8,332 research outputs found
An evaluation of the palliative care-related outcomes of a cohort of TB patients in a district hospital setting: a multiple methods quality improvement study
No full textIncludes bibliographical references.Although curable, tuberculosis (TB) remains a serious health care problem. During 2011 there were almost 9 million new cases and 1.4 million TB deaths worldwide. The World Health Organisation (WHO) lists South Africa as a country with a high TB, HIV and MDR-TB burden. In this country the dual TB/HIV epidemic which has reached critical proportions is fuelled by the high TB/HIV co-infection rate. By definition the focus of palliative care is on the alleviation of suffering associated with lifelimiting illnesses. TB clearly falls into this category. The palliative care-related outcomes of a cohort of hospitalized TB patients were determined during this prospective longitudinal study and a quality improvement strategy was then generated from the audit data. The APCA POS, a validated outcome measurement tool was used to conduct weekly interviews. The audit sample comprised 57 patients with MDR-TB and 57 with drug responsive TB (n=114). The intensity of the multi-dimensional palliative care-related problems experienced by TB and MDR-TB patients on admission as well as the differences that occurred over time were measured over four consecutive weeks. In order to get staff perspectives on using the audit data to develop a quality improvement strategy, a report on the analyzed audit data formed the basis of a focus group discussion (FGD). The purposive sample of FGD participants included key members of staff from the TB and MDR TB wards. Audit findings indicated that on admission to hospital the predominant problems were pain, symptoms and worry. On a Lickert scale of 0-5 with 0 indicating best and 5 worst, the median score for both pain and other symptoms was 3.0, with an inter-quartile range of 2.00-4.25. Participants' worry about their illness attained the worst median baseline score of 4.0. Neither pain nor symptoms showed any sustained improvement over the four weeks of data collection. A statistically significant improvement in worry which moved from 4.0 to 2.0 occurred after week 1 but then remained static. An unexpected crucial finding was that the collective score for participants with drug responsive TB was worse than for those with MDR-TB for both the physical and psycho-social components, and at each time point. Using the APCA POS audit data as the basis of a FGD with key staff members resulted in the development of an appropriate palliative care-focused quality improvement strategy which they considered to be realistic and achievable within their busy hospital setting. Findings from this study support the recent WHO Declaration on the provision of palliative care for people with drug-resistant TB. Furthermore they clearly show that patients with drug responsive TB should not be excluded from a comprehensive palliative care person-centred approach. Palliative care within the context of TB is still an emerging concept. This study makes a meaningful contribution to the scarce information currently available. The topic is important in that the suffering experienced by vast numbers of TB patients and their families could and should be substantially relieved. It is suggested that it would be valuable to explore the impact of a palliative care approach on TB treatment outcomes
Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study.
No full textBACKGROUND: Global health investment has reduced HIV mortality and transmission. However, little is known of patient-reported outcomes alongside ART rollout. This study aimed to measure wellbeing using patient-reported outcome measures (PROMS) among outpatients at PEPFAR-funded facilities. METHODS: In a multicentre 2 country cross-sectional study, adults attending 12 facilities in Kenya and Uganda gave self-reported data on quality of life (physical and mental wellbeing dimensions), functional and a measure of multidimensional problems (physical, psychological, social and spiritual). RESULTS: Among the 1,337 participants, multidimensional problems were more common in psychological, spiritual and social domains than in physical. In multivariable analysis using GEE to adjust for facility effect, the mental health subscale of quality of life was lower for people with limited functional status (B = -5.27, 95% CI -5.99, 1. -4.56 p < 0.001) and higher for wealthier people (B = 0.91, 95% CI 0.48, 1.33, p < 0.001). The physical health subscale of quality of life was lower for those with limited functional status (B = -8.58, 95% CI -9.46 to -7.70, p < 0.001) and those who had a caregiver present (B = -1.97, 95% CI -3.72 to -0.23, p = 0.027), higher for wealthier people (B = 1.14, 95% CI 0.65, 1.64, p < 0.001), and positively associated with CD4 count (B = 1.61, 95% CI 1.08-2.14, p < 0.001). Multidimensional problems were more burdensome for people with limited functional status (B = -2.06, 95% CI -2.46 to -1.66, p < 0.001), and less burdensome with more education (B = 0.63, 95% CI 0.25-1.00, p = 0.001) or ART use (B = 0.94, 95% CI 0.34-1.53, p = 0.002). CONCLUSIONS: Multidimensional problems are highly prevalent, and worse with declining function. Importantly, ART use does not appear to be protective for self-reported physical and mental dimensions of quality of life. Assessment and management of self-reported wellbeing must form part of HIV care and treatment services to ensure maximum benefit from ART investment
Foster, Richard J.
No full textRichard J. Foster, author of Celebration and Discipline and Money Sex and Power , professor at Friends University in Wichita, Kansas. 095B:https://place.asburyseminary.edu/holinessphotos/1531/thumbnail.jp
Foster, Richard J.
No full textRichard J. Foster, author of Celebration and Discipline and Money Sex and Power , professor at Friends University in Wichita, Kansas. 095B:https://place.asburyseminary.edu/holinessphotos/1529/thumbnail.jp
Foster, Richard J.
No full textRichard J. Foster, author of Celebration and Discipline and Money Sex and Power , professor at Friends University in Wichita, Kansas. 095B:https://place.asburyseminary.edu/holinessphotos/1530/thumbnail.jp
Foster, Richard J.
No full textRichard J. Foster, author of Celebration and Discipline and Money Sex and Power , professor at Friends University in Wichita, Kansas. 095B:https://place.asburyseminary.edu/holinessphotos/1528/thumbnail.jp
Bipolar disorder, Type A behavior, and coronary disease
No full textThis paper describes a model for integrating two psychological constructs--bipolar disorder and the Type A behavior pattern--each of which has been associated with enhanced risk of coronary heart disease (CHD). It highlights similarities between manic/hypomanic behaviors associated with bipolarity and the behaviors observed in Type A individuals. The proposed model conceptualizes Type A behavior as an alternating pattern of coping with challenging and stressful events. Thus, initial coping efforts are manifested as behavioral hyper-reactivity (including mania/hypomania), but this gives way to hypo-reactivity (including helplessness and depression) after repeated failure to assert control and/or attain relevant goals. This alternation of Type A coping patterns resembles the affective and behavioral transitions often seen in bipolar patients. Future research on psychological, epidemiological, and pathophysiological issues concerning CHD should document areas of commonality and independence between bipolarity and Type A behavior. Such studies would benefit from consideration of a model that identifies psychosocial dimensions common to Type A, mania/hypomania, and depression.Peer reviewedThis is an electronic version of an article published in Glass, David C. and Richard J. Contrada. "Bipolar disorder, Type A behaviour and coronary disease." Health Psychology Review, available online 15 Feb 2011. DOI:10.1080/17437199.2010.531568. Health Psychology Review is available online at: www.tandfonline.co
Rabbi Richard J. Israel Papers, undated, 1949-1996, bulk 1980-1992.
No full textThe bulk of this collection contains resources and information pertaining to the career of Rabbi Richard J. Israel at the Jewish Community Center. The papers also contain several documents regarding Israel's work in Hillel and the Reconstructionist Rabbinical College. In addition, a brief memoir of his trip to the Soviet Union in 1974 is included, as well as copies of various Black Panther newspapers from New Haven, Connecticut.Rabbi Richard J. and Dr. Sherry Israel,Rabbi Richard J. Israel was born in 1929 in Chicago. After attending the University of Chicago and Hebrew Union College, Rabbi Israel began his lengthy career in Hillel at the University of California, Los Angeles. He later worked at Hillel at Yale University, followed by an Executive Director position at the Hillel Council of Greater Boston. Rabbi Israel was also the Director of Central Services and Judaica at the Jewish Community Center of Greater Boston and was the Director of the Rabbinic Program at Reconstructionist Rabbinical College. In addition to his work on college campuses and in Jewish education, he was the author of “The Kosher Pig and Other Curiosities of Modern Jewish Life” and “Jewish Identity Games: A How to do it Book.”Finding Aid available in New York and Newton Center, MA Reading Rooms and on Internet.far031
Dispelling the Myths Behind First-author Citation Counts
No full textWe 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
[Newspaper Clipping: Author Claims Evidence of Second JFK Assassin #1]
No full textNewspaper article titled "Author Claims Evidence of Second JFK Assassin." The article states that author Richard J. Whalen concluded "that there is circumstantial evidence to support the theory of a second assassin in the shooting of President John F. Kennedy.
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