wards of two different hospitals. The issue at stake was the apparent disparity in the way in which the two teams communicated. To further explore this, the original transcribed interview data was analysed from a symbolic interactionist perspective in order that the language and communication patterns between the two teams could be identified and compared. Differences appeared to parallel the distinctions between multidisciplinary and interprofessional teams as reported in the literature. Our observations were that an interprofessional team was characterized by its use of inclusive language, continual sharing of information between team members and a collaborative working approach. In the multidisciplinary team, the members worked in parallel, drawing information from one another but did not have a common understanding of issues that could influence intervention. The implications of these communication differences for team members, team leaders and future research are then discussed.
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Affiliation(s)
- D Sheehan
- Christchurch College of Education, School of Professional Development, Christchurch, New Zealand.
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Moats G. Discharge decision-making with older people: The influence of the institutional environment. Aust Occup Ther J 2006. [DOI: 10.1111/j.1440-1630.2006.00568.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Neufeld SW, Lysack CL, Macneill SE, Lichtenberg PA. Living Arrangement Decisions at Discharge and Later: Differences in Criteria and Outcomes. Home Health Care Serv Q 2004; 23:29-47. [PMID: 15778151 DOI: 10.1300/j027v23n04_03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined the pattern of post rehabilitation living arrangements over 18 months of 172 adults discharged from a geriatric rehabilitation unit at a large urban medical center, all of whom were living alone prior to admission. Results showed the diminishing importance of physical function and cognition as factors in decisions to return home as the length of time after hospital discharge increased. Patients who returned home to live alone after a period of time living in more supported environments had significantly lower assessment scores on physical function (p < 0.001) and cognition (p < 0.001) compared to patients who went home to live alone immediately upon discharge. As well, patients who returned home to live alone later than three months post discharge were significantly more likely to move to more supported environments by 18 months after discharge (p = 0.043) and to experience re-hospitalizations (p = 0.008), which raises questions about the appropriateness of these later decisions.
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Affiliation(s)
- Stewart W Neufeld
- Institute of Gerontology, Wayne State University, 87 East Ferry, 227 Knapp Bldg., Detroit, MI, 48202, USA.
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Harries PA, Gilhooly K. Identifying occupational therapists' referral priorities in community health. Occup Ther Int 2004; 10:150-64. [PMID: 12897893 DOI: 10.1002/oti.182] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Occupational therapists in British community mental health teams have been debating how the most effective services can be targeted at the most needy clients. This paper presents the results of a quantitative study that examined 40 British occupational therapists' referral prioritization policies. Results showed half of the participants felt their generic responsibilities, which involved having care co-ordination responsibilities, were too large. Only 25% of participants co-ordinated care for clients whose needs were related to occupational dysfunction. Judgement analysis, that involved regressing the 40 individuals' prioritization decisions onto the 90 respective referral scenarios, was used to statistically model how referral information had been weighted. Group agreement of prioritization was moderate with the reason for referral, history of violence and diagnosis being given the most weighting. Consistency in policy application, as measured by examining prioritization decisions on identical referrals, showed wide variability. Further research is required to identify the optimal and most stable policies within this group.
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Unsworth CA, Thomas SA. External validation of a housing recommendation model for clients following stroke rehabilitation. Disabil Rehabil 2004; 25:1208-18. [PMID: 14578060 DOI: 10.1080/09638280310001600003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Using a Social Judgment Theory approach, mathematical models of clinical decisions can be developed to predict new decisions. However, since these models are often developed under 'laboratory conditions' using hypothetical cases rather than real world client samples, questions may be raised concerning the external validity of such models. The purpose of this research was to validate a discharge housing decision making model developed with hypothetical clients with stroke with a real sample. This process is referred to as external validation. METHODS Cross-tabulations were performed to compare the model discharge housing prediction against the team's actual recommendations for 60 clients from three rehabilitation centres. A sensitivity and specificity analysis was used to compare the model predictions against the client's actual discharge housing. RESULTS A simple mathematical model was constructed to accurately predict housing recommendations. However, the predictive power of the model appeared to be limited by clinician/team consideration of unmeasured factors such as client personality and motivation. CONCLUSION It is suggested that the housing decision model developed may be useful for rehabilitation teams as a starting point when discussing the best place to recommend a client reside on discharge from rehabilitation. Such a model may assist teams to standardise their decision processes and minimise the potential for unwarranted bias.
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Affiliation(s)
- Carolyn A Unsworth
- School of Occupational Therapy, La Trobe University, Bundoora, Australia.
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Abstract
Neurological rehabilitation is increasingly seen as a specialist form of rehabilitation requiring specialist nursing knowledge. However, as in many areas of nursing, nurses in this field recognize that there is a need to increase their knowledge base to ensure that they provide the best and most up-to-date quality care for their patients and their families. To achieve high levels of competence, neurological rehabilitation nurses need to be aware of the existing body of research in this field so that they can make sound decisions regarding their practice and future research endeavours. This review aims to validate the existing knowledge base in this area by identifying and critically analysing research conducted in the area of neurological rehabilitation nursing during the decade 1988-1998 and by identifying any gaps and weaknesses that may be addressed by future research. Studies were included in the review if they examined an aspect of rehabilitation nursing, were concerned predominately with the neurological patient and were conducted in an in-patient setting. Research with a medical focus was not included and only research published in English was reviewed. Relevant research located examined the following areas: (1) the role of the rehabilitation nurse; (2) specific problems concerning the neurological rehabilitation patient; (3) specific nursing interventions; (4) rehabilitation nursing practice; (5) the delivery of rehabilitation programmes and team working; and (6) the family of the rehabilitation patient. The review concludes that research in this speciality remains limited both in quantity and quality. Most of the studies lack rigour and, because they were conducted at a single site, their generalizability to other clinical sites may be limited.
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Affiliation(s)
- S Thorn
- Rivermead Rehabilitation Centre, Oxford, England
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Unsworth C. Letters to the Editor. Am J Phys Med Rehabil 1997. [DOI: 10.1097/00002060-199707000-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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