scholarly journals Changes in Identity after Aphasic Stroke: Implications for Primary Care

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Benjamin Musser ◽  
Joanne Wilkinson ◽  
Thomas Gilbert ◽  
Barbara G. Bokhour
Keyword(s):  
Primary Care ◽  
Psychosocial Adjustment ◽  
Stroke Survivors ◽  
Family Roles ◽  
Communication Disorder ◽  
Care Relationship ◽  
Semistructured Interviews ◽  
The Impact ◽  
Experience Difficulty

Background. Stroke survivors with aphasia experience difficulty associated with their communication disorder. While much has been written about aphasia’s impacts on partners/family, we lack data regarding the psychosocial adjustment of aphasic stroke survivors, with a paucity of data from the patients themselves. Methods. Qualitative study of lived experiences of individuals with poststroke aphasia. Each of the stroke survivors with aphasia completed 3-4 semistructured interviews. In most cases, patients’ partners jointly participated in interviews, which were transcribed and analyzed using techniques derived from grounded theory. Results. 12 patients were interviewed, with the total of 45 interviews over 18 months. Themes included poststroke changes in patients’ relationships and identities, which were altered across several domains including occupational identity, relationship and family roles, and social identity. While all these domains were impacted by aphasia, the impact varied over time. Conclusion. Despite the challenges of interviewing individuals with aphasia, we explored aphasia’s impacts on how individuals experience their identity and develop new identities months and years after stroke. This data has important implications for primary care of patients with aphasia, including the importance of the long-term primary care relationship in supporting psychosocial adjustment to life after aphasic stroke.

scholarly journals The impact of long-term care on primary care doctor consultations for people over 75 years

2018 ◽  
Vol 20 (3) ◽  
pp. 375-387 ◽  
Author(s):  
Julien Forder ◽  
Katerina Gousia ◽  
Eirini-Christina Saloniki
Keyword(s):  
Primary Care ◽  
Long Term Care ◽  
Primary Care Doctor ◽  
Term Care ◽  
The Impact

Psychosocial adjustment among women with breast cancer stages I and II: six-year follow-up of consecutive patients.

1994 ◽  
Vol 12 (9) ◽  
pp. 1778-1782 ◽  
Author(s):  
M Omne-Pontén ◽  
L Holmberg ◽  
P O Sjödén
Keyword(s):  
Breast Cancer ◽  
Psychosocial Adjustment ◽  
Social Adjustment ◽  
Negative Experience ◽  
Follow Up Study ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
The Impact

PURPOSE To evaluate, in a long-term follow-up study of consecutive patients (N = 99), the impact of surgery--breast-conserving treatment (BCT) versus mastectomy (MT)--on psychosocial adjustment among women with breast cancer, pTNM stage I/II. PATIENTS AND METHODS Semistructured interviews were conducted at a median of 6 years (range, 5.8 to 8.1) after primary surgery. Sixty-six women were available for the long-term follow-up study. Twenty-six women had been treated with BCT and 40 with MT. RESULTS No statistically significant differences were found between the two groups concerning psychosocial adjustment, as measured by the Social adjustment Scale (SAS). In general, the levels of maladjustment were lower than at 13 months postoperatively, but 10% still showed maladjustment. Sixty percent of the women were unwilling to show themselves naked, and 22% felt that they had become less attractive because of the surgical treatment. In an explorative part of the interview, 68% of the women complained about how they had been informed of the diagnosis. A tendency toward a significant difference was found in the relation between previous maladjustment and a negative experience at the time of diagnosis (P = .07). CONCLUSION Few data are available on long-term follow-up results with regard to psychosocial adjustment among women after breast cancer surgery. This study provides the important information that there are no differences in patient psychosocial adjustment that can be ascribed to the type of surgery at 6-year follow-up evaluation.

Longevity, legacy, and lament: Learning from longstanding educators in an innovative curriculum

2021 ◽  
Vol 2021 (April) ◽  
pp. 1-20
Author(s):  
Gillian Maudsley
Keyword(s):  
Student Outcomes ◽  
Medical Curriculum ◽  
Research Question ◽  
System Integrity ◽  
Semistructured Interviews ◽  
Innovative Curriculum ◽  
The Impact ◽  
Long Term Experience

Research about problem-based learning (PBL) tutoring in medicine has prioritized quantifying relationships between tutor characteristics or learning environment and tutoring behaviour or student outcomes. Longitudinal studies and qualitative research about how such tutors conceptualize their long-term experience are rare. The research question was thus: What educator outlooks do inaugural PBL tutors develop after substantial experience in a problem-based medical curriculum? At16 year-follow-up of interviews with an inaugural cohort of PBL tutors, semistructured interviews with the remaining ten explored their outlooks as educators now versus then. Two years later, an open-ended e-questionnaire (E-interview) reviewed their outlooks, particularly about the curriculum being replaced. Tutors viewed their role now through a more discerning, reflective, and constructivist ‘good educator’ lens. They articulated principles for facilitating active learning. When that curriculum was replaced, tutors were positive about its legacy but also lamented flawed educational governance for maintaining and renewing whole-system integrity. Educator development should prompt critical reflection about ‘the good educator’ identity, the related enthusiasms, discomforts, and uncertainties, and the impact of curriculum shifts.

Caregivers’ Experiences With Food Insecurity Screening and Impact of Food Insecurity Resources

2019 ◽  
Vol 58 (14) ◽  
pp. 1484-1492 ◽  
Author(s):  
Colin J. Orr ◽  
Christina Chauvenet ◽  
Holly Ozgun ◽  
Claudia Pamanes-Duran ◽  
Kori B. Flower
Keyword(s):  
Primary Care ◽  
Food Insecurity ◽  
Thematic Analysis ◽  
Care Setting ◽  
Primary Care Setting ◽  
Infants And Children ◽  
Future Studies ◽  
Spanish Speaking ◽  
Semistructured Interviews ◽  
The Impact

We explored caregivers’ experiences with food insecurity screening in a primary care setting and the impact of resources provided. English- and Spanish-speaking food insecure caregivers of children aged 1 to 5 years were recruited. In-depth individual semistructured interviews were conducted (n = 17) eliciting caregivers’ experiences with food insecurity, clinic screening, and resources provided. Interviews were audio-recorded and transcribed verbatim. Interviews were double-coded and thematic analysis was used to identify themes and subthemes. All caregivers described multiple and repeat experiences with food insecurity. Food insecurity screening was acceptable, but families were not always connected with resources. Caregivers described WIC (Women, Infants, and Children) as the most commonly used program to address food insecurity and infrequently utilized other food insecurity resources. Screening for food insecurity in primary care was generally well accepted by this sample of food insecure caregivers. Future studies are needed to determine how to improve connecting resources with families most in need.

scholarly journals Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study

2020 ◽  
Vol 30 (2) ◽  
pp. 339-348
Author(s):  
Joy N. J. Buie ◽  
Yujing Zhao ◽  
Suzanne Burns ◽  
Gayenell Magwood ◽  
Robert Adams ◽  
...  
Keyword(s):  
Racial Differences ◽  
Motor Skills ◽  
Stroke Recovery ◽  
Fine Motor ◽  
Stroke Survivors ◽  
Factors Associated ◽  
Post Stroke ◽  
Stroke Disability ◽  
The Impact

Background and Purpose: Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery.Methods: We examined Health and Retire­ment Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000- 2014. Analysis of 1,002 first-time, non- Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily liv­ing (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes.Results: Black stroke survivors were young­er compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comor­bidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of hav­ing increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites.Conclusion: Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy.Ethn Dis. 2020;30(2):339-348; doi:10.18865/ ed.30.2.339

Impact on a Person’s Daily Life During Episodes of Supraventricular Tachycardia

2016 ◽  
Vol 35 (1) ◽  
pp. 33-43 ◽  
Author(s):  
Ann-Katrin Nordblom ◽  
Anders Broström ◽  
Bengt Fridlund
Keyword(s):  
Supraventricular Tachycardia ◽  
Health Care Professionals ◽  
Daily Life ◽  
Qualitative Content Analysis ◽  
Relevant Information ◽  
Short Term ◽  
Optimal Care ◽  
Semistructured Interviews ◽  
The Impact

Purpose: To describe the impact of episodes of supraventricular tachycardia (SVT) on a person’s daily life from a holistic perspective. Method: A deductive descriptive design was used. Twenty semistructured interviews (12 women and 8 men) were conducted before planned ablation of SVT and were analyzed using qualitative content analysis. Results: Living with SVT had a complex impact on daily life. Initially, the patients described an inhibited existence due to demands to give up things that they had previously been doing, in case the unpredictable episodes of SVT would occur. The episodes caused fatigue and worry, which together created a barrier for living life to the full by making the person give up undertakings. The patients constantly needed to find short-term and long-term strategies to prevent new episodes from happening. Conclusion: Episodes of SVT entail a complex life situation as the person’s entire existence is affected in daily life. To understand the impact of SVT on daily life, nurses and other health care professionals need increased knowledge and understanding to be able to provide support through relevant information and take optimal care measures.

scholarly journals Practice nurse-led proactive care for chronic depression in primary care: A randomised controlled trial

2016 ◽  
Vol 208 (4) ◽  
pp. 374-380 ◽  
Author(s):  
Marta Buszewicz ◽  
Mark Griffin ◽  
Elaine M. McMahon ◽  
Kate Walters ◽  
Michael King
Keyword(s):  
Primary Care ◽  
Practice Nurse ◽  
Controlled Trial ◽  
Intervention Group ◽  
Chronic Depression ◽  
Activity Schedule ◽  
Proactive Care ◽  
The Impact ◽  
Nurse Intervention

BackgroundManagement of long-term depression is a significant problem in primary care populations with considerable on-going morbidity, but few studies have focused on this group.AimsTo evaluate whether structured, nurse-led proactive care of patients with chronic depression in primary care improves outcomes.MethodParticipants with chronic/recurrent major depression or dysthymia were recruited from 42 UK general practices and randomised to general practitioner (GP) treatment as usual or nurse intervention over 2 years (the ProCEED trial, trial registration: ISRCTN36610074).ResultsIn total 282 people received the intervention and there were 276 controls. At 24 months there was no significant improvement in Beck Depression Inventory (BDI-II) score or quality of life (Euroquol-EQ-VAS), but a significant improvement in functional impairment (Work and Social Activity Schedule, WSAS) of 2.5 (95% CI 0.6–4.3, P = 0.010) in the intervention group. The impact per practice-nurse intervention session was –0.37 (95% CI –0.68 to –0.07, P = 0.017) on the BDI-II score and –0.33 (95% CI –0.55 to –0.10, P = 0.004) on the WSAS score, indicating that attending all 10 intervention sessions could lead to a BDI-II score reduction of 3.7 points compared with controls.ConclusionsThe intervention improved functioning in these patients, the majority of whom had complex long-term difficulties, but only had a significant impact on depressive symptoms in those engaging with the full intervention.

scholarly journals Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care

BMJ ◽  
2006 ◽  
Vol 332 (7536) ◽  
pp. 259-263 ◽  
Author(s):  
Enid M Hunkeler ◽  
Wayne Katon ◽  
Lingqi Tang ◽  
John W Williams ◽  
Kurt Kroenke ◽  
...  
Keyword(s):  
Primary Care ◽  
Elderly Patients ◽  
Randomised Trial ◽  
Long Term Outcomes ◽  
The Impact

scholarly journals “Sometimes I Feel Overwhelmed”: Educational Needs of Family Physicians Caring for People with Intellectual Disability

2012 ◽  
Vol 50 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Joanne Wilkinson ◽  
Deborah Dreyfus ◽  
Mary Cerreto ◽  
Barbara Bokhour
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Intellectual Disability ◽  
Primary Care Physicians ◽  
Family Physicians ◽  
Educational Needs ◽  
Frame Of Reference ◽  
Content Areas ◽  
Care Relationship ◽  
Semistructured Interviews

Abstract Primary care physicians who care for adults with intellectual disability often lack experience with the population, and patients with intellectual disability express dissatisfaction with their care. Establishing a secure primary care relationship is particularly important for adults with intellectual disability, who experience health disparities and may rely on their physician to direct/coordinate their care. The authors conducted semistructured interviews with 22 family physicians with the goal of identifying educational needs of family physicians who care for people with intellectual disability. Interviews were transcribed and coded using tools from grounded theory. Several themes related to educational needs were identified. Physician participants identified themes of “operating without a map,” discomfort with patients with intellectual disability, and a need for more exposure to/experience with people with intellectual disability as important content areas. The authors also identified physician frustration and lack of confidence, compounded by anxiety related to difficult behaviors and a lack of context or frame of reference for patients with intellectual disability. Primary care physicians request some modification of their educational experience to better equip them to care for patients with intellectual disability. Their request for experiential, not theoretical, learning fits well under the umbrella of cultural competence (a required competency in U.S. medical education).

scholarly journals Anticipatory Care Planning Intervention for Older Adults at Risk of Functional Decline: Study protocol for a Primary Care Cluster Feasibility Randomised Trial

2019 ◽  
Author(s):  
Kevin Brazil ◽  
David Scott ◽  
Emma Wallace ◽  
Mike Clarke ◽  
Tom Fahey ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Health Systems ◽  
Functional Decline ◽  
Randomised Trial ◽  
Care Planning ◽  
The Impact

Abstract Background The treatment and management of long-term health conditions is the greatest challenge facing health systems around the world today. Innovative approaches to patient care in the community such as Anticipatory Care Planning (ACP), which seek to help with the provision of high-quality comprehensive care to older adults at risk of functional decline, require evaluation. This study will evaluate one approach that will include primary care as the setting for Anticipatory Care Planning.Methods This study will help to determine the feasibility for a definitive randomised trial to evaluate the implementation and outcomes of an ACP intervention. The intervention will be delivered by specially trained registered nurses in a primary care setting with older adults identified as at risk of functional decline. The intervention will comprise of: a) information collection via patient assessment; b) facilitated informed dialogue between the patient, family carer, general practitioner and other healthcare practitioners; and, c) documentation of the agreed support plan and follow-up review dates. Through a structured consultation with patients and their family carers, the nurses will complete a mutually agreed personalized support plan.Discussion This study will determine the feasibility for a full trial protocol to evaluate the implementation and outcomes of an (ACP) intervention in primary care to assist older adults aged 70 years of age or older and assessed as at risk of functional decline. The study will be implemented in two jurisdictions on the island of Ireland which employ different health systems but which face similar health challenges. This study will allow us to examine important issues, such as the impact of two different healthcare systems on the health of older people and the influence of different legislative interpretations on undertaking cross jurisdictional research in Ireland.

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