Social science & medicine
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Social science & medicine · Feb 2002
Comparative StudyFactors determining inpatient satisfaction with care.
The objective of the study was to identify factors associated with satisfaction among inpatients receiving medical and surgical care for cardiovascular, respiratory, urinary and locomotor system diseases. Two weeks after discharge, 533 patients completed a Patient Judgments Hospital Quality questionnaire covering seven dimensions of satisfaction (admission, nursing and daily care, medical care, information, hospital environment and ancillary staff, overall quality of care and services, recommendations/intentions). Patient satisfaction and complaints were treated as dependent variables in multivariate ordinal polychotomous and dichotomous logistic stepwise regressions, respectively. ⋯ Men tended to be more satisfied than women. Other predictors specific for certain dimensions of satisfaction were: married, Karnofsky index more than 70, critical/serious self-reported condition at admission, emergency admission, choice of hospital by her/himself, stay in a medical service, stay in a private room, length of stay less than one week, stay in a service with a mean length of stay longer than one week. The factors associated with inpatient satisfaction elucidated in this study may be helpful in interpreting patient satisfaction scores when comparing hospitals, services or time periods, in targeting patient groups at risk of worse experiences and in focusing care quality programs.
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Despite use of the term dignity in arguments for and against a patient's self-governance in matters pertaining to death, there is little empirical research on how this term has been used by patients who are nearing death. The objective of this study was to determine how dying patients understand and define the term dignity, in order to develop a model of dignity in the terminally ill. A semi-structured interview was designed to explore how patients cope with their advanced cancer and to detail their perceptions of dignity. ⋯ These broad categories and their carefully defined themes and sub-themes form the foundation for an emerging model of dignity amongst the dying. The concept of dignity and the dignity model offer a way of understanding how patients face advancing terminal illness. This will serve to promote dignity and the quality of life of patients nearing death.
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The social and demographic characteristics of approximately 65,000 Tibetan refugees in India were determined from data collected 1994-1996. Approximately 55,000 refugees were living in 37 settlements widely distributed around India. The remaining 10,000 refugees were monks living in monasteries associated with some of the settlements, mostly in the south of India. ⋯ The burden of illness in this society was mainly characterized by diarrhoea. skin infections, respiratory infections, fevers, and, among the elderly. joint pains and cardiovascular problems. Although calculated death rates were unrealistically low, due to under-reporting, causes of death, derived from "verbal autopsies", were mainly cancer, tuberculosis, accidents, cirrhosis and heart disease in order of decreasing frequency. Overall, the sociodemographic and health characteristics of this population appear to be in transition from those typical of the least developed countries to those typical of middle income and more affluent societies.
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Tuberculosis (TB) is a major public health problem among Tibetan refugees in India. To determine the incidence of and risk factors for TB among Tibetan refugees in India, data on TB were included in the demographic and health surveillance project carried out by the Tibetan government-in-exile in Dharamsala from 1994 to 1996. Risk factor and morbidity data were determined by baseline and monthly follow-up home visits, and reported TB was confirmed by clinic records. ⋯ The proportion of patients without sputum results and variation in the proportion of smear positive cases indicated inadequate use and poor quality of laboratory services. India's Revised National Tuberculosis Control Program, based on WHO-recommendations, has been highly successful in pilot districts and is being extended to the whole country. This program should be adopted promptly by the health care system serving Tibetan refugees and vigorously implemented among the refugee population.
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Social science & medicine · Feb 2002
Comparative StudyThe doctor as God's mechanic? Beliefs in the Southeastern United States.
Spiritual practice and beliefs related to healing are described using data from a telephone survey. Questions in the survey address the practice of prayer and spiritual beliefs related to healing. Questions explore belief in miracles, that God acts through religious healers, the importance of God's will in healing, and that God acts through physicians. ⋯ Although 69% say they would want to speak to someone about spiritual concerns if seriously ill, only 3% would choose to speak to a physician. We conclude that religious faith in healing is prevalent and strong in the southern United States and that most people believe that God acts through doctors. Knowledge of the phenomena and variation across the population can guide inquiry into the spiritual concerns of patients.