To (1) evaluate perceptions of person-centered care (PCC) in individuals with traumatic spinal cord injury (SCI); and (2) examine perceived differences in PCC concepts between patients continuing to ...receive any services from a Spinal Cord Injury Model Systems (SCIMS) facility and those who are not.
We used a cross-sectional design, mailed a paper survey, and followed up with a second mailing to nonrespondents after 4 weeks.
Community.
Individuals (N=326) who received initial rehabilitation at an SCIMS facility and agreed to participate in this research study. We distinguished respondents who received any SCIMS outpatient services in the past 2 years (SCIMS users, n=137) or longer ago (SCIMS nonusers, n=189).
Not applicable.
Participants completed the Patient Activation Measure (PAM), the Patient Assessment of Chronic Illness Care, the Global Practice Experience measure, and 5 Press-Ganey questions that assessed key elements of patient- and family-centered care.
Patient perspectives of chronic illness care were more positive in the SCIMS users than nonusers (3.15 vs 2.91, P<.05); the difference is attributable primarily to higher subscale scores on goal setting and tailoring. The SCIMS users and nonusers did not differ in terms of PAM overall score or activation stage, Global Practice Experience, or Press-Ganey scores.
SCIMS users and nonusers differed on perceptions of chronic illness care (largely the goal-setting and tailoring component), which were more favorable for Model System users than nonusers. Results can guide strategies to enhance PCC practices after inpatient rehabilitation.
To examine agreement between patient and proxy responses on the Quality of Life in Neurological Disorders (Neuro-QoL) instruments after stroke.
Cross-sectional observational substudy of the ...longitudinal, multisite, multicondition Neuro-QoL validation study.
In-person, interview-guided, patient-reported outcomes.
Convenience sample of dyads (N=86) of community-dwelling persons with stroke and their proxy respondents.
Not applicable.
Dyads concurrently completed short forms of 8 or 9 items for the 13 Neuro-QoL adult domains using the patient-proxy perspective. Agreement was examined at the scale-level with difference scores, intraclass correlation coefficients (ICCs), effect size statistics, and Bland-Altman plots, and at the item-level with kappa coefficients.
We found no mean differences between patients and proxies on the Applied Cognition-General Concerns, Depression, Satisfaction With Social Roles and Activities, Stigma, and Upper Extremity Function (Fine Motor, activities of daily living) short forms. Patients rated themselves more favorably on the Applied Cognition-Executive Function, Ability to Participate in Social Roles and Activities, Lower Extremity Function (Mobility), Positive Affect and Well-Being, Anxiety, Emotional and Behavioral Dyscontrol, and Fatigue short forms. The largest mean patient-proxy difference observed was 3 T-score points on the Lower Extremity Function (Mobility). ICCs ranged from .34 to .59. However, limits of agreement showed dyad differences exceeding ±20 T-score points, and item-level agreement ranged from not significant to weighted kappa=.34.
Proxy responses on Neuro-QoL short forms can complement responses of moderate- to high-functioning community-dwelling persons with stroke and augment group-level analyses, but do not substitute for individual patient ratings. Validation is needed for other stroke populations.
To describe the unique and overlapping content of the newly developed Environmental Factors Item Banks (EFIB) and 7 legacy environmental factor instruments, and to evaluate the EFIB's construct ...validity by examining associations with legacy instruments.
Cross-sectional, observational cohort.
Community.
A sample of community-dwelling adults with stroke, spinal cord injury, and traumatic brain injury (N=568).
None.
EFIB covering domains of the built and natural environment; systems, services, and policies; social environment; and access to information and technology; the Craig Hospital Inventory of Environmental Factors (CHIEF) short form; the Facilitators and Barriers Survey/Mobility (FABS/M) short form; the Home and Community Environment Instrument (HACE); the Measure of the Quality of the Environment (MQE) short form; and 3 of the Patient Reported Outcomes Measurement Information System's (PROMIS) Quality of Social Support measures.
The EFIB and legacy instruments assess most of the International Classification of Functioning, Disability and Health (ICF) environmental factors chapters, including chapter 1 (products and technology; 75 items corresponding to 11 codes), chapter 2 (natural environment and human-made changes; 31 items corresponding to 7 codes), chapter 3 (support and relationships; 74 items corresponding to 7 codes), chapter 4 (attitudes; 83 items corresponding to 8 codes), and chapter 5 (services, systems, and policies; 72 items corresponding to 16 codes). Construct validity is provided by moderate correlations between EFIB measures and the CHIEF, MQE barriers, HACE technology mobility, FABS/M community built features, and PROMIS item banks and by small correlations with other legacy instruments. Only 5 of the 66 legacy instrument correlation coefficients are moderate, suggesting they measure unique aspects of the environment, whereas all intra-EFIB correlations were at least moderate.
The EFIB measures provide a brief and focused assessment of ICF environmental factor chapters. The pattern of correlations with legacy instruments provides initial evidence of construct validity.
Monumentalna romanička bazilika sv. Krševana u Zadru trobrodne je podjele od čega je začelje južnoga broda bilo namijenjeno kultu akvilejskoga mučenika sv. Krševana. Tome u prilog govori ...arhitektonska forma začelja: dvoetažnost i promišljena osvijetljenost samog prostora. Tako je pod razinom svetišta koje je sezalo do drugoga para stupova oblikovana omanja kripta s podužim i užim pristupnim hodnikom do prostorije u kojoj se sve do početka 20. st. nalazila konfesija s ranokršćanskim sarkofagom. Sarkofag je bio vidljiv preko otvora probijenog posred pregradnog zida konfesije te je za pretpostaviti da je imao određenu vezu s kultom akvilejskog mučenika, zadarskog sveca zaštitnika. Povrh konfesije, u dijelu svetišta južnog bočnog broda, nalazio se svečev oltar. Apostolski vizitator Valier svjedoči da se tijelo sveca nalazilo u sklopu oltara, a to potvrđuje i Priuli koji navodi drvenu škrinju, mramorni sarkofag u kojem je smješteno tijelo te kamen-relikviju ex-contactu na kojem je svetac pogubljen. U crkvi se tijekom ranog novog vijeka nalazila i škrinja s narativnim prizorima iz svečeva života. Cijeli je ambijent, odnosno kapela podignuta po južnom boku glavne apside posvećena sv. Krševanu bila osvjetljena jednim manjim prozorom u apsidi i dvama jednostavnim monoforama na južnom brodu čime se i arhitektonski naglašava važnost prostora.
The monumental Romanesque basilica of St. Chrysogonus (Krševan) in Zadar is divided into three naves, of which the rear of the southern nave was assigned to the cult of the Aquileian martyr St. Krševan. This is supported by the architectural form of the rear: the two-story structure and the well-planned lighting of the space itself. Thus, under the level of the sanctuary, which reached to the second pair of columns, a smaller crypt was formed with a long and narrow access corridor to the room where, until the beginning of the 20th century, there was a confessional with an early Christian sarcophagus. The sarcophagus was visible through the opening cut in the middle of the dividing wall of the confessional, and it can be assumed that it had a certain connection with the cult of the martyr of Aquileia, the patron saint of Zadar. Above the confessional, in the part of the sanctuary of the southern side nave, there was the saint's altar. The apostolic visitor Valier testifies that the saint's body was in the altar, and this is confirmed by Priuli, who mentions the wooden chest, the marble sarcophagus in which the body was placed, and the ex-contactu relic stone on which the saint was executed. During the early modern century, the church housed a chest with narrative scenes from the lives of saints. The entire environment, that is, the chapel built on the south side of the main apse, is dedicated to St. Krševan was lit by one smaller window in the apse and two simple monophores on the south nave, which architecturally emphasizes the importance of the space.
During COVID-19 pandemics, the availability of testing has often been a limiting factor during patient admissions into the hospital. To circumvent this problem, we adapted an existing diagnostic ...assay, Seegene Allplex SARS-CoV-2, into a point-of-care-style direct qPCR (POC dqPCR) assay and implemented it in the Emergency Department of Clinical Hospital Center Rijeka, Croatia. In a 4-month analysis, we tested over 10,000 patients and demonstrated that POC-dqPCR is robust and reliable and can be successfully implemented in emergency departments and similar near-patient settings and can be performed by medical personnel with little prior experience in qPCR.
To develop a measure of perceived systems, services, and policies facilitators (see Chapter 5 of the International Classification of Functioning, Disability and Health) for people with neurologic ...disabilities and to evaluate the effect of perceived systems, services, and policies facilitators on health-related quality of life.
Qualitative approaches to develop and refine items. Confirmatory factor analysis including 1-factor confirmatory factor analysis and bifactor analysis to evaluate unidimensionality of items. Rasch analysis to identify misfitting items. Correlational and analysis of variance methods to evaluate construct validity.
Community-dwelling individuals participated in telephone interviews or traveled to the academic medical centers where this research took place.
Participants (N=571) had a diagnosis of spinal cord injury, stroke, or traumatic brain injury. They were 18 years or older and English speaking.
Not applicable.
An item bank to evaluate environmental access and support levels of services, systems, and policies for people with disabilities.
We identified a general factor defined as "access and support levels of the services, systems, and policies at the level of community living" and 3 local factors defined as "health services," "community living," and "community resources." The systems, services, and policies measure correlated moderately with participation measures: Community Participation Indicators (CPI) - Involvement, CPI - Control over Participation, Quality of Life in Neurological Disorders - Ability to Participate, Quality of Life in Neurological Disorders - Satisfaction with Role Participation, Patient-Reported Outcomes Measurement Information System (PROMIS) Ability to Participate, PROMIS Satisfaction with Role Participation, and PROMIS Isolation.
The measure of systems, services, and policies facilitators contains items pertaining to health services, community living, and community resources. Investigators and clinicians can measure perceptions of systems, services, and policies resources reliably with the items described here. Moderate relations between systems, services, and policies facilitators and PROMIS and CPI variables provide support for the measurement and theory of environmental effects on social functioning related to participation.
To evaluate the feasibility of computer adaptive testing (CAT) using an Internet or telephone interface to collect patient-reported outcomes after inpatient rehabilitation and to examine patient ...characteristics associated with completion of the CAT-administered measure and mode of administration.
Prospective cohort study of patients contacted approximately 4 weeks after discharge from inpatient rehabilitation. Patients selected an Internet or telephone interface.
Rehabilitation hospital.
Patients (N=674) with diagnoses of neurologic, orthopedic, or medically complex conditions.
None.
CAT version of the Community Participation Indicators (CAT-CPI).
From an eligible pool of 3221 patients, 674 (21%) agreed to complete the CAT-CPI. Patients who agreed to complete the CAT-CPI were younger and reported slightly higher satisfaction with overall care than those who did not participate. Among these patients, 231 (34%) actually completed the CAT-CPI; 141 (61%) selected telephone administration, and 90 (39%) selected Internet administration. Decreased odds of completing the CAT-CPI were associated with black and other race; stroke, brain injury, or orthopedic and other impairments; and being a Medicaid beneficiary, whereas increased odds of completing the CAT-CPI were associated with longer length of stay and higher discharge FIM cognition measure. Decreased odds of choosing Internet administration were associated with younger age, retirement status, and being a woman, whereas increased odds of choosing Internet administration were associated with higher discharge FIM motor measure.
CAT administration by Internet and telephone has limited feasibility for collecting postrehabilitation outcomes for most rehabilitation patients, but it is feasible for a subset of patients. Providing alternative ways of answering questions helps assure that a larger proportion of patients will respond.
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