Biomedical subjects

Nancy Mayo

Publications and source records attributed to Nancy Mayo.

11 recordsLinked to original sources

PubMed2006

Canadian dietitians' use and perceptions of glycemic index in diabetes management.

PURPOSE: Several health organizations, including the Canadian Diabetes Association, advocate use of the glycemic index (GI) in the nutritional management of diabetes. However, the clinical utility and applications of the GI remain controversial. Our goal was to determine, via a postal survey, whether dietitians were using the GI and barriers to its use if they were not. METHODS: This cross-sectional study was conducted in 2003. Members of Dietitians of Canada and the Ordre professionnel des diététistes du Québec (n=6,060) were first contacted by mail to identify those working with individuals with diabetes. Among respondents (n=2,857), 1,805 worked with individuals with diabetes and were sent a questionnaire. Using Chi-square analyses, users and nonusers were compared for their professional characteristics, perceived benefits, barriers, general knowledge about the concept, and confidence in teaching the GI. RESULTS: Among questionnaire respondents (n=1,057), 39% (n=415) used the GI and 61% (n=642) did not. Overall, users were more likely to have a greater diabetes patient caseload, perceived greater benefits and had greater confidence in teaching the concept. Nonusers cited lack of teaching tools and lack of knowledge on how to teach the concept as major barriers. CONCLUSIONS: Further research is required to identify the clinical reasoning that triggers dietitians to apply the concept in their practice.

Clinical Competence↗

PubMed2005

Older women's health priorities and perceptions of care delivery: results of the WOW health survey.

BACKGROUND: As women get older, their health priorities change. We surveyed a sample of older Canadian women to investigate what health priorities are of concern to them, their perceptions about the care delivered to address these priorities and the extent to which priorities and perceptions of care differ across age groups and provinces. METHODS: The WOW (What Older women Want) cross-sectional health survey was mailed in October 2003 to 5000 community-dwelling women aged 55-95 years from 10 Canadian provinces. Women were asked questions on 26 health priorities according to the World Health Organization's International Classification of Functioning, Disability and Health, and their perceptions of whether these priorities were being addressed by health care providers through screening or counselling. Differences in priorities and perceptions of care delivery were examined across age groups and provinces. RESULTS: The response rate was 52%. The mean age of the respondents was 71 (standard deviation 7) years. The health priorities identified most frequently by the respondents were preventing memory loss (88% of the respondents), learning about the side effects of medications (88%) and correcting vision impairment (86%). Items least frequently selected were counselling about community programs (28%), counselling about exercise (33%) and pneumonia vaccination (33%). Up to 97% of the women recalled being adequately screened for heart disease and stroke risk factors, but as little as 11% reported receiving counselling regarding concerns about memory loss or end-of-life issues. Women who stated that specific priorities were of great concern or importance to them were more than twice as likely as those who stated that they were not of great concern or importance to perceive that these priorities were being addressed: osteoporosis (odds ratio [OR] 2.6, 95% confidence interval [CI] 2.1- 3.2), end-of-life care (OR 2.6, 95% CI 2.0-3.4), anxiety reduction (OR 2.2, 95% CI 1.8-2.6), fall prevention (OR 2.1, 95% CI 1.6-2.7), stroke (OR 2.1, 95% CI 1.4-3.0), depression (OR 2.1, 95% CI 1.7-2.7) and urinary incontinence (OR 2.1, 95% CI 1.7-2.5). The respondents' perceptions of care delivery varied across age groups and provinces. INTERPRETATION: According to the perceptions of surveyed women, health care providers are addressing many, but not all, of their health concerns, especially those that are of great concern or importance to these women.

Aged↗

PubMed2004

Postdischarge nursing interventions for stroke survivors and their families.

BACKGROUND: The physical, cognitive, and emotional sequelae of stroke underscore the need for nursing interventions across the continuum of care. Although there are several published studies evaluating community interventions for stroke survivors, the nursing role has not been clearly articulated. AIM: The aim of this paper is to report a study to describe, using a standardized classification system, the nursing interventions used with stroke survivors during the initial 6 weeks following discharge home. METHODS: In the context of a randomized controlled trial, two nurse case managers provided care to 90 community-dwelling stroke survivors who were assigned to the intervention arm of the trial. The nursing documentation was analysed, using the Nursing Intervention Classification (NIC) system, to identify and quantify the interventions that were provided. FINDINGS: Stroke survivors received, on average, six different interventions. There was a trend for those who were older, more impaired, and who lived alone to receive more interventions. The most commonly reported interventions included those directed towards ensuring continuity of care between acute and community care, family care, and modifying stroke risk factors. The study was limited to the nursing documentation, which may represent an underestimation of the care delivered. CONCLUSIONS: The NIC system was useful in capturing the interventions delivered by the nurse case managers. Nursing interventions are often not clearly articulated and less often use standardized terminology. Describing nursing activities in a standard manner will contribute to an increase in nursing knowledge and to evidence-based practice.

Aftercare↗

PubMed2003

Evolution of the caregiving experience in the initial 2 years following stroke.

Relationships between stroke survivor and family caregiver factors and the caregiver's health-related quality of life (HRQL) and overall quality of life (QoL) were examined in 97 dyads during the first and second years after stroke. Compared to age- and sex-matched population norms, caregivers scored significantly lower on the mental subscales of HRQL, and differences were greater for women than for men. Caregiver characteristics (older age, less burden, and fewer physical symptoms) were associated with better HRQL (mental summary scale) in the first year, with similar findings in the second year. Moderate stroke survivor physical impairment and caregiver characteristics (younger age and better HRQL) were associated with better QoL in the first year. During the second year poorer caregiver physical and mental health and caring for a stroke survivor with communication difficulties were associated with diminished QoL.

Aged↗

PubMed2003

Women's health priorities and perceptions of care: a survey to identify opportunities for improving preventative health care delivery for older women.

BACKGROUND: women live longer than men but consistently report poorer health status and health-related quality of life. Information is scarce on what components of care women desire to help them meet the challenges of their later years. OBJECTIVES: to identify older women"s priorities for maintaining physical, emotional and social well-being in later years and to measure the extent to which women perceive that these priorities are being met by the health care system. METHODS: a cross-sectional survey of community-dwelling women aged 55-93 years old (n = 609, mean age 70). Women attendees of outpatient medical clinics were invited to fill out a written questionnaire on health priorities and perceptions of care. Mismatches between the care that women desired and the care they perceived to be receiving were identified. Predictors of unmet priorities were evaluated. SETTING: the Greater Montreal Area in Quebec, Canada. RESULTS: in general, respondents were more concerned about preventing disability than with developing certain diseases later in life. Women prioritised feeling validated in the health care relationship and having their health care provider see them as a whole person. Deficiencies in addressing memory loss, preserving mobility and function and treating urinary incontinence were highlighted. Women aged 75 years and older were less likely to perceive that their priorities were unmet compared to women aged 55-74 years (OR 0.571; 95% confidence interval 0.404-0.808), when adjusting for other socio-demographic and health variables. CONCLUSIONS: Opportunities exist to improve the preventive health care that women are receiving to promote healthy ageing. Women aged 55-74 should especially be targeted for interventions to prevent disability in later life.

Activities of Daily Living↗

PubMed2003

Understanding older women's health care concerns: a qualitative study.

BACKGROUND: Older women often have different physical and psychological health priorities compared to men, and health systems must strive to extend and improve health care delivery to meet older women's specific health care needs. The goal of this study was to obtain information from older women on how to improve health care services to best support their efforts to age successfully and receive optimal quality health care in later life. METHODS: Focus groups were conducted among women aged 65 or older recruited from the community in the Montreal, Quebec area. A total of 36 women participated. The focus group sessions were audiotaped, and the transcripts of each session were analyzed for issues and themes emerging from the text. Content analysis using the framework approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent ideas and concepts. RESULTS: Participants felt that their physical health care needs were being met, but that a number of issues relating to psychological health were inadequately addressed by health care professionals. The importance of feeling validated as active participants in a health care relationship, recognition of fears and anxieties associated with aging, and the need for information-sharing and education were all viewed as important health care priorities for older women. Time and accessibility were identified as the most significant barriers towards receiving optimal health care in later life. INTERPRETATION: The current health care system does not meet the global health care needs of older women. Health care leaders must recognize that success in program development and delivery for older women will require designing clinical programs that address both the physiological and psychosocial requirements of women. Only when women feel that they are being cared for in a comprehensive manner, one that includes attention to physical, psychological and emotional health, are we likely to be delivering health care that optimally promotes successful aging.

Age Factors↗

PubMed2003

Understanding older women's health care concerns: a qualitative study.

BACKGROUND: Older women often have different physical and psychological health priorities compared to men, and health systems must strive to extend and improve health care delivery to meet older women's specific health care needs. The goal of this study was to obtain information from older women on how to improve health care services to best support their efforts to age successfully and receive optimal quality health care in later life. METHODS: Focus groups were conducted among women aged 65 or older recruited from the community in the Montreal, Quebec, area. A total of 36 women participated. The focus group sessions were audiotaped, and the transcripts of each session were analyzed for issues and themes emerging from the text. Content analysis using the framework approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent ideas and concepts. RESULTS: Participants felt that their physical health care needs were being met, but that a number of issues relating to psychological health were inadequately addressed by health care professionals. The importance of feeling validated as active participants in a health care relationship, recognition of fears and anxieties associated with aging, and the need for information-sharing and education were all viewed as important health care priorities for older women. Time and accessibility were identified as the most significant barriers towards receiving optimal health care in later life. INTERPRETATION: The current health care system does not meet the global health care needs of older women. Health care leaders must recognize that success in program development and delivery for older women will require designing clinical programs that address both the physiological and psychosocial requirements of women. Only when women feel that they are being cared for in a comprehensive manner, one that includes attention to physical, psychological and emotional health, are we likely to be delivering health care that optimally promotes successful aging.

Age Factors↗

PubMed2003

A workflow model for adapting e-charts in specialty clinics.

Modeling of health professionals' activities and matching of these processes to applied information technologies are necessary for acceptance and optimal utilization of a clinical information system. The overall objective of this study was to describe the different processes involved in current clinical practice of neurologists and to estimate the extent by which these processes are standardised across neurologists. Results from this study will be used to optimise the deployment of a stroke e-record and provide insight on some of the characteristics that will need to be addressed.

Ambulatory Care Facilities↗

PubMed2002

A Quebec survey of issues in cancer pain management.

We report the results of a cancer pain survey mailed to Quebec hematologist-oncologists and palliative care physicians in 1999. The survey was designed to sample views on the current status of pain management and on obstacles to the provision of adequate pain relief for patients. The survey, formulated by an ethics network centered at the Clinical Research Institute of Montreal, was distributed to all members of the Association of Hematologist-Oncologists of Quebec and to all physician members of the Quebec Palliative Care Association. Responses were obtained from 138 Palliative Care Association members (response rate 61%) and 76 hematologist-oncologists (response rate 45%). Major obstacles reported included inadequate assessment of both contributory psychosocial issues and severity of pain, patient reluctance to take opioids, and inadequate access to non-drug techniques for pain relief. Access to opioids was not regarded as a problem. Both groups felt generally competent in their ability to manage various aspects of cancer pain therapy. They gave little credit to their formal medical school or residency training. Fifty-six percent of the palliative care group and 57% of the hemato-oncologists rated their medical school experience as only "poor" or "fair" on a 4-point scale. Residency ratings were modestly better. We conclude that medical faculties should assign a high priority to teaching health professionals patient assessment techniques. Simple symptom assessment scales should be routinely used in oncology/palliative care practice. Medical school training in pain management is not highly regarded and should be enhanced. We also note that, based on response to the scenario of a patient presenting with severe pain, many physicians, while feeling competent in the use of opioids, may be overly conservative in their initial use.

Attitude of Health Personnel↗

PubMed2002

Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial.

BACKGROUND: Multimodal analgesia programs have been shown to decrease hospital stay, but it not clear which functions are restored after surgery. The objective of this study is to evaluate the impact of epidural anesthesia and analgesia on functional exercise capacity and health-related quality of life. METHODS: Sixty-four patients undergoing elective colonic resection were randomized to either patient-controlled analgesia with morphine or thoracic epidural analgesia with bupivacaine and fentanyl (epidural group). All patients in both groups received similar perioperative care and were offered the same amount of postoperative oral nutrition and assistance with mobilization. Primary outcome was functional exercise capacity as measured by the 6-min walking test, and secondary outcome was health-related quality of life, as measured by the SF-36 health survey. These were assessed before surgery and at 3 and 6 weeks after hospital discharge. Other variables measured in hospital included pain and fatigue visual analogue scale, bowel function, time out of bed, nutritional intake, complication rate, readiness for discharge, and length of hospital stay. RESULTS: Although the 6-min walking test and the SF-36 physical health component decreased in both groups at 3 and 6 weeks after surgery, the patient-controlled analgesia group experienced a significantly greater decrease at both times (P < 0.01). Patients in the epidural group had lower postoperative pain and fatigue scores, which allowed them to mobilize to a greater extent (P < 0.05) and eat more (P < 0.05). Length of hospital stay and incidence of complications were similar in both groups, although patients in the epidural group were ready to be discharged earlier. CONCLUSIONS: The superior quality of pain relief provided by epidural analgesia had a positive impact on out-of-bed mobilization, bowel function, and intake of food, with long-lasting effects on exercise capacity and health-related quality of life.

Adult↗

PubMedDate not supplied

Early supported discharge services for stroke patients: a meta-analysis of individual patients' data.

BACKGROUND: Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. METHODS: We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. FINDINGS: Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (p<0.0001). There were also significant improvements in scores on the extended activities of daily living scale and in the odds of living at home and reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patients with mild to moderate disability. INTERPRETATION: Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as shortening hospital stays.

Activities of Daily Living↗