1,720,963 research outputs found
The impact of chronic breathlessness on psychological concerns and quality of life in an older, frail population in primary care
Full text linkBackground Chronic breathlessness is a debilitating symptom with major detrimental impact on individuals, carers, across health care settings. Little is known about prevalence, impact, or experience of breathlessness in the older, frail population.Aims For older adults at risk of frailty: to explore the impact of chronic breathlessness on patients’ and carers’ psychological wellbeing and quality of life (QoL), and to explore how chronic breathlessness is identified and assessed in primary care, considering patient, carer, and health care practitioner (HCP) experiences. Methods A multiple-methods thesis incorporating a systematic review and mixed-methods study. My quantitative narrative systematic review of published literature aimed to determine how clinicians identified and assessed breathlessness across health care settings. My mixed-methods study included: a quantitative cross-sectional survey to determine prevalence and psychological impact of chronic breathlessness, and clinical factors associated with breathlessness, in the primary care setting; qualitative in-depth interviews further explored psychological impact and experiences of management in primary care for patients, carers, and HCPs. Mixed-methods findings were synthesised using modified critical interpretative synthesis, then integrated with the systematic review results.Findings Chronic breathlessness is prevalent (40%) in older, frail adults and associated with worse psychological outcomes and poorer QoL. People with chronic breathlessness give up activities because of their breathlessness which is conflated with the underlying disease and not recognised as therapeutic target by patient or HCPs. Chronic breathlessness is often ‘one of many’ symptoms and in the primary care context of ‘one appointment, one problem’, remains invisible and unmanaged. HCPs can feel helpless and do not routinely ask about impact of breathlessness on QoL.Conclusions Lack of routine assessment in primary care means older, frail adults with chronic breathlessness may not access evidence-based symptom-targeted interventions. Systematic identification, assessment, and management in primary care may help improve psychological health, QoL, and overall wellbeing
Interview transcripts for “I’m living in a ‘no’ world now…”- A Qualitative Study of The Widespread Impact of Living with Chronic Breathlessness, and Experiences of Identification and Assessment of this Symptom in an Older, Frail community-based Population.
No full textBackgroundChronic breathlessness is a debilitating symptom with detrimental impact on individuals and carers. However, little is known about the experiences of community-dwelling, frail, older adults living with chronic breathlessness. AimsTo explore, i) the psychological impact of living with chronic breathlessness, (older frail adult patients, carers) and ii) how patients, carers, and clinicians experience identification and assessment of chronic breathlessness in the primary care setting. MethodsIn-depth semi-structured interviews with eligible older adults (≥65 years; moderate to severe frailty [electronic Frailty Index >0.36]), and carers recruited from a community-based Integrated Care Centre in England. Clinicians were recruited from the Centre and affiliated GP practices. Recorded in-person interviews were transcribed and subjected to reflexive thematic analysis using Total Dyspnoea and Breathing Space conceptual frameworks.Results20 patients (9 females), carers (4 spouses, 1 daughter), and clinicians (5 GPs, 3 advanced clinical practitioners, 2 nurses) were interviewed. Four themes were identified: 1) Widespread negative impact of chronic breathlessness. Breathlessness adversely impacts physical and psychological wellbeing. 2) Barriers to optimal health-seeking and identification of chronic breathlessness. Breathlessness is ‘one of many’ symptoms, and not prioritised in ‘one appointment, one problem’ consultations. Clinicians do not routinely ask about breathlessness. Patients are unaware of breathlessness-specific therapies; 3) Variations in chronic breathlessness management. Management is limited; few are offered evidence-based treatments (e.g., handheld fan) and patients find their own strategies. 4) Need for education and information. Clinicians felt helpless about breathlessness management, and patients lacked understanding and had low expectations of receiving help for this symptom.ConclusionBreathlessness adversely impacts the psychological wellbeing of older frail adults. Chronic breathlessness in older, frail adults is invisible, unidentified and unmanaged in primary care. Evidence-based breathlessness interventions are available, but not routinely implemented with few patients accessing them. Proactive identification, assessment and management of breathlessness in primary care is needed to support adults living with chronic breathlessness
The impact of chronic breathlessness on psychological concerns and quality of life in an older, frail population in primary care
No full textBackground Chronic breathlessness is a debilitating symptom with major detrimental impact on individuals, carers, across health care settings. Little is known about prevalence, impact, or experience of breathlessness in the older, frail population.Aims For older adults at risk of frailty: to explore the impact of chronic breathlessness on patients’ and carers’ psychological wellbeing and quality of life (QoL), and to explore how chronic breathlessness is identified and assessed in primary care, considering patient, carer, and health care practitioner (HCP) experiences. Methods A multiple-methods thesis incorporating a systematic review and mixed-methods study. My quantitative narrative systematic review of published literature aimed to determine how clinicians identified and assessed breathlessness across health care settings. My mixed-methods study included: a quantitative cross-sectional survey to determine prevalence and psychological impact of chronic breathlessness, and clinical factors associated with breathlessness, in the primary care setting; qualitative in-depth interviews further explored psychological impact and experiences of management in primary care for patients, carers, and HCPs. Mixed-methods findings were synthesised using modified critical interpretative synthesis, then integrated with the systematic review results.Findings Chronic breathlessness is prevalent (40%) in older, frail adults and associated with worse psychological outcomes and poorer QoL. People with chronic breathlessness give up activities because of their breathlessness which is conflated with the underlying disease and not recognised as therapeutic target by patient or HCPs. Chronic breathlessness is often ‘one of many’ symptoms and in the primary care context of ‘one appointment, one problem’, remains invisible and unmanaged. HCPs can feel helpless and do not routinely ask about impact of breathlessness on QoL.Conclusions Lack of routine assessment in primary care means older, frail adults with chronic breathlessness may not access evidence-based symptom-targeted interventions. Systematic identification, assessment, and management in primary care may help improve psychological health, QoL, and overall wellbeing
Interview transcripts for “I’m living in a ‘no’ world now…”- A Qualitative Study of The Widespread Impact of Living with Chronic Breathlessness, and Experiences of Identification and Assessment of this Symptom in an Older, Frail community-based Population.
No full textBackgroundChronic breathlessness is a debilitating symptom with detrimental impact on individuals and carers. However, little is known about the experiences of community-dwelling, frail, older adults living with chronic breathlessness. AimsTo explore, i) the psychological impact of living with chronic breathlessness, (older frail adult patients, carers) and ii) how patients, carers, and clinicians experience identification and assessment of chronic breathlessness in the primary care setting. MethodsIn-depth semi-structured interviews with eligible older adults (≥65 years; moderate to severe frailty [electronic Frailty Index >0.36]), and carers recruited from a community-based Integrated Care Centre in England. Clinicians were recruited from the Centre and affiliated GP practices. Recorded in-person interviews were transcribed and subjected to reflexive thematic analysis using Total Dyspnoea and Breathing Space conceptual frameworks.Results20 patients (9 females), carers (4 spouses, 1 daughter), and clinicians (5 GPs, 3 advanced clinical practitioners, 2 nurses) were interviewed. Four themes were identified: 1) Widespread negative impact of chronic breathlessness. Breathlessness adversely impacts physical and psychological wellbeing. 2) Barriers to optimal health-seeking and identification of chronic breathlessness. Breathlessness is ‘one of many’ symptoms, and not prioritised in ‘one appointment, one problem’ consultations. Clinicians do not routinely ask about breathlessness. Patients are unaware of breathlessness-specific therapies; 3) Variations in chronic breathlessness management. Management is limited; few are offered evidence-based treatments (e.g., handheld fan) and patients find their own strategies. 4) Need for education and information. Clinicians felt helpless about breathlessness management, and patients lacked understanding and had low expectations of receiving help for this symptom.ConclusionBreathlessness adversely impacts the psychological wellbeing of older frail adults. Chronic breathlessness in older, frail adults is invisible, unidentified and unmanaged in primary care. Evidence-based breathlessness interventions are available, but not routinely implemented with few patients accessing them. Proactive identification, assessment and management of breathlessness in primary care is needed to support adults living with chronic breathlessness
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
- …
