Patient perceptions of the causes of preoperative symptoms, expected impact of surgery on symptoms and anticipated timeline of recovery are likely to affect the risk of readmission following elective ...surgical procedures. However, these perceptions have not been studied. A qualitative study was designed to explore these perceptions, using the common-sense model of self-regulation (CSM) as the conceptual framework. CSM is grounded in illness representations, describing how patients make sense of changes in physical well-being (e.g. symptoms) and develop and assess management plans. It also establishes a broader framework for examining patients’ a priori expectations and timelines for outcomes based on comparisons to prior experiences and underlying self-prototypes, or “Self as Anchor”. A convenience sample of 14 patients aged 56–81 who underwent elective surgery was recruited. Semi-structured interviews informed by the CSM were completed on the day of discharge. Content analysis with deductive coding was used, and emerging themes were fit to components of the CSM, including the five domains of Illness Representations—
identity
,
cause
,
timeline
,
control
, and
consequences.
Two additional themes,
outlook
(toward the health care system, providers and recovery efforts), and
motivation
(external or internal for recovering), relate to self-prototypes, expectations for outcomes, and search for coherence. Misattribution of symptoms, unrealistic expectations for outcomes (e.g. expecting complete resolution of symptoms unrelated to the surgical procedure) and timelines for recovery (unrealistically short), and the (baseline) “normal healthy self” as distinct from the (temporarily) “sick self” were recurrent themes. Findings suggest that patient perceptions and the actual recovery process may be misaligned. The results underscore the importance of assessing patients’ perceptions and expectations, actively engaging patients in their own healthcare, and providing adequate support during the transition to home.
Aim
Home visits have successfully been used to deliver various health services, but what role could they play in paediatric weight management? Low treatment initiation and high attrition prompted our ...multidisciplinary paediatric weight management clinic to investigate how families perceived the benefits and barriers of home visits.
Methods
We focused on children with obesity aged 2–17 who were enrolled in our tertiary‐level clinic in Alberta, Canada. None had received a home visit. The families were interviewed face‐to‐face from October 2015 to October 2016, and we used a qualitative description methodological framework and manifest content analysis. The parents were the main interviewees.
Results
Of the 56 families, 89% were interested in a home visit, 82% wanted support from a dietician and 54% from an exercise specialist. The perceived benefits of home visits included comprehensive assessment (95%), convenience (86%), tailored care (29%) and family involvement (13%), while the costs and barriers included clinicians’ potential judgmental attitudes (30%), loss of privacy (19%) and distractions (10%). Some thought clinicians would find home visits inconvenient (25%), with bureaucratic challenges (14%) and sustainability issues (5%).
Conclusion
Families felt home visits were a convenient option for managing paediatric obesity and identified important benefits and barriers that could guide such interventions.
Severe obesity (SO) in Canadian children remains poorly understood. However, based on international data, the prevalence of SO appears to be increasing and is associated with a number of ...psychosocial, bio-mechanical, and cardiometabolic health risks. The purpose of our national Team to Address Bariatric Care in Canadian Children (Team ABC3) is to develop and lead a series of inter-related studies to enhance the understanding and management of SO in Canadian children and adolescents (0-18 years).
From 2015 to 2019, Team ABC3 will conduct a series of projects at the regional, provincial, and national levels using multiple methods and study designs to respond to key knowledge gaps by (i) generating evidence on the prevalence of SO and its impact on health services utilization in children using existing Canadian data sources from primary care settings, (ii) exploring contemporary definitions of SO that link with health outcomes, (iii) comparing and contrasting health risks across the continuum of SO, (iv) understanding potential barriers to and facilitators of treatment success in children with SO, and (v) examining innovative lifestyle and behavioral interventions designed to successfully manage SO in children and their families. Furthermore, to examine the impact of innovative interventions on the management SO, we will (vi) evaluate whether adding a health coach, who provides support via text, email, and/or phone, improves children's ability to adhere to a web-based weight management program and (vii) test the feasibility and impact of a community-based weight management program for pre-school children with SO and their parents that combines group-based parenting sessions with in-home visits.
Our research aligns with national priorities in obesity research, brings together leading scientists, clinicians, and stakeholders from across Canada, and will inform health services delivery throughout the country to provide the best care possible for children with SO and their families.
Since searching for health information is among the most popular uses of the Internet, we analyzed a survey of 6,019 callers to the National Cancer Institute's (NCI's) Cancer Information Service ...(CIS) to assess Internet usage and interest in technologies to access health and cancer information. Findings suggest that about 40% of CIS callers used the Internet to obtain cancer information and, of these, only about 20% found all the information they sought. Nearly 33% of Internet users called the CIS to discuss information found on the Internet; most (>90%) reported that the CIS was helpful. Those who sought cancer information on the Internet were more likely to call the CIS about this information if they found all or most of the information they were seeking, compared with those who found some or little of the information. New communication services endorsed by most CIS callers included e-mails from an information specialist and telephone support from the CIS while on the Internet. The survey results indicate the importance of multiple access points, both traditional and technology based, and that there is still a need for more traditional, personalized forms of health communication. A crucial question is how best to harness and integrate these new technologies within the current generation of mediated health information systems.
Objective: This study was undertaken to determine whether women with high-risk pregnancies and an amniotic fluid index of ≤5 cm require labor induction to prevent adverse perinatal outcomes.
Study ...Design: All women at high risk at ≥34 weeks’ gestation with an amniotic fluid index of ≤5 cm were admitted to the hospital for labor induction. Each woman was compared with the next patient at high risk seen with an amniotic fluid index of >5 cm and the same pregnancy complication. Case patients were also matched with control subjects for maternal race, age, parity, and gestational age.
Results: Prospectively, 79 women at high risk with an amniotic fluid index of ≤5 cm were compared with 79 control subjects. There were no statistically significant differences between the 2 groups in the risks of thick meconium (
P = .29), variable decelerations (moderate
P = .27, severe
P = .37), amnioinfusion (
P = .37), cesarean delivery for fetal distress (
P = .4), and umbilical artery pH <7.10 (
P = .29).
Conclusion: High-risk pregnancies with an amniotic fluid index of ≤5 cm appear to carry intrapartum complication rates similar to those of similar high-risk pregnancies with an amniotic fluid index of >5. (Am J Obstet Gynecol 1999;180:1354-9.)
PDF
