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Healthcare, Volume 2, Issue 3 (September 2014), Pages 253-416

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Research

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Open AccessArticle Diagnostic Reasoning across the Medical Education Continuum
Healthcare 2014, 2(3), 253-271; doi:10.3390/healthcare2030253
Received: 30 April 2014 / Revised: 10 June 2014 / Accepted: 20 June 2014 / Published: 15 July 2014
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Abstract
We aimed to study linguistic and non-linguistic elements of diagnostic reasoning across the continuum of medical education. We performed semi-structured interviews of premedical students, first year medical students, third year medical students, second year internal medicine residents, and experienced faculty (ten each) as
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We aimed to study linguistic and non-linguistic elements of diagnostic reasoning across the continuum of medical education. We performed semi-structured interviews of premedical students, first year medical students, third year medical students, second year internal medicine residents, and experienced faculty (ten each) as they diagnosed three common causes of dyspnea. A second observer recorded emotional tone. All interviews were digitally recorded and blinded transcripts were created. Propositional analysis and concept mapping were performed. Grounded theory was used to identify salient categories and transcripts were scored with these categories. Transcripts were then unblinded. Systematic differences in propositional structure, number of concept connections, distribution of grounded theory categories, episodic and semantic memories, and emotional tone were identified. Summary concept maps were created and grounded theory concepts were explored for each learning level. We identified three major findings: (1) The “apprentice effect” in novices (high stress and low narrative competence); (2) logistic concept growth in intermediates; and (3) a cognitive state transition (between analytical and intuitive approaches) in experts. These findings warrant further study and comparison. Full article
Open AccessArticle The Patient’s Conceptions of Wound Treatment with Negative Pressure Wound Therapy
Healthcare 2014, 2(3), 272-281; doi:10.3390/healthcare2030272
Received: 31 March 2014 / Revised: 10 June 2014 / Accepted: 2 July 2014 / Published: 21 July 2014
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Abstract
During the last two decades, additional methods have been developed in wound care where traditional treatments have been insufficient. Negative pressure wound therapy (NPWT) is one such method. This method has been described in multiple studies, but still, many pieces of the puzzle
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During the last two decades, additional methods have been developed in wound care where traditional treatments have been insufficient. Negative pressure wound therapy (NPWT) is one such method. This method has been described in multiple studies, but still, many pieces of the puzzle are missing to get a complete picture of NPWT’s impact on the patient’s health-related quality of life and how the patient experiences the treatment. The purpose of this study was to describe the patient’s conceptions of wound treatment with NPWT. The study was inspired by phenomenography, and eight interviews were conducted with patients treated with NPWT. The results of the study were grouped into two main categories: stress and adaptation. Three descriptive categories were presented under stress: personal environment, competence of the nursing staff and organization and continuity of the dressing changes. Two descriptive categories were presented under adaptation: knowledge and creativity and confidence with the healthcare. Patients were affected by the treatment, and at times, the stress meant that they had difficulty coping. The most common source of stress observed in this study was the care environment, particularly the organization of the dressing changes and deficiencies in the healthcare personnel’s competence. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle Dietary Intake Is Related to Multifactor Cardiovascular Risk Score in Obese Boys
Healthcare 2014, 2(3), 282-298; doi:10.3390/healthcare2030282
Received: 5 February 2014 / Revised: 21 June 2014 / Accepted: 3 July 2014 / Published: 23 July 2014
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Abstract
Cardiovascular disease (CVD) originates in childhood and early identification of risk factors provides an early intervention opportunity. The aim was to identify children at higher risk using a CVD risk score, developed from factors known to cluster in childhood. Risk was scored as
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Cardiovascular disease (CVD) originates in childhood and early identification of risk factors provides an early intervention opportunity. The aim was to identify children at higher risk using a CVD risk score, developed from factors known to cluster in childhood. Risk was scored as very high (≥97.5th centile), high (≥95th), moderate (≥90th) or threshold (<90th) using normal pediatric reference ranges for 10 common biomedical risk factors. These were summed in a multifactor CVD risk score and applied to a sample of 285 observations from 136 overweight Australian children (41% male, aged 7–12 years). Strength of associations between CVD risk score and individual biomedical and dietary variables were assessed using univariate logistic regression. High waist circumference (Odds Ratio: 5.48 [95% CI: 2.60–11.55]), body mass index (OR: 3.22 [1.98–5.26]), serum insulin (OR: 3.37 [2.56–4.42]) and triglycerides (OR: 3.02 [2.22–4.12]) were all significantly related to CVD risk score. High intakes of total fat (OR: 4.44 [1.19–16.60]), sugar (OR: 2.82 [1.54–5.15]) and carbohydrate (OR 1.75 [1.11–2.77]) were significantly related to CVD risk score in boys only. This multifactor CVD risk score could be a useful tool for researchers to identify elevated risk in children. Further research is warranted to examine sex-specific dietary factors related to CVD risk in children. Full article
(This article belongs to the Special Issue The Close Relationship: Health and Nutrition)
Figures

Open AccessArticle Sustaining Behavior Changes Following a Venous Leg Ulcer Client Education Program
Healthcare 2014, 2(3), 324-337; doi:10.3390/healthcare2030324
Received: 16 April 2014 / Revised: 18 August 2014 / Accepted: 22 August 2014 / Published: 4 September 2014
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Abstract
Venous leg ulcers are a symptom of chronic insufficiency of the veins. This study considered the sustainability of behavior changes arising from a client focus e-Learning education program called the “Leg Ulcer Prevention Program” (LUPP) for people with a venous leg ulcer. Data
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Venous leg ulcers are a symptom of chronic insufficiency of the veins. This study considered the sustainability of behavior changes arising from a client focus e-Learning education program called the “Leg Ulcer Prevention Program” (LUPP) for people with a venous leg ulcer. Data from two related studies were used to enable a single sample (n = 49) examination of behavior maintenance across an average 8 to 9 months period. Physical activity levels increased over time. Leg elevation, calf muscle exercises, and soap substitute use were seen to fluctuate over the follow up time points. The use of a moisturizer showed gradual decline over time. The provision of a client-focused venous leg ulcer program was associated with behavior changes that had varied sustainability across the evaluation period. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle The Role of Preference on Outcomes of People Receiving Evidence-Informed Community Wound Care in Their Home or in a Nurse-Clinic Setting: A Cohort Study (n = 230)
Healthcare 2014, 2(3), 401-416; doi:10.3390/healthcare2030401
Received: 13 May 2014 / Revised: 1 August 2014 / Accepted: 4 September 2014 / Published: 19 September 2014
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Abstract
This study followed a cohort of community-dwelling individuals receiving wound-care in a large urban-rural region. During a randomized control trial (RCT) evaluating outcomes of receiving care in a nurse-clinic or at home, many approached were willing to participate if they could choose their
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This study followed a cohort of community-dwelling individuals receiving wound-care in a large urban-rural region. During a randomized control trial (RCT) evaluating outcomes of receiving care in a nurse-clinic or at home, many approached were willing to participate if they could choose their location of care. This provided a unique opportunity to enroll them as a “choice” cohort, following them in the same manner as the trial participants but allowing them to select their setting of care. The objective was to investigate the role of preference and location of care on care outcomes, including satisfaction with care, healing, health-related quality of life (HRQL), pain, and resource use. This is a secondary analysis of a prospective cohort of 126 individuals enrolled in an RCT to receive care at home or in a nurse-clinic (Allocated group), and an additional 104 who received care at home or in a nurse-clinic based on their preference (Choice group). Mobile individuals with a leg ulcer of venous or mixed venous etiology, referred for community leg ulcer care, were eligible. Specially-trained nurses provided care to both groups using an evidence-informed protocol. Baseline data included socio-demographic, circumstance-of-living and a detailed wound assessment. Mean age of the cohort was 68 years. Satisfaction, healing, recurrence, pain, HRQL, and resource utilization did not differ between groups. If available, individuals should have an option of care venue given almost half of those approached indicated a clear preference for clinic or home. With outcomes being similar, health care planners and decision-makers, as well as individuals and their families, can feel confident that the setting of care will not impact the outcomes. However, larger studies in other contexts are needed to explore the interaction between choice and setting. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available

Review

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Open AccessReview Evaluation of Cueing Innovation for Pressure Ulcer Prevention Using Staff Focus Groups
Healthcare 2014, 2(3), 299-314; doi:10.3390/healthcare2030299
Received: 18 March 2014 / Revised: 3 July 2014 / Accepted: 10 July 2014 / Published: 25 July 2014
Cited by 1 | PDF Full-text (935 KB) | HTML Full-text | XML Full-text
Abstract
The purpose of the manuscript is to describe long-term care (LTC) staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU) prevention guidelines regarding consistent and regular movement of LTC residents a minimum of every two hours.
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The purpose of the manuscript is to describe long-term care (LTC) staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU) prevention guidelines regarding consistent and regular movement of LTC residents a minimum of every two hours. The Diffusion of Innovation (DOI) model guided staff interviews about their perceptions of the intervention’s characteristics, outcomes, and sustainability. Methods: This was a qualitative, observational study of staff perceptions of the PrU prevention intervention conducted in Midwestern U.S. LTC facilities (N = 45 staff members). One focus group was held in each of eight intervention facilities using a semi-structured interview protocol. Transcripts were analyzed using thematic content analysis, and summaries for each category were compared across groups. Results: The a priori codes (observability, trialability, compatibility, relative advantage and complexity) described the innovation characteristics, and the sixth code, sustainability, was identified in the data. Within each code, two themes emerged as a positive or negative response regarding characteristics of the innovation. Moreover, within the sustainability code, a third theme emerged that was labeled “brainstormed ideas”, focusing on strategies for improving the innovation. Implications: Cueing LTC staff using music offers a sustainable potential to improve PrU prevention practices, to increase resident movement, which can subsequently lead to a reduction in PrUs. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessReview Exploring Resilience When Living with a Wound — An Integrative Literature Review
Healthcare 2014, 2(3), 346-355; doi:10.3390/healthcare2030346
Received: 13 May 2014 / Revised: 10 July 2014 / Accepted: 26 August 2014 / Published: 5 September 2014
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Abstract
The psychological impact for patients with wounds can be significant, and adverse psychological effects frequently occur when there are permanent changes in the body’s structure or function. Evidence suggests that anxiety, depression and stress can adversely affect the wound healing process. An integrative
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The psychological impact for patients with wounds can be significant, and adverse psychological effects frequently occur when there are permanent changes in the body’s structure or function. Evidence suggests that anxiety, depression and stress can adversely affect the wound healing process. An integrative review examined any paper that discussed any patient in any health care setting who had experienced a psychological impact from the experience of having a wound and the experience of being resilient in that context. Ninety nine papers were located in the initial search with twelve meeting the inclusion criteria and being reviewed. A review of the papers identified that improvement and maintenance of quality of life was perceived to be an important aspect of patient management, but none focused on resilience as a primary endpoint. Further research is required into the clinical benefits of resilient behaviours in patients living with a wound. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessReview Wound Healing: Biologics, Skin Substitutes, Biomembranes and Scaffolds
Healthcare 2014, 2(3), 356-400; doi:10.3390/healthcare2030356
Received: 26 May 2014 / Revised: 8 July 2014 / Accepted: 19 August 2014 / Published: 10 September 2014
Cited by 2 | PDF Full-text (870 KB) | HTML Full-text | XML Full-text
Abstract This review will explore the latest advancements spanning several facets of wound healing, including biologics, skin substitutes, biomembranes and scaffolds. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available

Other

Jump to: Research, Review

Open AccessCase Report A Rare Case of Aggressive Digital Adenocarcinoma of the Lower Extremity, Masquerading as an Ulcerative Lesion that Clinically Favored Benignancy
Healthcare 2014, 2(3), 315-323; doi:10.3390/healthcare2030315
Received: 18 June 2014 / Revised: 2 August 2014 / Accepted: 15 August 2014 / Published: 27 August 2014
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Abstract
A rare case report of Aggressive Digital Adenocarcinoma (ADPCa) is presented complete with a literature review encompassing lesions that pose potential diagnostic challenges. Similarities between basal cell carcinoma (BCC), marjolin’s ulceration/squamous cell carcinoma (MSCC) and ADPCa are discussed. This article discusses potential treatment
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A rare case report of Aggressive Digital Adenocarcinoma (ADPCa) is presented complete with a literature review encompassing lesions that pose potential diagnostic challenges. Similarities between basal cell carcinoma (BCC), marjolin’s ulceration/squamous cell carcinoma (MSCC) and ADPCa are discussed. This article discusses potential treatment options for ADPCa and the need for early biopsy when faced with any challenging lesion. An algorithmic approach to ADPCa treatment based on the most current research is recommended. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessCase Report Perforating Granuloma Annulare — An Unusual Subtype of a Common Disease
Healthcare 2014, 2(3), 338-345; doi:10.3390/healthcare2030338
Received: 16 June 2014 / Revised: 13 August 2014 / Accepted: 1 September 2014 / Published: 4 September 2014
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Abstract
Perforating granuloma annulare (GA) is a rare subset of GA with an unknown etiology and chronic course. Herein, we report the case of 72 year-old women with a 3-month history of a post-traumatic, persistent, erythematous and exudative plaque located on her left leg.
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Perforating granuloma annulare (GA) is a rare subset of GA with an unknown etiology and chronic course. Herein, we report the case of 72 year-old women with a 3-month history of a post-traumatic, persistent, erythematous and exudative plaque located on her left leg. Differential diagnosis included mycobacterial infection, subcutaneous mycosis, perforating dermatoses, pyoderma and squamous cell carcinoma. The histopathology was highly suggestive of a perforating GA. The patient was treated with betamethasone dipropionate cream applied once daily and a complete resolution of the lesion was observed in three weeks. Despite being a very rare subtype of a common disease, perforating granuloma annulare has clinical and histopathological characteristic features that facilitate the differential diagnosis, avoiding unnecessary procedures and inadequate and potentially more invasive treatments. Full article

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