In Sweden, governmental agencies and bodies are required to implement a higher level of accessibility in their buildings than that stipulated by the National Building and Planning Act (PBL). The Swedish Agency for Participation (MFD, Myndigheten för delaktighet) develops holistic guidelines in order to conceptualize this higher level of accessibility. In conjunction to these guidelines, various checklist protocols have been produced. The present study focuses on the efficiency of such checklist protocols. The study revolved around the use of a checklist protocol in assessments of two buildings in Stockholm: the new head office for the National Authority for Social Insurances (ASI) and the School of Architecture at the Royal Institute of Technology (KTH). The study included three groups: Group 1 and Group 2 consisted of 50 real estate managers employed by the ASI, while Group 3 consisted of three participants in a course at the KTH. The results were similar in all of the groups. The use of the checklist protocol generated queries, which related mainly to two factors: (1) the accompanying factsheet consisted of textual explanations with no drawings, photographs or illustrations and (2) the order of the questions in the checklist protocol was difficult to correlate with the two buildings' spatial logic of accessing, egressing and making use of the built space.
To use the philosophy and methodology of Appreciative Inquiry (AI) in the investigation of unit to unit transfers to determine aspects which are working well and should be incorporated into standard practice.
Handoffs can result in threats to patient safety and an atmosphere of distrust and blaming among staff can be engendered. As the majority of handoffs go well, an alternative is to build on successful handoffs.
The AI methodology was used to discover what was currently working well in unit to unit transfers. The data from semi-structured interviews that were conducted with staff, patients, and family informed structural process improvements.
Themes extracted from the interviews focused on the situational variables necessary for the perfect transfer, the mode and content of transfer-related communication, and important factors in communication with the patient and family.
This project was successful in demonstrating the usefulness of AI as both a quality improvement methodology and a strategy to build trust among key stakeholders.
Giving staff members the opportunity to contribute positively to process improvements and share their ideas for innovation has the potential to highlight expertise and everyday accomplishments enhancing morale and reducing conflict.
This study explores the stability and change in maternal life satisfaction and psychological distress following the birth of a child with a congenital anomaly using 5 assessments from the Norwegian Mother and Child Cohort Study collected from Pregnancy Week 17 to 36 months postpartum. Participating mothers were divided into those having infants with (a) Down syndrome (DS; n = 114), (b) cleft lip/palate (CLP; n = 179), and (c) no disability (ND; n = 99,122). Responses on the Satisfaction With Life Scale and a short version of the Hopkins Symptom Checklist were analyzed using structural equation modeling, including latent growth curves. Satisfaction and distress levels were highly diverse in the sample, but fairly stable over time (retest correlations: .47-.68). However, the birth of a child with DS was associated with a rapid decrease in maternal life satisfaction and a corresponding increase in psychological distress observed between pregnancy and 6 months postpartum. The unique effects from DS on changes in satisfaction (Cohen's d = -.66) and distress (Cohen's d = .60) remained stable. Higher distress and lower life satisfaction at later assessments appeared to reflect a persistent burden that was already experienced 6 months after birth. CLP had a temporary impact (Cohen's d = .29) on maternal distress at 6 months. However, the overall trajectories did not differ between CLP and ND mothers. In sum, the birth of a child with DS influences maternal psychological distress and life satisfaction throughout the toddler period, whereas a curable condition like CLP has only a minor temporary effect on maternal psychological distress.
In addition to a previously published study about Siberian Colletes species, we here further report on poorly known species. Twenty six species are currently known from Siberia with C. cinerascens Morawitz 1893, C. kaszabi Kuhlmann 2002, and C. ebmeri Kuhlmann 2002 found in Russia for the first time and C. wacki Kuhlmann 2002 is newly recorded from the Asian part of Russia. The male of C. wacki is here described for the first time and a lectotype designated for the closely related C. conradti Noskiewicz 1936 to clarify the taxonomy of this group. Colletes uralensis Noskiewicz 1936 was erroneously recorded from Russia and is removed from the list of Russian species. Images and updated distribution maps are provided for the closely related C. kaszabi and C. uralensis as well as for C. conradti and C. wacki to facilitate their identification. An updated checklist of the 42 species of Colletes so far known from Russia is provided.
Despite the inclusion of equity in the design of many health care systems, pragmatic tools for considering equity systematically, alongside the efficiency categories of cost-effectiveness in health technology assessment (HTA), remain underdeveloped. This article develops a framework to help decision makers supplement the standard efficiency criteria of HTA and avoid building inequities, explicit or implicit, into their methods. The framework is intended as a first step toward creating a checklist for alerting decision makers to a wide range of equity considerations for HTA. This framework is intended be used as part of the process through which advisory bodies receive their terms of reference; scope the agenda prior to the selection of a candidate intervention and its comparators for HTA; prepare background briefing for decision makers; and help to structure the discussion and composition of professional and lay advisory groups during the assessment process. The framework is offered as only a beginning of an ongoing process of deliberation and consultation, through which the matters covered can be expected to become more comprehensive and the record of past decisions and their contexts in any jurisdiction adopting the tool can serve to guide subsequent evidence gathering and decisions. In these ways, it may be hoped that equity will be more systematically and fully considered and implemented in both the procedures and decisions of HTA.
To help physicians become more comfortable assessing the fitness to drive of patients with complex cardiac and cognitive conditions.
The approach described is based on the authors' clinical practices, recommendations from the Third Canadian Consensus Conference on Diagnosis and Treatment of Dementia, and guidelines from the 2003 Canadian Cardiovascular Society Consensus Conference.
When assessing fitness to drive in patients with multiple, complex health problems, physicians should divide conditions that might affect driving into acute intermittent (ie, not usually present on examination) and chronic persistent (ie, always present on examination) medical conditions. Physicians should address acute intermittent conditions first, to allow time for recovery from chronic persistent features that might be reversible. Decisions regarding fitness to drive in acute intermittent disorders are based on probability of recurrence; decisions in chronic persistent disorders are based on functional assessment.
Assessing fitness to drive is challenging at the best of times. When patients have multiple comorbidities, assessment becomes even more difficult. This article provides clinicians with systematic approaches to work through such complex cases.
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Motor disturbances and disturbed self-recognition are common features that affect mobility in persons with schizophrenia spectrum disorder and bipolar disorder. Physiotherapists in Scandinavia assess and treat movement difficulties in persons with severe mental illness. The Body Awareness Scale Movement Quality and Experience (BAS MQ-E) is a new and shortened version of the commonly used Body Awareness Scale-Health (BAS-H). The purpose of this study was to investigate the inter-rater reliability and the concurrent validity of BAS MQ-E in persons with severe mental illness. The concurrent validity was examined by investigating the relationships between neurological soft signs, alexithymia, fatigue, anxiety, and mastery. Sixty-two persons with severe mental illness participated in the study. The results showed a satisfactory inter-rater reliability (n = 53) and a concurrent validity (n = 62) with neurological soft signs, especially cognitive and perceptual based signs. There was also a concurrent validity linked to physical fatigue and aspects of alexithymia. The scores of BAS MQ-E were in general higher for persons with schizophrenia compared to persons with other diagnoses within the schizophrenia spectrum disorders and bipolar disorder. The clinical implications are presented in the discussion.
In 2011, a panel of primary healthcare (PHC) providers in Nova Scotia rated 19 of 35 selected Canadian Institute for Health Information (2006) clinical quality indicators (QIs) as "acceptable." In this study, the authors explored the feasibility of extracting electronic medical record (EMR) data required to create these PHC QI measures.