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1.

Background

Due to the rising demand in home healthcare services in France as well as in other European countries, homecare organizations are facing challenges in terms of coordination and continuity of care. In both cases, the problem is linked to the efficiency in which care interventions are distributed and managed among the different participants involved in home care processes. Project Plas'O'Soins which was developed within the framework of the French research program TecSan, aims to address these contemporary problems by providing an interactive ICT platform to improve coordination and continuity of care within homecare organizations.

Main achievements

Plas'O'Soins, the software platform we designed, supports care specification as well as planning and monitoring of the care plans. It allows the modeling of care plans using a dedicated Domain Specific Language, the scheduling of care operations taking into account the human resources, the medical constraints and the geographical distribution of patients, and the monitoring of the execution of the operations by the care actors. This software platform enables the coordination of activities and the communication between actors and reacts to unforeseen events and produces dashboards in order to quantify the effectiveness of the processes.

Conclusion

The software platform has been deployed and used in an experimental setting by homecare partner organizations, providing valuable insights on the organizational changes required by the introduction of such an ICT solution in the actual practice of homecare.  相似文献   

2.
N. Shanmathi  M. Jagannath 《IRBM》2018,39(5):359-367

Background

Remote health monitoring plays a major role in handling the critical situation of patients and avoiding death and also enhancing the quality of healthcare services. The effective real time monitoring with accurate decision has to be made in advance with the help of decision making system by continuously acquiring biosignals.

Objectives

The main objective was to outline the research on remote patient health monitoring system that constitutes the multimodal biosignal acquisition system, thereby providing multi-label classification and clinical decision support system (CDSS).

Methods and results

A review was conducted with search terms such as multi-label classification, clinical decision support system, context-awareness and remote health monitoring. The study criteria included the randomized clinical trials evaluating the impact of efficient remote health monitoring system which incorporates CDSS for context-awareness systems by correlating several vital signs. From the total papers (n=52) which were included in the review, the major concentration of the review is multi-label classification (n=21, 40%). Further, this article included the review in context-awareness methods (n=5, 10%), clinical decision support systems (n=12, 23%), different means of biosignal acquisition and pre-processing (n=5, 10%), databases and software techniques for developing learning algorithms (n=3, 6%) and from general category (n=6, 12%). Several studies were effectively included which provides faster diagnosis for critically ill-patients. It is decisive for the critically ill-patients to be treated at the right time with proper and effective treatment which can be done efficiently using the CDSS and multi-label classification. The disease labels are classified as single and multi-labels where multi-label classification includes the disease labels for the correlated multiple vital signs and single label classification includes disease labels for individual vital signs. Further, on developing the logical learning model using multi-label classification, decision support system can be enhanced using context-awareness methods to predict the future vital signs, thereby providing an alert to the patients or doctors to take necessary actions.

Conclusion

The proposed system includes the model that provides the correlations of several biosignals like electrocardiogram (ECG), peripheral capillary oxygen saturation (SPO2), body temperature and heartbeat, thereby identifying the critical situations and making the decisions using CDSS that helps in taking the necessary clinical interventions.  相似文献   

3.
R. Souron  T. Lapole 《IRBM》2018,39(5):291-294

Background

Local vibration (LV) training is efficient to improve muscle strength due to adaptations within the central nervous system. However, little is known about adaptations at the muscular level after this form of training. The aim of this study was to assess the effect of LV training on muscle elastic properties using supersonic shear imaging technique.

Methods

Twenty-eight subjects were allocated to a training (VIB, n=14) or control (CON, n=14) group. The VIB group performed twenty-four 1-h sessions (3 sessions/wk) of 100-Hz vibration applied to the tibialis anterior. Maximal force (MVC) as well as active and passive muscle stiffness (i.e. using elastography) were assessed before and after the LV training.

Results

MVC was increased by 9.4 ± 9.7% in VIB (p<0.001) while no changes were reported in CON (p=0.52). No changes were reported in passive and active muscle stiffness for both groups (p>0.05).

Conclusion

Our results suggest that adaptations in elastic muscle properties do not explain the increased muscle strength reported after LV training.  相似文献   

4.

Purpose

Today's orthotics should be designed to apply the external orthosis moment to the knee joint solely during the stance phase instead of the entire gait cycle. The aim of this study was to validate the reliability of a simple device for measuring forces at the leg–orthosis interface and describe the behavior of an innovating dynamic unloader knee brace built to interrupt its mechanical action during large knee flexion (swing phase of gait).

Methods

A compression testing machine was used to apply known (standard) forces to the device (modeled forces) and the results were compared.

Results

The low absolute mean bias (4%), the narrow agreement limits associated with the Bland and Altman analysis as well as the significant linear correlation (r=0.99; p<0.001) validate the agreement between standard and modeled forces. Likewise, the low standard error of measurement between trials (1.3%) and the intraclass correlation coefficient (1.00) reflect high test-retest reliability.

Conclusion

These results demonstrate the validity of the proposed device for measuring constraints induced by the dynamic unloader knee brace. An example of an application is provided through an orthosis moment calculation using kinematic data, which reveal a changeable mechanical action, necessary to improve comfort resulting in potentially better compliance.  相似文献   

5.

Objective

The aims of this study, to investigate the interaction among heart rate variability (HRV), respiratory, systolic arterial blood pressure variability (SABPV) and systolic arterial pressure interval variability (APIV) signals for understanding of cardiovascular control.

Methods

In this study, three methods referred as adaptive continuous Morlet wavelet transform (ADCMWT), adaptive Stockwell transform (ADST) and adaptive modified Stockwell transform (ADMST) was used to assess the accuracy (AC) of time-varying spectral coherence (TVSC). The adaptation of these estimators was based on maximum energy concentration measurement. The capability to correct temporal localization of time–frequency regions was validated on synthetic time series data modeled as dynamic characteristics of cardiovascular signals.

Results

The results on synthetic simulated data show that the ADCMWT method allows for the temporal localization of the time–frequency regions with higher accuracy (AC > 96.074% for SNR ≥ 0 dB), compared to ADST (AC > 90.71% for SNR ≥ 0 dB) and ADMST (AC > 84.45% for SNR ≥ 5 dB). Further, the ADCMWT was applied to real cardiovascular data obtained from Fantasia standard data base and grouped as, 8 young subjects (4M + 4F, age range 23–32) and 8 elderly subjects (4M + 4F, age range 70–82) for estimating the TVSC in low frequency (LF) band (0.04 Hz–0.15 Hz) and high frequency (HF) band (0.15 Hz–0.4 Hz) of HRV spectrum. The global result depict that the median value of interquartile range of coherency between HRV-SABPV and HRV-APIV signals in LF and HF band were significantly (p=0.00001) lower in elderly group subjects compared to young group subjects. The coupling between HRV-Respiratory signals in LF band was not significantly affected with the aging of healthy subjects. However, this coupling in HF band significantly reduced in elderly compare to young group subjects (p=0.0125).

Conclusion

The comparative study shows that the time-varying spectra and accurate localization of coupling between two physiological signals can be affected by energy concentration. The ADCMWT at w0=6, could be an alternative, possibly more suitable and highly accurate method for assessment and detection of time varying spectral and coherence components of cardiovascular time series.  相似文献   

6.

Background

Elastic properties of arteries have long been recognized as playing a major role in the cardiovascular system. However, non-invasive in vivo assessment of local arterial stiffness remains challenging and imprecise as current techniques rely on indirect estimates such as wall deformation or pulse wave velocity. Recently, Shear Wave Elastography (SWE) has been proposed to non-invasively assess the intrinsic arterial stiffness.

Methods

In this study, we applied SWE in the abdominal aortas of rats while increasing blood pressure (BP) to investigate the dependence of shear wave speed with invasive arterial pressure and non-invasive arterial diameter measurements. A 15 MHz linear array connected to an ultrafast ultrasonic scanner, set non-invasively, on the abdominal aorta of anesthetized rats (N=5) was used. The SWE acquisition followed by an ultrafast (UF) acquisition was repeated at different moment of the cardiac cycle to assess shear wave speed and arterial diameter variations respectively. Invasive arterial BP catheter placed in the carotid, allowed the accurate measurement of pressure responses to increasing does of phenylephrine infused via a venous catheter.

Results

The SWE acquisition coupled to the UF acquisition was repeated for different range of pressure. For normal range of BP, the shear wave speed was found to follow the aortic BP variation during a cardiac cycle. A minimum of (5.06 ± 0.82) m/s during diastole and a maximum of (5.97 ± 0.90) m/s during systole was measured. After injection of phenylephrine, a strong increase of shear wave speed (13.85 ± 5.51) m/s was observed for a peak systolic arterial pressure of (190 ± 10) mmHg. A non-linear relationship between shear wave speed and arterial BP was found. A complete non-invasive method was proposed to characterize the artery with shear wave speed combined with arterial diameter variations. Finally, the results were validated against two elastic moduli: the incremental elastic modulus and the pressure elastic modulus derived from BP and arterial diameter variations.

Conclusion

The slopes derived from the proposed method could be a useful index to characterize arteries completely non-invasively in the clinic without the need to use blood pressure measurements.  相似文献   

7.

Background

Dedicated devices like GT3X+, Actical or ActivPal have been widely used to measure physical activity (PA) levels by using cut-points on activity counts. However, the calculation of activity counts relies on proprietary software. Since smartphones incorporate accelerometers they are suitable candidates to determine PA levels in a wider population.

Objective

Our aim was to compare several algorithms so that smartphones can reproduce the results obtained with GT3X+. The influence of smartphone location was also investigated.

Methods

Volunteers participated in the experiment performing several activities carrying two smartphones (hip and pocket) and one GT3X+ (hip). Four algorithms (A1–A4) were considered to obtain GT3X+ counts from smartphone accelerometer signals. A1 was based on a traditional filtering on temporal domain and a posterior calculation of the area under the curve. A2 was based on computing histograms of acceleration values, which were used as independent variables in a standard linear regression procedure. A3 also used a linear regression, but in this case the independent variables were power spectrum bands, leading to a kind of filtering in the frequency domain. A4 was based on a direct measure of area under the rectified curve of the raw accelerometer signal. Performance was measured in terms of raw activity counts or the corresponding PA level classification. The influence of the algorithm was tested with a Quade test. Multiple comparisons were performed with Wilcoxon test with Bonferroni's correction. Besides, battery consumption was also measured as a secondary parameter. The output of the selected algorithm was compared with GT3X+ counts using correlation (pearson and spearman) and agreement (Intra-Class Coefficient, ICC and Bland–Altmann plots for raw counts, and weighted kappa for activity levels). Several experimental conditions regarding smartphone location were compared with Wilcoxon tests.

Results

Thirty-two volunteers participated in the experiment. More refined algorithms based on filtering techniques did not prove to achieve better performance than A2 or A4. In terms of classification of PA level, A4 got the lowest error rate, although in some cases the differences with other algorithms were not statistically significant (p-value > 0.05). A4 is also the simplest and the one that implies less battery depletion. The comparison of A4 with GT3X+ gave good agreement (ICC=0.937) and correlation (spearman=0.927) for raw counts and good agreement when classifying four or two PA levels (weighted kappa=0.874 or 0.923 respectively). Besides, in real situations, activity classification into four levels was significantly improved (p-value<0.05) if data from several body locations were used to find model parameters.

Conclusions

Simple algorithms can reproduce the results of GT3X+. Thus, smartphones could be used to control the fulfillment of PA recommendations previously validated with cut-points. However, it must be acknowledged that accelerometers are not the gold standard to measure PA.  相似文献   

8.

Background

The Older Persons and Informal Caregivers Survey—Minimum Dataset (TOPICS-MDS) collects uniform information from research projects funded under the Dutch National Care for the Elderly Programme. To compare the effectiveness of these projects a preference-weighted outcome measure that combined multidimensional TOPICS-MDS outcomes into a composite endpoint (TOPICS-CEP) was developed based on the health state preferences of older persons and informal caregivers.

Objectives

To derive preference weights for TOPICS-CEP’s components based on health state preferences of healthcare professionals and to investigate whether these weights differ between disciplines and differ from those of older persons and informal caregivers.

Materials and Methods

Vignette studies were conducted. Participants assessed the general wellbeing of older persons described in vignettes on a scale (0-10). Mixed linear analyses were used to obtain and compare the preference weights of the eight TOPICS-CEP components: morbidities, functional limitations, emotional wellbeing, pain experience, cognitive problems, social functioning, self-perceived health, and self-perceived quality of life (QOL).

Results

Overall, 330 healthcare professionals, 124 older persons and 76 informal caregivers participated. The preference weights were not significantly different between disciplines. However, the professionals’ preference weights differed significantly from those of older persons and informal caregivers. Morbidities and functional limitations were given more weight by older persons and informal caregivers than by healthcare professionals [difference between preference weights: 0.12 and 0.07] while the opposite was true for pain experience, social functioning, and self-perceived QOL [difference between preference weights: 0.13, 0.15 and 0.26].

Conclusion

It is important to recognize the discrepancies between the health state preferences of various stakeholders to (1) correctly interpret results when studying the effectiveness of interventions in elderly care and (2) establish appropriate healthcare policies. Furthermore, we should strive to include older persons in our decision making process through a shared decision making approach.  相似文献   

9.
Y. Matanga  K. Djouani  A. Kurien 《IRBM》2018,39(5):324-333

Context

Sensorimotor rhythms (SMR) have been the neuronal phenomena of choice in non-invasive EEG-based endogenous brain computer interfaces (BCIs) for more than two decades and SMR-based BCIs have achieved the highest degree of freedom control so far. Nevertheless, they are subject to long periods of training prior to attaining a satisfactory level of control requiring users to learn to modulate their rhythms. The goal of this work is to analyse this problem, discuss the causes of the slow rise in performance and provide recommendations on alternative solutions to quicken control attainment.

Methods

The study has been conducted by both theoretical and empirical analysis. A theoretical model has been developed that explains the principle operation of SMR-based BCIs focusing on major performance contributors respectively the user, periodic feature selection and the translation model thus contrasting user adaptation and machine learning. Five able-bodied subjects (age: 26±2.55) participated in six sessions of online computer cursor control experiments over three weeks to evaluate control attainment performances and gather data for statistical analysis (~1152 trials per subject). Correlation (r2) between user control features and target position over sessions was assessed as an estimate of neural adaptation and the predictive power of the translation algorithm (10 × 10 fold cross-validation) was calculated over sessions as an estimate of machine adaptation. Auxiliary performance metrics were evaluated.

Results

Features-target correlation increased over sessions, while at the same time the predictive accuracy (R2) of the translation model remained averagely steady and very low (Rbest2=0.04) demonstrating continuous user adaptation and low model predictive accuracy. Periodic feature selection was theoretically discussed to be very instrumental and its relevance was empirically illustrated.

Conclusions

The study concludes that the slow control attainment in SMR-based BCIs is due to its reliance on user training (neural adaptation) which is adaptive but too slow in the context of SMR modulations and due to the weak decoding of the neuronal phenomenon utilised by the user. As a recommendation, the optimality of the feature selection algorithm could be looked at to guarantee the use of the most relevant features. However and most importantly the predictive power of the translation model should be significantly improved in order to quicken control attainment as thereafter the control attainment effort could be shifted from neural adaptation to machine learning.  相似文献   

10.

Introduction & Objectives

Due to the scale up of antiretroviral therapy, increasing numbers of HIV-infected children are living into adolescence. As these children grow and surpass the immediate threat of death, the issue of informing them of their HIV status arises. This study aimed to understand how perinatally-infected adolescents learn about their HIV-status as well as to examine their preferences for the disclosure process.

Methods

In-depth interviews were conducted with 31 (14 male, 17 female) perinatally-infected adolescents aged 16–20 at an HIV clinic in Harare, Zimbabwe, and focused on adolescents'' experiences of disclosure. In addition, 15 (1 male, 14 female) healthcare workers participated in two focus groups that were centred on healthcare workers'' practices surrounding disclosure in the clinic. Purposive sampling was used to recruit participants. A coding frame was developed and major themes were extracted using grounded theory methods.

Results

Healthcare workers encouraged caregivers to initiate disclosure in the home environment. However, many adolescents preferred disclosure to take place in the presence of healthcare workers at the clinic because it gave them access to accurate information as well as an environment that made test results seem more credible. Adolescents learned more specific information about living with an HIV-positive status and the meaning of that status from shared experiences among peers at the clinic.

Conclusions

HIV-status disclosure to adolescents is distinct from disclosure to younger children and requires tailored, age-appropriate guidelines. Disclosure to this age group in a healthcare setting may help overcome some of the barriers associated with caregivers disclosing in the home environment and make the HIV status seem more credible to an adolescent. The study also highlights the value of peer support among adolescents, which could help reduce the burden of psychosocial care on caregivers and healthcare workers.  相似文献   

11.

Introduction

In low resource settings, the vast majority of ‘Person/people Living with HIV’ (PLHIV/s) and inadequate healthcare delivery systems to meet their treatment and care needs, caregivers play a vital role. Home based caregivers are often unrecognized with limited AIDS policies and programs focusing on them. We explored the perceptions and norms regarding care being provided by family caregivers of PLHIVs in India.

Methodology

A community based qualitative study to understand the issues pertaining to home based care for PLHIV was conducted in urban settings of Pune city, in Maharashtra, India. Eight Focus Group Discussions (FGDs) among men, women and peer educators were carried out. A total of 44 in-depth Interviews (IDIs) with PLHIVs (20) and their caregivers (24), were conducted using separate guides respectively. Data was analyzed thematically.

Results

Home based care was perceived as economically viable option available for PLHIVs. ‘Care’ comprised of emotional, adherence, nursing and financial support to PLHIV. Home based care was preferred over hospital based care as it ensured confidentiality and patient care without hampering routine work at home. Women emerged as more vital primary caregivers compared to men. Home based care for men was almost unconditional while women had no such support. The natal family of women also abandoned. Their marital families seemed to provide support. Caregivers voiced the need for respite care and training.

Discussion

Gender related stigma and discrimination existed irrespective of women being the primary family caregivers. The support from marital families indicates a need to explore care and support issues at natal and marital homes of the women living with HIV respectively. Home based care training and respite care for the caregivers is recommended. Gender sensitive interventions addressing gender inequity and HIV related stigma should be modeled while designing interventions for PLHIVs and their family caregivers.  相似文献   

12.
As healthcare organizations are struggling to enhance healthcare qualities and efficiencies, they focus on secure and efficient sharing of clinical information among healthcare providers including doctors, nurses, medical laboratories, and informal caregivers, throughout the entire healthcare life cycle. Any failure or error during this clinical collaborative communication can have negative impact on the efficiencies of the whole healthcare delivery system. This paper suggests a methodological approach to address the needs in this area and proposes a methodology for developing clinical collaborative communication (C\(^{3})\) systems. Since C\(^{3}\) demands a variety of collaborative communications among multiple healthcare stakeholders, the proposed approach focuses on the effective system design and analysis with the objective to enhance collaboration and communication in healthcare organizations.  相似文献   

13.
14.
BackgroundApproximately 10% to 20% of people with concussion experience prolonged post-concussion symptoms (PPCS). There is limited information identifying risk factors for PPCS in adult populations. This study aimed to derive a risk score for PPCS by determining which demographic factors, premorbid health conditions, and healthcare utilization patterns are associated with need for prolonged concussion care among a large cohort of adults with concussion.Methods and findingsData from a cohort study (Ontario Concussion Cohort study, 2008 to 2016; n = 1,330,336) including all adults with a concussion diagnosis by either primary care physician (ICD-9 code 850) or in emergency department (ICD-10 code S06) and 2 years of healthcare tracking postinjury (2008 to 2014, n = 587,057) were used in a retrospective analysis. Approximately 42.4% of the cohort was female, and adults between 18 and 30 years was the largest age group (31.0%). PPCS was defined as 2 or more specialist visits for concussion-related symptoms more than 6 months after injury index date. Approximately 13% (73,122) of the cohort had PPCS. Total cohort was divided into Derivation (2009 to 2013, n = 417,335) and Validation cohorts (2009 and 2014, n = 169,722) based upon injury index year. Variables selected a priori such as psychiatric disorders, migraines, sleep disorders, demographic factors, and pre-injury healthcare patterns were entered into multivariable logistic regression and CART modeling in the Derivation Cohort to calculate PPCS estimates and forward selection logistic regression model in the Validation Cohort. Variables with the highest probability of PPCS derived in the Derivation Cohort were: Age >61 years (p^ = 0.54), bipolar disorder (p^ = 0.52), high pre-injury primary care visits per year (p^ = 0.46), personality disorders (p^ = 0.45), and anxiety and depression (p^ = 0.33). The area under the curve (AUC) was 0.79 for the derivation model, 0.79 for bootstrap internal validation of the Derivation Cohort, and 0.64 for the Validation model. A limitation of this study was ability to track healthcare usage only to healthcare providers that submit to Ontario Health Insurance Plan (OHIP); thus, some patients seeking treatment for prolonged symptoms may not be captured in this analysis.ConclusionsIn this study, we observed that premorbid psychiatric conditions, pre-injury health system usage, and older age were associated with increased risk of a prolonged recovery from concussion. This risk score allows clinicians to calculate an individual’s risk of requiring treatment more than 6 months post-concussion.

In a retrospective study of data from a cohort of adults with a concussion diagnosis in Ontario, Laura Kathleen Langer and colleagues derive a risk score for predicting risk of prolonged post-concussion symptoms.  相似文献   

15.
16.

Background

Serious games have recently immerged as a good tool for physical rehabilitation. This new technology can be used at home, to complement a traditional, clinic based, rehabilitation program. To implement a serious game at home, we need to use multiple sensors to record patients' data. Many serious games use visual motion capture techniques, like the Kinect camera, due to their low price and high portability. On the other hand, some other systems use inertial sensors to collect data at a higher degree of accuracy. In previous works, we showed that a serious gaming system could benefit from combining data from different sensors. However, the use of inertial sensors, in a home-based setting, remains a challenge since they need to be supplied by an independent battery source, which could influence the acceptability of such systems.

Methods

In this paper, we present an energy consumption study, performed on the inertial sensors used in our serious game system.

Results

The results show that the sensors are rarely affected by environmental factors. They also show that the sensors can function continuously for about 14 hours without battery recharge.

Conclusion

Finally, these results allowed us to establish an optimal set up configuration for home based rehabilitation using serious games.  相似文献   

17.

Aim

This work aims to achieve the highest possible monitor units (MU) reduction using the MU Objective tool included in the Eclipse treatment planning system, while preserving the plan quality.

Background

The treatment planning system Eclipse (Varian Medical Systems, Palo Alto, CA) includes a control mechanism for the number of monitor units of volumetric modulated arc therapy (VMAT) plans, named the MU Objective tool.

Material and methods

Forty prostate plans, 20 gynecological plans and 20 head and neck plans designed with VMAT were retrospectively studied. Each plan (base plan) was optimized without using the MU Objective tool, and it was re-optimized with different values of the Maximum MU (MaxMU) parameter of the MU Objective tool. MU differences were analyzed with a paired samples t-test and changes in plan quality were assessed with a set of parameters for OARs and PTVs.

Results

The average relative MU difference (ΔMU¯) considering all treatment sites, was the highest when MaxMU = 400 (?4.2%, p < 0.001). For prostate plans, the lowest ΔMU¯ was obtained (?3.7%, p < 0.001). For head and neck plans ΔMU¯ was ?7.3% (p < 0.001) and for gynecological plans ΔMU¯ was 7.0% (p = 0.002). Although similar MU reductions were observed for both sites, for some gynecological plans maximum differences were greater than 10%. All the assessed parameters for PTVs and OARs sparing showed average differences below 2%.

Conclusion

For the three studied clinical sites, establishing MaxMU = 400 led to the optimum MU reduction, maintaining the original dose distribution and dosimetric parameters practically unaltered.  相似文献   

18.
S. Li  J.C. Nunes  C. Toumoulin  L. Luo 《IRBM》2018,39(1):69-82

Background

3D reconstruction of the coronary arteries can provide more information in the interventional surgery. Motion compensation is one kind of the 3D reconstruction method.

Methods

We propose a novel and complete 2D motion compensated reconstruction method. The main components include initial reconstruction, forward projection, registration and compensated reconstruction. We apply the mutual information (MI) and rigidity penalty (RP) as registration measure. The advanced adaptive stochastic gradient descent (ASGD) is adopted to optimize this cost function. We generate the maximum forward projection by the simplified distance driven (SDD) projector. The compensated reconstruction adopts the MAP iterative reconstruction algorithm which is based on L0 prior.

Results

Comparing with the ECG-gating reconstruction and other reference method, the evaluation indicates that the proposed 2D motion compensation leads to a better 3D reconstruction for both the rest and stronger motion phases. The algorithm compensates the residual motion and reduces the artifact largely. As the gating window width increases, the overall image noise decreases and the contrast of the vessels improves.

Conclusions

The proposed method improved the 3D reconstruction quality and reduced the artifact level. The considerable improvement in the image quality results from motion compensation increases the clinical usability of 3D coronary artery.  相似文献   

19.

Background

Family caregivers of people with mental disorders are frequently involved in involuntary hospital admissions of their relatives.

Objective

To explore family caregivers'' experience of involuntary admission of their relative.

Method

30 in-depth interviews were conducted with family caregivers of 29 patients who had been involuntarily admitted to 12 hospitals across England. Interviews were analysed using thematic analysis.

Results

Four major themes of experiences were identified: relief and conflicting emotions in response to the relative''s admission; frustration with a delay in getting help; being given the burden of care by services; and difficulties with confidentiality.Relief was a predominant emotion as a response to the relative''s admission and it was accompanied by feelings of guilt and worry. Family caregivers frequently experienced difficulties in obtaining help from services prior to involuntary admission and some thought that services responded to crises rather than prevented them. Family caregivers experienced increased burden when services shifted the responsibility of caring for their mentally unwell relatives to them. Confidentiality was a delicate issue with family caregivers wanting more information and a say in decisions when they were responsible for aftercare, and being concerned about confidentiality of information they provided to services.

Conclusion

Compulsory admission of a close relative can be a complex and stressful experience for family caregivers. In order for caregivers to be effective partners in care, a balance needs to be struck between valuing their involvement in providing care for a patient and not overburdening them.  相似文献   

20.
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