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Kosteniuk J, Osman BA, Osman M, Quail J, Islam N, O'Connell ME, Kirk A, Stewart N, Karunanayake C, Morgan D. Rural-urban differences in use of health services before and after dementia diagnosis: a retrospective cohort study. BMC Health Serv Res 2024; 24:399. [PMID: 38553765 PMCID: PMC10981340 DOI: 10.1186/s12913-024-10817-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 03/03/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Rural-urban differences in health service use among persons with prevalent dementia are known. However, the extent of geographic differences in health service use over a long observation period, and prior to diagnosis, have not been sufficiently examined. The purpose of this study was to examine yearly rural-urban differences in the proportion of patients using health services, and the mean number of services, in the 5-year period before and 5-year period after a first diagnosis of dementia. METHODS This population-based retrospective cohort study used linked administrative health data from the Canadian province of Saskatchewan to investigate the use of five health services [family physician (FP), specialist physician, hospital admission, all-type prescription drug dispensations, and short-term institutional care admission] each year from April 2008 to March 2019. Persons with dementia included 2,024 adults aged 65 years and older diagnosed from 1 April 2013 to 31 March 2014 (617 rural; 1,407 urban). Matching was performed 1:1 to persons without dementia on age group, sex, rural versus urban residence, geographic region, and comorbidity. Differences between rural and urban persons within the dementia and control cohorts were separately identified using the Z-score test for proportions (p < 0.05) and independent samples t-test for means (p < 0.05). RESULTS Rural compared to urban persons with dementia had a lower average number of FP visits during 1-year and 2-year preindex and between 2-year and 4-year postindex (p < 0.05), a lower likelihood of at least one specialist visit and a lower average number of specialist visits during each year (p < 0.05), and a lower average number of all-type prescription drug dispensations for most of the 10-year study period (p < 0.05). Rural-urban differences were not observed in admission to hospital or short-term institutional care (p > 0.05 each year). CONCLUSIONS This study identified important geographic differences in physician services and all-type prescription drugs before and after dementia diagnosis. Health system planners and educators must determine how to use existing resources and technological advances to support care for rural persons living with dementia.
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Affiliation(s)
- Julie Kosteniuk
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, S7N 2Z4, Saskatoon, SK, Canada.
| | - Beliz Acan Osman
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241- 111 Research Drive, S7N 3R2, Saskatoon, SK, Canada
| | - Meric Osman
- Saskatchewan Medical Association, 2174 Airport Drive #201, S7L 6M6, Saskatoon, SK, Canada
| | - Jacqueline Quail
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241- 111 Research Drive, S7N 3R2, Saskatoon, SK, Canada
| | - Naorin Islam
- College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, S7N 5E5, Saskatoon, SK, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Arts 182, 9 Campus Drive, S7N 5A5, Saskatoon, SK, Canada
| | - Andrew Kirk
- Department of Medicine, University of Saskatchewan, S7N 0W8, Saskatoon, SK, Canada
| | - Norma Stewart
- College of Nursing, University of Saskatchewan, 104 Clinic Place, S7N 2Z4, Saskatoon, SK, Canada
| | - Chandima Karunanayake
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, S7N 2Z4, Saskatoon, SK, Canada
| | - Debra Morgan
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, S7N 2Z4, Saskatoon, SK, Canada
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Bonaccorso S, Ricciardi A, Ouabbou S, Theleritis C, Ross-Michaelides A, Metastasio A, Stewart N, Mohammed M, Schifano F. Neutropenia in patients under treatment with clozapine and COVID-19 infection. Eur Psychiatry 2021. [PMCID: PMC9470401 DOI: 10.1192/j.eurpsy.2021.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionClozapine is among the most effective antipsychotics used for treatment resistant schizophrenia. Adverse reactions to clozapine include neutropenia. Case series report that clozapine-treated patients with COVID-19 have no documented neutropenia.ObjectivesWe sought to investigate the potential adverse effect of coronavirus disease (COVID-19) in patients taking clozapine.MethodsWe retrospectively inspected data of 13 consecutive patients on clozapine, admitted to Highgate Mental Health Centre -Camden & Islington NHS Foundation Trust between March and June 2020. Selection was based on their COVID-19 symptoms presentation and/or COVID-19 positive test. We used a linear regression model with COVID status as independent variable and absolute neutrophil count (ANC) as dependent variable to inform about a correlation between COVID-19 status and neutrophil count. STATA was used for statistics.ResultsWe collected data on thirteen patients of which nine were male. The median age was of 41.97 years; six subjects were Black, three were Asian and four were White Caucasian. Ten subjects tested positive to COVID-19 and 3 were suspected cases -these latter were excluded from stastical analysis. During COVID-19 infection, neutrophils count (ANC) dropped significantly to 4.215 from a baseline value of 5.337. The beta values of 0.83 shows that ANC declined significantly during COVID-19 infection (p =<.0001, R2 = 95%). In three of thirteen patients, ANC drop was significant and changed the patients’ monitoring status from green to amber and required frequent blood tests.ConclusionsClinicians should bear in mind that a significant drop in neutrophils count may occur in COVID-19 -infected patients taking clozapine.DisclosureNo significant relationships.
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Quintana Castanedo L, Rodríguez Bandera AI, Feito Rodríguez M, González García MC, Stewart N, de Lucas Laguna R. Clinical presentation, sonographic features and treatment options of segmental stiff skin syndrome. Clin Exp Dermatol 2020; 46:135-141. [PMID: 32697852 DOI: 10.1111/ced.14394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/22/2020] [Accepted: 07/18/2020] [Indexed: 01/20/2023]
Abstract
Segmental stiff skin syndrome is a rare genetic connective tissue disease, which is often misdiagnosed. High-frequency ultrasonography can represent a useful clinical adjunct in the differential diagnosis of this condition, in conjunction with the clinical and histopathological findings. Treatment options are limited and evidence is scarce. We present the clinical, sonographic and histological features of five paediatric patients diagnosed at our institution and discuss their response to treatment.
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Affiliation(s)
- L Quintana Castanedo
- Departments of, Department of, Dermatology, La Paz University Hospital, Madrid, Spain
| | - A I Rodríguez Bandera
- Departments of, Department of, Dermatology, La Paz University Hospital, Madrid, Spain
| | - M Feito Rodríguez
- Departments of, Department of, Dermatology, La Paz University Hospital, Madrid, Spain
| | | | - N Stewart
- The Skin Hospital, Sydney, NSW, Australia
| | - R de Lucas Laguna
- Departments of, Department of, Dermatology, La Paz University Hospital, Madrid, Spain
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Quintana L, Rodríguez AI, Stewart N. Skin lesions in a diabetic patient. Neth J Med 2019; 77:346. [PMID: 31814593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Danylyshen-Laycock T, Morgan D, Stewart N, O’Connell M, Goodridge D. THE IMPACT OF LEADERSHIP AND CULTURE ON SUSTAINABILITY OF A DEMENTIA TRAINING PROGRAM IN LONG-TERM CARE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - D Morgan
- Canadian Centre for Health & Safety in Agriculture
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Danylyshen-Laycock T, Morgan D, Stewart N, O’Connell M, Goodridge D. THE ROLE OF FACILITATION IN SUSTAINABILITY OF A DEMENTIA TRAINING PROGRAM IN RURAL LONG-TERM CARE HOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - D Morgan
- Canadian Centre for Health & Safety in Agriculture
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Stewart N, Walters R, Mokhlesi B, Arora V. 0243 Risk of Sleep Disorders in Hospitalized Patients with Obstructive Lung Disease: An Observational Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - V Arora
- University of Chicago, Chicago, IL
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Tahir B, Hughes P, Robinson S, Marshall H, Stewart N, Biancardi A, Chan H, Collier G, Hart K, Swinscoe J, Hatton M, Wild J, Ireland R. OC-0182: A comparison of CT ventilation with 3He and 129Xe MRI for functional avoidance treatment planning. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Tahir B, Marshall H, Hughes P, Stewart N, Horn F, Collier G, Norquay G, Hart K, Swinscoe J, Hatton M, Wild J, Ireland R. WE-AB-202-07: Ventilation CT: Voxel-Level Comparison with Hyperpolarized Helium-3 & Xenon-129 MRI. Med Phys 2016. [DOI: 10.1118/1.4957748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kaasalainen S, Stewart N, Middleton J, Knezacek S, Hartley T, Ife C, Robinson L. Development and evaluation of the Pain Assessment in the Communicatively Impaired (PACI) tool: part I. Int J Palliat Nurs 2016; 17:387-91. [PMID: 22067678 DOI: 10.12968/ijpn.2011.17.8.387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pain is a common symptom for long-term care residents, particularly those in need of palliative care. However, pain assessment in residents who have communication limitations is challenging. A study was conducted with the aim of developing a pain assessment tool that could feasibly be used by direct care providers in long-term care with minimal training yet demonstrating strong psychometric properties. The study used both qualitative and quantitative methods to develop and test the Pain Assessment in the Communicatively Impaired (PACI) tool. Part I of this paper reports on the development phase; a forthcoming second part will report on the testing phase. The overall results of this study support the psychometric properties and feasibility of the PACI tool, offering preliminary support for its use in clinical practice.
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Kyriacou C, Stewart N, Melville A, Brown J, Edwards K, Lloyd R, Johnson M, Flint J, Rodger A, Lipman M. S81 Feasibility and uptake of enhanced smoking cessation services within ambulatory HIV care. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Estabrooks CA, Squires JE, Hayduk L, Morgan D, Cummings GG, Ginsburg L, Stewart N, McGilton K, Kang SH, Norton PG. The influence of organizational context on best practice use by care aides in residential long-term care settings. J Am Med Dir Assoc 2015; 16:537.e1-10. [PMID: 25899110 DOI: 10.1016/j.jamda.2015.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/10/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study assessed individual and organizational context (work environment) factors that influence use of best practices by care aides (nursing assistants) in nursing homes. Little scientific attention has been focused on understanding best practice use in nursing homes and almost none on care aides. SETTING AND PARTICIPANTS A total of 1262 care aides in 25 nursing homes in the 3 Canadian prairie provinces. Care aides are unregulated workers who provide 80% of direct care to residents in Canadian nursing homes. METHOD We used hierarchical linear modeling to (1) assess the amount of variance in use of best practices, as reported by care aides, that could be attributed to individual or organizational factors, and (2) identify predictors of best practices use by care aides. RESULTS At the individual level, statistically significant predictors of instrumental use of best practices included sex, age, shift worked, job efficacy, and belief suspension. At the unit level, significant predictors were social capital, organizational slack (staffing and time), number of informal interactions, and unit type. At the facility level, ownership model and province were significant. Significant predictors of conceptual use of best practices at the individual level included English as a first language, job efficacy, belief suspension, intent to use research, adequate knowledge, and number of information sources used. At the unit level, significant predictors were evaluation (feedback mechanisms), structural resources, and organizational slack (time). At the facility level, province was significant. The R(2) was 18.3% for instrumental use of best practices and 43.4% for conceptual use. Unit level factors added a substantial amount of explained variance whereas facility level factors added relatively little explained variance. CONCLUSIONS Our study suggests that context plays an important role in care aides' use of best practices in nursing homes. Individual characteristics played a more prominent role than contextual factors in predicting conceptual use of best practices.
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Affiliation(s)
| | - Janet E Squires
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Leslie Hayduk
- Department of Sociology, University of Alberta, Edmonton, Alberta, Canada
| | - Debra Morgan
- Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Norma Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Katherine McGilton
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Sung Hyun Kang
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Lin R, Taylor BV, Charlesworth J, van der Mei I, Blizzard L, Stewart N, Ponsonby AL, Dwyer T, Pittas F, Simpson S. Modulating effects of WT1 on interferon-β-vitamin D association in MS. Acta Neurol Scand 2015; 131:231-9. [PMID: 25312909 DOI: 10.1111/ane.12315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate whether those genes involved in the vitamin D pathway modulate the relationship between 25-hydroxyvitamin D (25(OH)D) and IFN-β, the relationship between IFN-β and sun in predicting 25(OH)D, and the interaction between IFN-β and 25(OH)D in modulating relapse risk in patients with MS. METHODS Prospective cohort study of 169 participants with MS and genotype data followed 2002-2005. Gene-IFN-β and gene-IFN-β-sun interactions predicting 25(OH)D evaluated by multilevel mixed-effects linear regression. Gene-IFN-β interactions with 25(OH)D in modulating in relapse risk assessed using survival analysis. RESULTS The cohort was 71.6% female and of mean age 47.8. Two-independent intronic genotyped SNPs (rs10767935 and rs5030244) in WT1 significantly modified the IFN-β-25(OH)D association after adjustment (P(interaction) = 0.001, 0.0002; P(adj) = 0.003, 0.006, respectively). There was a marked difference in the interaction between self-reported sun exposure and IFN-β in predicting 25(OH)D by level of rs10767935, although this did not reach statistical significance. No SNPs modified the interaction between IFN-β and 25(OH)D in predicting relapse. CONCLUSIONS We have demonstrated that two-independent SNPs (rs10767935 and rs5030244) in WT1 modified the IFN-β-25(OH)D association in patients with MS. Some evidence was shown for a difference in the sun-IFN-β-25(OH)D association by level of rs10767935. These findings indicate that WT1 variants may play a role in altering the effects of IFN-β on vitamin D in MS.
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Affiliation(s)
- R. Lin
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tas. Australia
- Guangxi Center for Disease Prevention and Control; Nanning China
| | - B. V. Taylor
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tas. Australia
| | - J. Charlesworth
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tas. Australia
| | - I. van der Mei
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tas. Australia
| | - L. Blizzard
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tas. Australia
| | - N. Stewart
- School of Pharmacy; University of Tasmania; Hobart Tas. Australia
- School of Medicine; University of Tasmania; Hobart Tas. Australia
| | - A.-L. Ponsonby
- Murdoch Children's Research Institute; Royal Children's Hospital; Hobart Tas. Australia
| | - T. Dwyer
- Murdoch Children's Research Institute; Royal Children's Hospital; Hobart Tas. Australia
| | - F. Pittas
- School of Medicine; University of Tasmania; Hobart Tas. Australia
| | - S. Simpson
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tas. Australia
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Thavapalachandran S, Stewart N, Kotlar A, Tan T, Skinner M. Cardiac Myxoma: An unusual presentation. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stewart N, Norquay G, Parra-Robles J, Marshall H, Leung G, Murphy P, Schulte R, Elliot C, Condliffe R, Billings C, Smith I, Griffiths P, Wolber J, Whyte M, Kiely D, Wild J. P273 Assessment Of Lung Microstructure In Interstitial Lung Disease With Hyperpolarised Gas Mri. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Morgan DG, Kosteniuk J, Stewart N, O'Connell ME, Karunanayake C, Beever R. The telehealth satisfaction scale: reliability, validity, and satisfaction with telehealth in a rural memory clinic population. Telemed J E Health 2014; 20:997-1003. [PMID: 25272141 DOI: 10.1089/tmj.2014.0002] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Patient satisfaction is a key aspect of quality of care and can inform continuous quality improvement. Of the few studies that have reported on patient satisfaction with telehealth in programs aimed at individuals with memory problems, none has reported on the psychometric properties of the user satisfaction scales used. MATERIALS AND METHODS We evaluated the construct validity and internal consistency reliability of the Telehealth Satisfaction Scale (TeSS), a 10-item scale adapted for use in a rural and remote memory clinic (RRMC). The RRMC is a one-stop interprofessional clinic for rural and remote seniors with suspected dementia, located in a tertiary-care hospital. Telehealth videoconferencing is used for preclinic assessment and for follow-up. Patients and caregivers completed the TeSS after each telehealth appointment. With data from 223 patients, exploratory factor analysis was conducted using the principal components analysis extraction method. RESULTS The eigenvalue for the first factor (5.2) was greater than 1 and much larger than the second eigenvalue (0.92), supporting a one-factor solution that was confirmed by the scree plot. The total variance explained by factor 1 was 52.1%. Factor loadings (range, 0.54-0.84) were above recommended cutoffs. The TeSS items demonstrated high internal consistency reliability (Cronbach's alpha=0.90). Satisfaction scores on the TeSS items ranged from 3.43 to 3.72 on a 4-point Likert scale, indicating high satisfaction with telehealth. CONCLUSIONS The study findings demonstrate high user satisfaction with telehealth in a rural memory clinic and the sound psychometric properties of the TeSS in this population.
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Affiliation(s)
- Debra G Morgan
- 1 Canadian Centre for Health & Safety in Agriculture, College of Medicine, University of Saskatchewan , Saskatoon, Saskatchewan, Canada
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Dal Bello-Haas VPM, Cammer A, Morgan D, Stewart N, Kosteniuk J. Rural and remote dementia care challenges and needs: perspectives of formal and informal care providers residing in Saskatchewan, Canada. Rural Remote Health 2014; 14:2747. [PMID: 25081857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Rural and remote settings pose particular healthcare and service delivery challenges. Providing appropriate care and support for individuals with dementia and their families living in these communities is especially difficult, and can only be accomplished when the needs of care providers and the context and complexity of care provision are understood. This paper describes formal and informal caregivers' perceptions of the challenges and needs in providing care and support for individuals with dementia living in rural and remote areas of Saskatchewan, Canada. METHODS A mixed-methods exploratory approach was used to examine caregivers' needs. This research was a component of a broader process evaluation designed to inform the initial and ongoing development of a community-based participatory research program in rural dementia care, which included the development of the Rural and Remote Memory Clinic (RRMC). Four approaches were used for data collection and analyses: (1) thematic analysis of consultation meetings with rural healthcare providers: documented discussions from consultation meetings that occurred in 2003-2004 with rural physicians and healthcare providers regarding plans for a new RRMC were analysed thematically; (2) telephone and mail questionnaires: consultation meeting participants completed a subsequent telephone or mail questionnaire (2003-2004) that was analysed descriptively; (3) thematic analysis of referral letters to the Rural and Remote Memory Clinic: physician referral letters over a five-year period (2003-2008) were analysed descriptively and thematically; and (4) examination of family caregiver satisfaction: four specific baseline questionnaire questions completed by family caregivers (2007-2010) were analysed descriptively and thematically. RESULTS Both physician and non-physician healthcare providers identified increased facilities and care programs as needs. Physicians were much more likely than other providers to report available support services for patients and families as adequate. Non-physician providers identified improved services, better coordination of services, travel and travel burden related needs, and staff training and education needs as priorities. Physician needs, as determined via referral letters, included confirmation of diagnosis or treatment, request for further management suggestions, patient or family request, and consultation regarding difficult cases. One-third of informal caregivers expressed not being satisfied with the care received prior to the Rural and Remote Memory Clinic assessment visit, and identified lack of diagnosis and long wait times for services as key issues. CONCLUSIONS Delivering services and providing care and support for individuals with dementia living in rural and remote communities are especially challenging. The need for increased extent of services was a commonality among formal and informal caregivers. Primary care physicians may seek confirmation of their diagnosis or may need assistance when dealing with difficult aspects of care, as identified by referral letters. Differences between the needs identified via referral letters and questionnaire responses of physicians may be a reflection of the rural or remote context of care provision. Informal caregiver needs were more aligned with non-physician healthcare providers with respect to the need for improved access to additional healthcare professionals and services. The findings have implications for regional policy development that addresses human and other resource shortages.
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Affiliation(s)
| | - Allison Cammer
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Norma Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Julie Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
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Dal Bello-Haas V, Cammer A, Morgan D, Stewart N, Kosteniuk J. Rural and remote dementia care challenges and needs: perspectives of formal and informal care providers residing in Saskatchewan, Canada. Rural Remote Health 2014. [DOI: 10.22605/rrh2747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Ebert MA, Foo K, Haworth A, Gulliford SL, Kearvall R, Kennedy A, Richardson S, Krawiec M, Stewart N, Joseph DJ, Denham JW. Derivation and representation of dose-volume response from large clinical trial data sets: an example from the RADAR prostate radiotherapy trial. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1742-6596/489/1/012090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Morgan D, Crossley M, Stewart N, Kirk A, Forbes D, D'Arcy C, Dal Bello-Haas V, McBain L, O'Connell M, Bracken J, Kosteniuk J, Cammer A. Evolution of a community-based participatory approach in a rural and remote dementia care research program. Prog Community Health Partnersh 2014; 8:337-45. [PMID: 25435560 PMCID: PMC4469481 DOI: 10.1353/cpr.2014.0040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Community-based participatory research (CBPR) approaches are valuable strategies for addressing complex health and social problems and powerful tools to support effective transformation of social and health policy to better meet the needs of diverse stakeholders. OBJECTIVES Since 1997, our team has utilized CBPR approaches to improve health service delivery for persons with dementia and their caregivers in rural and remote settings. We describe the evolution of our approach, including benefits, challenges, and lessons learned over the last 15 years. METHODS A multistage approach initiated an ongoing CBPR research program in rural dementia care and shaped its direction based on stakeholders' recommendation to prioritize both community and facility-based care. Strategies to develop and foster collaborative partnerships have included travel to rural and remote regions, province-wide community meetings, stakeholder workshops, creation of a Decision-Maker Advisory Council to provide ongoing direction to the overall program, development of diverse project-specific advisory groups, and a highly successful and much anticipated annual knowledge exchange and team-building event. LESSONS LEARNED Partnering with stakeholders in the full research process has enhanced the research quality, relevance, application, and sustainability. These benefits have supported the team's evolution from a relatively traditional focus to an integrated approach guiding all aspects of our research. CONCLUSIONS Developing and sustaining the full range of stakeholder and decision-maker partnerships is resource-and time-intensive, but our experience shows that community-based participatory strategies are highly suited to health services research that is designed to support sustainable service delivery improvements.
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Grotzinger JP, Sumner DY, Kah LC, Stack K, Gupta S, Edgar L, Rubin D, Lewis K, Schieber J, Mangold N, Milliken R, Conrad PG, DesMarais D, Farmer J, Siebach K, Calef F, Hurowitz J, McLennan SM, Ming D, Vaniman D, Crisp J, Vasavada A, Edgett KS, Malin M, Blake D, Gellert R, Mahaffy P, Wiens RC, Maurice S, Grant JA, Wilson S, Anderson RC, Beegle L, Arvidson R, Hallet B, Sletten RS, Rice M, Bell J, Griffes J, Ehlmann B, Anderson RB, Bristow TF, Dietrich WE, Dromart G, Eigenbrode J, Fraeman A, Hardgrove C, Herkenhoff K, Jandura L, Kocurek G, Lee S, Leshin LA, Leveille R, Limonadi D, Maki J, McCloskey S, Meyer M, Minitti M, Newsom H, Oehler D, Okon A, Palucis M, Parker T, Rowland S, Schmidt M, Squyres S, Steele A, Stolper E, Summons R, Treiman A, Williams R, Yingst A, Team MS, Kemppinen O, Bridges N, Johnson JR, Cremers D, Godber A, Wadhwa M, Wellington D, McEwan I, Newman C, Richardson M, Charpentier A, Peret L, King P, Blank J, Weigle G, Li S, Robertson K, Sun V, Baker M, Edwards C, Farley K, Miller H, Newcombe M, Pilorget C, Brunet C, Hipkin V, Leveille R, Marchand G, Sanchez PS, Favot L, Cody G, Fluckiger L, Lees D, Nefian A, Martin M, Gailhanou M, Westall F, Israel G, Agard C, Baroukh J, Donny C, Gaboriaud A, Guillemot P, Lafaille V, Lorigny E, Paillet A, Perez R, Saccoccio M, Yana C, Armiens-Aparicio C, Rodriguez JC, Blazquez IC, Gomez FG, Gomez-Elvira J, Hettrich S, Malvitte AL, Jimenez MM, Martinez-Frias J, Martin-Soler J, Martin-Torres FJ, Jurado AM, Mora-Sotomayor L, Caro GM, Lopez SN, Peinado-Gonzalez V, Pla-Garcia J, Manfredi JAR, Romeral-Planello JJ, Fuentes SAS, Martinez ES, Redondo JT, Urqui-O'Callaghan R, Mier MPZ, Chipera S, Lacour JL, Mauchien P, Sirven JB, Manning H, Fairen A, Hayes A, Joseph J, Sullivan R, Thomas P, Dupont A, Lundberg A, Melikechi N, Mezzacappa A, DeMarines J, Grinspoon D, Reitz G, Prats B, Atlaskin E, Genzer M, Harri AM, Haukka H, Kahanpaa H, Kauhanen J, Paton M, Polkko J, Schmidt W, Siili T, Fabre C, Wray J, Wilhelm MB, Poitrasson F, Patel K, Gorevan S, Indyk S, Paulsen G, Bish D, Gondet B, Langevin Y, Geffroy C, Baratoux D, Berger G, Cros A, d'Uston C, Forni O, Gasnault O, Lasue J, Lee QM, Meslin PY, Pallier E, Parot Y, Pinet P, Schroder S, Toplis M, Lewin E, Brunner W, Heydari E, Achilles C, Sutter B, Cabane M, Coscia D, Szopa C, Robert F, Sautter V, Le Mouelic S, Nachon M, Buch A, Stalport F, Coll P, Francois P, Raulin F, Teinturier S, Cameron J, Clegg S, Cousin A, DeLapp D, Dingler R, Jackson RS, Johnstone S, Lanza N, Little C, Nelson T, Williams RB, Jones A, Kirkland L, Baker B, Cantor B, Caplinger M, Davis S, Duston B, Fay D, Harker D, Herrera P, Jensen E, Kennedy MR, Krezoski G, Krysak D, Lipkaman L, McCartney E, McNair S, Nixon B, Posiolova L, Ravine M, Salamon A, Saper L, Stoiber K, Supulver K, Van Beek J, Van Beek T, Zimdar R, French KL, Iagnemma K, Miller K, Goesmann F, Goetz W, Hviid S, Johnson M, Lefavor M, Lyness E, Breves E, Dyar MD, Fassett C, Edwards L, Haberle R, Hoehler T, Hollingsworth J, Kahre M, Keely L, McKay C, Bleacher L, Brinckerhoff W, Choi D, Dworkin JP, Floyd M, Freissinet C, Garvin J, Glavin D, Harpold D, Martin DK, McAdam A, Pavlov A, Raaen E, Smith MD, Stern J, Tan F, Trainer M, Posner A, Voytek M, Aubrey A, Behar A, Blaney D, Brinza D, Christensen L, DeFlores L, Feldman J, Feldman S, Flesch G, Jun I, Keymeulen D, Mischna M, Morookian JM, Pavri B, Schoppers M, Sengstacken A, Simmonds JJ, Spanovich N, Juarez MDLT, Webster CR, Yen A, Archer PD, Cucinotta F, Jones JH, Morris RV, Niles P, Rampe E, Nolan T, Fisk M, Radziemski L, Barraclough B, Bender S, Berman D, Dobrea EN, Tokar R, Cleghorn T, Huntress W, Manhes G, Hudgins J, Olson T, Stewart N, Sarrazin P, Vicenzi E, Bullock M, Ehresmann B, Hamilton V, Hassler D, Peterson J, Rafkin S, Zeitlin C, Fedosov F, Golovin D, Karpushkina N, Kozyrev A, Litvak M, Malakhov A, Mitrofanov I, Mokrousov M, Nikiforov S, Prokhorov V, Sanin A, Tretyakov V, Varenikov A, Vostrukhin A, Kuzmin R, Clark B, Wolff M, Botta O, Drake D, Bean K, Lemmon M, Schwenzer SP, Lee EM, Sucharski R, Hernandez MADP, Avalos JJB, Ramos M, Kim MH, Malespin C, Plante I, Muller JP, Navarro-Gonzalez R, Ewing R, Boynton W, Downs R, Fitzgibbon M, Harshman K, Morrison S, Kortmann O, Williams A, Lugmair G, Wilson MA, Jakosky B, Balic-Zunic T, Frydenvang J, Jensen JK, Kinch K, Koefoed A, Madsen MB, Stipp SLS, Boyd N, Campbell JL, Perrett G, Pradler I, VanBommel S, Jacob S, Owen T, Savijarvi H, Boehm E, Bottcher S, Burmeister S, Guo J, Kohler J, Garcia CM, Mueller-Mellin R, Wimmer-Schweingruber R, Bridges JC, McConnochie T, Benna M, Franz H, Bower H, Brunner A, Blau H, Boucher T, Carmosino M, Atreya S, Elliott H, Halleaux D, Renno N, Wong M, Pepin R, Elliott B, Spray J, Thompson L, Gordon S, Ollila A, Williams J, Vasconcelos P, Bentz J, Nealson K, Popa R, Moersch J, Tate C, Day M, Francis R, McCullough E, Cloutis E, ten Kate IL, Scholes D, Slavney S, Stein T, Ward J, Berger J, Moores JE. A Habitable Fluvio-Lacustrine Environment at Yellowknife Bay, Gale Crater, Mars. Science 2013; 343:1242777. [DOI: 10.1126/science.1242777] [Citation(s) in RCA: 578] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Vaniman DT, Bish DL, Ming DW, Bristow TF, Morris RV, Blake DF, Chipera SJ, Morrison SM, Treiman AH, Rampe EB, Rice M, Achilles CN, Grotzinger JP, McLennan SM, Williams J, Bell JF, Newsom HE, Downs RT, Maurice S, Sarrazin P, Yen AS, Morookian JM, Farmer JD, Stack K, Milliken RE, Ehlmann BL, Sumner DY, Berger G, Crisp JA, Hurowitz JA, Anderson R, Des Marais DJ, Stolper EM, Edgett KS, Gupta S, Spanovich N, Agard C, Alves Verdasca JA, Anderson R, Archer D, Armiens-Aparicio C, Arvidson R, Atlaskin E, Atreya S, Aubrey A, Baker B, Baker M, Balic-Zunic T, Baratoux D, Baroukh J, Barraclough B, Bean K, Beegle L, Behar A, Bender S, Benna M, Bentz J, Berger J, Berman D, Blanco Avalos JJ, Blaney D, Blank J, Blau H, Bleacher L, Boehm E, Botta O, Bottcher S, Boucher T, Bower H, Boyd N, Boynton B, Breves E, Bridges J, Bridges N, Brinckerhoff W, Brinza D, Brunet C, Brunner A, Brunner W, Buch A, Bullock M, Burmeister S, Cabane M, Calef F, Cameron J, Campbell JI, Cantor B, Caplinger M, Caride Rodriguez J, Carmosino M, Carrasco Blazquez I, Charpentier A, Choi D, Clark B, Clegg S, Cleghorn T, Cloutis E, Cody G, Coll P, Conrad P, Coscia D, Cousin A, Cremers D, Cros A, Cucinotta F, d'Uston C, Davis S, Day MK, de la Torre Juarez M, DeFlores L, DeLapp D, DeMarines J, Dietrich W, Dingler R, Donny C, Drake D, Dromart G, Dupont A, Duston B, Dworkin J, Dyar MD, Edgar L, Edwards C, Edwards L, Ehresmann B, Eigenbrode J, Elliott B, Elliott H, Ewing R, Fabre C, Fairen A, Farley K, Fassett C, Favot L, Fay D, Fedosov F, Feldman J, Feldman S, Fisk M, Fitzgibbon M, Flesch G, Floyd M, Fluckiger L, Forni O, Fraeman A, Francis R, Francois P, Franz H, Freissinet C, French KL, Frydenvang J, Gaboriaud A, Gailhanou M, Garvin J, Gasnault O, Geffroy C, Gellert R, Genzer M, Glavin D, Godber A, Goesmann F, Goetz W, Golovin D, Gomez Gomez F, Gomez-Elvira J, Gondet B, Gordon S, Gorevan S, Grant J, Griffes J, Grinspoon D, Guillemot P, Guo J, Guzewich S, Haberle R, Halleaux D, Hallet B, Hamilton V, Hardgrove C, Harker D, Harpold D, Harri AM, Harshman K, Hassler D, Haukka H, Hayes A, Herkenhoff K, Herrera P, Hettrich S, Heydari E, Hipkin V, Hoehler T, Hollingsworth J, Hudgins J, Huntress W, Hviid S, Iagnemma K, Indyk S, Israel G, Jackson R, Jacob S, Jakosky B, Jensen E, Jensen JK, Johnson J, Johnson M, Johnstone S, Jones A, Jones J, Joseph J, Jun I, Kah L, Kahanpaa H, Kahre M, Karpushkina N, Kasprzak W, Kauhanen J, Keely L, Kemppinen O, Keymeulen D, Kim MH, Kinch K, King P, Kirkland L, Kocurek G, Koefoed A, Kohler J, Kortmann O, Kozyrev A, Krezoski J, Krysak D, Kuzmin R, Lacour JL, Lafaille V, Langevin Y, Lanza N, Lasue J, Le Mouelic S, Lee EM, Lee QM, Lees D, Lefavor M, Lemmon M, Malvitte AL, Leshin L, Leveille R, Lewin-Carpintier E, Lewis K, Li S, Lipkaman L, Little C, Litvak M, Lorigny E, Lugmair G, Lundberg A, Lyness E, Madsen M, Mahaffy P, Maki J, Malakhov A, Malespin C, Malin M, Mangold N, Manhes G, Manning H, Marchand G, Marin Jimenez M, Martin Garcia C, Martin D, Martin M, Martinez-Frias J, Martin-Soler J, Martin-Torres FJ, Mauchien P, McAdam A, McCartney E, McConnochie T, McCullough E, McEwan I, McKay C, McNair S, Melikechi N, Meslin PY, Meyer M, Mezzacappa A, Miller H, Miller K, Minitti M, Mischna M, Mitrofanov I, Moersch J, Mokrousov M, Molina Jurado A, Moores J, Mora-Sotomayor L, Mueller-Mellin R, Muller JP, Munoz Caro G, Nachon M, Navarro Lopez S, Navarro-Gonzalez R, Nealson K, Nefian A, Nelson T, Newcombe M, Newman C, Nikiforov S, Niles P, Nixon B, Noe Dobrea E, Nolan T, Oehler D, Ollila A, Olson T, Owen T, de Pablo Hernandez MA, Paillet A, Pallier E, Palucis M, Parker T, Parot Y, Patel K, Paton M, Paulsen G, Pavlov A, Pavri B, Peinado-Gonzalez V, Pepin R, Peret L, Perez R, Perrett G, Peterson J, Pilorget C, Pinet P, Pla-Garcia J, Plante I, Poitrasson F, Polkko J, Popa R, Posiolova L, Posner A, Pradler I, Prats B, Prokhorov V, Purdy SW, Raaen E, Radziemski L, Rafkin S, Ramos M, Raulin F, Ravine M, Reitz G, Renno N, Richardson M, Robert F, Robertson K, Rodriguez Manfredi JA, Romeral-Planello JJ, Rowland S, Rubin D, Saccoccio M, Salamon A, Sandoval J, Sanin A, Sans Fuentes SA, Saper L, Sautter V, Savijarvi H, Schieber J, Schmidt M, Schmidt W, Scholes DD, Schoppers M, Schroder S, Schwenzer S, Sebastian Martinez E, Sengstacken A, Shterts R, Siebach K, Siili T, Simmonds J, Sirven JB, Slavney S, Sletten R, Smith M, Sobron Sanchez P, Spray J, Squyres S, Stalport F, Steele A, Stein T, Stern J, Stewart N, Stipp SLS, Stoiber K, Sucharski B, Sullivan R, Summons R, Sun V, Supulver K, Sutter B, Szopa C, Tan F, Tate C, Teinturier S, ten Kate I, Thomas P, Thompson L, Tokar R, Toplis M, Torres Redondo J, Trainer M, Tretyakov V, Urqui-O'Callaghan R, Van Beek J, Van Beek T, VanBommel S, Varenikov A, Vasavada A, Vasconcelos P, Vicenzi E, Vostrukhin A, Voytek M, Wadhwa M, Ward J, Webster C, Weigle E, Wellington D, Westall F, Wiens RC, Wilhelm MB, Williams A, Williams R, Williams RBM, Wilson M, Wimmer-Schweingruber R, Wolff M, Wong M, Wray J, Wu M, Yana C, Yingst A, Zeitlin C, Zimdar R, Zorzano Mier MP. Mineralogy of a Mudstone at Yellowknife Bay, Gale Crater, Mars. Science 2013; 343:1243480. [DOI: 10.1126/science.1243480] [Citation(s) in RCA: 433] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Morgan DG, Walls-Ingram S, Cammer A, O'Connell ME, Crossley M, Dal Bello-Haas V, Forbes D, Innes A, Kirk A, Stewart N. Informal caregivers' hopes and expectations of a referral to a memory clinic. Soc Sci Med 2013; 102:111-8. [PMID: 24565148 DOI: 10.1016/j.socscimed.2013.11.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 07/25/2013] [Accepted: 11/12/2013] [Indexed: 12/19/2022]
Abstract
Although only 20-50% of individuals with dementia are diagnosed, early diagnosis enables patients and families to access interventions and services, and plan for the future. The current study explored the experiences of rural family caregivers in the period leading up to a diagnostic assessment at a Canadian memory clinic, their hopes and expectations of the assessment, and their experiences in the six months following diagnosis. Using a longitudinal, retrospective and prospective qualitative research design, caregivers of 30 patients referred to the clinic were interviewed during the diagnostic assessment process and again six months after the diagnosis. Most caregivers reported first noticing symptoms two years prior to diagnosis. The pre-diagnostic interviews revealed a prevalent 'need to know' among caregivers that drove the help-seeking process. Caregivers hoped that the diagnosis would have the benefits of 'naming it,' 'accessing treatment,' 'knowing what to expect,' and 'receiving guidance.' When asked six months later about the impact of the diagnosis, the main theme was 'acceptance and moving forward.' Caregivers reported that the diagnosis provided 'relief,' 'validation,' and 'improved access to services.' These findings can inform care practices of primary health care providers who represent the first point of contact regarding expectations and experiences of dementia-related diagnoses.
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Lachmann HJ, Stewart N, Lane T, Rowczenio DM, Hawkins PN. P03-017 - Health related quality of life in adult with HRFS. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952217 DOI: 10.1186/1546-0096-11-s1-a215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Leshin LA, Mahaffy PR, Webster CR, Cabane M, Coll P, Conrad PG, Archer PD, Atreya SK, Brunner AE, Buch A, Eigenbrode JL, Flesch GJ, Franz HB, Freissinet C, Glavin DP, McAdam AC, Miller KE, Ming DW, Morris RV, Navarro-Gonzalez R, Niles PB, Owen T, Pepin RO, Squyres S, Steele A, Stern JC, Summons RE, Sumner DY, Sutter B, Szopa C, Teinturier S, Trainer MG, Wray JJ, Grotzinger JP, Kemppinen O, Bridges N, Johnson JR, Minitti M, Cremers D, Bell JF, Edgar L, Farmer J, Godber A, Wadhwa M, Wellington D, McEwan I, Newman C, Richardson M, Charpentier A, Peret L, King P, Blank J, Weigle G, Schmidt M, Li S, Milliken R, Robertson K, Sun V, Baker M, Edwards C, Ehlmann B, Farley K, Griffes J, Miller H, Newcombe M, Pilorget C, Rice M, Siebach K, Stack K, Stolper E, Brunet C, Hipkin V, Leveille R, Marchand G, Sanchez PS, Favot L, Cody G, Fluckiger L, Lees D, Nefian A, Martin M, Gailhanou M, Westall F, Israel G, Agard C, Baroukh J, Donny C, Gaboriaud A, Guillemot P, Lafaille V, Lorigny E, Paillet A, Perez R, Saccoccio M, Yana C, Armiens-Aparicio C, Rodriguez JC, Blazquez IC, Gomez FG, Gomez-Elvira J, Hettrich S, Malvitte AL, Jimenez MM, Martinez-Frias J, Martin-Soler J, Martin-Torres FJ, Jurado AM, Mora-Sotomayor L, Caro GM, Lopez SN, Peinado-Gonzalez V, Pla-Garcia J, Manfredi JAR, Romeral-Planello JJ, Fuentes SAS, Martinez ES, Redondo JT, Urqui-O'Callaghan R, Mier MPZ, Chipera S, Lacour JL, Mauchien P, Sirven JB, Manning H, Fairen A, Hayes A, Joseph J, Sullivan R, Thomas P, Dupont A, Lundberg A, Melikechi N, Mezzacappa A, DeMarines J, Grinspoon D, Reitz G, Prats B, Atlaskin E, Genzer M, Harri AM, Haukka H, Kahanpaa H, Kauhanen J, Kemppinen O, Paton M, Polkko J, Schmidt W, Siili T, Fabre C, Wilhelm MB, Poitrasson F, Patel K, Gorevan S, Indyk S, Paulsen G, Gupta S, Bish D, Schieber J, Gondet B, Langevin Y, Geffroy C, Baratoux D, Berger G, Cros A, d'Uston C, Forni O, Gasnault O, Lasue J, Lee QM, Maurice S, Meslin PY, Pallier E, Parot Y, Pinet P, Schroder S, Toplis M, Lewin E, Brunner W, Heydari E, Achilles C, Oehler D, Coscia D, Israel G, Dromart G, Robert F, Sautter V, Le Mouelic S, Mangold N, Nachon M, Stalport F, Francois P, Raulin F, Cameron J, Clegg S, Cousin A, DeLapp D, Dingler R, Jackson RS, Johnstone S, Lanza N, Little C, Nelson T, Wiens RC, Williams RB, Jones A, Kirkland L, Treiman A, Baker B, Cantor B, Caplinger M, Davis S, Duston B, Edgett K, Fay D, Hardgrove C, Harker D, Herrera P, Jensen E, Kennedy MR, Krezoski G, Krysak D, Lipkaman L, Malin M, McCartney E, McNair S, Nixon B, Posiolova L, Ravine M, Salamon A, Saper L, Stoiber K, Supulver K, Van Beek J, Van Beek T, Zimdar R, French KL, Iagnemma K, Goesmann F, Goetz W, Hviid S, Johnson M, Lefavor M, Lyness E, Breves E, Dyar MD, Fassett C, Blake DF, Bristow T, DesMarais D, Edwards L, Haberle R, Hoehler T, Hollingsworth J, Kahre M, Keely L, McKay C, Wilhelm MB, Bleacher L, Brinckerhoff W, Choi D, Dworkin JP, Floyd M, Garvin J, Harpold D, Jones A, Martin DK, Pavlov A, Raaen E, Smith MD, Tan F, Meyer M, Posner A, Voytek M, Anderson RC, Aubrey A, Beegle LW, Behar A, Blaney D, Brinza D, Calef F, Christensen L, Crisp JA, DeFlores L, Ehlmann B, Feldman J, Feldman S, Hurowitz J, Jun I, Keymeulen D, Maki J, Mischna M, Morookian JM, Parker T, Pavri B, Schoppers M, Sengstacken A, Simmonds JJ, Spanovich N, Juarez MDLT, Vasavada AR, Yen A, Cucinotta F, Jones JH, Rampe E, Nolan T, Fisk M, Radziemski L, Barraclough B, Bender S, Berman D, Dobrea EN, Tokar R, Vaniman D, Williams RME, Yingst A, Lewis K, Cleghorn T, Huntress W, Manhes G, Hudgins J, Olson T, Stewart N, Sarrazin P, Grant J, Vicenzi E, Wilson SA, Bullock M, Ehresmann B, Hamilton V, Hassler D, Peterson J, Rafkin S, Zeitlin C, Fedosov F, Golovin D, Karpushkina N, Kozyrev A, Litvak M, Malakhov A, Mitrofanov I, Mokrousov M, Nikiforov S, Prokhorov V, Sanin A, Tretyakov V, Varenikov A, Vostrukhin A, Kuzmin R, Clark B, Wolff M, McLennan S, Botta O, Drake D, Bean K, Lemmon M, Schwenzer SP, Anderson RB, Herkenhoff K, Lee EM, Sucharski R, Hernandez MADP, Avalos JJB, Ramos M, Kim MH, Malespin C, Plante I, Muller JP, Ewing R, Boynton W, Downs R, Fitzgibbon M, Harshman K, Morrison S, Dietrich W, Kortmann O, Palucis M, Williams A, Lugmair G, Wilson MA, Rubin D, Jakosky B, Balic-Zunic T, Frydenvang J, Jensen JK, Kinch K, Koefoed A, Madsen MB, Stipp SLS, Boyd N, Campbell JL, Gellert R, Perrett G, Pradler I, VanBommel S, Jacob S, Rowland S, Atlaskin E, Savijarvi H, Boehm E, Bottcher S, Burmeister S, Guo J, Kohler J, Garcia CM, Mueller-Mellin R, Wimmer-Schweingruber R, Bridges JC, McConnochie T, Benna M, Bower H, Blau H, Boucher T, Carmosino M, Elliott H, Halleaux D, Renno N, Wong M, Elliott B, Spray J, Thompson L, Gordon S, Newsom H, Ollila A, Williams J, Vasconcelos P, Bentz J, Nealson K, Popa R, Kah LC, Moersch J, Tate C, Day M, Kocurek G, Hallet B, Sletten R, Francis R, McCullough E, Cloutis E, ten Kate IL, Kuzmin R, Arvidson R, Fraeman A, Scholes D, Slavney S, Stein T, Ward J, Berger J, Moores JE. Volatile, Isotope, and Organic Analysis of Martian Fines with the Mars Curiosity Rover. Science 2013; 341:1238937. [DOI: 10.1126/science.1238937] [Citation(s) in RCA: 327] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Mahaffy PR, Webster CR, Atreya SK, Franz H, Wong M, Conrad PG, Harpold D, Jones JJ, Leshin LA, Manning H, Owen T, Pepin RO, Squyres S, Trainer M, Kemppinen O, Bridges N, Johnson JR, Minitti M, Cremers D, Bell JF, Edgar L, Farmer J, Godber A, Wadhwa M, Wellington D, McEwan I, Newman C, Richardson M, Charpentier A, Peret L, King P, Blank J, Weigle G, Schmidt M, Li S, Milliken R, Robertson K, Sun V, Baker M, Edwards C, Ehlmann B, Farley K, Griffes J, Grotzinger J, Miller H, Newcombe M, Pilorget C, Rice M, Siebach K, Stack K, Stolper E, Brunet C, Hipkin V, Leveille R, Marchand G, Sanchez PS, Favot L, Cody G, Steele A, Fluckiger L, Lees D, Nefian A, Martin M, Gailhanou M, Westall F, Israel G, Agard C, Baroukh J, Donny C, Gaboriaud A, Guillemot P, Lafaille V, Lorigny E, Paillet A, Perez R, Saccoccio M, Yana C, Armiens-Aparicio C, Rodriguez JC, Blazquez IC, Gomez FG, Gomez-Elvira J, Hettrich S, Malvitte AL, Jimenez MM, Martinez-Frias J, Martin-Soler J, Martin-Torres FJ, Jurado AM, Mora-Sotomayor L, Caro GM, Lopez SN, Peinado-Gonzalez V, Pla-Garcia J, Manfredi JAR, Romeral-Planello JJ, Fuentes SAS, Martinez ES, Redondo JT, Urqui-O'Callaghan R, Mier MPZ, Chipera S, Lacour JL, Mauchien P, Sirven JB, Fairen A, Hayes A, Joseph J, Sullivan R, Thomas P, Dupont A, Lundberg A, Melikechi N, Mezzacappa A, DeMarines J, Grinspoon D, Reitz G, Prats B, Atlaskin E, Genzer M, Harri AM, Haukka H, Kahanpaa H, Kauhanen J, Kemppinen O, Paton M, Polkko J, Schmidt W, Siili T, Fabre C, Wray J, Wilhelm MB, Poitrasson F, Patel K, Gorevan S, Indyk S, Paulsen G, Gupta S, Bish D, Schieber J, Gondet B, Langevin Y, Geffroy C, Baratoux D, Berger G, Cros A, d'Uston C, Forni O, Gasnault O, Lasue J, Lee QM, Maurice S, Meslin PY, Pallier E, Parot Y, Pinet P, Schroder S, Toplis M, Lewin E, Brunner W, Heydari E, Achilles C, Oehler D, Sutter B, Cabane M, Coscia D, Israel G, Szopa C, Dromart G, Robert F, Sautter V, Le Mouelic S, Mangold N, Nachon M, Buch A, Stalport F, Coll P, Francois P, Raulin F, Teinturier S, Cameron J, Clegg S, Cousin A, DeLapp D, Dingler R, Jackson RS, Johnstone S, Lanza N, Little C, Nelson T, Wiens RC, Williams RB, Jones A, Kirkland L, Treiman A, Baker B, Cantor B, Caplinger M, Davis S, Duston B, Edgett K, Fay D, Hardgrove C, Harker D, Herrera P, Jensen E, Kennedy MR, Krezoski G, Krysak D, Lipkaman L, Malin M, McCartney E, McNair S, Nixon B, Posiolova L, Ravine M, Salamon A, Saper L, Stoiber K, Supulver K, Van Beek J, Van Beek T, Zimdar R, French KL, Iagnemma K, Miller K, Summons R, Goesmann F, Goetz W, Hviid S, Johnson M, Lefavor M, Lyness E, Breves E, Dyar MD, Fassett C, Blake DF, Bristow T, DesMarais D, Edwards L, Haberle R, Hoehler T, Hollingsworth J, Kahre M, Keely L, McKay C, Wilhelm MB, Bleacher L, Brinckerhoff W, Choi D, Dworkin JP, Eigenbrode J, Floyd M, Freissinet C, Garvin J, Glavin D, Jones A, Martin DK, McAdam A, Pavlov A, Raaen E, Smith MD, Stern J, Tan F, Meyer M, Posner A, Voytek M, Anderson RC, Aubrey A, Beegle LW, Behar A, Blaney D, Brinza D, Calef F, Christensen L, Crisp JA, DeFlores L, Ehlmann B, Feldman J, Feldman S, Flesch G, Hurowitz J, Jun I, Keymeulen D, Maki J, Mischna M, Morookian JM, Parker T, Pavri B, Schoppers M, Sengstacken A, Simmonds JJ, Spanovich N, Juarez MDLT, Vasavada AR, Yen A, Archer PD, Cucinotta F, Ming D, Morris RV, Niles P, Rampe E, Nolan T, Fisk M, Radziemski L, Barraclough B, Bender S, Berman D, Dobrea EN, Tokar R, Vaniman D, Williams RME, Yingst A, Lewis K, Cleghorn T, Huntress W, Manhes G, Hudgins J, Olson T, Stewart N, Sarrazin P, Grant J, Vicenzi E, Wilson SA, Bullock M, Ehresmann B, Hamilton V, Hassler D, Peterson J, Rafkin S, Zeitlin C, Fedosov F, Golovin D, Karpushkina N, Kozyrev A, Litvak M, Malakhov A, Mitrofanov I, Mokrousov M, Nikiforov S, Prokhorov V, Sanin A, Tretyakov V, Varenikov A, Vostrukhin A, Kuzmin R, Clark B, Wolff M, McLennan S, Botta O, Drake D, Bean K, Lemmon M, Schwenzer SP, Anderson RB, Herkenhoff K, Lee EM, Sucharski R, Hernandez MADP, Avalos JJB, Ramos M, Kim MH, Malespin C, Plante I, Muller JP, Navarro-Gonzalez R, Ewing R, Boynton W, Downs R, Fitzgibbon M, Harshman K, Morrison S, Dietrich W, Kortmann O, Palucis M, Sumner DY, Williams A, Lugmair G, Wilson MA, Rubin D, Jakosky B, Balic-Zunic T, Frydenvang J, Jensen JK, Kinch K, Koefoed A, Madsen MB, Stipp SLS, Boyd N, Campbell JL, Gellert R, Perrett G, Pradler I, VanBommel S, Jacob S, Rowland S, Atlaskin E, Savijarvi H, Boehm E, Bottcher S, Burmeister S, Guo J, Kohler J, Garcia CM, Mueller-Mellin R, Wimmer-Schweingruber R, Bridges JC, McConnochie T, Benna M, Bower H, Brunner A, Blau H, Boucher T, Carmosino M, Elliott H, Halleaux D, Renno N, Elliott B, Spray J, Thompson L, Gordon S, Newsom H, Ollila A, Williams J, Vasconcelos P, Bentz J, Nealson K, Popa R, Kah LC, Moersch J, Tate C, Day M, Kocurek G, Hallet B, Sletten R, Francis R, McCullough E, Cloutis E, ten Kate IL, Kuzmin R, Arvidson R, Fraeman A, Scholes D, Slavney S, Stein T, Ward J, Berger J, Moores JE. Abundance and Isotopic Composition of Gases in the Martian Atmosphere from the Curiosity Rover. Science 2013; 341:263-6. [PMID: 23869014 DOI: 10.1126/science.1237966] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Cammer A, Morgan D, Stewart N, McGilton K, Rycroft-Malone J, Dopson S, Estabrooks C. The Hidden Complexity of Long-Term Care: how context mediates knowledge translation and use of best practices. Gerontologist 2013; 54:1013-23. [PMID: 23856027 DOI: 10.1093/geront/gnt068] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Context is increasingly recognized as a key factor to be considered when addressing healthcare practice. This study describes features of context as they pertain to knowledge use in long-term care (LTC). DESIGN AND METHODS As one component of the research program Translating Research in Elder Care, an in-depth qualitative case study was conducted to examine the research question "How does organizational context mediate the use of knowledge in practice in long-term care facilities?" A representative facility was chosen from the province of Saskatchewan, Canada. Data included document review, direct observation of daily care practices, and interviews with direct care, allied provider, and administrative staff. RESULTS The Hidden Complexity of Long-Term Care model consists of 8 categories that enmesh to create a context within which knowledge exchange and best practice are executed. These categories range from the most easily identifiable to the least observable: physical environment, resources, ambiguity, flux, relationships, and philosophies. Two categories (experience and confidence, leadership and mentoring) mediate the impact of other contextual factors. Inappropriate physical environments, inadequate resources, ambiguous situations, continual change, multiple relationships, and contradictory philosophies make for a complicated context that impacts care provision. IMPLICATIONS A hidden complexity underlays healthcare practices in LTC and each care provider must negotiate this complexity when providing care. Attending to this complexity in which care decisions are made will lead to improvements in knowledge exchange mechanisms and best practice uptake in LTC settings.
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Affiliation(s)
- Allison Cammer
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada.
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Norma Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | | | | | - Sue Dopson
- Said Business School, University of Oxford, UK
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Smith A, Sun M, Bhargava R, Stewart N, Flint M, Krivak T, Strange M, Bigbee W, Yates N, Zorn K. Proteomic analysis of matched formalin-fixed, paraffin-embedded specimens in patients with advanced serous ovarian carcinoma. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patel HDL, Dryden S, Gupta A, Stewart N. Human body projectiles implantation in victims of suicide bombings and implications for health and emergency care providers: the 7/7 experience. Ann R Coll Surg Engl 2012; 94:313-7. [PMID: 22943225 PMCID: PMC3954371 DOI: 10.1308/003588412x13171221591772] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION On 7 July 2005 four suicide bombings occurred on the London transport systems. In some of the injured survivors, bone fragments were embedded as biological foreign bodies. The aim of this study was to revisit those individuals who had sustained human projectile implantation injuries as a result of the bomb blasts at all scenes, review the process of body parts mapping and DNA identification at the scene, detail the management of such injuries and highlight the protocols that have been put in place for protection against blood borne pathogens. METHODS We retrospectively reviewed 12 instances of victims who sustained human body projectile implantation injuries. The Metropolitan Police and forensic scientists identified the human projectiles using DNA profiling and mapped these on the involved carriages and those found outside. All human projectiles included were greater than 3cm2. RESULTS Twelve cases had human projectile implantation injuries. Of these, two died at the scene and ten were treated in hospital. Projectiles were mapped at three of the four bomb blast sites. Our findings show that victims within a 2m radius of the blast had human projectile injuries. Eight of the allogenic bony fragments that were identified in the survivors originated from the suicide bomber. All the victims with an open wound should have prophylaxis against hepatitis B and serum stored for appropriate action against HIV and hepatitis C infection. CONCLUSIONS All victims following a suicide bombing should be assumed to have human body projectile implantation injuries with blood products or bony fragments. All immediate care providers should receive prophylaxis against hepatitis B virus and appropriate action should be taken against HIV and hepatitis C infection.
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O'Connell ME, Germaine N, Burton R, Stewart N, Morgan DG. Degree of rurality is not related to dementia caregiver distress, burden, and coping in a predominantly rural sample. J Appl Gerontol 2012; 32:1015-29. [PMID: 25474826 DOI: 10.1177/0733464812450071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Earlier research suggests that geographic location matters for informal caregivers of persons with dementia: rural caregivers tend to rely on more informal supports and may report more psychological distress and burden than urban caregivers. Differential access to services may underlie these findings, but degree of rurality is typically measured with population size. In contrast, the current article measured degree of rurality with standardized scale of access to metropolitan centers. In a large sample we found nonsignificant and trivial associations between metropolitan access with self-reported caregiver distress, (N = 272; Brief Symptom Inventory), burden (N = 234; Zarit Burden Interview), and coping (n = 46; Jalowiec Coping Scale). The null findings were likely related to the use of a proxy variable for dementia-related caregiver supports (i.e., degree of access to metropolitan centers). In future research, direct measures of access to appropriate dementia related services should be used to study caregiver outcomes.
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Stewart N, Simpson S, van der Mei I, Ponsonby AL, Blizzard L, Dwyer T, Pittas F, Eyles D, Ko P, Taylor BV. Interferon- and serum 25-hydroxyvitamin D interact to modulate relapse risk in MS. Neurology 2012; 79:254-60. [DOI: 10.1212/wnl.0b013e31825fded9] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kaasalainen S, Stewart N, Middleton J, Knezacek S, Hartley T, Ife C, Robinson L. Development and evaluation of the Pain Assessment in the Communicatively Impaired (PACI) tool: part II. Int J Palliat Nurs 2011; 17:431-8. [PMID: 22067734 DOI: 10.12968/ijpn.2011.17.9.431] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pain is a common symptom for long-term care residents, particularly those in need of palliative care. However, pain assessment in residents who have communication limitations is challenging. A study was conducted with the aim of developing a pain assessment tool that could feasibly be used by direct care providers in long-term care with minimal training yet demonstrating strong psychometric properties. The study used both qualitative and quantitative methods to develop and test the Pain Assessment in the Communicatively Impaired (PACI) tool. Part I of this paper reported on the development phase; this second part reports on the test results. The validity and reliability results of the PACI tool were acceptable, and the convergent validity was moderately strong. A moderate level of interobserver agreement was evident, with kappas ranging from 0.46 to 0.63 for the individual items and a kappa score of 0.59 for the total tool score. The overall results of this study support the psychometric properties and feasibility of the PACI tool, offering preliminary support for its use in clinical practice.
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Kulig JC, Stewart N, Penz K, Forbes D, Morgan D, Emerson P. Work Setting, Community Attachment, and Satisfaction Among Rural and Remote Nurses. Public Health Nurs 2009; 26:430-9. [DOI: 10.1111/j.1525-1446.2009.00801.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rycroft-Malone J, Dopson S, Degner L, Hutchinson AM, Morgan D, Stewart N, Estabrooks CA. Study protocol for the translating research in elder care (TREC): building context through case studies in long-term care project (project two). Implement Sci 2009; 4:53. [PMID: 19671167 PMCID: PMC2742509 DOI: 10.1186/1748-5908-4-53] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 08/11/2009] [Indexed: 11/13/2022] Open
Abstract
Background The organizational context in which healthcare is delivered is thought to play an important role in mediating the use of knowledge in practice. Additionally, a number of potentially modifiable contextual factors have been shown to make an organizational context more amenable to change. However, understanding of how these factors operate to influence organizational context and knowledge use remains limited. In particular, research to understand knowledge translation in the long-term care setting is scarce. Further research is therefore required to provide robust explanations of the characteristics of organizational context in relation to knowledge use. Aim To develop a robust explanation of the way organizational context mediates the use of knowledge in practice in long-term care facilities. Design This is longitudinal, in-depth qualitative case study research using exploratory and interpretive methods to explore the role of organizational context in influencing knowledge translation. The study will be conducted in two phases. In phase one, comprehensive case studies will be conducted in three facilities. Following data analysis and proposition development, phase two will continue with focused case studies to elaborate emerging themes and theory. Study sites will be purposively selected. In both phases, data will be collected using a variety of approaches, including non-participant observation, key informant interviews, family perspectives, focus groups, and documentary evidence (including, but not limited to, policies, notices, and photographs of physical resources). Data analysis will comprise an iterative process of identifying convergent evidence within each case study and then examining and comparing the evidence across multiple case studies to draw conclusions from the study as a whole. Additionally, findings that emerge through this project will be compared and considered alongside those that are emerging from project one. In this way, pattern matching based on explanation building will be used to frame the analysis and develop an explanation of organizational context and knowledge use over time. An improved understanding of the contextual factors that mediate knowledge use will inform future development and testing of interventions to enhance knowledge use, with the ultimate aim of improving the outcomes for residents in long-term care settings.
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Werezak L, Stewart N. Learning to live with early dementia. Can J Nurs Res 2009; 41:366-384. [PMID: 19485061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Much of the literature on early dementia is focused on caregiver perspectives, while little is known about the perspective of persons with early-stage dementia such as what it is like to live with this syndrome. This study was conducted to explore the process of learning to live with early-stage dementia. Interviews were conducted with 6 early-stage participants (3 men and 3 women) ranging in age from 61 to 79 years.Theory construction was facilitated using a qualitative approach and grounded theory. A preliminary theoretical framework was developed from the data which outlines a 5-stage process of learning to live with dementia that begins with various antecedents and proceeds through the stages of anticipation, appearance, assimilation, and acceptance. This process evolved as participants' awareness of themselves and their outer world changed. Ultimately, the findings of this study have several implications for clinicians and researchers working with persons in early-stage dementia.
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Affiliation(s)
- Leona Werezak
- Saskatchewan Institute of Applied Science and Technology, Saskatoon, Saskatchewan, Canada
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Abstract
BACKGROUND Antenatal depression is potentially deleterious to the mother and baby. Canadian Aboriginal women have an increased risk for living in poverty, family violence, and substance use; however, little is known about antenatal depression in this group. The aim of this study was to determine the prevalence and correlates of depression in socially high-risk, mostly Aboriginal pregnant women. METHODS Women (Aboriginal and non-Aboriginal), in two prenatal outreach programmes were approached and depressive symptoms between the two groups were compared, using the Edinburgh Postnatal Depression Scale (EPDS). RESULTS Sixty per cent (n = 402) of potential participants were recruited for the study. The prevalence of depression was 29.5% (n = 402). Depression was associated with a history of depression, mood swings, increased stressors, current smoker, and lack of social support. Aboriginal women were more likely to be depressed, but this was not significantly higher than non-Aboriginal women; however, they did experience significantly more self-harm thoughts. Exercise was a significant mediator for depression. CONCLUSION The prevalence of antenatal depression confirms rates in other high-risk, ethnic minority groups of women. A previous history of depression and mood problems were associated with depression, thus prenatal care should include a careful mental health assessment. On a positive note, the present study suggests that exercise may mediate antenatal depression.
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Affiliation(s)
- A Bowen
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.
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Morgan DG, Crossley M, Kirk A, D’Arcy C, Stewart N, Biem J, Forbes D, Harder S, Basran J, Dal Bello-Haas V, McBain L. Improving access to dementia care: development and evaluation of a rural and remote memory clinic. Aging Ment Health 2009; 13:17-30. [PMID: 19197686 PMCID: PMC3966903 DOI: 10.1080/13607860802154432] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The availability, accessibility and acceptability of services are critical factors in rural health service delivery. In Canada, the aging population and the consequent increase in prevalence of dementia challenge the ability of many rural communities to provide specialized dementia care. This paper describes the development, operation and evaluation of an interdisciplinary memory clinic designed to improve access to diagnosis and management of early stage dementia for older persons living in rural and remote areas in the Canadian province of Saskatchewan. We describe the clinic structure, processes and clinical assessment, as well as the evaluation research design and instruments. Finally, we report the demographic characteristics and geographic distribution of individuals referred during the first three years.
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Affiliation(s)
- Debra G. Morgan
- a University of Saskatchewan, Canadian Centre for Health and Safety in Agriculture , Saskatoon, Saskatchewan, Canada
| | - Margaret Crossley
- b University of Saskatchewan, Department of Psychology , Saskatoon, Saskatchewan, Canada
| | - Andrew Kirk
- c University of Saskatchewan, Division of Neurology , Saskatoon, Saskatchewan, Canada
| | - Carl D’Arcy
- d University of Saskatchewan, Applied Research/Psychiatry , Saskatoon, Saskatchewan, Canada
| | - Norma Stewart
- e University of Saskatchewan, College of Nursing , Saskatoon, Saskatchewan, Canada
| | - Jay Biem
- f Lakeshore General Hospital, Department of Medicine , Montreal, Quebec, Canada
| | - Dorothy Forbes
- g University of Western Ontario, School of Nursing , London, Ontario, Canada
| | - Sheri Harder
- h Loma Linda University Medical Centre, Radiology , Loma Linda, California, USA
| | - Jenny Basran
- i University of Saskatchewan, Geriatric Medicine , Saskatoon, Saskatchewan, Canada
| | - Vanina Dal Bello-Haas
- j University of Saskatchewan, School of Physical Therapy , Saskatoon, Saskatchewan, Canada
| | - Lesley McBain
- k First Nations University of Canada, Indigenous Studies Department, Prince Albert , Saskatchewan, Canada
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Penz K, Stewart N. Differences in Autonomy and Nurse-Physician Interaction Among Rural and Small Urban Acute Care Registered Nurses in Canada. OJRNHC 2008. [DOI: 10.14574/ojrnhc.v8i1.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Penz K, D'Arcy C, Stewart N, Kosteniuk J, Morgan D, Smith B. Barriers to Participation in Continuing Education Activities Among Rural and Remote Nurses. J Contin Educ Nurs 2007; 38:58-66; quiz 67-8, 93. [PMID: 17402377 DOI: 10.3928/00220124-20070301-03] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This article examines the barriers to participation in continuing education activities that are perceived by rural and remote registered nurses in Canada. METHODS The data are drawn from a national survey that was part of a larger national project, "The Nature of Nursing Practice in Rural and Remote Canada." RESULTS Perceived barriers to participation in continuing education activities include the isolation of rural nurses and time and financial constraints. Nurses who perceived barriers to participation were more likely to be middle-aged, unmarried, and working full-time than nurses who did not perceive barriers. They were also more likely to possess higher levels of nursing education and have children or dependents. The perception of barriers to participation was also associated with lower job and scheduling satisfaction. CONCLUSIONS Rural and remote registered nurses have moderately high levels of participation in continuing education; however, participation and job satisfaction can be improved if some of the barriers identified are addressed.
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Affiliation(s)
- Kelly Penz
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Abstract
BACKGROUND Anaemia is an adverse prognostic marker in acute coronary syndromes (ACS), but the epidemiology of abnormal haemoglobin levels in such patients is uncertain. AIMS To investigate the prevalence, nature and predictors of abnormal haemoglobin levels in ACS patients at admission. DESIGN Observational study. METHODS All emergency admissions from January to April 2005 were assessed within 24-48 h of hospital admission. ACS patients (unstable angina, non-ST-elevation or ST-elevation myocardial infarction) were enrolled (n = 320, 190 men). Clinical information was recorded. RESULTS Overall, 71% had unstable angina; 18% non-ST-elevation myocardial infarction (MI), and 11% ST-elevation MI. Mean +/- SD haemoglobin was 14.3 +/- 1.7 g/dl in men and 13.2 +/- 1.5 g/dl in women. Abnormal haemoglobin was more common in men (65, 34%) than in women (34, 22%) (p = 0.013). Anaemia (haemoglobin <13 g/dl in men, or <12.0 g/dl in women) was recorded in 35 (18%) men and 24 (18%) women. All had admission haemoglobin >8 g/dl, and anaemia was usually normocytic. Multivariate predictors of anaemia (OR, 95%CI) were age (1.07, 1.04-1.1) and serum albumin (0.90, 0.81-1.00). Elevated haemoglobin (>16 g/dl) was recorded in 30 (16%) men and 4 (3%) women (p < 0.01), and was more common in ST-elevation MI patients (26%) than in unstable angina or non-ST elevation MI patients (9%) (p = 0.005). In patients who underwent invasive management with a post-procedure haemoglobin the following day (n = 85), 15 (18%) new cases of anaemia were detected. Admission duration correlated with haemoglobin (p < 0.01), creatinine (p < 0.01), troponin I (p < 0.01) and C-reactive protein (p < 0.01). Anaemia was more common in those who died in hospital (3, 60%) than in those who survived (56, 18%) (adjusted p = 0.0135). DISCUSSION Abnormal haemoglobin levels were common in our ACS admissions. Anaemia was generally mild. Increasing age and interventional management were associated with anaemia, which in turn was associated with adverse in-hospital outcomes. Interventions to prevent and detect anaemia in this setting merit prospective testing.
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Affiliation(s)
- K Bindra
- Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
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Abstract
AIMS This paper reports a study examining the use of central (colleagues, inservice and newsletters) and peripheral information sources (Internet, library, journal subscriptions and continuing education) among a large sample of rural and remote nurses and explores the factors associated with the use of particular peripheral information sources. BACKGROUND There have been few studies of the specific sources of information accessed by Registered Nurses, particularly rural or remote nurses, and the characteristics of nurses and their organizations that are associated with the use of particular information sources. METHODS A questionnaire survey was conducted with 3933 Registered Nurses from all regions of rural and remote Canada between October 2001 and July 2002. We used frequencies and cross-tabulations to describe rates of information use, and forward selection logistic regression with likelihood ratio selection to build the best-fitting model of the variables that affected the odds of using each peripheral information source. RESULTS Nursing colleagues ranked as the information source most frequently used, and the Internet and library ranked lowest. On average, nurses used a statistically significantly greater number of central than peripheral sources. Peripheral information source use was higher among nurses who had access to current information, opportunities to share their knowledge with others, higher education levels, were in positions of authority and worked with healthcare students. The associations between age and geographical location varied according to the peripheral information source under consideration. CONCLUSIONS The vast majority of rural and remote nurses used at least one peripheral information source to inform their practice. Increasing the number of research sources used by these nurses requires attention to issues of information access in these areas, as well as issues of staff recruitment and retention of staff in under-serviced rural and remote regions.
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Affiliation(s)
- Julie G Kosteniuk
- Applied Research, Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Zheng S, Robinson E, Yeoman S, Stewart N, Crabbe J, Rouse J, McQueen FM. MRI bone oedema predicts eight year tendon function at the wrist but not the requirement for orthopaedic surgery in rheumatoid arthritis. Ann Rheum Dis 2006; 65:607-11. [PMID: 16219706 PMCID: PMC1798116 DOI: 10.1136/ard.2005.043323] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the role of early magnetic resonance imaging (MRI) of the wrist in predicting functional outcome in rheumatoid arthritis. METHODS MRI scans of the dominant wrist were scored for synovitis, tendon inflammation, bone oedema, and erosion at first presentation (n = 42), at 1 year (n = 42), and at 6 years (n = 31). At 8 years, clinical reassessment (n = 28) was undertaken. Tendon function was graded 0-3 for movement, tendon sheath swelling, and pain on resistance at nine flexor and extensor tendons of the hand. Hand function was also assessed using the Sollerman grip test. The requirement for joint or tendon surgery by 8 years was determined by telephone survey in 39 of the original 42 patients. RESULTS At 8 years, tendon function was highly correlated with hand function (Sollerman score, R = -0.51, p = 0.005) and global function (health assessment questionnaire score, R = 0.53, p = 0.004). Using a model incorporating baseline and 1 year MRI scores, the MRI bone oedema score was strongly predictive of tendon function at 8 years (chi(2)(2) = 15.3, p = 0.0005), as was the MRI bone erosion score (chi(2)(2) = 9.23, p = 0.01). Hand function was also predicted by the baseline MRI erosion score (p = 0.02). MRI variables did not predict the requirement for surgery, but patients who had surgery were more likely to show progression of MRI bone erosion scores between baseline and 1 year (p = 0.008). CONCLUSIONS Extensive MRI bone oedema and erosions at the wrist in early rheumatoid arthritis predict tendon dysfunction and impaired hand function in the medium term but not the requirement for joint or tendon surgery.
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Affiliation(s)
- S Zheng
- Department of Molecular Medicine, Auckland School of Medicine, Auckland University, Private Bag 92019, Auckland, New Zealand
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Price J, Hickey P, Stewart N. Pentoxifylline for dementia. Hippokratia 2005. [DOI: 10.1002/14651858.cd002956.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ramachandran S, Stewart N, Chapman W, Babinsky N, Mohanakumar T. MICA inhibits NK cell responses to porcine endothelial cells mediated by NKG2D. Hum Immunol 2005. [DOI: 10.1016/j.humimm.2005.08.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ziegler JL, Lee R, Crawford B, Mak J, Stewart N, Beattie M, Luce J, Strachowski L, Shaw L, McLennan J. Genetic counseling and testing for BRCA mutations: A comparison of ethnically diverse families in a public hospital with Caucasian families in a university hospital. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - R. Lee
- UCSF Comp Cancer Ctr, San Francisco, CA
| | | | - J. Mak
- UCSF Comp Cancer Ctr, San Francisco, CA
| | | | | | - J. Luce
- UCSF Comp Cancer Ctr, San Francisco, CA
| | | | - L. Shaw
- UCSF Comp Cancer Ctr, San Francisco, CA
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Kulig J, Minore B, Stewart N. Capacity building in rural health research: a Canadian perspective. Rural Remote Health 2004. [DOI: 10.22605/rrh274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Benton N, Stewart N, Crabbe J, Robinson E, Yeoman S, McQueen FM. MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years. Ann Rheum Dis 2004; 63:555-61. [PMID: 15082487 PMCID: PMC1755000 DOI: 10.1136/ard.2003.011544] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether magnetic resonance (MR) scans of the dominant wrist of patients with early rheumatoid arthritis (RA) can be used to predict functional outcome at 6 years' follow up. METHODS Dominant wrist MR scans were obtained in 42 patients with criteria for RA at first presentation. Patients were followed up prospectively for 6 years, and further scans obtained at 1 year (42 patients) and 6 years (31 patients). Two radiologists scored scans for synovitis, tendonitis, bone oedema, and erosions. The Stanford Health Assessment Questionnaire (HAQ) score, indicating functional outcome, and standard measures of disease activity were assessed at 0, 1, 2, and 6 years. The physical function component of the SF-36 score (PF-SF36) was also used as a functional outcome measure at 6 years. RESULTS Baseline MR parameters, including bone oedema score and the total baseline MR score, were predictive of the PF-SF36 at 6 years (R2 = 0.22, p = 0.005 and R2 = 0.16, p = 0.02, respectively). The PF-SF36 score correlated strongly with the HAQ score at 6 years (rs = -0.725, p<0.0001); none of the baseline MR parameters predicted the 6 year HAQ score. The total MR score obtained at 1 year was predictive of the 6 year HAQ (R2 = 0.04, p = 0.01). Standard clinical and radiographic measures at baseline were not predictive of the 6 year PF-SF36, but when combined in a model with baseline MR oedema score, prediction increased from 0.09 to 0.23, or 23% of the 6 year variance. CONCLUSION MR imaging of the wrist in patients with early RA can help to predict function at 6 years and could be used to plan aggressive management at an earlier stage.
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Affiliation(s)
- N Benton
- Department of Rheumatology, Auckland Hospital, Aukland, New Zealand.
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Forbes DA, Stewart N, Morgan D, Anderson M, Parent K, Janzen BL. Individual determinants of home-care nursing and housework assistance. Can J Nurs Res 2003; 35:14-36. [PMID: 14746119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
The purpose of this study was to examine individual determinants of use of publicly funded home-care nursing and housework assistance by Canadians 18 years and older from 1994 to 1999. Andersen and Newman's Behavioural Model of Health Services Use guided the selection of variables, analyses, and interpretation of the findings. Descriptive, correlation, and multiple logistic regression analyses were completed in each of the first 3 cross-sectional cycles of Statistics Canada's National Population Health Surveys. The determinants of use of housework assistance were older age, female, living alone, lower income, activity restriction, needing help with housework, not hospitalized in the previous year, and having at least 1 chronic condition. The determinants for home nursing tended to be the opposite of those for housework assistance. Between 1994 and 1999, use of housework assistance appeared to decrease and use of nursing services appeared to remain relatively stable. The findings underscore the need to target these 2 discrete subgroups of home-care users and ensure that funding is directed at support services as well as nursing services.
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Affiliation(s)
- Dorothy A Forbes
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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Werezak L, Stewart N. Learning to live with early dementia. Can J Nurs Res 2002; 34:67-85. [PMID: 12122774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Much of the literature on early dementia is focused on caregiver perspectives, while little is known about the perspective of persons with early-stage dementia such as what it is like to live with this syndrome. This study was conducted to explore the process of learning to live with early-stage dementia. Interviews were conducted with 6 early-stage participants (3 men and 3 women) ranging in age from 61 to 79 years. Theory construction was facilitated using a qualitative approach and grounded theory. A preliminary theoretical framework was developed from the data which outlines a 5-stage process of learning to live with dementia that begins with various antecedents and proceeds through the stages of anticipation, appearance, assimilation, and acceptance. This process evolved as participants' awareness of themselves and their outer world changed. Ultimately, the findings of this study have several implications for clinicians and researchers working with persons in early-stage dementia.
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Affiliation(s)
- Leona Werezak
- Saskatchewan Institute of Applied Science and Technology, Kelsey Campus, Saskatoon, Saskatchewan, Canada
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McQueen FM, Benton N, Crabbe J, Robinson E, Yeoman S, McLean L, Stewart N. What is the fate of erosions in early rheumatoid arthritis? Tracking individual lesions using x rays and magnetic resonance imaging over the first two years of disease. Ann Rheum Dis 2001; 60:859-68. [PMID: 11502613 PMCID: PMC1753833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVES To investigate the progression of erosions at sites within the carpus, in patients with early rheumatoid arthritis (RA), using magnetic resonance imaging (MRI) and plain radiology over a two year period. METHODS Gadolinium enhanced MRI scans of the dominant wrist were performed in 42 patients with RA at baseline (within six months of symptom onset) and one year. Plain wrist radiographs (x rays) and clinical data were obtained at baseline, one year, and two years. Erosions were scored by two musculoskeletal radiologists on MRI and x ray at 15 sites in the wrist. A patient centred analysis was used to evaluate the prognostic value of a baseline MRI scan. A lesion centred analysis was used to track the progression of individual erosions over two years. RESULTS The baseline MRI erosion score was predictive of x ray erosion score at two years (p=0.004). Patients with a "total MRI score" (erosion, bone oedema, synovitis, and tendonitis) > or =13 at baseline were significantly more likely to develop erosions on x ray at two years (odds ratio 13.4, 95% CI 2.65 to 60.5, p=0.002). Baseline wrist MRI has a sensitivity of 80%, a specificity of 76%, a positive predictive value of 67%, and a high negative predictive value of 86% for the prediction of wrist x ray erosions at two years. A lesion centred analysis, which included erosions scored by one or both radiologists, showed that 84% of baseline MRI erosions were still present at one year. When a more stringent analysis was used which required complete concordance between radiologists, all baseline lesions persisted at one year. The number of MRI erosion sites in each patient increased from 2.1 (SD 2.7) to 5.0 (4.6) (p<0.0001) over the first year of disease. When MRI erosion sites were tracked, 21% and 26% were observed on x ray, one and two years later. A high baseline MRI synovitis score, Ritchie score, and erythrocyte sedimentation rate were predictive of progression of MRI erosions to x ray erosions over one year (p=0.005, 0.01, and 0.03 respectively), but there was no association with the shared epitope. Progression of MRI erosions to x ray erosions was not seen in those with transient polyarthritis. CONCLUSIONS MRI scans of the wrist, taken when patients first present with RA, can predict radiographic erosions at two years. MRI may have a role in the assessment of disease prognosis and selection of patients for more or less aggressive treatment. However, only one in four MRI erosions progresses to an x ray erosion over one year, possibly owing to healing, observer error, or technical limitations of radiography at the carpus. Progression of MRI erosions to x ray erosions is greatest in those with high baseline disease activity.
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Affiliation(s)
- F M McQueen
- Department of Molecular Medicine, Auckland School of Medicine, Auckland University, New Zealand.
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