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Objectives: After resection of an oral carcinoma, patients are faced with physical, psychological, and socioeconomic challenges. Rehabilitation plays an essential role in patients’ reintegration into their social and professional environment. This study evaluated whether socioeconomic aspects affect oral cancer patients’ participation in rehabilitation treatment. Materials and methods: A retrospective analysis was conducted with 1,532 patients following surgical treatment of oral cancer during an international multicenter rehabilitation study of the German-Swiss-Austrian Cooperative Working Group on Maxillofacial Tumors using a questionnaire comprising disease-related and psychosocial items postoperatively and at least 6 months after surgery.Results: Only 35.4% of patients participated in rehabilitation. Age (p

The tension between powerlessness and creative power: »First do no harm, second be careful, third heal!« Beyond an increased sensitivity to the issue of boundary violations and abuse in therapies in recent decades, there often seems to be little awareness that psychoanalysis, psychotherapy and counselling can also cause harm. The seemingly naïve conviction that well-intentioned things are always helpful is deceptive. The author offers a critical reflection on the attitude in today's culture that exaggerates individuality and the victim role. Even across various psychotherapy methods and counselling approaches, the zeitgeist is often dominated by a focus on the understanding of clients as (current or biographical) victims of, for example, violence, disregard, bullying, discrimination or a lack of parental response and unfavourable developmental conditions. The »creative power« of the individual in the individual processing of favourable and less favourable environmental conditions is lost from view. Thus there is a danger that sufferers are restricted to a one-sided perception of themselves as passive victims, fixated and thus once again objectified. This article aims to encourage psychotherapists to perceive clients more fully as subjects of their lives. [ABSTRACT FROM AUTHOR]

Unnecessary hospital readmissions increase patient burden, decrease health care quality and efficiency, and raise overall costs. This retrospective cohort study sought to identify high-risk patients who may serve as targets for interventions aiming at reducing hospital readmissions. The authors compared geospatial, social demographic, and clinical characteristics of patients with or without a 90-day readmission. Electronic health records of 42 330 adult patients admitted to 2 Midwestern hospitals during 2013 to 2016 were used, and logistic regression was performed to determine risk factors for readmission. The 90-day readmission percentage was 14.9%. Two main groups of patients with significantly higher odds of a 90-day readmission included those with severe conditions, particularly those with a short length of stay at incident admission, and patients with Medicare but younger than age 65. These findings expand knowledge of potential risk factors related to readmissions. Future interventions to reduce hospital readmissions may focus on the aforementioned high-risk patient groups. [ABSTRACT FROM AUTHOR]

Strong academic and practice partnerships are needed in the ever‐changing health care environment. Sometimes an invisible barrier exists between clinical practice and academia; academic‐practice partnerships are a way to bridge this barrier. Since 2008a team‐based model of clinical education known as the Culture of Caring (COC) has brought together three academic institutions with a large hospital system to develop a unified clinical experience and curriculum that improves the student, provider, and patient experience. In the COC model the team consists of academic‐practice leaders, clinical instructors, staff nurses, and students. Together they engage in a structured curriculum that is integrated into both the clinical environment and the academic setting. Each week of clinical the students focus on a topic that is paired with journal articles and learning activities that allow the team to engage in learning that is applicable to the clinical practice environment. The learning activities allow students to engage in learning about evidence‐based practice and quality improvement initiatives that are taking place on the unit. The implementation of this collaborative approach to a clinical nursing education model has had a positive impact on the working relationships between the academic partners and clinical practice leaders. [ABSTRACT FROM AUTHOR]

The ideal conception of ending psychotherapy is that therapists make themselves dispensable and that patients are freed from their symptoms. With greater autonomy and enhanced self-reflection, they detach themselves from the therapeutic relationship. Time limitations on psychotherapy serve as a protection against destructive tendencies towards perfection claims as well as preventing persisting dependency. The finite quality of the »cure« has traditionally been viewed as a structuring element that opens opportunities for development. Treatments that do not come to an end are considered to be faulty. On the other hand, a characteristic limitation of somatic medicine is that diseases and their symptoms can often not be healed but at best alleviated. Thus, the question arises in the field of psychotherapy whether an ending and the dissolution of the transference are indispensable. Using examples from long-term psychoanalytic psychotherapy treatment, the advantages and risks of a psychotherapeutic concept that emphasizes time limitations are discussed. Based on the observation that the helpful therapeutic object cannot always be internalized in such a way that he is no longer be needed as a real object, the author discusses the consequences for structuring the ending of therapy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients may not understand the importance of medication adherence when discharged with aspirin (ASA) as an anticoagulant for venous thromboembolism (VTE) prophylaxis after joint replacement surgery. PURPOSE: The purpose of this study was to examine selfreported rates of adherence to postoperative use of ASA for VTE prophylaxis. METHODS: This was an exploratory, descriptive study using a convenience sample of 99 participants. Adherence was measured with a 4-question self-reporting tool. RESULTS: Thirty-seven percent were male and 76% were Caucasian, and median age was 63 years. Ninety-two percent had the dosage correct, 76% knew how long to take the medication, and 100% of the sample was still taking the ASA; 40% had forgotten to take 1 or more doses of the medication. No associations were noted. Overall compliance was 44%. CONCLUSION: A significant number missed 1 or more doses. This is an opportunity for nurses to work with patients on innovative ways to improve adherence. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with nonsurgical pain (NSP) after a total knee arthroplasty (TKA) report different patterns of pain interference than those without NSP. PURPOSE: This study explores the severity and ways in which NSP interferes with activities 48 hours and 6–7 weeks post surgery. ANALYSIS: Univariate and multivariate analyses were used. The mean score for intensity at 48 hours was 1.78, and at 6–7 weeks it was 1.15. The mean score for interference with activities at 48 hours was 1.62 and at 6–7 weeks it was 0.91. Highest NSP pain interference at 48 hours was for “activity,” “sleep,” and “enjoyment of life.” At 6–7 weeks, the highest scores were for “activity,” “sleep,” and “walking.” No significant differences were noted for age, race, education, or gender. IMPLICATIONS: Although rated “mild,” this pain should be addressed. The NSP indicates a baseline of chronic and persistent pain, which is an opportunity to work with our patients to mitigate this pain. Total knee arthroplasty, a common and effective treatment for painful knee conditions attributed to various forms of arthritis, is known to be a painful surgical procedure. Two of the major concerns voiced by patients awaiting TKA are about postoperative pain management and rehabilitation efforts after the procedure (J. Rudan, M. Harrison, & H. Grant, 2009). Healthcare providers offer a range of methods and strategies to deal with postoperative TKA pain, yet to date no single method offers complete satisfaction (H. Anderson, J. Gyrn, B. Christensen, & D. Zaric, 2013; H. B. J. Fischer et al., 2008; I. Koh et al., 2010; A. Maheshwari, Y. Blum, L. Shekhar, A. Ranawat, & C. Ranawat, 2009). [ABSTRACT FROM AUTHOR]

In spoken dialog systems, information must be presented sequentially, making it difficult to quickly browse through a large number of options. Recent studies have shown that user satisfaction is negatively correlated with dialog duration, suggesting that systems should be designed to maximize the efficiency of the interactions. Analysis of the logs of 2,000 dialogs between users and nine different dialog systems reveals that a large percentage of the time is spent on the information presentation phase, thus there is potentially a large pay-off to be gained from optimizing information presentation in spoken dialog systems. This article proposes a method that improves the efficiency of coping with large numbers of diverse options by selecting options and then structuring them based on a model of the user's preferences. This enables the dialog system to automatically determine trade-offs between alternative options that are relevant to the user and present these trade-offs explicitly. Multiple attractive options are thereby structured such that the user can gradually refine her request to find the optimal trade-off. To evaluate and challenge our approach, we conducted a series of experiments that test the effectiveness of the proposed strategy. Experimental results show that basing the content structuring and content selection process on a user model increases the efficiency and effectiveness of the user's interaction. Users complete their tasks more successfully and more quickly. Furthermore, user surveys revealed that participants found that the user-model based system presents complex trade-offs understandably and increases overall user satisfaction. The experiments also indicate that presenting users with a brief overview of options that do not fit their requirements significantly improves the user's overview of available options, also making them feel more confident in having been presented with all relevant options. [ABSTRACT FROM AUTHOR]

Quality clinical learning is increasingly challenging, yet essential for aspiring nurses. Creativity is needed to optimize scarce clinical experiences, maximize faculty talents, and ensure direct student engagement with clinical experts. The authors discuss a clinical academic partner project designed to address these issues. [ABSTRACT FROM AUTHOR]