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Long-term experience with Passive House buildings is illustrated with two early large-scale projects, a school and an office building located in Germany. Those were monitored in lump energy performance (school, commissioned 2004) and great detail (office, commissioned 2002), respectively. Moreover, they give an indication of the characteristics of such buildings subject to changes in usage intensity. Both buildings generally performed as expected with the school facing occasional overheating in the summer due to inflexible shading controls. Following an extension in schooling hours, the addition of a canteen was required and the ventilation system was adapted to the changed usage. Nevertheless, the building’s user comfort and energy performance remain high, despite exceeding the Passive House primary energy target slightly due to increased electricity consumption. The office likewise meets the calculated efficiency in operation. The ground-coupled cooling worked well despite greatly increased internal heat gains due to unexpected usage. This extra heat input did not, however, exhaust the geothermal (passive) cooling capacity for the future. Thermal comfort proved near optimal at all times, despite a very simple control regime of the one-circuit concrete core activation system for heating and cooling. In the last section, airtightness design and measurement experience in the UK and, particularly, the question of long-term stability of the airtight building envelope are assessed. It was found that measurement results are not only repeatable in relatively short intervals such as a few months. The data available suggests stability of the airtight envelope over many years. Attention is required as regards the leakage of party walls of terraced buildings which need to be integrated in the overall airtightness concept. A high permeability of party walls in terraced buildings with a common airtight envelope presents a challenge for measuring airtightness. Long-term series of airtightness measurements exist for the Kranichstein House in Darmstadt, Germany, and prove the stability of the chosen airtightness concept. Moreover, results for 17 early Passive House buildings in Germany in eight locations and various construction types revisited in 2001 (1.4 to 10 years after the initial airtightness test) suggest stability of airtightness values over time. Great advances have since been made in materials and methods available and the general understanding in the industry. This is supported by a large sample of 2934 Passive House projects of varied construction materials, locations, sizes, and usages that yielded an average airtightness test result as low as n50 = 0.41 h−1. [ABSTRACT FROM AUTHOR]

Background: A patient's self-management of chronic disease is influenced in part by their explanatory model of illness (EMI) and daily lived experiences (DLE). Unfortunately, assessing patient's EMI and using this information to engage patients in chronic illness self-management continues to be a challenge.Objective: "Health mind mapping" (HMM) is a novel process that captures a patient's EMI and DLE through the use of a graphic representation of ideas. We aimed to explore patient's experiences using HMM.Design: Qualitative study utilizing semi-structured interviews.Participants: Adult patients with uncontrolled type 2 diabetes from a primary care clinic.Approach: A facilitator guided 20 participants through the process of developing a health mind map. Subsequently, each participant completed a semi-structured interview about their experience with the process and perceptions about how their maps could be used. The process and interviews were video and audio recorded. We conducted a content analysis of the maps and a thematic analysis, using an inductive approach, of the interview data.Results: Participants explored a wide range of EMs and DLEs in their HMM process. Participants reported that the HMM process (1) helped to develop insight about self and illness; (2) was a catalyst for wanting to take actions to improve illness; and (3) represented an opportunity to actively share illness experiences. They reported potential uses of the map: (1) to communicate about their illness to others in their social network; (2) to communicate about their illness to providers; (3) to help others with diabetes manage their illness; and (4) to encourage ongoing engagement in diabetes self-care.Conclusions: Participants reported that HMM helped them develop new insight about their illness and was a catalyst for encouraging them to take control of their illness. HMM has the potential to facilitate communication with providers and engage patients in collaborative goal setting to improve self-care in chronic illness. [ABSTRACT FROM AUTHOR]

Background: Guidelines recommend, and Medicare requires, shared decision-making between patients and clinicians before referring individuals at high risk of lung cancer for chest CT screening. However, little is known about the extent to which shared decision-making about lung cancer screening is achieved in real-world settings.Objective: To characterize patient and clinician impressions of early experiences with communication and decision-making about lung cancer screening and perceived barriers to achieving shared decision-making.Design: Qualitative study entailing semi-structured interviews and focus groups.Participants: We enrolled 36 clinicians who refer patients for lung cancer screening and 49 patients who had undergone lung cancer screening in the prior year. Participants were recruited from lung cancer screening programs at four hospitals (three Veterans Health Administration, one urban safety net).Approach: Using content analysis, we analyzed transcripts to characterize communication and decision-making about lung cancer screening. Our analysis focused on the recommended components of shared decision-making (information sharing, deliberation, and decision aid use) and barriers to achieving shared decision-making.Key Results: Clinicians varied in the information shared with patients, and did not consistently incorporate decision aids. Clinicians believed they explained the rationale and gave some (often purposely limited) information about the trade-offs of lung cancer screening. By contrast, some patients reported receiving little information about screening or its trade-offs and did not realize the CT was intended as a screening test for lung cancer. Clinicians and patients alike did not perceive that significant deliberation typically occurred. Clinicians perceived insufficient time, competing priorities, difficulty accessing decision aids, limited patient comprehension, and anticipated patient emotions as barriers to realizing shared decision-making.Conclusions: Due to multiple perceived barriers, patient-clinician conversations about lung cancer screening may fall short of guideline-recommended shared decision-making supported by a decision aid. Consequently, patients may be left uncertain about lung cancer screening's rationale, trade-offs, and process. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of healthcare access and other characteristics on physician trust among black and white prostate cancer patients.Methods: A three-timepoint follow-up telephone survey after cancer diagnosis was conducted. This study analyzed data on 474 patients and their 1,320 interviews over three time periods.Results: Among other subpopulations, black patients who delayed seeking care had physician trust levels that were far lower than that of both Caucasians as well as that of the black patients overall. Black patients had greater variability in their levels of physician trust compared to their white counterparts.Conclusions: Both race and access are important in explaining overall lower levels and greater variability in physician trust among black prostate cancer patients. Access barriers among black patients may spill over to the clinical encounter in the form of less physician trust, potentially contributing to racial disparities in treatment received and subsequent outcomes. Policy efforts to address the racial disparities in prostate cancer should prioritize improving healthcare access among minority groups. [ABSTRACT FROM AUTHOR]

The active participation of young adults with serious mental illnesses (SMI) in making decisions about their psychotropic medications is beneficial to their care quality and overall health. Many however report not expressing treatment preferences to psychiatrists. Qualitative methods were used to interview 24 young adults with SMI about their experiences making medication decisions with their psychiatrists. An inductive analytic approach was taken to identifying conceptual themes in the transcripts. Respondents reported that the primary facilitators to active participation were the psychiatrist's openness to the client's perspective, the psychiatrist's availability outside of office hours, the support of other mental health providers, and personal growth and self-confidence of the young adults. The primary barriers to active participation reported were the resistance of the psychiatrist, the lack of time for consultations, and limited client self-efficacy. Young adults with SMI can be active participants in making decisions about their psychiatric treatment. [ABSTRACT FROM AUTHOR]

Patient navigation has emerged as a promising strategy for addressing racial-ethnic and socioeconomic disparities in cancer-related care. However, little is known about the impact of patients' perception of the quality of navigation on patient outcomes. We examined the impact of better-rated navigators on patients' satisfaction with cancer-related care. The sample included 1,593 adults (85.8 % with abnormal cancer screening and 14.2 % with confirmed cancer diagnosis) who received patient navigation. We defined better-rated navigators as those scoring above the first quartile of mean scores on the Patient Satisfaction with Interpersonal Relationship with Navigator scale. We defined patient satisfaction based on scores above or below the median of the Patient Satisfaction with Cancer-Related Care (PSCC) scale. We controlled for patient and site characteristics using backward selection logistic regression analyses. Among patients with abnormal screening, having a better-rated navigator was associated with higher score on the PSCC ( p < 0.05). After controlling for other bivariate predictors of satisfaction (e.g., age, race, income, and household size), navigation by better-rated navigators was associated with a greater likelihood of having higher patient satisfaction [odds ratio (OR), 1.38; 95 % confidence interval (CI), 1.05-1.82]. Similar findings between better-rated navigators and score on the PSCC were found for participants with diagnosed cancer (OR, 3.06; 95 % CI, 1.56-6.0). Patients navigated by better-rated navigators reported higher satisfaction with their cancer-related care. [ABSTRACT FROM AUTHOR]

Chronic hepatitis C (HCV) infection affects millions of people in the USA and prevalence rates are higher in US veterans. The consequences of HCV infection include reduced quality of life, liver damage, and reduced longevity. Our objective was to describe the experiences of US veterans living with chronic HCV infection and use this information in the development of an HCV self-management intervention. Twenty-two male HCV-infected veterans completed qualitative interviews. Participants were recruited via flyers and hepatitis C clinic providers at a major VA medical center. Participants were asked about their medical history, being diagnosed with HCV, and general experiences living with HCV. The study gathered the following findings: the impact of HCV on interpersonal relationships was pronounced, recovery from substance use disorders and getting care for HCV were connected, receiving the HCV diagnosis was more troubling to non-IV drug users, participants had misconceptions about HCV and its treatment, psychological problems were prevalent as were barriers to participating in antiviral treatment and HCV care in general. The themes derived from our analysis indicate that affected veterans may benefit from interventions or support to improve HCV-related health education, social/relationship issues, psychological issues, and exploration of the connection between substance use recovery and motivation to get care for HCV infection. [ABSTRACT FROM AUTHOR]

In both research and clinical settings, men who survive prostate cancer emphasize the need for more open communication about the challenges they face. They explain that symptomatic dysfunction associated with treatment is grounded in complex social situations and relationships. Yet, structured quality of life questionnaires preclude expressions of the elaborate accounts they often evoke. We explore this in the case of prostate cancer. Seventy-one patients who had undergone radical prostatectomy at a mid-Atlantic University Medical Center, a Veterans Affairs medical center affiliated with the same university, or were US members of an international prostate cancer support group completed a survey protocol including assessments of urinary morbidity, psychosocial adjustment to illness (PAIS), and health status (SF-36). At the conclusion, a single open-ended item was offered; 48 offered an extended response. The open-ended item was recorded and analyzed qualitatively. Data were summarized according to four main themes: (1) quality of patient-physician communication; (2) change in sexual identity; (3) fear of cancer; and (4) the humiliation of urinary incontinence. Future research on outcomes of treatment and clinical inquiry must focus on methods that systematically capture patients' experiences. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore perceptions of the impact of erectile dysfunction on men who had undergone definitive treatment for early nonmetastatic prostate cancer. DESIGN: Seven focus groups of men with early prostate cancer. The groups were semistructured to explore men's experiences and quality-of-life concerns associated with prostate cancer and its treatment. SETTING: A staff model health maintenance organization, and a Veterans Affairs medical center. PATIENTS: Forty-eight men who had been treated for early prostate cancer 12 to 24 months previously. RESULTS: Men confirmed the substantial effect of sexual dysfunction on the quality of their lives. Four domains of quality of life related to men's sexuality were identified: 1) the qualities of sexual intimacy; 2) everyday interactions with women; 3) sexual imagining and fantasy life; and 4) men's perceptions of their masculinity. Erectile problems were found to affect men in both their intimate and nonintimate lives, including how they saw themselves as sexual beings. CONCLUSIONS: Erectile dysfunction, the most common side effect of treatment for early prostate cancer, has far-reaching effects upon men's lives. Assessment of quality of life related to sexual dysfunction should address these broad impacts of erectile function on men's lives. Physicians should consider these effects when advising men regarding treatment options. Physicians caring for patients who have undergone treatment should address these psychosocial issues when counseling men with erectile dysfunction. [ABSTRACT FROM AUTHOR]

THE ETHNOGRAPH is a computer program designed to facilitate the processing of qualitatively gathered sociological data. The purpose of THE ETHNOGRAPH is to manage some of the mechanical tasks of qualitative data analysis while freeing the researcher to concentrate on the analytical or thinking parts of the research. THE ETHNOGRAPH is not a concordance type of program, but concordance for key-word-in-context techniques can he used on ETHNOGRAPH data files. THE ETHNOGRAPH does not do the coding work for the researcher. But the programs do facilitate the coding work of the researcher. This paper briefly describes the steps involved in using the programs. These include 1) formating the text. 2) using the XNUMBER program to number the lines of the text. 3) using the XCODE program to code segments of the text, 4) using the XMODIFY program to selectively or globally delete or replace coding categories. 5) using the XSORT program to produce an output file containing sorted, cross-referenced coded segments from the original data sets. THE ETEINOGRAPH can process various types of qualitative data including transcripts, fieldnotes, diaries, letters. etc. [ABSTRACT FROM AUTHOR]