Source Of Burden Research Articles

Meaningful conversations in living with and treating chronic conditions: development of the ICAN discussion aid.

BackgroundThe needs of the growing population of complex patients with multiple chronic conditions calls for a different approach to care. Clinical teams need to acknowledge, respect, and support the work that patients do and the capacity they mobilize to enact this work, and to adapt and self-manage. Tools that enable this approach to care are needed.MethodsUsing user-centered design principles, we set out to create a discussion aid for use by patients, clinicians, and other health professionals during clinical encounters. We observed clinical encounters, visited patient homes, and dialogued with patient support groups. We then developed and tested prototypes in routine clinical practice. Then we refined a final prototype with extensive stakeholder feedback.ResultsFrom this process resulted the ICAN Discussion Aid, a tool completed by the patient and reviewed during the consultation in which patients classified domains that contribute to capacity as sources of burden or satisfaction; clinical demands were also classified as sources of help or burden. The clinical review facilitated by ICAN generates hypotheses regarding why some treatment plans may be problematic and may not be enacted in the patient’s situation.ConclusionWe successfully created a discussion aid to elucidate and share insights about the capacity patients have to enact the treatment plan and hypotheses as to why this plan may or may not be enacted. Next steps involve the evaluation of the impact of the ICAN Discussion Aid on clinical encounters with a variety of health professionals and the impact of ICAN-informed treatment plans on patient-important outcomes.

Admission Policy Analysis of the Ideal Unit in the National Center for Mental Health

Decision of hospital admission is a clinical decision; it is a clinical process that will be carrying out in concordance with each hospital’s policies, operating procedures, protocols, and guidelines [1]. Admission to mental health hospitals may be planned (voluntarily) or against the desires of the patient (involuntarily), that may increases source of burden on health system resources locally and internationally [2].

Antinociceptive Activity of Methanolic Stem Bark Extracts of Harrisonia Abyssinica Oliv and Landolphia Buchananii (Hallier F.) Stapf in Mice Model

Pain is an unpleasant sensation attributed to an interplay of sensory and cognitive mechanisms and thus a source of burden to the individual and society. Since pain acts as a source of discomfort, it requires medical suppression. There is a growing interest in the use of herbal remedies as an attractive healthcare alternative to synthetic drugs. This is due to conventional medications being expensive and arguably associated with various adverse effects, hence the necessity for herbal agents that are effective, safe and relatively cheap. Harrisonia abyssinica and Landolphia buchananii are herbs that have been utilized to manage various ailments afflicting people especially in tropical Africa. However, despite their wide folklore use, extensive literature research reveals limited evaluation on the pharmacological activities of their described effects on pain. Thus, the aim of the current study was to evaluate the antinociceptive effects of their methanolic extracts. Experimental mice were divided into a normal control group, a negative control group, a reference group and three dosage groups. The dosage groups were treated with stem bark extracts at concentration of 50 mg/kg, 100 mg/kg and 150 mg/kg. The formalin paw licking test was used to determine the antinociceptive potential. Evaluation of the antinociceptive activities was compared with diclofenac as the reference drug. The H. abyssinica extract reduced pain by 39.73%-81.13% (in the early phase) and 15.92%-69.84% (in the late phase) while L. buchananii extract reduced it by between 35.35%-47.72% (in the early phase) and 20.57-55.17% (in the late phase). In the early phase, reduction of pain by diclofenac was by 19.97%-46.50% and 76.77-74.80% (in the late phase). Several phytochemicals were observed to be present. The traditional medicinal use of the aforementioned plants in the suppression of pain has thus been confirmed by the study results.

Abstract 341: Cost of Care Implications for Unstable Angina and Coronary Revascularization Readmissions Following Acute Myocardial Infarction

Objectives: While mortality following acute myocardial infarction (AMI) has decreased over time, subsequent hospitalizations due to unstable angina (UA) and coronary revascularization (CR) continue to be a great source of burden both from a patient’s and a societal perspective. It is unknown, however, how AMI patients who experience these additional readmissions value their health and what the associated costs are, beyond the hospitalization itself. Methods: From TRIUMPH, a 24-center observational AMI registry, we identified patients readmitted for unstable angina (UA) or unplanned CR ≥1 month following index AMI discharge. Propensity matching was used to compare (1) patients who were vs. were not readmitted for UA and (2) patients who were vs. were not readmitted for CR. We examined one-year quality-adjusted life-years (QALYs) using the EQ-5D measurements at 1, 6 and 12 months, as well as post-discharge costs (office visits, cardiac rehabilitation and cardiovascular readmissions, excluding costs for the UA/CR event). Confidence intervals were calculated via bootstrap analysis. Results: A total of 140 (4.26%) were readmitted for UA and 112 (3.41%) patients underwent CR after their AMI. Unadjusted mean 1-year QALYs for UA and non-UA patients were 0.743 and 0.821 [propensity-matched difference -0.076 (95% CI -0.100, -0.042)]. Unadjusted mean 1-year QALYs for CR and non-CR patients were 0.798 and 0.828 [propensity-matched difference -0.032 (95% CI -0.063, -0.003]. Mean differences in costs were $8009 (95% CI $3997, $14229) for UA vs. non-UA patients and $4498 (95% CI $4046, $4966) for CR vs. non-CR patients. Cardiovascular rehospitalizations contributed most to these costs (Table) . Conclusion: In this study, over the year following AMI, patients experiencing UA or unplanned coronary revascularization were challenged in maintaining their health status as compared with those not experiencing the respective event and had significantly higher health care costs.

Doing damage in delirium: the hazards of antipsychotic treatment in elderly people

Delirium can be associated with behavioural manifestations such as agitation, inappropriate be haviours, delusions, and hallucinations, which can be distressing to patients and to their families. Moreover, these symptoms can make patients diffi cult to provide care for and are a source of burden and stress for both health-care workers and informal carers. Largely to address these behavioural symptoms, the fi eld of delirium prevention and treatment has come to focus on clinical trials of antipsychotic drugs. 2,3 A search of the PubMed database shows that the annual number of studies of antipsychotic drugs for prevention or treatment of delirium has grown substantially in the past 20 years, from two studies published in 1990 to more than 40 in 2013. This necessitates an urgent call for caution in the use of antipsychotic drugs for the management of patients with delirium. The use of antipsychotics might be regarded as counterintuitive because these drugs can all cause confusion or delirium as side-eff ects. However, powerful incentives in our health-care systems promote prescription of antipsychotics for patients with delirium, and have led to the frequent use of these drugs. Antipsychotics may have appeal as a potential quick fi x compared with non-pharmacological approaches, but clinicians might not fully realise that their attempt to make patients more manageable and less distressed can result in worsened clinical outcomes. In essence, these drugs can be regarded to be a form of chemical restraint, and concern exists that the use of drugs such as haloperidol and atypical antipsychotics for treatment of delirium might often be serving the interests of the providers rather than the patients. The marketing and promotion by the pharmaceutical industry of off -label use of antipsychotics for treatment of agitation in cognitively impaired patients 4

Systematic review of interventions to support well-informed person-centered decision making for dementia care

Introduction: Creating dementia care plans can reduce caregiver burden and prolong aging in place. However, family caregivers state that surrogate decision making is a primary source of burden and a barrier to creating care plans. Decision support interventions (e.g. patients’ decision aids, decision coaching, etc.) have been shown to improve information comprehension, communication, decisional conflict, and engagement in decision making. However, the quantity, quality, and effects of decision support interventions for dementia families remain unclear. Therefore, this systematic review critically assessed the scientific literature regarding the following research question: Compared with usual care, do individuals with dementia and/or their family caregivers who receive a decision support intervention have improved information comprehension, decisional conflict, or engagement in decision making? Methods: Two research librarians searched the MEDLINE, CINAHL, EMBASE, Cochrane, Web of Knowledge, Google Scholar, PsychInfo, and related dissertation libraries for “dementia”,”decision support”, and related sub-terms. Three researchers hand-searched abstracts from relevant academic society meetings, and spoke with identified experts in the field. Eligibility criteria included papers about individuals with dementia or their family caregivers using any form of intervention designed to support health care decision making. Primary outcomes included information comprehension, decisional conflict, and engagement in decision making. Critical appraisal followed the Cochrane and GRADE guidelines. Results: Two blinded reviewers reviewed 5,922 abstracts and 131 full text manuscripts to yield 14 included papers reporting on 9 decision aids designed specifically for dementia care. These papers were published in 2001-2012 and describe studies in the United States, United Kingdom, Canada, France, Germany, The Netherlands, and Australia. Nine decision aids were identified covering topics such as advanced care plan options, respite care, antibiotics, feeding tubes, goals of care, long term care, and memory medications. These decision aids exist in paper workbook and video/DVD media. Three decision aids are reported available on the Internet, but studies evaluating Internet-delivery were limited. The majority of studies (66%) focused on caregivers’ decision making. Critical analyses suggest moderate effects on information comprehension and decisional conflict; however, insufficient information was provided to critically assess the effect on engagement in decision making. Risk of bias varied, as many studies reported on early development stages. Conclusions: Since 2001, nine patients’ decision aids have been developed internationally for decisions related to dementia care. Early evidence suggests dementia care decision aids can improve information comprehension and decisional conflict similar to other decision aids; however, gaps remain in the evidence regarding their effect on engagement in creating care plans.

Sources of parental burden in a UK sample of first-generation North Indian Punjabi Sikhs and their white British counterparts

The correlates of parental burden in schizophrenia may differ between ethnic groups, but few studies have examined this in a UK setting. Our aim was to identify the correlates of burden in a UK sample of first-generation North Indian Punjabi Sikh parents and their white British counterparts. Test the association of burden with a series of clinical, social and service use variables and control for potential confounding factors in a model predicting drivers of burden in a combined sample of the above. The strongest correlates of burden were patient symptoms and parental distress. Differences in correlates of burden between the groups emerged when individual components of service use and parental social network were tested. The group comparisons also revealed differences in expressed emotion (EE) and social networks. The similarities in sources of burden between the groups could be explained by a commonality of sociocultural and economic experience, resulting from the successful acculturation and affluence of this British Sikh group. The differences between the groups may be related to enduring cultural factors such as kin support, since larger family groups were associated with low burden in the British Sikh group. The nature of EE in this British Sikh group may explain why it was not associated with burden in this sample.

Balancing between inspiration and exhaustion: PhD students' experienced socio-psychological well-being

This paper explores doctoral students' experiences of their scholarly communities in terms of socio-psychological well-being. Further, the study examines how experiences were related to study engagement and to self-reported stress, exhaustion, and anxiety. Altogether 669 doctoral students from the University of Helsinki, Finland, responded a survey. The answers to an open-ended question were content analysed and then statistically compared to well-being and study engagement items. The results showed that there was variation in students' experiences of the scholarly community regarding socio-psychological well-being. More than half of the answers, where students had explicitly described their experience (n = 383), emphasised the scholarly community as source of burden (56%), but experiences of inspiration and empowerment were also frequently reported in the answers (44%). Feelings of empowerment were positively related to study engagement and negatively related to stress, exhaustion, and anxiety.

Family Burden During Exacerbation of Schizophrenia: Quantification and Determinants of Additional Costs

Family members of people with schizophrenia are heavily burdened. Thus, we aimed at quantifying the amount of additional efforts during the two weeks before hospitalisation of acute exacerbating psychosis compared to the time before. By means of the semi-structured 'Interview for Measuring the Burden on the Family' we interviewed relatives of people with schizophrenia. To quantify additional burden we asked how much time a person who would take over the additional burden has to afford. Subscales of different sources of burden and total scales were correlated. An additional 8.9 hours per day would have to be spent in favour of the patient, which results in additional costs of Euro 3,115-Euro 4,984 (ca. pounds 2,100-3,400) for two weeks. The main sources of additional burden are quantity, quality and nature of contacts to the affected. This includes the frequency of contact to the affected, the whereabouts and symptoms of the affected, as well as the social contacts of the relatives. Our results clarify the quantitative aspect of care provided by relatives of people with schizophrenia. Apart from the practical and emotional help to relatives the development of a diversified network of community psychiatry services, e.g. day and night hospitals, as well as crisis accommodations should be established.

Sources of burdens on families of individuals with mental illness

Sources of burdens on families of individuals with mental illness

Family support--a burden to patient and caregiver.

The aim of this paper was to describe family support in terms of the sources as well as the consequences of burden for caregivers, patients and family interaction. Caregivers' sources of burden were related to difficulties in coping with patients' emotional responses, physical complaints and altered life style behaviour as well as future oriented factors. Consequences in terms of caregivers' perceptions of emotional distress and personal losses are elucidated. In terms of family support, when focusing on sources of burden for patients' concerning family support, emotional support is emphasised and related to overprotection. Two different definitions of the overprotection concept are used in order to elucidate different consequences of the phenomenon. Sources and consequences of burden are also related to family interaction. The family is regarded as a system in which a cardiac disease may cause an imbalance. Poor marital quality or poor family functioning is described as a hindrance to a new balance. To summarise, the reviewed literature unanimously shows that the interactive support between family members when dealing with cardiac disease constitutes a considerable emotional burden. Therefore the support for emotional communication within the family should take priority. The knowledge described can provide a foundation for the development of family support in the cardiac area.

Caregiver burden: A concept analysis

The development of the concept of burden for use in research lacks consistent conceptualization and operational definitions. The purpose of this article is to analyze the concept of burden in an effort to promote conceptual clarity. The technique advocated by Walker and Avant is used to analyze this concept. Critical attributes of burden include subjective perception, multidimensional phenomena, dynamic change, and overload. Predisposing factors are caregiver's characteristics, the demands of caregivers, and the involvement in caregiving. The consequences of burden generate problems in care-receiver, caregiver, family, and health care system. Overall, this article enables us to advance this concept, identify the different sources of burden, and provide directions for nursing intervention. Copyright © 2000 by W.B. Saunders Company

Dysfunctional Behavior Rating Instrument

A dysfunctional behavior can be defined as “an inappropriate action or response, other than an activity of daily living, in a given social milieu that is a problem for the caregiver.” Dysfunctional behaviors commonly accompany cognitive impairment and are a significant source of burden to caregivers. Dysfunctional behaviors may be the first sign of a dementing illness, even before caregivers perceive changes in the patient's cognitive abilities. However, unlike cognitive impairment, dysfunctional behaviors are amenable to medical treatment. Effective treatment of these behaviors requires their description and identification, evaluation of their frequency and impact on the caregiver, identification of causes, development of a treatment plan, and evaluation of the effects of treatment.

Family Stress at the Time of a Geropsychiatric Hospitalization

The intensity and sources of stress experienced by family members of elderly psychiatric patients were examined. Family members were distressed at a rate similar to reports of other points of caregiving, except males who reported particularly high levels of caregiving burden. Family members' distress was more strongly related to general life event stress than to patient-related burden although many of their life stressors were likely secondary to the caregiving role. Distress was also affected by characteristics of the family structure such as clarity in decision-making roles and family support. Key Words: aging family, caregiving, geriatric hospitalization, stress. Stephen J. Owens and Sara Honn Qualls** The admission of an older adult into an inpatient psychiatric unit marks a crisis point for the patient, the individuals who were previously providing care to that patient, and potentially for the entire family. Given that psychiatric hospitalizations are both unusual and often dramatic events, family members, particularly those involved in making caregiving decisions, are likely to be stressed at the time an older family member is admitted to a geropsychiatric unit. It is well established that families are extensively involved in the lives of older adults, especially during times of illness (Horowitz, 1985; Shanas, 1979). Approximately 80% of ill and frail older adults receive care from members of their family (Brody, 1985). An acute illness episode or a disruption in functioning affects family members who provide care or assist with decisions. Whether family members are providing daily care, or less formal assistance to the older adult, a geropsychiatric hospitalization will at least cause a change in routine, and may result in family members significantly restructuring roles and responsibilities. Hospitalizations are usually precipitated by severe behavioral problems or deterioration in daily functioning, either of which is likely to be disturbing to family members, regardless of the family member's role. In addition, either of these events would likely pull the family into the role of either decision-maker or caregiver, both of which are potentially stressful. If this reasoning is correct, family members should report being highly distressed at the time their elderly relative is admitted. The purpose of this paper was to describe the psychiatric symptoms, burden, and life stress that is reported by family members of geropsychiatric inpatients. In addition, answers to the following questions were investigated. Is there a relationship between either burden or life stress and psychiatric symptoms? If such relationships exist, does burden or life stress have more negative psychological consequences for family members? Which family characteristics are significantly correlated with burden and life stress? Caregiver Distress Family members who are responsible for caring for an ill or frail older adult often experience distress. A commonly reported negative consequence for caregivers has been termed burden, the negative emotional and physical costs of providing health care to a family member (Zarit, Reever, & Bach-Peterson, 1980). The source of burden in the caregiving role may result from reduced personal time, role strain, disrupted household routines, the deteriorating physical and mental health of the care provider (Noelker & Wallace, 1985), decreased social activities (Thompson, Futterman, Gallagher-Thompson, Rose, & Lovett, 1993), and behavioral problems exhibited by the care-receiver (Kosberg, Cairl, & Keller, 1990; Pearson, Verma, & Nellett, 1988). Family members who provide care and assistance to older adults are exposed to burden and associated distress throughout the time they function as care providers. However, it is likely that this burden and distress will be elevated during the crisis surrounding the admission to a psychiatric unit because admission is often precipitated by behavior problems. …

Burden, Coping and Health Status

This study investigates caregiver health, burden and coping strategies of family caregivers to institutionalized and community-dwelling Alzheimer's disease patients. Patient residence was significantly related to caregiver health status, sources of burden and the efficacy of various strategies for reducing burden. Implications for intervention with family caregivers are discussed.