Original Complaint Research Articles

Partnering with Local Schools of Traditional Chinese Medicine to Provide Accessible Acupuncture Services for Pain Management in a Group of Low-Income Hispanics/Latinos.

This field report describes the accessibility and perceived effectiveness of a free acupuncture program among a group of predominantly low-income Hispanic/Latino adults. Surveys, developed based on the Levesque Conceptual Framework of Access to Health Care, were administered to clients. Baseline (n = 245) and 6-week follow-up (n = 79) surveys were analyzed to document early program findings. A majority of clients were Hispanic/Latino (72.7%) and female (73.1%). Most reported their original pain complaint was treated very well/well (98.7%). Clients reported an average 1.2 points pain level decrease (scale 1-10) at follow-up (p < 0.0001). Early program results suggest this acupuncture program was accessible and well received by low-income Hispanics/Latinos.

Accusations of racist language in Norwegian football: stakeholder management of whistleblowing

This qualitative study analyses whistleblowing in relation to incidents of racism in one Norwegian Premier Division FC. Focused on stakeholder management, the paper examines: (1) the management of the whistleblowing case and its impact on stakeholders; and (2) how the stakeholders’ roles changed over time. Main findings: a) the failure by the board to act effectively on the original complaint allowed the dispute to escalate; b) the actions of the whistleblower’s colleagues were crucial in forcing a reopening of the case; c) some stakeholders were conflicted by being both stakeowners and stakewatchers; d) the inaction by regulartory organisations (stakekeepers); e) the extent to which power, urgency, legitimacy and homogeneity of interests were crucial in determining the management of the incident; and f) the requirement for stakeowneers to reinforce their de jure ownership with effective, de facto, leadership.

Correction of hallux abducto valgus by scarf osteotomy. A ten-year retrospective multicentre review of patient reported outcomes shows high satisfaction rates with podiatric surgery

BackgroundCorrective surgery for hallux abducto valgus is one of the most performed elective procedures in foot and ankle practice. Numerous methods of surgical correction have been reported within the literature, with varying clinical and patient reported outcomes. This study reviews the patient experience and outcomes in five podiatric surgery centres using the scarf diaphyseal osteotomy.MethodPatient reported outcome measures (PROMs) were captured using the Patient Satisfaction Questionnaire 10 (PSQ-10), part of the PASCOM-10 podiatric surgery audit tool. PROMs were collated across five hospital sites over a 10-year period.ResultsOf 1351 patients reported during the period, 1189 had complete retrospective data. The most common patient aim of surgery was ‘no/less pain’ reported in 70% of patients. 96.8% of patients reported their original foot complaint as ‘better’ or ‘much better’ after surgery. 92.8% of patients reported their expectations had been met with 96.6% reporting they would have surgery again under the same conditions. 98.5% of patients noted that the risks, complications, and expectations had been discussed prior to surgery. The most common complication was metatarsal fracture (4.6%).ConclusionThe scarf osteotomy (with or without an Akin phalangeal osteotomy) consistently showed high patient satisfaction with low complication rates using PSQ-10 and this information can be used as part of the pre-operative consenting process. Patient expectations for surgery were often achieved, which may be attributed to the pre-operative work up of the patient. Further investigation into this correlation is suggested.Level of clinical evidenceIV (retrospective review).

Clinician Stress and Adolescent Patient Anxiety: Understanding an Unfamiliar Case of a Dark Green-Effusion Peritoneal Dialysis Fluid

A 17-year-old Palestinian patient has been undergoing peritoneal dialysis for the past 4 years owing to reflux nephropathy. The patient was recently diagnosed positive for coronavirus disease 2019. Seven days after the diagnosis she complained of loss of vision in the right eye. The patient was referred for an angiography test for suspected right eye infarct. Fluorescein sodium was given by intravenous injection to examine the ophthalmic vasculature by retinal angiography. There was an indication of an eye infract. She was discharged and on returning home started her peritoneal dialysis. She began to drain the DIANEAL fluid and noticed a dark green fluid instead of the transparent fluid that comes out in every dialysis. After much inquiry the nephrologist decided to perform 6 short cycles of 1 hour each lasting for 7 hours altogether. The shade of the fluid began to change but the change was insufficient. The nephrologist decided to continue with the procedure. It was only on the sixth day that the color reverted to the familiar transparent shade. Over 6 days, the patient felt good, had no further complaints, except for the original complaint of loss of vision in the right eye. Her anxiety, however, was rising owing to the lack of familiarity with the DIANEL green fluid in her body draining. As for the nephrologist, it was only on the third day, when the fluid began to clear, that he could relax.

MARINA DISTRICT DEVELOPMENT COMPANY LLC., DOING BUSINESS AS BORGATA HOTEL CASINO &amp; SPA V. AC OCEAN WALK LLC, DOING BUSINESS AS OCEAN CASINO RESORT

MARINA DISTRICT DEVELOPMENT COMPANY LLC., DOING BUSINESS AS BORGATA HOTEL CASINO &amp; SPA V. AC OCEAN WALK LLC, DOING BUSINESS AS OCEAN CASINO RESORT

SINGLE-INSTANCE GRIEVANCE PROCEDURE VS. MANIFESTATION OF DISSATISFACTION WITH THE METHOD OF HANDLING THE COMPLAINT

This paper presents the procedure of grievance proceedings initiated as a result of a common complaint, which is essentially simplified, informalised and of single instance. This paper also discusses the adopted methods of handling complaints and presents the issues arising in situations where the complaining party attempts to challenge the received notification on the manner of handling the complaint, expressing dissatisfaction with the response received. Manifestation of dissatisfaction with the method the complaint is handled due to single-instance nature of the grievance procedure does not refer the case to the higher instance, and is not an institution regulated in the provisions of the Code of Administrative Procedure. Challenging the method of handling a complaint results in a new complaint and the initiation of another grievance procedure before the authority that reviewed the original complaint

Neutrality, Critique, and Social Visibility

This piece continues an exchange between David Beaver and Jason Stanley, on the one hand, and Alice Crary, on the other, to which Beaver’s and Stanley’s “Neutrality” (immediately above) is a contribution. All three authors agree that the critique of ideology, propaganda, and oppressive structures should not be conceived as eliminating socially-situated perspectives and subjectively-mediated sensibilities from an allegedly neutral discursive space. Their exchange began with Crary’s 2018 article, “The Methodological as Political: What’s the Matter with ‘Analytic Feminism’?” which attacks appeals to neutrality, including one Crary finds in Stanley’s 2015 book, How Propaganda Works, for obscuring a pivotal methodological insight of radical feminist thought, namely, that feminism’s political radicalism is complemented by a “methodological radicalism that involves making use of the practical power of ethically non-neutral resources, conceived as in themselves cognitively authoritative” (Crary 2018: 47). This new reply argues that Beaver’s and Stanley’s practice-based image of language, while at first seemingly aligned with this rejection of neutrality as an ideal for political discourse, fails to fully respond to her original complaint. The ideal of neutrality is problematic, not only in masking social location, but in wrongly impugning as ‘non-cognitive’ or ‘irrational’ critical resources drawn from socially-situated perspectives—the sorts of perspectives to which notable strands of feminist theory give voice precisely for their cognitive value. The current piece claims that to address this further danger it is necessary to go beyond Beaver’s and Stanley’s study of meaning and critically examine engrained philosophical assumptions about how to construe logical notions such as objectivity and truth. It closes by suggesting that, within philosophy of language broadly conceived, the tradition of ordinary language philosophy provides a more promising source of resources and illumination for struggles to make gender-based and overlapping forms of structural bias socially visible.

Alborada iberyjska. Kobieca pieśń spotkania o świcie, XI–XVII wiek

Iberian Alborada. The Woman’s Song at the Dawn, 11th-17th Century The aim of the article is to define the genre of alborada, referring to its oldest Iberian forms, Mozarabic and Portuguese, and showing its evolution in the Early Modern Castilian poetry. This study will therefore serve as a basis for delineating the genre, which was present also in other European literatures, i.a. Polish from Renaissance to Romanticism. Iberian songs discussed here display a clear structure established in a long tradition and exploit the theme of lovers meeting at dawn, originating in the folk tradition, and implemented in Medieval formal courtly genres of kharja, cantiga de amigo (examples of Pero Meogo and Dom Dinis), and in 15th-century villancico, and entering other genres, most prominently sonnets, during the Renaissance. These multiple formal changes result in a gradual evolution of the lyrical subject of the alborada - the original complaint of a girl in love, a girl who is active and fighting for her happiness, has been transformed into a song of adoration and regret of a he-lover who serenades at nights for a lady who is mute and confined to the frame of her window. By this token, the history of the lyrical genre reflects the gradual removal of voices and subjectivity from women.

Comparison of conventional, burst and high-frequency spinal cord stimulation on pain relief in refractory failed back surgery syndrome patients: study protocol for a prospective randomized double-blinded cross-over trial (MULTIWAVE study)

BackgroundWhile the evolution of technology provides new opportunities to manage chronic refractory pain using different waveform modalities of spinal cord stimulation in failed back surgery syndrome (FBSS), there is no randomized controlled trial available to compare the efficacy of these different stimulations waveforms to date. MULTIWAVE is a prospective, randomized, double-blinded, crossover trial study designed to compare the clinical efficacy of tonic conventional stimulation (TCS), burst stimulation (BURST) and high-frequency stimulation (HF) in FBSS patients over a 15-month period in SCS implanted patients.Methods/designTwenty-eight patients will be recruited in the Poitiers University Hospital, in Niort and La Rochelle Hospitals in France. Eligible patients with post-operative low back and leg pain with an average visual analog scale (VAS) score ≥ 5 for low back pain are implanted and randomly assigned to one of the six arms (in a 1:1:1:1:1:1 ratio), where they receive a 3-month combination of TCS, BURST and HF including one treatment modality per month and varying the order of the modality received within the six possible combinations. Patients receiving intrathecal drug delivery, peripheral nerve stimulation and back resurgery related to the original back pain complaint and experimental therapies are excluded from this study. Patients included in the spinal cord stimulation group undergo trial stimulation, and they all receive a TCS treatment for 2 months, as the gold standard modality. Thereafter, patients are randomly assigned to one of the six arms for the total duration of 3-month crossover period. Then, patients choose their preferred stimulation modality (TCS, BURST, or HF) for the follow-up period of 12 months. Outcome assessments are performed at baseline (first implant), before randomization (2 months after baseline) and at 1, 2, 3, 6, 9 and 15 months post-randomization. Our primary outcome is the average global VAS of pain over 5-day pain diary period between baseline and after each period of stimulation. Additional outcomes include changes in leg and back pain intensity, functional disability, quality of life, psychological state, paraesthesia intensity perception, patient satisfaction and the number of adverse events.DiscussionRecruitment began in February 2017 and will continue through 2019.Trial registrationClinicaltrials.gov NCT03014583. Registered on 9 January 2017.

Impact of the NSSP’s transition to ESSENCE on chief complaint field-based syndromes

Objective: To evaluate the effect and implications of changing the chief complaint field during the National Syndromic Surveillance Program (NSSP) transition from BioSense 2.0 analytical tools to BioSense Platform – ESSENCEIntroduction: In January 2017, the NSSP transitioned their BioSense analytical tools to Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE). The chief complaint field in BioSense 2.0 was a concatenation of the record’s chief complaint, admission reason, triage notes, and diagnostic impression. Following the transition to ESSENCE, the chief complaint field was comprised of the first chief complaint entered or the first admission reason, if the chief complaint was blank. Furthermore, the ESSENCE chief complaint field was electronically parsed (i.e., the original chief complaint text was altered to translate abbreviations and remove punctuation). This abstract highlights key findings from Maricopa County Department of Public Health’s evaluation of the new chief complaint field, its impact on heat-related illness syndromic surveillance, and implications for ongoing surveillance efforts.Methods: For this evaluation, we used the heat-related illness query recommended in Council of State and Territorial Epidemiologists’ (CSTE)2016 Guidance Document for Implementing Heat-Related Illness Syndromic Surveillance. Before the transition, we used BioSense 2.0’s, phpMyAdmin analytical tool to generate a list of patients who visited Maricopa County emergency departments or inpatient hospitals between 5/1/2016 – 9/30/2016 due to heat-related illness. After the transition, we used the CC and DD Category “Heat-related Illness, v1” in ESSENCE, which was based on the CSTE heat-related illness query, to generate a list of patients for the same time period. We compared the line-lists and time-series trends from phpMyAdmin and ESSENCE.Results: The phpMyAdmin analytical tool identified 785 heat-related illness records with the query (Figure). 642 (82%) of these heat-related illness records were also captured by ESSENCE. Reasons for 143 (18%) records not being identified by ESSENCE included: the patient’s admission reason field contained keywords that were not available in the ESSENCE chief complaint field (n=94, 66%); data access changed, which disabled access to patients who resided in zip codes that crossed a county border (30, 21%); discrepancies between ESSENCE parsing and text in the original chief complaint (11, 8%); heat-related illness discharge diagnoses were removed by the facility after the phpMyAdmin line-list for heat-related illness was extracted (7, 5%); and one record was undetermined. Conversely, ESSENCE captured 36 additional heat-related illness records, not previously captured by phpMyAdmin. Reasons included: a query exclusion term was located in the patient’s admission reason but not the ESSENCE chief complaint field (16, 44%); a heat-related illness discharge diagnosis code was added by the facility after the data were extracted by phpMyAdmin (4, 11%); and 16 (44%) were undetermined. Time-series trend evaluation revealed a significant correlation between the two surveillance tools (Pearson coefficient = 0.97, p &lt; 0.01).Conclusions: Though the data trends over time were not significantly affected by changes in the chief complaint field, differences in the field’s composition have important implications for syndromic surveillance practitioners. Free-text queries designed to search the chief complaint field in ESSENCE may not retrieve records previously identified with BioSense 2.0 analytical tools, which may limit individual case-finding capacity. The elimination of admission reason from the chief complaint field in ESSENCE has the greatest effect on case-finding capacity. Furthermore, surveillance reports produced by ESSENCE cannot be directly compared to reports that were previously published with data from BioSense 2.0. These limitations may be addressed if ESSENCE creates a feature that allows users to easily query fields (e.g., admission reason) in addition to the chief compliant field.

P059: Who will be ready to fly? Characteristics of successful and unsuccessful geriatric discharges from the Nanaimo Regional General Hospital emergency department through the ED2Home program

Introduction: As the baby-boomer generation ages, the number of elderly patients with complex health issues visiting emergency departments (EDs) will continue to increase. Evidence suggests elderly patients often have better health outcomes if they can be managed at home with appropriate community and primary care supports in place, rather than being admitted to hospital. ED2Home is a program that launched March 1, 2016 in the Nanaimo Regional General Hospital (NRGH) ED. It aims to assess admitted patients aged 70 and over and discharge them with community supports and follow-up. The aim of this Quality Improvement project was to evaluate how many patients were successfully discharged by the ED2Home program in its first few months, and to characterize which patients were more likely to be successfully discharged versus bounce back to the ED. Methods: This Quality Improvement project audited the charts of 87 patients discharged by ED2Home from June-Sept 2016. Variables examined included the following: age, gender, chief complaint, mobility status, living situation, which ED2Home health care provider (RN vs MD) to facilitate discharge, whether patient had a family physician, and resources used (ex. pharmacy, physiotherapy, occupational therapy, etc.) to help facilitate discharge. Our evaluation was conducted by means of a retrospective chart review. Descriptive statistics were derived for variables of interest. Results: There were 87 patients discharged home by the ED2Home whose charts were reviewed. 48 (55%) of these patients were successfully discharged home without revisit to the NRGH ED within 30 days of discharge. 29 patients returned to the NRGH ED within 30 days of original discharge for the same original chief complaint. Patients successfully discharged were similar to those who bounced back in terms of gender and mean age. Patients who bounced back to the ED were more likely to have chief complaints of dyspnea and confusion compared to those successfully discharged. Patients who were successfully discharged had a higher proportion of patients with social admissions compared to those who bounced back to the ED within 30 days. A higher proportion of patients successfully discharged had been evaluated by the ED2Home physician (versus nursing alone) compared to patients who bounced back within 30 days. Conclusion: ED2Home appears to be successful at discharging patients and preventing revisit to the ED and re-hospitalization, similar to other transitional programs for the elderly that have been reviewed in the literature. Patients presenting with more complex issues, such as dyspnea and confusion, may not be as suitable for rapid discharge from the ED through this program as patients presenting with issues helped by additional allied health care supports, such as failure to thrive/social admission. Additional Quality Improvement iterations of the ED2Home program should be undertaken in the future, using these suggestions.

Investigating True β-lactam Allergy in the Outpatient Allergy Clinics at a Public Children’s Hospital, Ceará, Brazil

Objective: The aim of the study was to investigate true β-lactam allergy at a public pediatric hospital. Material and Methods: Children and adolescents with allergy symptoms were referred to the Allergy and Immunology Service, Hospital Infantil Albert Sabin, Fortaleza, Brazil. During the allergist interviews, β-lactam drug allergy was suspected in 24 patients. Results: Urticaria, angioedema, erythematous macules and papules were the clinical manifestations most frequently reported in 23 patients with immediate reaction. The drugs implicated were amoxicillin (58.3%), penicillin (20.8%), ceftriaxone (12.5%) and ampicillin (8.4%). The majority of the patients showed negative results for ampicillin, penicillin and ceftriaxone in skin testing and also negative results in oral provocation testing (OPT) to amoxicillin. One patient with clinical history of ceftriaxone allergy showed positive prick test to the drug and negative OPT to amoxicillin. Conclusion: b-lactam drugs are a very useful choice for treatment of bacterial infections in children. In this way, it is reasonable that hypothesis of allergy to those drugs be investigated. For this reason, during consultation, it is necessary that the allergist questions about drug allergy, apart from the original complaint (if it is not directly related to drug allergy). Upon suggestive history, the hypothesis of drug allergy should be ruled out by doing a careful laboratorial and clinical investigation. In order to rationalize the operating and economical costs related to skin testing and OPT, we suggest grouping a number of patients for whom the tests will be performed during a half-day period two to three times a year. Key words: Allergy, Beta-lactamic, Hypersensitivity, Pediatric, Public hospital.

Specialized Police-Based Mental Health Crisis Response: The First 10 Years of Colorado's Crisis Intervention Team Implementation.

This study examined the implementation of crisis intervention teams by law enforcement agencies in Colorado. Rates of Special Weapons and Tactics (SWAT) use, arrests, use of force, and injuries were assessed during 6,353 incidents involving individuals experiencing a mental health crisis. Relationships among original complaint, psychiatric illness, substance abuse, violence risk, and disposition of crisis calls were analyzed. Rates of SWAT use (<1%), injuries (<1%), arrests (<5%), and use of force (<5%) were low. The relative risk of transfer to treatment (versus no transfer) was significantly higher for incidents involving psychiatric illness, suicide threat or attempt, weapons, substance abuse, and violence potential. Use of force or SWAT, arrests, and injuries were infrequent. Suicide risk, psychiatric illness and substance abuse, even in the presence of a weapon or violence threat, increased the odds of transfer to treatment, whereas suicide risk lowered the odds of transfer to jail.

A Midterm Review of Lesser Toe Arthrodesis With an Intramedullary Implant

Therapeutic, Level IV: Case series.

An assessment of employer liability for workplace stress

PurposeThis study aims to examine workplace stress in a random sample of litigated cases heard in UK courts. The majority of claims related to clinical depression. The alleged causes of workplace stress most commonly cited in the litigation included excessive workload, followed by poor management practices; organisational, economic or technical changes; aggressive management style; and bullying by co-workers.Design/methodology/approachThe term claimant is used to refer to the worker who made the original complaint of workplace stress, and the term defendant refers to the employing organisation defending the claim. In an attempt to establish the number and type of claims brought forward, the population of individual case records relating to workplace stress was accessed electronically from a variety of legal databases.FindingsThe presence of effective workplace stress management policies were important interventions that played a particularly significant role in avoiding legal action and reducing employees’ detrimental experiences. A significant finding was that 94 per cent of the cases were found in favour of the employer as the defendant, and the implications of this for managerial practice are suggested. This analysis of 75 cases between 1992-2014 will shed valuable light on the nature of workplace stress claims heard in the courts and the likelihood of the claimant employee’s success in such cases.Research limitations/implicationsFurther work could be undertaken to examine the extent to which the legal framework could be regarded as encouraging a compensation culture and placing excessive burdens on employing organisations. This paper assesses the scope of liability for workplace stress through an analysis of some of the legal claims made and evaluates whether these sorts of fears are justified.Practical implicationsThese court cases are real scenarios in which various organisations faced civil action arising from workplace stress claims. The main contribution that this research makes to the existing body of literature on the subject is to discern the different contexts that led to litigation in these cases.Social implicationsResearchers have reported on the negative consequences associated with workplace stress, both for individuals and organisations (Cooper and Marshall, 1976). It has been recognised that employers have a duty, which is in many cases enforceable by law, to ensure that employees do not become ill (Michie, 2002). The aim of this paper is to analyse the legal record on litigation since 1992 and discuss how the findings inform the wider literature.Originality/valueWorkplace stress claims have been described as the “next growth area” in claims for psychiatric illness (Mullany and Handford, 1997; Elvin, 2008; Horsey and Rackley, 2009). Hugh Collins stated “owing to the limitations of the statutory compensatory scheme in the UK […] private law has been used to expand the range of protection against illness […] in the workplace” (Collins, 2003). To understand how court decisions are changing, the development of this body of law needs to be traced (Ivancevich et al., 1985).

Neuralgias of the Head: Occipital Neuralgia.

Occipital neuralgia is defined by the International Headache Society as paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily. More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures. Moreover, treatment of occipital neuralgia is sometimes challenging. More invasive procedures, such as C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, neurectomy, and neurolysis with or without sectioning of the inferior oblique muscle, are now rarely performed for medically refractory patients. Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.

Efficacy of Noncontrast Computed Tomography of the Abdomen and Pelvis for Evaluating Nontraumatic Acute Abdominal Pain in the Emergency Department

BackgroundComputed tomography (CT) clarity has significantly improved since it became widely available in the early 1980s, making the utility and benefit of contrast material for image quality of the abdomen and pelvis uncertain, and so far, minimally studied. ObjectivesThis study sought to assess the efficacy of a noncontrast CT scan of the abdomen and pelvis by evaluating patients presenting to the emergency department (ED) with acute nontraumatic abdominal pain by following them for 7 days and observing for signs and symptoms of clinically significant acute emergent pathology. MethodsWe enrolled, and for 7 days followed, a prospective observational convenience sample of patients who received a noncontrast CT scan of the abdomen and pelvis in the ED for acute nontraumatic abdominal pain. The primary outcome, and defined as a failure, was abdominal surgery or death as the result of an intraabdominal process not found on the original noncontrast CT scan, or a subsequent contrasted CT scan with a finding that could explain the original complaint of abdominal pain that was also not seen on the initial noncontrast CT, during the 7-day observation. ResultsSeventy-two patients were enrolled in the study. The incidence of failure was 0% (0/72), 46% of patients (33/72) had a negative CT scan, 54% (39/72) had a positive CT scan, 57% (41/72) were admitted, 43% (31/72) discharged, 11% (8/72) had abdominal surgery, and a repeat contrasted CT scan was done on 4% (3/72). ConclusionsWith certain inclusion and exclusion criteria, noncontrast CT of the abdomen and pelvis is likely a reliable diagnostic modality for the evaluation of acute nontraumatic abdominal pain in the ED.

Spatiotemporal effects of nuisance black bear management actions in Wisconsin

Abstract American black bears (Ursus americanus) triggered complaints from property owners across much of Wisconsin, USA, from 2008 to 2010. Wildlife managers provided technical assistance and live-trapped bears to mitigate nuisances. We examined the longevity of these management actions as measured by the risk (or hazard) that a conflict site would generate a subsequent complaint after live-trapping or technical assistance had been implemented. We observed that as one expanded outward in distance from the original complaint site, the number of days separating a management action and a subsequent complaint decreased. Additionally, the number of bears that were translocated from a conflict location was not associated with decreased hazard. The percentages of locations that did not have a subsequent complaint were nearly identical for both technical assistance and live-trapping interventions. Our technique is a practical one, which could be used to analyze existing agency records. Also, our results could im...

Comparing Simulated Nursing Performance to Actual Practice

Between 2007 and 2013, the Arizona Board of Nursing (BON), a community college, and a university developed the Nursing Performance Profile (NPP), a legally defensible competency evaluation using simulation. Using the NPP, the board evaluated the competency of nurses who were reported to the BON for unsafe practice. Then, we compared the unsafe behaviors revealed by the NPP evaluation with those reported to the BON in the original complaint and investigative reports (IRs). The comparative analysis revealed remarkable consistency between the IRs and the NPP findings. Between 2007 and 2013, the Arizona Board of Nursing (BON), a community college, and a university developed the Nursing Performance Profile (NPP), a legally defensible competency evaluation using simulation. Using the NPP, the board evaluated the competency of nurses who were reported to the BON for unsafe practice. Then, we compared the unsafe behaviors revealed by the NPP evaluation with those reported to the BON in the original complaint and investigative reports (IRs). The comparative analysis revealed remarkable consistency between the IRs and the NPP findings.

Psychosomatic Aspects of Low Adherence to Antihypertensive Therapy in Patients with Arterial Hypertension

Aim. To evaluate psychosomatic aspects of adherence to antihypertensive therapy (AHT) in patients with arterial hypertension and its relationships with comorbid somatic disturbances.Subjects and methods. A total of 161 patients with arterial hypertension with duration of more than 12 months (19 women, 42 men) aged 53,4±11,4 years were included in the study. All studied patients were followed up in the outpatient department of the Cardiology Research Institutenamed after A.L.Miasnikov, Russian Cardiology Research and Production Complex, Ministry of Health of the Russian Federation, and were consented for the psychiatric examination. To evaluate the patient adherence to AHT the following questionnaires and scales have been used: original Complaint Questionnaire designed by the authors for patients with arterial hypertension, USK, USK-B, ORB, GOTD, and patient self-reported Morisky-Green medication adherence scale. Consistent with data of patient case histories and responses to questionnaires, studied subjects were classified into two groups of adherence levels to AHT: Group I - 30 (19%) subjects; 17 women/13 men; mean age 52,9±11,7 years - included patients with high adherence to AHT, who started medication right after being diagnosed for arterial hypertension, and were treated regularly. Group II - 131 (81%) subjects; 102 women/29 men; mean age 53,1±11,8 years - included patients with low adherence to AHT, with postponed initiation of AHT after the diagnosis, and irregular or absent treatment.Results and conclusions. Patients comprising Group I with high adherence to AHT were characterized by short duration of arterial hypertension, crisis-type of its onset followed by panic attacks; concomitant disorders (ischemic heart disease, arrhythmias, ulcer disease, thyroid gland abnormalities), high anxiety level, panic attacks, anxiety and phobic paroxysms, subclinical depressions (dysthymia, cyclothymia), anxiodepressivesituational adaptation reactions, and nozogenic (adaptive) anxiodepressive reactions (hypernozognosia). Patients comprising Group II with low adherence to AHT were characterized by more severe affective symptoms (depressive and maniacal phases of bipolar affective disorder and recurrent depressions) and different variants of pathocharacterologic personality development.