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Sample records for patients comparacao entre

  1. "Entre libre" dans la classe ("Entre Libre" in the Classroom).

    ERIC Educational Resources Information Center

    Compte, Carmen

    1987-01-01

    In an interview, two teachers describe and discuss their different classroom use of the same set of instructional materials for "Entre Libre" and compare the results. Activities include role playing, music, and reporting. (MSE)

  2. How To Talk to Your Doctor (and Get Your Doctor To Talk to You!). An Educational Workshop on Doctor Patient Communication = Como Hablarle a su Doctor (iY que su doctor le hable a usted!). Un seminario educativo sobre la comunicacion entre el doctor y el paciente.

    ERIC Educational Resources Information Center

    Baylor Coll. of Medicine, Houston, TX.

    This workshop, written in both English and Spanish, focuses on improving communication between physician and patient. In the workshop, the trainers will talk about "building bridges" between patient and doctor by understanding the doctor's role and his/her duty to the patient. According to the workshop, a person's doctor should communicate…

  3. Patient satisfaction.

    PubMed

    Prakash, Bhanu

    2010-09-01

    Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. Patient satisfaction is thus a proxy but a very effective indicator to measure the success of doctors and hospitals. This article discusses as to how to ensure patient satisfaction in dermatological practice. PMID:21430827

  4. La problematica de la demarcacion entre ciencia y pseudociencia y sus implicaciones en la educacion cientifica

    NASA Astrophysics Data System (ADS)

    Jimenez Tolentino, Dinorah

    2011-12-01

    En la sociedad prevalece una tendencia generalizada hacia la inclusion de creencias y practicas pseudocientificas. Esta investigacion responde a la necesidad de analizar como la proliferacion de las pseudociencias afecta la vision que tienen los estudiantes universitarios sobre las ciencias naturales. A tales efectos, la investigadora describe las concepciones epistemologicas que tienen los estudiantes sobre las ciencias y las pseudociencias e identifica los criterios de demarcacion, entre un area y otra, que se derivan de estas concepciones. De igual modo, esta identifica las creencias y practicas pseudocientificas de mayor arraigo entre los estudiantes, destacando, a su vez, la razon de ser de las mismas. Por ultimo, la investigadora analiza las implicaciones educativas de la problematica de la demarcacion entre ciencia y pseudociencia. La investigacion es de naturaleza mixta, enmarcada en los paradigmas empirico- analitico y cualitativo. El proceso investigativo se llevo a cabo mediante la administracion del cuestionario Criterios para la demarcacion entre ciencia y pseudociencia. La parte cualitativa estuvo enmarcada en el diseno de estudio de caso, recopilando informacion mediante entrevistas semiestructuradas en dos grupos focales. La poblacion de estudio estuvo constituida por estudiantes universitarios del nivel subgraduado de la Universidad Central de Bayamon. Los resultados del estudio reflejaron las concepciones erroneas de los estudiantes sobre la naturaleza de las ciencias y las pseudociencias. Con respecto a la demarcacion entre ciencia y pseudociencia, el criterio imperante entre los universitarios es el de la verificabilidad, considerando la aplicacion del metodo cientifico como el metodo para demostrar la veracidad de las teorias cientificas. Las creencias y practicas pseudocientificas no son muy frecuentes entre los universitarios. Estos atribuyen las mismas a la prevalencia de elementos supersticiosos y al engano a que es sometida la poblacion

  5. Entre Dos Mundos/Between Two Worlds: Youth Violence Prevention for Acculturating Latino Families

    ERIC Educational Resources Information Center

    Smokowski, Paul R.; Bacallao, Martica

    2009-01-01

    Objective: This study evaluated the efficacy of Entre Dos Mundos/Between Two Worlds (EDM) prevention for Latino adolescents. Method: In an experimental trial to compare implementation formats, 41 Latino families were randomly assigned to EDM action-oriented skills training groups, and 47 families were randomly assigned to unstructured EDM support…

  6. ESTIGMA Y VIH/SIDA ENTRE PADRES/MADRES Y ADOLESCENTES PUERTORRIQUEÑOS/AS

    PubMed Central

    Pérez, Grace Rosado; Reyes, Glendalys Rivera; Villanueva, Victoria Larrieux; Torres, Gilliam J. Torres; Díaz, Elba Betancourt; Varas-Díaz, Nelson; Villaruel, Antonia

    2016-01-01

    La comunicación entre padres/madres y adolescentes sobre el tema de la sexualidad es importante para el desarrollo de la salud de personas jóvenes. Dicha comunicación puede verse negativamente impactada por actitudes estigmatizantes hacia el tema del VIH/SIDA. El objetivo de este estudio fue identificar actitudes estigmatizantes hacia el VIH/SIDA entre padres/madres y adolescentes puertorriqueños/as. Este esfuerzo es parte del Proyecto Cuídalos, dirigido a probar una intervención en formato electrónico que busca aumentar la comunicación sobre sexualidad y salud entre padres/madres y adolescentes mediante un diseño experimental con 458 diadas de padres/madres y adolescentes de 13 a 17 años. Para propósitos de este artículo reportamos estadísticas descriptivas sobre estigma hacia el VIH/SIDA con la información recopilada en la medición basal. Tanto adultos/as como adolescentes mostraron actitudes estigmatizantes hacia el VIH/SIDA. A la luz de los resultados es necesario continuar desarrollando intervenciones para la reducción de estigma en esta población. Los/as padres/madres pueden ser un recurso invaluable para reducir el estigma en los/as jóvenes, y prevenir conductas sexuales de riesgo e infecciones. PMID:27099649

  7. Discharging patients.

    PubMed

    Causey, Amy

    2016-06-22

    What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice? The CPD article discussed the importance of effective planning when discharging patients from acute care hospitals. It emphasised the benefit of early assessment and planning, and outlined the essential principles that should be followed when discharging a patient. PMID:27332612

  8. Patient Roadmap

    MedlinePlus

    ... Follow ATA’s Patient Roadmap for the step-by-step process of how to achieve the best results. Find ... Patient Roadmap,” that identifies the optimal step-by-step process for finding medical support. Please note: this “Roadmap” ...

  9. Patient education.

    PubMed

    Lindeman, C A

    1988-01-01

    The 120 studies included in this review were grouped in relation to five categories of variables basic to a theory of instruction in patient education. Findings in the studies related to the characteristics of the patient as learner support the following variables as significant for a theory of instruction: demographic characteristics including age, race, duration and type of illness, educational level, and family preparedness. Selected psychological variables are significant as they interact with teaching approaches. Given only two studies in which the characteristics of the nurse as teacher were the main variables, no inferences for a theory of instruction could be drawn. However, the findings from those studies combined with results from studies in which characteristics of the nurse were secondary variables support the importance of this category of variables. The educational preparation, motivation, values, and job description of the nurse implementing patient teaching appear to be significant variables for a theory of instruction. Investigators explored a wide range of teaching strategies in the studies of patient teaching. The setting for teaching, group and individual teaching, and a variety of instructional strategies all prove promising at the operational level. The instructional strategies were too diverse to allow analysis at a level of abstraction beyond the operational. Findings in this review also support characteristics of the health care setting as an important category of variables for a theory of instruction. The organizational structure, a quality assurance framework, and valuing patient teaching appear to be significant variables. Patient education research provides a rich data source for future developments in theory, practice, and research. The effectiveness of patient education as a nursing intervention is clearly established. Furthermore, positive learning outcomes are associated with a broad range of teaching strategies, content areas, and

  10. Estudo comparativo entre estrelas centrais de nebulosas planetárias deficientes em hidrogênio

    NASA Astrophysics Data System (ADS)

    Marcolino, W. L. F.; de Araújo, F. X.

    2003-08-01

    Apresentamos neste trabalho o resultado de um estudo das principais características espectrais das estrelas centrais de nebulosas planetárias (ECNP) deficientes em hidrogênio. A origem e a evolução dessas estrelas ainda constitui um problema em aberto na evolução estelar. Geralmente esses objetos são divididos em [WCE], [WCL] e [WELS]. Os tipos [WCE] e [WCL] apresentam um espectro típico de uma estrela Wolf-Rayet carbonada de população I e as [WELS] apresentam linhas fracas de carbono e oxigênio em emissão. Existem evidências que apontam a seguinte sequência evolutiva : [WCL] = > [WCE] = > [WELS] = > PG 1159 (pré anã-branca). No entanto, tal cenário apresenta falhas como por exemplo a falta de ECNP entre os tipos [WCL] e [WCE]. Baseados em uma amostra de 24 objetos obtida no telescópio de 1.52m em La Silla, Chile (acordo ESO/ON), ao longo do ano 2000, apresentamos os resultados da comparação das larguras equivalentes de diversas linhas relevantes entre os tipos [WCL], [WCE] e [WELS]. Verificamos que nossos dados estão de acordo com a sequência evolutiva. Baseado nas linhas de C IV, conseguimos dividir pela primeira vez as [WELS] em dois grupos principais. Além disso, os dados reforçam a afirmação de que as [WCE] são as estrelas que possuem a maior temperatura entre as ECNP deficientes em hidrogênio. Discutimos ainda, a escassez de dados disponíveis na literatura e a necessidade da obtenção de parametros físicos para estes objetos.

  11. Patient Empowerment

    MedlinePlus

    ... cancer patient organization. Ask for this help. Your Responsibilities Keep Good Records Get in the habit of ... responsible for your follow-up. You should take responsibility for getting a follow-up scheduled and for ...

  12. Patient monitoring.

    PubMed

    Morton, A

    1976-11-01

    Optimum results are obtained in the care of the critically ill patient if efforts are directed to maintaining the internal environment in a state as near normal as possible. This cannot be done without the use of basic monitoring procedures. Complex investigations may have a legitmate and necessary role as research tools. There is, however, a real risk of complex procedures becoming an end in themselves in general intensive therapy units, where they are apt to distract overworked nurses and medical attendants from the care of their patients. It is important, therfore, for clearcut indications for various monitoring procedures to be defined, and in this paper an attempt has been made to outline alogical approach to the monitoring of critically ill genral surgical patients admitted intensive therapy units. PMID:1071552

  13. Patient Monitoring

    NASA Technical Reports Server (NTRS)

    1978-01-01

    In photo above, the electrocardiogram of a hospitalized patient is being transmitted by telemetry. Widely employed in space operations, telemetry is a process wherein instrument data is converted to electrical signals and sent to a receiver where the signals are reconverted to usable information. In this instance, heart readings are picked up by the electrode attached to the patient's body and delivered by wire to the small box shown, which is a telemetry transmitter. The signals are relayed wirelessly to the console in the background, which converts them to EKG data. The data is displayed visually and recorded on a printout; at the same time, it is transmitted to a central control station (upper photo) where a nurse can monitor the condition of several patients simultaneously. The Patient Monitoring System was developed by SCI Systems, Inc., Huntsville, Alabama, in conjunction with Abbott Medical Electronics, Houston, Texas. In developing the system, SCI drew upon its extensive experience as a NASA contractor. The company applied telemetry technology developed for the Saturn launch vehicle and the Apollo spacecraft; instrumentation technology developed for heart, blood pressure and sleep monitoring of astronauts aboard NASA's Skylab long duration space station; and communications technology developed for the Space Shuttle.

  14. Refugee patients.

    PubMed

    Valeras, Aimee Burke

    2016-06-01

    This short story focuses on refugee patients. Family members talk about the horrific struggles of civil war, refugee camps, and promises of US resettlement. Their harsh reception into a brutal world includes unemployment, food scarcity, and isolation. (PsycINFO Database Record PMID:27270253

  15. Patient Rights

    MedlinePlus

    ... your health care provider must give you the information you need to make a decision. Many hospitals have patient advocates who can help you if you have problems. Many states have an ombudsman office for problems with long term care. Your state's department of health may also be able to help.

  16. Etude des relations entre photosynthese respiration, transpiration et nutrition minerale chez le ble

    NASA Astrophysics Data System (ADS)

    André, M.; Ducloux, H.; Richaud, C.; Massimino, D.; Daguenet, A.; Massimino, J.; Gerbaud, A.

    La croissance du Blé Triticum aestivum a été étudiée en environnement contrôlé et fermé pendant une période de 70 jours. Les échanges gazeux (Photosynthèse, Respiration) hydriques (Transpiration) et la consommation en éléments minéraux (Azote, Phosphore, Potassium) ont été mesurés en continu. On présentera les relations dynamiques observées entre les différentes fonctions physiologiques, d'une part sous l'influence de la croissance et d'autre part en réponse à des modifications de l'environnement. L'influence de la teneur en CO2 pendant la croissance (teneur normale ou doublée) sera mise en évidence.

  17. No Financial Disincentive for Choosing More Healthful Entrées on Children’s Menus in Full-Service Restaurants

    PubMed Central

    West, Delia

    2013-01-01

    Children are eating restaurant foods more than ever before, and price is among the top considerations for food choices. We categorized and enumerated entrées on children’s menus from 75 full-service restaurant chains to compare prices of more healthful and less healthful entrées to test the assumption that more healthful food is more expensive. The mean (standard deviation) price of more healthful entrées ($5.38 [$2.01]) was not significantly different from the price of less healthful entrées ($5.27 [$2.04]). In contrast to research demonstrating that more healthful foods tend to be more expensive in grocery stores, more healthful entrées on children’s menus in restaurants were not more expensive than less healthful entrées. PMID:23742942

  18. An Environmental Management Model of Thermal Waters in Entre Ríos Province, Argentina

    NASA Astrophysics Data System (ADS)

    Pablo, Mársico Daniel; Luís, Díaz Eduardo; Ivana, Zecca; Oscar, Dallacosta; Antonio, Paz-González

    2015-04-01

    Deep exploratory drillings, i.e. those with more than 500 meters depth, have been performed in the Entre Ríos province, Argentina, in order to ascertain the presence of thermal water. Drilling began in 1994, and until now there have been 18 polls with very variable results in terms of mineralization, resource flow, and temperature. The aim of this study was to present a management model, which should allow operators of thermal complexes to further develop procedures for safeguarding the biodiversity of the ecosystems involved, both during exploration and exploitation activities. The environmental management Plan proposed is constituted by a set of technical procedures that are formulated and should be performed during the stages of exploration and exploitation of the resource, and consists of: environmental monitoring, environmental audit, public information and contingency programs. This Plan describes the measures and proposals aimed at protecting environmental quality in the area of influence of a thermal complex project, ensuring that its execution remains environmentally responsibly, and allowing implementation of specific actions to prevent or correct environmental impacts, as predicted in the evaluation of the Environmental Program. The audit of environmental impact includes and takes into account natural factors, such as water, soil, atmosphere, flora and fauna, and also cultural factors. The technical audit Plan was prepared in order to get a systematic structure and organization of the verification process, and also with regard to document the degree of implementation of the proposed mitigation measures. Finally, an environmental contingency program was implemented, and its objective was to consider the safeguarding of life and its natural environment. Thus, a guide has been developed with the main actions to be taken on a contingency, since forecast increases the efficiency of the response. The methodology developed here was adopted as the procedure

  19. Patient Advocate Foundation

    MedlinePlus

    ... The Process is Simple. Patient Advocate Foundation's Patient Services provides patients with arbitration, mediation and negotiation to settle issues ... the following to learn more about how PAF Patient Services may assist you: Specialized Patient Programs Co-Pay ...

  20. Religiosidade, juventude e sexualidade: entre a autonomia e a rigidez1

    PubMed Central

    Silva, Cristiane Gonçalves da; Santos, Alessandro Oliveira; Licciardi, Daniele Carli; Paiva, Vera; Parker, Richard

    2009-01-01

    Esse artigo descreve como jovens religiosos e autoridades religiosas de sua comunidade compreendem a sexualidade, considerando suas experiências pessoais e como membros de comunidades religiosas. A análise pretende contribuir para que políticas públicas dedicadas à promoção da saúde sexual da juventude considerem a religiosidade, no contexto de um estado laico e da promoção do direito à prevenção. Foram realizadas 26 entrevistas abertas e semidirigidas em diferentes comunidades da região metropolitana da cidade de São Paulo (comunidades católicas, da umbanda, do candomblé e de diferentes denominações evangélicas) sobre iniciação sexual, casamento, gravidez, contracepção e prevenção das DST/Aids, homossexualidade, aborto e direitos humanos. Observou-se como jovens e autoridades religiosas convivem com a tensão entre tradição e modernidade e os distintos discursos sobre a sexualidade. Como sujeitos religiosos (do discurso religioso) e sujeitos sexuais (de discursos sobre sexualidade), devem ser incorporados pelos programas como sujeitos de direito nos termos de sua religiosidade. PMID:21886456

  1. Communicating with patients

    MedlinePlus

    ... patient. Be careful not to make assumptions. Patient teaching based on incorrect assumptions may not be very ... information you receive can help guide your patient teaching. Ask the right questions. Ask if the patient ...

  2. Occurrence of alternariol and alternariol monomethyl ether in beverages from the Entre Rios Province market, Argentina.

    PubMed

    Broggi, Leticia; Reynoso, Cora; Resnik, Silvia; Martinez, Fernanda; Drunday, Vanesa; Bernal, Angela Romero

    2013-02-01

    One hundred and eighty five samples of red, white and rosé wines and different juices purchased in Entre Rios, Argentina, were analyzed for the Alternaria mycotoxins alternariol (AOH) and alternariol methyl ether (AME). White wines were analyzed after removal of alcohol by a nitrogen stream and concentrated. AOH in red wines was cleaned up by solid-phase extraction columns in series (octadecyl and amino propyl modified silica) and AME quantified directly on the sample. The juices were filtered and concentrated, and then all sample extracts were quantified by high performance liquid chromatography with photodiode array detector that allows confirmation through UV spectra. Method validation revealed a good sensitivity with adequate LOD and LOQ for AME and less sensitivity for AOH (i.e. white wine: AME 0.8 and 1.4 ng/mL, AOH 2 and 3.3 ng/mL; red wine: AME 0.1 and 0.2 ng/mL, AOH 4.5 and 7.5 ng/mL; apple juice: AME 1.7 and 2.8 ng/mL, AOH 5 and 9 ng/mL; other juices: AME 2.0 and 3.1 ng/mL, AOH 6 and 10 ng/mL). Recoveries in all cases were greater than 80 %. Four of 53 white wine samples were contaminated with AOH with a maximum level of 18 ng/mL, 6 of 56 samples of red wine had a maximum of 13 ng/mL, and 3 of 68 samples of juices had traces of AOH. AME was less frequently detected than AOH, and the LOD and LOQ for AME are smaller than for AOH. Only three samples of white wine and one of red wine were contaminated, but in only one white wine sample (AME 225 ng/mL) did the toxin level exceed the LOQ. PMID:23334721

  3. Analyse des interactions energetiques entre un arena et son systeme de refrigeration

    NASA Astrophysics Data System (ADS)

    Seghouani, Lotfi

    La presente these s'inscrit dans le cadre d'un projet strategique sur les arenas finance par le CRSNG (Conseil de Recherche en Sciences Naturelles et en Genie du Canada) qui a pour but principal le developpement d'un outil numerique capable d'estimer et d'optimiser la consommation d'energie dans les arenas et curlings. Notre travail s'inscrit comme une suite a un travail deja realise par DAOUD et coll. (2006, 2007) qui a developpe un modele 3D (AIM) en regime transitoire de l'arena Camilien Houde a Montreal et qui calcule les flux de chaleur a travers l'enveloppe du batiment ainsi que les distributions de temperatures et d'humidite durant une annee meteorologique typique. En particulier, il calcule les flux de chaleur a travers la couche de glace dus a la convection, la radiation et la condensation. Dans un premier temps nous avons developpe un modele de la structure sous la glace (BIM) qui tient compte de sa geometrie 3D, des differentes couches, de l'effet transitoire, des gains de chaleur du sol en dessous et autour de l'arena etudie ainsi que de la temperature d'entree de la saumure dans la dalle de beton. Par la suite le BIM a ete couple le AIM. Dans la deuxieme etape, nous avons developpe un modele du systeme de refrigeration (REFSYS) en regime quasi-permanent pour l'arena etudie sur la base d'une combinaison de relations thermodynamiques, de correlations de transfert de chaleur et de relations elaborees a partir de donnees disponibles dans le catalogue du manufacturier. Enfin le couplage final entre l'AIM +BIM et le REFSYS a ete effectue sous l'interface du logiciel TRNSYS. Plusieurs etudes parametriques on ete entreprises pour evaluer les effets du climat, de la temperature de la saumure, de l'epaisseur de la glace, etc. sur la consommation energetique de l'arena. Aussi, quelques strategies pour diminuer cette consommation ont ete etudiees. Le considerable potentiel de recuperation de chaleur au niveau des condenseurs qui peut reduire l'energie requise par

  4. Patient-centered Radiology.

    PubMed

    Itri, Jason N

    2015-10-01

    Patient-centered care (ie, care organized around the patient) is a model in which health care providers partner with patients and families to identify and satisfy patients' needs and preferences. In this model, providers respect patients' values and preferences, address their emotional and social needs, and involve them and their families in decision making. Radiologists have traditionally been characterized as "doctor-to-doctor" consultants who are distanced from patients and work within a culture that does not value patient centeredness. As medicine becomes more patient driven and the trajectory of health care is toward increasing patient self-reliance, radiologists must change the perception that they are merely consultants and become more active participants in patient care by embracing greater patient interaction. The traditional business model for radiology practices, which devalues interaction between patients and radiologists, must be transformed into a patient-centered model in which radiologists are reintegrated into direct patient care and imaging processes are reorganized around patients' needs and preferences. Expanding radiology's core assets to include direct patient care may be the most effective deterrent to the threat of commoditization. As the assault on the growth of Medicare spending continues, with medical imaging as a highly visible target, radiologists must adapt to the changing landscape by focusing on their most important consumer: the patient. This may yield substantial benefits in the form of improved quality and patient safety, reduced costs, higher-value care, improved patient outcomes, and greater patient and provider satisfaction. PMID:26466190

  5. Counseling the Coronary Patient

    ERIC Educational Resources Information Center

    Semmler, Caryl; Semmler, Maynard

    1974-01-01

    The article discusses counseling sessions designed to a) help the coronary patient adjust to cardiovascular disease, b) diminish patient anxieties and fears, and c) educate the patient and family members on controlling risk factors to deter another coronary attack. (JS)

  6. Seroprevalence of Salmonella and Mycoplasma infection in backyard chickens in the state of Entre Rios in Argentina.

    PubMed

    Xavier, J; Pascal, D; Crespo, E; Schell, H L; Trinidad, J A; Bueno, D J

    2011-04-01

    The present work was conducted to study the seroprevalence of Salmonella, Mycoplasma gallisepticum (MG), and Mycoplasma synoviae (MS) infection in backyard chickens located in Entre Ríos, Argentina, over 3 periods of time. A total of 2,441 sera samples were collected from backyard chickens belonging to 256 family farms in 16 counties in the state of Entre Ríos from January to May 2003 (first period), December 2004 to April 2005 (second period), and October 2006 to May 2007 (third period). The prevalence of family farms testing seropositive for Salmonella averaged 23.9, 15.9, and 28.6% during the first, second, and third period, respectively. The highest prevalence of Salmonella-seropositive farms recorded (66.7%) was on farms from Concordia county, and the lowest prevalence (0%) was on farms from La Paz county. In contrast, the prevalence of family farms seropositive for MG averaged 32.8, 55.1, and 76.2% during the first, second, and third periods, respectively. The highest prevalence of MG-seropositive farms (100%) was found in the counties of Victoria and Tala, and the lowest prevalence (8.7%) was found on farms on Colón county. The prevalence of family farms seropositive for MS averaged 68.6 and 100% during the first and second periods, respectively. The highest prevalence of MS-seropositive farms (100%) was on farms in 85% of the counties tested, and the lowest prevalence (21.7%) was on farms from Colón county. Salmonella, MG, and MS infection are present at high levels in backyard chicken farms, and this presents a high risk to commercial poultry production in Entre Ríos, the state with the highest chicken population and density in Argentina. PMID:21406358

  7. [Ambulatory surgery. Patients and patient education].

    PubMed

    Bredland, T; Duesund, R

    1996-02-20

    This article reviews the concept of day surgery and shows how the treatment can be organized pre-, per- and post-operatively. It can be established in a hospital-integrated unit, a unit separate from the hospital, but connected with it, or a satellite ambulatory facility. Because the patient spends only a short time in hospital it is necessary to have structured preparations before admission, for the benefit of both patient and staff. It should be easy to identify patients suitable for day surgery from the waiting lists, and preparations should be directed at treatment by day surgery right from the start. Rules must be worked out for selecting patients, as well as guidelines for information to patients. It is also necessary to plan the operation programme, and to agree how nurses and doctors should take care of the patient during the different steps of treatment. PMID:8658453

  8. Monte Carlo simulation of a prototypical patient dosimetry system for fluoroscopic procedures

    NASA Astrophysics Data System (ADS)

    Goertz, Lukas; Tsiamas, Panagiotis; Karellas, Andrew; Sajo, Erno; Zygmanski, Piotr

    2015-08-01

    The purpose of this study is to investigate feasibility of a novel real-time dosimetry method for fluoroscopically guided interventions utilizing thin-film detector arrays in several potential locations with respect to the patient and x-ray equipment. We employed Monte Carlo (MC) simulation to establish the fluoroscopic beam model to determine dosimetric quantities directly from measured doses in thin-film detector arrays at three positions: A—attached to the x-ray source, B—on the couch under the patient and C—attached to the fluoroscopic imager. Next, we developed a calibration method to determine skin dose at the entry of the beam ({{D}\\text{entr}} ) as well as the dose distribution along each ray of the beam in a water-equivalent patient model. We utilized the concept of water-equivalent thickness to determine the dose inside the patient based on doses measured outside of the patient by the thin-film detector array layers: (a) A, (b) B, or (c) B and C. In the process of calibration we determined a correction factor that characterizes the material-specific response of the detector, backscatter factor and attenuation factor for slab water phantoms of various thicknesses. Application of this method to an anthropomorphic phantom showed accuracy of about 1% for {{D}\\text{entr}} and up to about 10% for integral dose along the beam path when compared to a direct simulation of dose by MC.

  9. Periprocedural Patient Care.

    PubMed

    Kohi, Maureen P; Fidelman, Nicholas; Behr, Spencer; Taylor, Andrew G; Kolli, Kanti; Conrad, Miles; Hwang, Gloria; Weinstein, Stefanie

    2015-10-01

    Periprocedural care of patients who undergo image-guided interventions is a task of monumental importance. As physicians who perform procedures, radiologists rely on their noninterpretive skills to optimize patient care. At the center of periprocedural care is proper patient identification. It is imperative to perform the indicated procedure for the correct patient. It is also of great importance to discuss with the patient the nature of the procedure. This conversation should include the indications, risks, benefits, alternatives, and potential complications of the procedure. Once the patient agrees to the procedure and grants informed consent, it is imperative to stop and confirm that the correct procedure is being performed on the correct patient. This universal time-out policy helps decrease errors and improves patient care. To optimize our interpretative and procedural skills, it may be necessary to provide the patient with sedation or anesthesia. However, it is important to understand the continuum of sedation and be able to appropriately monitor the patient and manage the sedation in these patients. To minimize the risks of infection, periprocedural care of patients relies on aseptic or, at times, sterile techniques. Before the procedure, it is important to evaluate the patient's coagulation parameters and bleeding risks and correct the coagulopathy, if needed. During the procedure, the patient's blood pressure and at times the patient's glucose levels will also require monitoring and management. After the procedure, patients must be observed in a recovery unit and deemed safe for discharge. The fundamental components of periprocedural care necessary to enhance patient safety, satisfaction, and care are reviewed to familiarize the reader with the important noninterpretive skills necessary to optimize periprocedural care. PMID:26466184

  10. Burns in diabetic patients

    PubMed Central

    Maghsoudi, Hemmat; Aghamohammadzadeh, Naser; Khalili, Nasim

    2008-01-01

    CONTEXT AND AIMS: Diabetic burn patients comprise a significant population in burn centers. The purpose of this study was to determine the demographic characteristics of diabetic burn patients. MATERIALS AND METHODS: Prospective data were collected on 94 diabetic burn patients between March 20, 2000 and March 20, 2006. Of 3062 burns patients, 94 (3.1%) had diabetes; these patients were compared with 2968 nondiabetic patients with burns. Statistical analysis was performed using the statistical analysis software SPSS 10.05. Differences between the two groups were evaluated using Student's t-test and the chi square test. P < 0.05 was considered as significant. RESULTS: The major mechanism of injury for the diabetic patients was scalding and flame burns, as was also the case in the nondiabetic burn patients. The diabetic burn patients were significantly older, with a lower percentage of total burn surface area (TBSA) than the nondiabetic burn population. There was significant difference between the diabetic and nondiabetic patients in terms of frequency of infection. No difference in mortality rate between diabetic and nondiabetic burn patients was observed. The most common organism in diabetic and nondiabetic burn patients was methicillin-resistant staphylococcus. Increasing %TBSA burn and the presence of inhalation injury are significantly associated with increased mortality following burn injury. CONCLUSIONS: Diabetics have a higher propensity for infection. Education for diabetic patients must include caution about potential burn mishaps and the complications that may ensue from burns. PMID:19902035

  11. Individualizing patient education for greater patient satisfaction.

    PubMed

    Alagheband, Sharzad J; Miller, Jeffrey J; Clarke, Jennie T

    2015-05-01

    The benefits of educational intervention on health outcomes has been widely discussed, but the most educational methods have not been addressed. We sought to assess preferred modes of education during an outpatient dermatology visit (ie, verbal instruction [VI], written instruction [WI], demonstration [DM], Internet resources [IR]). We secondarily looked at patient satisfaction with the educational methods used. The results indicate the most preferred method of education among 157 patients who completed a 12-question survey and areas where physicians may need to improve patient education. PMID:26057507

  12. Repositioning the Patient:

    PubMed Central

    Mold, Alex

    2013-01-01

    Summary This article explores how and why the patient came to be repositioned as a political actor within British health care during the 1960s and 1970s. Focusing on the role played by patient organizations, it is suggested that the repositioning of the patient needs to be seen in the light of growing demands for greater patient autonomy and the application of consumerist principles to health. Examining the activities of two patient groups—the National Association for the Welfare of Children in Hospital (NAWCH) and the Patients Association (PA)—indicates that while such groups undoubtedly placed more emphasis on individual autonomy, collective concerns did not entirely fall away. The voices of patients, as well as the patient, continued to matter within British health care. PMID:23811711

  13. [Patient education of hepatitis].

    PubMed

    Boyer, Dominique; Faillebin, Françoise; de la Brière, Aice

    2013-11-01

    The therapeutic education of patients with hepatitis C helps to improve their health and quality of life. The aim is to encourage compliance with the treatment and the fight against side effects, through to the patient's recovery. PMID:24409616

  14. Patient Eye Examinations - Adults

    MedlinePlus

    ... Examinations, Adults Patient Eye Examinations, Children Refractive Errors Scientists in the Laboratory Visual Acuity Testing Patient Eye Examinations, Adults × Warning message Automatic fallback to the cURL connection method kicked in to handle the request. Result code ...

  15. Evolution of patient navigation.

    PubMed

    Shockney, Lillie D

    2010-08-01

    The role of nurses in patient navigation has evolved over more than four decades. Navigators in cancer care can guide patients through the physical, emotional, and financial challenges that come with a diagnosis of cancer and facilitate communication among healthcare providers. Navigation has the potential to improve patient outcomes and system efficiency. Oncology nurses are well suited to help patients with cancer navigate the healthcare system from diagnosis and treatment through survivorship and palliative care. PMID:20682496

  16. Clostridium perfringens growth from spore inocula in sous-vide processed pork-based Mexican entrée.

    PubMed

    Miguel-Garcia, Denise Y; Juneja, Vijay K; Valenzuela-Melendrez, Martin; Díaz-Cinco, Martha E; Thippareddi, H; Aida Peña-Ramos, E

    2009-01-01

    The combined effect of Citricidal wih irradiation on Clostridium perfringens growth from spores in a sous-vide processed marinated pork meat Mexican entrée was investigated. Citricidal was added at 200 or 800 ppm after mixing pork meat with tomatillo sauce and inoculated with 3 log(10) CFU/g of C. perfringens spores. Samples were irradiated at either 0 or 2 kGy, heated to an internal temperature of 71 degrees C, and stored at 4 degrees C for 28 d, 15 degrees C for 45 d, and 25 degrees C for 26 h. To simulate the conditions that may occur during transportation, distribution, storage, or handling in supermarkets or by consumers, the effect of static temperature abuse on C. perfringens growth was assessed by transferring samples stored at 4 to 25 degrees C for 13 and 15 h. Total C. perfringens populations were determined by plating diluted samples on tryptose-sulfite-cycloserine agar. Growth was not observed up to 45 d of storage at 15 degrees C in samples supplemented with 800 ppm of Citricidal. At 25 degrees C, no significant differences (P > 0.05) on the lag phase duration due to antimicrobial treatments was observed. The temperature abuse of refrigerated products for up to 15 h did not lead to C. perfringens growth to high infective dose levels of 1 million cells required to cause food poisoning. The results suggest that 800 ppm Citricidal can have significant bacteriostatic activity against C. perfringens and may provide a degree of protection against this pathogen in sous-vide processed marinated pork meat Mexican entrée, under mild temperature abuse (

  17. Patients Provide Recommendations for Improving Patient Satisfaction.

    PubMed

    Moore, Angelo D; Hamilton, Jill B; Krusel, Jessica L; Moore, LeeAntoinette G; Pierre-Louis, Bosny J

    2016-04-01

    National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. PMID:27046182

  18. Métastases cutanées vues au laboratoire d'anatomie pathologique à Lomé, Togo entre 2005 et 2014

    PubMed Central

    Darre, Tchin; Saka, Bayaki; Landoh, Dadja Essoya; Mouhari-Toure, Abas; Amegbor, Koffi; Pitché, Palokinam; Napo-Koura, Gado

    2015-01-01

    Introduction L'objectif de cette étude était de documenter le profil épidémiologique et histologique des métastases cutanées vues au laboratoire d'anatomie pathologique (LAP) de Lomé. Méthodes Il s'agissait d'une étude descriptive et transversale portant sur des cas de métastases cutanées observées au LAP du CHU Sylvanus Olympio entre 2005 et 2014. Résultats Au cours de cette période d’étude, nous avons recensé 32 cas de métastases cutanées représentant 3,2% (1005 cas) de l'ensemble des cas de métastases enregistrées au LAP. L’âge moyen des patients atteints de ces métastases cutanées était de 42,6 ans et le sex-ratio (F/H) de 2,2. Sur le plan macroscopique, ces métastases étaient nodulaires dans 15 cas, bourgeonnantes dans 12 cas, ulcéré dans 3 cas et ulcéro-bourgeonnant dans 2 cas. Les types histologiques étaient représentés par les adénocarcinomes (19 cas, 59,4%), les carcinomes épidermoïdes (8 cas, 25%), la maladie de Paget (3 cas, 9,4%), le carcinome à petites cellules du type neuroendocrine (un cas, 3,1%) et le mélanome (un cas, 3,1%). Selon le degré de différenciation, les métastases cutanées étaient bien différenciées dans 14 cas (56%). Les principales localisations de ces métastases cutanées étaient le thorax (11 cas, 34,4%) suivi de l'abdomen (10 cas, 31,3%). Les cancers primitifs étaient surtout d'origine mammaire (14 cas, 43,7%). Conclusion Cette étude montre que les métastases cutanées sont relativement rares et les tumeurs malignes d'origine mammaire sont les tumeurs primitives prédominantes. Avec un pourcentage élevé des formes peu différenciées et celles indifférenciées, l'amélioration du plateau technique du LAP (immunohistochimie) permettra d'accroitre ses capacités diagnostiques. PMID:27047627

  19. Surveying young patients.

    PubMed

    Foster, Theresa; Maillardet, Victoria

    2010-03-01

    The East of England Ambulance Service NHS Trust (the Trust) was keen to engage young patients and to encourage them to give feedback about the service they had received. The standard Trust satisfaction survey was modified for use with young patients, and this had the effect of increasing the response rate from this patient group by 8%, and increasing the percentage of young patients aged 5-10 years completing the survey themselves by 29%. The vast majority of parents/guardians were happy for the Trust to survey their child, but the age of the child affected to whom they would like the survey sent. The Trust subsequently altered patient survey practice to write to parents/guardians of patients aged <12 years and directly to all patients aged > or = 12 years. PMID:20304894

  20. Patient-centered Care.

    PubMed

    Reynolds, April

    2009-01-01

    Patient-centered care focuses on the patient and the individual's particular health care needs. The goal of patient-centered health care is to empower patients to become active participants in their care. This requires that physicians, radiologic technologists and other health care providers develop good communication skills and address patient needs effectively. Patient-centered care also requires that the health care provider become a patient advocate and strive to provide care that not only is effective but also safe. For radiologic technologists, patient-centered care encompasses principles such as the as low as reasonably achievable (ALARA) concept and contrast media safety. Patient-centered care is associated with a higher rate of patient satisfaction, adherence to suggested lifestyle changes and prescribed treatment, better outcomes and more cost-effective care. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your area of interest. For access to other quizzes, go to www.asrt.org/store. According to one theory, most patients judge the quality of their healthcare much like they rate an airplane flight. They assume that the airplane is technically viable and is being piloted by competent people. Criteria for judging a particular airline are personal and include aspects like comfort, friendly service and on-time schedules. Similarly, patients judge the standard of their healthcare on nontechnical aspects, such as a healthcare practitioner's communication and "soft skills." Most are unable to evaluate a practitioner's level of technical skill or training, so the qualities they can assess become of the utmost importance in satisfying patients and providing patient-centered care.(1). PMID:19901351

  1. Melanoma in Immunosuppressed Patients

    PubMed Central

    Kubica, Agnieszka W.; Brewer, Jerry D.

    2012-01-01

    The immunogenic characteristics of malignant melanoma are intriguing. To date, multiple studies exist regarding the immunogenicity of melanoma. In this article, we summarize data in the literature on the role of immunosuppression in melanoma and discuss several immunocompromised patient populations in detail. A comprehensive PubMed search was conducted with no date limitation. The following search terms were used: melanoma in combination with immunosuppression, immunocompromised, genetics, antigen processing, UV radiation, organ transplantation, organ transplant recipients, lymphoproliferative disease, lymphoma, CLL, NHL, radiation, and HIV/AIDS. Although no formal criteria were used for inclusion of studies, most pertinent studies on the topic were reviewed, with the exception of smaller case reports and case series. The included studies were generally large (≥1000 patients in organ transplant recipient studies; ≥500 patients in lymphoma studies), with a focus on institutional experiences, or population-based national or international epidemiologic studies. Melanoma-induced immunosuppression, the role of UV radiation in melanoma development, and the epidemiology, clinical course, and prognosis of melanoma in immunocompromised patients are highlighted. Organ transplant recipients, patients with lymphoproliferative disorders, patients with iatrogenic immunosuppression, and patients with human immunodeficiency virus infection/AIDS are also highlighted. Recommendations are proposed for the care and monitoring of immunosuppressed patients with melanoma. With better understanding of the molecular microenvironment and clinical course of melanoma in immunosuppressed patients, novel therapies could be developed and outcomes potentially affected in these patients. PMID:23036673

  2. Effect of grapefruit seed extract on thermal inactivation of Listeria monocytogenes during sous-vide processing of two marinated Mexican meat entrées

    Technology Transfer Automated Retrieval System (TEKTRAN)

    D and z values of Listeria monocytogenes were obtained for two Mexican meat entrées: pork meat marinated in tomatillo (green tomato) sauce (PTS) and beef marinated in a red chili sauce (BRCS), with addition of 0, 200 and 800 ppm of grapefruit seed extract (GSE). Meat samples, inoculated with L.monoc...

  3. A Process Evaluation of an Efficacious Family-Based Intervention to Promote Healthy Eating: The "Entre Familia: Reflejos de Salud" Study

    ERIC Educational Resources Information Center

    Schmied, Emily; Parada, Humberto; Horton, Lucy; Ibarra, Leticia; Ayala, Guadalupe

    2015-01-01

    "Entre Familia: Reflejos de Salud" was a successful family-based randomized controlled trial designed to improve dietary behaviors and intake among U.S. Latino families, specifically fruit and vegetable intake. The novel intervention design merged a community health worker ("promotora") model with an entertainment-education…

  4. Soil Quality Indicators to Define Land Use in the Area of Native Forest of Entre Ríos, Argentina

    NASA Astrophysics Data System (ADS)

    Wilson, M. G.; Tasi, H. A.; Paz González, A.; Díaz, E. L.; Sasal, M. C.

    2012-04-01

    The main economic activity in the area of native forest of the province of Entre Ríos (Argentina) has long been the agricultural and/or livestock production, especially cattle breeding. In recent years, the proportion of agricultural crops in the rotations, especially that of soybean, has increased, thus leading to an increase in the need for land clearing to incorporate new lands for agricultural use. Most of these lands are considered marginal for agricultural use. In addition rice farming with irrigation is a critical part of the Entre Ríos economy. Defining and assessing soil quality indicators (SQI) that show the evolution of the soil with different uses and management systems is a way to contribute to the knowledge of soil quality. The aims of this study were to characterize the current land use and land tenure in the area of native forest of Entre Ríos, as well as to identify and select variables sensitive to agricultural and/or livestock use of the most representative soils of this area (indicators of the dynamic quality of the soil) and define the most appropriate land use according to land suitability and behavior of these indicators. We identified the most representative soil subgroups (corresponding to the orders Vertisols, Mollisols and Alfisols) and defined the production systems livestock-agricultural, agricultural-livestock, agricultural without irrigation, and rice crop irrigated with water from groundwater and surface reservoirs. We also determined the physical, physico-chemical, chemical and microbiological variables of the soil, and characterized the quality of the water for irrigation. We selected the SQI using Principal Components Analysis, to form a minimum data set (MDS). The change in the use of the land responded to a favorable economic situation for agriculture that started in the 1990's. The leasing and sharecropping schemes and the incidental contracts have become increasingly important, predominating over the undivided property. We

  5. Patient-doctor communication.

    PubMed

    Teutsch, Carol

    2003-09-01

    Communication is an important component of patient care. Traditionally, communication in medical school curricula was incorporated informally as part of rounds and faculty feedback, but without a specific or intense focus on skills of communicating per se. The reliability and consistency of this teaching method left gaps, which are currently getting increased attention from medical schools and accreditation organizations. There is also increased interest in researching patient-doctor communication and recognizing the need to teach and measure this specific clinical skill. In 1999, the Accreditation of Council for Graduate Medical Education implemented a requirement for accreditation for residency programs that focuses on "interpersonal and communications skills that result in effective information exchange and teaming with patients, their families, and other health professionals." The National Board of Medical Examiners, Federation of State Medical Boards. and the Educational Commission for Foreign Medical Graduates have proposed an examination between the. third and fourth year of medical school that "requires students to demonstrate they can gather information from patients, perform a physical examination, and communicate their findings to patients and colleagues" using standardized patients. One's efficiency and effectiveness in communication can be improved through training, but it is unlikely that any future advances will negate the need and value of compassionate and empathetic two-way communication between clinician and patient. The published literature also expresses belief in the essential role of communication. "It has long been recognized that difficulties in the effective delivery of health care can arise from problems in communication between patient and provider rather than from any failing in the technical aspects of medical care. Improvements in provider-patient communication can have beneficial effects on health outcomes". A systematic review of

  6. [Two patients with mumps].

    PubMed

    van Brummelen, S E; de Vries, E; Schneeberger, P M; van Binnendijk, R S; Lestrade, P; Wever, P C

    2006-08-01

    Two patients, men aged 17 and 19 years respectively, were admitted with parotitis epidemica and orchitis caused by mumps. The second patient also had meningitis. PCR analysis revealed that, in both cases, the causative agentwas a mumps virus that was genetically related to a wild-type virus responsible for an outbreak in Singapore. This viral strain was also responsible for a mumps outbreak at Hotel School The Hague in September 2004. Both patients were not fully vaccinated. Both patients were from regions in which clustering of patients with clinical signs of mumps has been seen. Interestingly, a number of patients with confirmed mumps had been fully vaccinated. Possible explanations for the increase in mumps cases include low vaccination and immunity levels, primary and secondary vaccine failure and the emergence of genetically disparate mumps viruses. PMID:16924947

  7. Patient Education: An Annotated Bibliography.

    ERIC Educational Resources Information Center

    Simmons, Jeannette

    Topics included in this annotated bibliography on patient education are (1) background on development of patient education programs, (2) patient education interventions, (3) references for health professionals, and (4) research and evaluation in patient education. (TA)

  8. State of Conservation of the Native Forests in Entre Ríos (Argentina) and Changes in Land Use

    NASA Astrophysics Data System (ADS)

    Sabattini, R. A.; Sione, S. M.; Ledesma, S. G.; Sabattini, J. A.; Wilson, M. G.

    2012-04-01

    The native forest area of Entre Ríos province (Argentina) is associated with a constant change in land use, with an increase in recent years in agricultural use, especially for soybean crop. In addition, since its inadequate management has triggered degradation processes of the natural forest structure, the implementation of strategies for the restoration and conservation of native forests has become a priority. The aim of this study was to diagnose the conservation state of the native forest in the basin of the Estacas Stream (Entre Ríos, Argentina) after the change in land use, to help design guidelines for the restoration and sustainable management of these ecosystems. The field study was conducted in October 2010, in a representative area of the native forest of 73,000 ha. Using Landsat 5-TM images (INPE), environments were separated by manual vectorization, identifying and classifying native forests and other lands (agricultural, urban). Using a field exploratory survey (58 geo-referenced sampling points), we developed patterns corresponding to the different types of forests, contrasting this information with the digital data of the images. The native forests were classified according to type (high/low forest, open/closed forest, savanna), successional stage (climax, successional or regeneration forest) and degree of disturbance (weed growth, erosion, fire), and their frequency determined. Each classification was assessed by a contingency matrix, and global reliability index and the Kappa index. The information obtained generated a classification map of native forests in the basin scale. We found that the native forest covered an area of 42,726.91 ha, accounting for 58.52% of the total basin area, and that the rest corresponded to other land uses. The most frequent native forests (59.09%) were climax forest, but accounted for only 8.2% of the basin area. Within this group, the most important were the low and open forest, with Prosopis affinis and Prosopis

  9. Physicians as Patient Teachers

    PubMed Central

    Brunton, Stephen A.

    1984-01-01

    Physicians have a central role in educating patients and the public in the elements of personal health maintenance. To be an effective teacher, one must recognize the learning needs of each patient and use methods of information transfer that will result in comprehension and compliance. To bring about a change in life-style, one must also have an understanding of a patient's health beliefs and the determinants of human behavior. Using this information together with behavior modification strategies, physicians can forge an effective partnership with patients working toward the goal of optimum health. PMID:6395500

  10. The critically ill immunosuppressed patient

    SciTech Connect

    Parrillo, J.E.; Masur, H. )

    1987-01-01

    This book discusses the papers on the diagnosis and management of immunosuppressed patient. Some of the topics are: life-threatening organ failure in immunosuppressed patients; diagnosis and therapy of respiratory disease in the immunosuppressed patient; CNS complication of immunosuppression; infections; antineoplastic therapy of immunosuppressed patient; radiation therapy-issues in critically ill patient; AIDS; and management of bone marrow transplant patients.

  11. Patient Education Thesaurus.

    ERIC Educational Resources Information Center

    Cooper, Lynn

    This thesaurus was compiled to make the materials in the Patient Education Room of the Donald J. Vincent Medical Library at Riverside Methodist Hospital, Columbus, Ohio, more accessible to patients. Subjects are grouped in fairly broad categories (e.g., Aging & Problems of Aging; Alcohol & Alcohol Abuse; Careers in the Medical Field; Childhood and…

  12. National Patient Safety Foundation

    MedlinePlus

    ... 9/27/2016 NPSF Professional Learning Series Webcast: Health Literacy: Improving Patient Understanding 9/29/2016 Certified Professional in Patient Safety Review Course Webinar 10/4/2016 NPSF Webcast: Implementing RCA2: Lessons from the Trenches: Aurora Health ... In Remember Me Forgot your password? ...

  13. Patient Education in Thyrotoxicosis.

    ERIC Educational Resources Information Center

    Lincoln, N. B.; Sturrock, N. D. C.; Sowter, H.; Abbott-Harland, S.; Nichols, E.; Jeffcoate, W. J.

    2000-01-01

    Study aims to assess the need for a thyrotoxicosis patient education programs and evaluates a group education session. Patients with thyrotoxicosis were surveyed to assess their needs. Determined that people with thyrotoxicosis had limited knowledge about their condition. The offer of a group education program has little effect on that knowledge…

  14. Communicating with patients.

    PubMed

    Kaplowitz, G J

    1999-01-01

    Dental care providers need to be able to communicate effectively with their patients in order to build rapport and trust. Highly developed communication skills also enable the dental care provider to extract more accurate diagnostic information and to more effectively present treatment options to the patient. Neurolinguistic programming techniques can be employed to accomplish these as well as other objectives. PMID:10687469

  15. Five things patients want.

    PubMed

    Camahort, Elisa

    2006-01-01

    Many in the healthcare industry think it's inevitable that we're heading toward consumer-directed healthcare (CDHC). For CDHC to work, it will require more of a partnership between doctors and patients than ever before. The author offers key ways doctors and their staffs can respect the time and intelligence of their partners in health--their patients. PMID:16711095

  16. A Patient Assessment Guide

    ERIC Educational Resources Information Center

    Fuller, Dorothy; Rosenaur, Janet Allan

    1974-01-01

    Use of a nursing assessment/patient history tool developed by project faculty at the school of nursing, University of California, San Francisco and used in a primary care clinic assisted nursing students in collecting patient information, making home visits, functioning as team members, recording data, and in defining their nursing role. (EA)

  17. Caring for transgender patients.

    PubMed

    Abebe, Alyssa

    2016-06-01

    Clinicians need a better understanding of transgender populations and a systematic approach to treating transgender patients medically and psychologically while managing any potential judgment or bias. This article explains key concepts, describes transgender patient health concerns, and discusses how to perform a comprehensive history. PMID:27228044

  18. The Patient as Teacher.

    ERIC Educational Resources Information Center

    Weisser, Roland J.; Medio, Franklin J.

    1985-01-01

    A program of seminars designed to explore student perceptions of the emotional and psychological aspects of physician-patient interactions, part of a clinical diagnosis course, used graduate medical students to act as patients in videotaped interviews, interview evaluations, and lectures and demonstrations on interpersonal communication skills.…

  19. Measuring improved patient choice.

    PubMed

    Holmes-Rovner, M; Rovner, D R

    2000-08-01

    Patient decision support (PDS) tools or decision aids have been developed as adjuncts to the clinical encounter. Their aim is to support evidence-based patient choice. Clinical trials of PDS tools have used an array of outcome measures to determine efficacy, including knowledge, satisfaction, health status and consistency between patient choice and values. This paper proposes that the correlation between 'subjective expected utility' (SEU) and decision may be the best primary endpoint for trials. SEU is a measure usually used in behavioural decision theory. The paper first describes how decision support tools may use decision analysis to structure the presentation of evidence and guide patient decision-making. Uses of expected utility (EU) are suggested for evaluating PDS tools when improving population health status is the objective. SEU is the theoretically better measure when internal consistency of patient choices is the objective. PMID:11083037

  20. Issues with dying patients.

    PubMed

    Valent, P

    1978-04-22

    Doctors have the privilege of looking after patients from the moment of birth to the moment of death. Yet, the holistic approach to patients is interfered with by the doctor's role as a warrior against death, where death's everpresent claim on our lives, and its final victory, are ignored. This paper attempts to explore why doctors are in their current position, the mechanisms for ignoring death which are shared by doctors and patients, the nature of the fear of death, and practical implications for the treatment of dying patients. More and more patients die now in medical settings. It is incumbent on doctors to understand the dying process, if much unnecessary suffering is to be prevented. PMID:661717

  1. Doctor-patient relationship

    PubMed Central

    Chamsi-Pasha, Hassan; Albar, Mohammed A.

    2016-01-01

    The doctor-patient relationship is an intricate concept in which patients voluntarily approach a doctor and become part of a contract by which they tend to abide by doctor’s instructions. Over recent decades, this relationship has changed dramatically due to privatization and commercialization of the health sector. A review of the relevant literature in the database of MEDLINE published in English between 1966 and August 2015 was performed with the following keywords: doctor-patient relationship, physician-patient relationship, ethics, and Islam. The Muslim doctor should be familiar with the Islamic teachings on the daily issues faced in his/her practice and the relationship with his/her patients. PMID:26837392

  2. [Physiotherapy of cancer patients].

    PubMed

    Gomez, Izabella; Szekanecz, Éva; Szekanecz, Zoltán; Bender, Tamás

    2016-07-01

    Physiotherapy of cancer patients is one of the most controversial issues in our country. Malignant diseases are firstly mentioned as a contraindication of physiotherapy. Until now, physiotherapy was not suggested (or only in limited accessibility) for those patients who had malignant disease in medical history. International medical practice was less restrictive in managing this topic. The development of imaging techniques put this question in a new light. On the basis of evidence, the majority of articles have reported beneficial effects of physiotherapy in cancer patients, and only few articles mentioned it as harmful. Of course, each patient requires an individual assessment, however, if we exclude the possibility of tumor recurrence and metastasis, most of physiotherapy procedures can be used safely. One of the aims of this review is to support the physicians' decisions when to prescribe treatments, in such a way, that more patients could receive physiotherapy. Orv. Hetil., 2016, 157(31), 1224-1231. PMID:27476518

  3. Approach to bleeding patient

    PubMed Central

    Gopinath, Ramachandran; Sreekanth, Y.; Yadav, Monu

    2014-01-01

    Managing a bleeding patient is very challenging for the perioperative physician. Bleeding in a patient would be due to inherited or acquired disorders of haemostasis. Identifying the patients at risk of bleeding and utilising prophylactic treatment protocols has good outcomes. Along with clinical signs, trends in monitoring coagulation parameters and analysing blood picture are necessary. Management of patients in the postoperative period and in intensive care unit should be focused on normalization of coagulation profile as early as possible with available blood and its products. Available recombinant factors should be given priority as per the approved indications. Exploring the surgical site should be considered for persistent bleeding because haemodynamic compromise, excessive transfusion of fluids, blood and its products and more inotropic support may have a negative impact on the patient outcome. PMID:25535422

  4. Patients living with disabilities

    PubMed Central

    Lofters, Aisha; Guilcher, Sara; Maulkhan, Niraj; Milligan, James; Lee, Joseph

    2016-01-01

    Objective To compare the potential risk factors for lower-quality primary care, the potential markers of unmet needs in primary care, and the willingness to participate in future research among primary care patients with versus without physical disabilities. Design A waiting room survey using a convenience sample. Setting A family health team (FHT) in Kitchener-Waterloo, Ont, with a designated Mobility Clinic. Participants A total of 40 patients seen at the FHT Mobility Clinic and 80 patients from the general patient population of the same FHT. Main outcome measures Socioeconomic status and social capital, number of self-reported emergency department visits and hospitalizations in the preceding year, and willingness of the patients in the 2 groups to participate in future research studies. Results Patients from the Mobility Clinic were more than twice as likely to be receiving benefits or social assistance (75.0% vs 32.1%, P < .001), were twice as likely to report an annual household income of less than $40000 (58.6% vs 29.2%, P = .006), and were more likely to report their health status to be fair or poor (42.5% vs 16.2%, P = .002). Half of Mobility Clinic patients had visited the emergency department at least once in the preceding year, compared with 29.7% in the general patient population (P = .027). When asked if they would be willing to provide their health card number in the future so that it could be linked to health care data for research, 82.5% of Mobility Clinic patients agreed versus 55.0% of those in the general patient population (P = .004). Conclusion In this study, patients with disabilities were at a social disadvantage compared with their peers without disabilities and were more likely to use the emergency department, suggesting that they had unmet health needs. Future research should continue to explore this patient population and to investigate if an interprofessional primary health care team approach focused on patients with disabilities can

  5. Nutrition in dialysis patients.

    PubMed

    Sen, D; Prakash, J

    2000-07-01

    Malnutrition is a common clinical problem in dialysis patients, which is multifactorial in origin. It is most often found in a patient of chronic renal failure (CRF) during the period when the glomerular filtration rate (GFR) falls below 10 ml/min, but dialysis is yet to be started. The loss of proteins, aminoacids and other essential nutrients during the procedure of dialysis may further aggravate the malnutrition. Poor nutrition in dialysis patients is associated with increased morbidity and mortality in the form of delayed wound healing, malaise, fatigue, increased susceptibility to infection and poor rehabilitation. In view of the above consequences, all patients on dialysis must undergo nutritional assessment. It is very vital to maintain good nutritional status in-patients on dialysis by adequate protein and calories intake, appropriate supplementation of iron, calcium, minerals and water-soluble vitamins and, of course, the supplementation should be individualised. Nutritional needs are enhanced in presence of stresses like infection or surgery to limit excessive tissue catabolism and therefore, these are the situations, which demand intensive nutrition therapy. Total parenteral nutrition (TPN) may be required for patients on dialysis in intensive care unit, using a central venous catheter. However, enteral route is always preferred to parenteral ones, whenever possible. Even after adequate dialysis has been given, dietary counselling is often required for both hemodialysis and peritoneal dialysis patients to ensure that they ingest the recommended amount of protein, calories and essential micronutrients. PMID:11273510

  6. Do patients have duties?

    PubMed Central

    Evans, H M

    2007-01-01

    The notion of patients' duties has received periodic scholarly attention but remains overwhelmed by attention to the duties of healthcare professionals. In a previous paper the author argued that patients in publicly funded healthcare systems have a duty to participate in clinical research, arising from their debt to previous patients. Here the author proposes a greatly extended range of patients' duties grounding their moral force distinctively in the interests of contemporary and future patients, since medical treatment offered to one patient is always liable to be an opportunity cost (however justifiable) in terms of medical treatment needed by other patients. This generates both negative and positive duties. Ten duties—enjoining obligations ranging from participation in healthcare schemes to promoting one's own earliest recovery from illness—are proposed. The characteristics of these duties, including their basis, moral force, extent and enforceability, are considered. They are tested against a range of objections—principled, societal, epistemological and practical—and found to survive. Finally, the paper suggests that these duties could be thought to reinforce a regrettably adversarial characteristic, shared with rights‐based approaches, and that a preferable alternative might be sought through the (here unexplored) notion of a “virtuous patient” contributing to a problem‐solving partnership with the clinician. However, in defining and giving content to that partnership, there is a clear role for most, if not all, of the proposed duties; their value thus extends beyond the adversarial context in which they might first be thought to arise. PMID:18055897

  7. The medically compromised patient.

    PubMed

    Parnell, A G

    1986-06-01

    Diabetes mellitus is found in up to 5 per cent of the population. There is an excess of blood sugar due to a deficiency or diminished effectiveness of insulin. It is a complex disease which, if not controlled, has many major complications including an increased incidence of heart attacks, strokes and vascular changes in many other organs. The management of young onset diabetic patients is directed towards: controlling the carbohydrate intake, testing the blood sugar by the patient and regular insulin injections. Great care must be taken in treating diabetics in the dental surgery. Except for children, any diabetic can be treated for simple dental procedures by ensuring freedom from pain, by eliminating stress and by ensuring that the patient does not miss a meal. Children, unstable diabetic patients and those with infections or requiring multiple extractions should be treated in hospital under the care of an endocrinologist. In hypertension it is only after a number of years that complications begin to appear. The main ones are those of stroke, retinal haemorrhages, renal failure and heart disease. Dentists should be encouraged to take the blood pressure of all adults who present for treatment. Patients with increased blood pressure yet controlled by drugs may be treated as normal patients. Those that are not well controlled should be referred to their physician. Dental appointments must be free of pain and stress should be avoided. A screening method is presented which assists in the evaluation of medically compromised patients. PMID:2941377

  8. Respecting patient confidentiality.

    PubMed

    Price, Bob

    2015-02-01

    Nurses face a particular challenge in respecting the confidentiality of patients in a world where information is quickly shared and where information about illness can be sensitive. We have a duty of care towards patients. That duty includes maintaining privacy (protecting them from undue intrusion), and confidentiality (by the discreet management of information about themselves that they share with us). Legislation on confidentiality comes from different sources and should be interpreted in the clinical setting. This article summarises the principal requirements set out in the legislation and directs readers to questions and tools designed to help them explore the extent to which patient confidentiality is respected where they work. PMID:25627535

  9. On acoplamento mecânico entre a antena e o transdutor no detector de ondas gravitacionais Mario Schenberg

    NASA Astrophysics Data System (ADS)

    Melo, J. L.; Aguiar, O. D.; Velloso, W. F., Jr.; Lucena, A. U.

    2003-08-01

    O detector de ondas gravitacionais MARIO SCHENBERG consistirá de uma massa esférica de cobre-alumínio de 1150kg resfriada a 4K, sobre a qual serão instalados 6 transdutores de nióbio. Com estes trandutores pretende-se converter um possível sinal de onda gravitacional detectado em sinal elétrico, para tanto é necessário que o acoplamento mecânico entre os transdutores e a massa ressonante seja o maior possível. Isto significa que o transdutor deve ser ressonante na mesma freqüência que a antena (aproximadamente 3200Hz). Neste trabalho foi desenvolvida uma geometria para a estrutura mecânica do trandutor. Isto foi feito criando-se modelos em elementos finitos usando-se o "software" MSC/Nastran. Estes modelos criados foram analisados estaticamente (cálculo de tensões) e dinamicamente (cálculo das freqüências de ressonâncias e seus respectivos modos normais) de maneira a se obter o primeiro modo normal do transdutor em 3200Hz. A partir destes cálculos escolheu-se a melhor geometria para o transdutor. Os próximos passos do trabalho serão: usinar este transdutor em uma barra de nióbio e testá-lo à temperatura ambiente e à baixa temperatura. Após isto, pretende-se testá-lo na própria antena resfriada.

  10. Doctors and patients.

    PubMed

    Gillon, R

    1986-02-15

    Gillon outlines some prima facie moral duties of physicians to patients that have emerged from his previous articles in a series on philosophical medical ethics. These duties follow from four general ethical principles--respect for autonomy, beneficence, non-maleficence, and justice--plus the self-imposed supererogatory duty of medical beneficence. From these principles the author derives such duties as providing adequate information and advice on treatment options, encouraging patient participation leading to informed decisions, maintaining competence and exposing incompetence, admitting errors, disclosing personal medico-moral standards, and acknowledging that other interests may occasionally supersede those of the individual patient. Gillon concludes that, where self interest conflicts with medical beneficence, the claim of medicine as a profession requires that the patient's interests take priority. PMID:3081128

  11. Why make people patients?

    PubMed Central

    Marinker, Marshall

    1975-01-01

    People confront their doctors with three modes of unhealth - disease, illness and sickness. Each is discussed, and the question is asked and answered as to why in this situation people wish to become patients. PMID:1177270

  12. Psychiatric patient and anaesthesia

    PubMed Central

    Attri, Joginder Pal; Bala, Neeru; Chatrath, Veena

    2012-01-01

    Many patients with psychiatric illnesses are prescribed long-term drug treatment, and the anaesthesiologist must be aware of potential interactions with anaesthetic agents. Psychotropic drugs often given in combination with each other or with other non-psychiatric drugs generally exert profound effects on the central and peripheral neurotransmitter and ionic mechanisms. Hence, prior intake of these drugs is an important consideration in the management of the patient about to undergo anaesthesia and surgery. This article highlights the effects of anaesthetics on patients taking antipsychotics, tricyclic antidepressants, monoamine oxidase inhibitors and lithium carbonate. The risk that should be considered in the perioperative period are the extent of surgery, the patient's physical state, anaesthesia, the direct and indirect effects of psychotropics, risk of withdrawal symptoms and risk of psychiatric recurrence and relapse. PMID:22529413

  13. Appendicitis in mature patients.

    PubMed Central

    Burns, R P; Cochran, J L; Russell, W L; Bard, R M

    1985-01-01

    All patients greater than 50 years of age (N = 96) admitted with a pre- or postoperative diagnosis of acute appendicitis from 1971 to 1980 were reviewed. A comparative series of 91 patients aged 25 to 50 years was similarly reviewed. Noninflammatory diseases of the appendix and incidental appendectomies were excluded. Detailed study of symptoms, clinical presentation, laboratory evaluation, radiographic evaluation, concomitant diseases, hospital course, surgical findings, complications, and mortality were completed. Comparison of patients aged 25 to 50 to patients older than 50 years revealed a statistically significant increased incidence of perforation in the older group (p less than 0.0001). Sixty-five per cent of the older group showed greater incidence of perforation. Further analysis of this series yields the hypothesis that the increased incidence of perforation is related to a significant decrease in the frequency of classic presentation in the greater-than-50 age group, a significant decrease in frequency of correct admission diagnosis and a significant delay between admission and surgical procedure in the older group. A more rapid pathophysiologic progression of appendicitis with increasing age was noted. A much higher percentage of older patients was undiagnosed until the surgical procedure. In this group, there was a longer duration of symptoms, less frequent classic presentation, and decreased frequency of right lower quadrant guarding and tenderness as compared to patients with correct diagnosis prior to surgery. Complications were much more frequent in older patients and higher still in those with perforation. Analysis of findings by decade of life revealed an anticipated high incidence of perforated appendicitis in patients greater than 50, but also showed a continuation of the high incidence of perforation into the decade 40 to 50. There were three deaths in the entire study group (1.6%) all occurring in the older age group with postoperative

  14. [Patients' Rights Act].

    PubMed

    Haier, A J

    2016-09-01

    The new Patients' Rights Act does not reflect rights of patients as professional obligations of physicians for the first time. It adopted common longtime jurisdiction, but in some respects it is going beyond. This law clearly extended the documentation requirements of physicians, especially concerning the extent of documentation. In surgical fields the requirements for enlightening physicians were more strongly worded than in previous jurisdiction. In medical facilities it is now mandatory to establish an internal quality management system. PMID:27626814

  15. Depression in dialysis patients.

    PubMed

    King-Wing Ma, Terry; Kam-Tao Li, Philip

    2016-08-01

    Depression is the most common psychiatric illness in patients with end-stage renal disease (ESRD). The reported prevalence of depression in dialysis population varied from 22.8% (interview-based diagnosis) to 39.3% (self- or clinician-administered rating scales). Such differences were attributed to the overlapping symptoms of uraemia and depression. Systemic review and meta-analysis of observational studies showed that depression was a significant predictor of mortality in dialysis population. The optimal screening tool for depression in dialysis patients remains uncertain. The Beck Depression Inventory (BDI), Patient Health Questionnaire (PHQ) and Center for Epidemiologic Studies Depression Scale (CESD) have been validated for screening purposes. Patients who scored ≥14 using BDI should be referred to a psychiatrist for early evaluation. Structured Clinical Interview for DSM disorders (SCID) remains the gold standard for diagnosis. Non-pharmacological treatment options include cognitive behavioural therapy and exercise training programs. Although frequent haemodialysis may have beneficial effects on patients' physical and mental well-being, it cannot and should not be viewed as a treatment of depression. Selective serotonin reuptake inhibitors (SSRIs) are generally effective and safe in ESRD patients, but most studies were small, non-randomized and uncontrolled. The European Renal Best Practice (ERBP) guideline suggests a trial of SSRI for 8 to 12 weeks in dialysis patients who have moderate-major depression. The treatment effect should be re-evaluated after 12 weeks to avoid prolonging ineffective medication. This review will discuss the current understanding in the diagnosis and management of depression in dialysis patients. PMID:26860073

  16. Restraining potentially violent patients.

    PubMed

    Splawn, G

    1991-10-01

    People who are emotionally distraught or mentally ill are rarely predictable. A calm, reassuring, but firm and decisive manner is most effective in dealing with out-of-control patients. Staff members should be careful to never position themselves with a potentially violent or distraught patient between them and the door. A room should be emptied of all extraneous, potentially dangerous objects before restraint of a patient. A clear plan of what is to be done and who is to do what is necessary. All staff members should remove glasses, pens, scissors, and other items that are potential weapons before restraining a patient. A humane attitude when restraining patients is extremely important. Sometimes the attitude of those applying restraints can be more traumatic than the actual application of the restraints. It is important that staff members remember that patients who need restraint are not "bad" people. For whatever reason, they have lost the ability to control themselves. These people do not like being out of control; given a choice, they would choose not to be. The staff attitude during this stressful event, which is becoming all too common in the emergency department, can have a tremendous effect on patients who require this procedure. When a patient is restrained in a competent, humane manner, staff members can pride themselves on their skills in dealing successfully with this emergency, just as they can when dealing with a cardiac arrest. Finally, it has been said that you cannot truly understand what another person is going through until you have had the same experience yourself.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1921070

  17. [Patient safety: Glossary].

    PubMed

    Sabio Paz, Verónica; Panattieri, Néstor D; Cristina Godio, Farmacéutica; Ratto, María E; Arpí, Lucrecia; Dackiewicz, Nora

    2015-10-01

    Patient safety and quality of care has become a challenge for health systems. Health care is an increasingly complex and risky activity, as it represents a combination of human, technological and organizational processes. It is necessary, therefore, to take effective actions to reduce the adverse events and mitigate its impact. This glossary is a local adaptation of key terms and concepts from the international bibliographic sources. The aim is providing a common language for assessing patient safety processes and compare them. PMID:26294153

  18. Patient care in radiography

    SciTech Connect

    Ehrlich, R.A.; McCloskey, E.D.

    1989-01-01

    This book focuses on patient care procedures for radiographers. The authors focus on the role of the radiographer as a member of the health care team. The authors report on such topics as communication in patient care: safety, medico-legal considerations, transfer and positioning; physical needs; infection control; medication; CPR standards, acute situations; examination of the GI tract; contrast media; special imaging techniques and bedside radiography.

  19. Keeping the patient happy.

    PubMed

    Bomar, F

    1992-01-01

    Customer service is the catch word for the 90s and hospitals are constantly looking for ways to make their customer--the patient--happier. In a section of the country where fried chicken, grits and gravy are home-cooking staples, an unlikely marriage between Southern hospitals and a European food preparation process may be the key to many hospitals' ability to cater to the patient by offering gourmet meals on a regular basis. PMID:10120396

  20. White coat, patient gown.

    PubMed

    Wellbery, Caroline; Chan, Melissa

    2014-12-01

    Much has been written about the symbolic function of the white coat: its implications of purity, its representation of authority and professionalism, and its role in consolidating a medical hierarchy. By contrast, the medical literature has paid almost no attention to the patient gown. In this article, we argue that in order to understand the full implications of the white coat in the doctor-patient relationship, we must also take into account patients' dress, and even undress. We explore contemporary artistic images of white coat and patient gown in order to reveal the power differential in the doctor-patient relationship. Artistic representations capture some of the cultural ambivalence surrounding the use of the white coat, which confers professional status on its wearer, while undermining his or her personal identity. At the other end of the sartorial spectrum, hospital gowns also strip wearers of their identity, but add to this an experience of vulnerability. Although compelling reasons for continuing to wear the white coat in circumscribed settings persist, physicians should be mindful of its hierarchical implications. Ample room remains for improving patients' privacy and dignity by updating the hospital gown. PMID:24687912

  1. Half-size me? How calorie and price information influence ordering on restaurant menus with both half and full entrée portion sizes.

    PubMed

    Haws, Kelly L; Liu, Peggy J

    2016-02-01

    Many restaurants are increasingly required to display calorie information on their menus. We present a study examining how consumers' food choices are affected by the presence of calorie information on restaurant menus. However, unlike prior research on this topic, we focus on the effect of calorie information on food choices made from a menu that contains both full size portions and half size portions of entrées. This different focus is important because many restaurants increasingly provide more than one portion size option per entrée. Additionally, we examine whether the impact of calorie information differs depending on whether full portions are cheaper per unit than half portions (non-linear pricing) or whether they have a similar per unit price (linear pricing). We find that when linear pricing is used, calorie information leads people to order fewer calories. This decrease occurs as people switch from unhealthy full sized portions to healthy full sized portions, not to unhealthy half sized portions. In contrast, when non-linear pricing is used, calorie information has no impact on calories selected. Considering the impact of calorie information on consumers' choices from menus with more than one entrée portion size option is increasingly important given restaurant and legislative trends, and the present research demonstrates that calorie information and pricing scheme may interact to affect choices from such menus. PMID:26654889

  2. [Urosepsis in Geriatric Patients].

    PubMed

    Heppner, H J; Yapan, F; Wiedemann, A

    2016-02-01

    Due to the demographic shift, increasing numbers of geriatric patients are admitted to acute care hospitals of all levels of care. This means that special challenges must be met in the medical care and management of these patients.Immunosenescence and multimorbidity make elderly patients vulnerable to infectious diseases. Urinary tract infections range from "simple" cystitis to pyelonephritis and urosepsis and, at 25%, are the second most common form of infection in geriatric patients. It is often difficult to make a diagnosis because typical symptoms do not always occur. Urosepsis, a hyperactive and uncontrolled immune response of the organism due to exogenous damage, is based on bacterial infection of the urogenital tract. Urinary retention, immunosuppressive medication, malignancy, diabetes mellitus and renal or prostatic processes promote the risk for urosepsis. Complicated urosepsis additionally comprises a structural or functional abnormality, including ureteral obstruction. Risk factors for urosepsis are urinary incontinence, an indwelling urinary catheter, hydronephrosis or ureteral calculi. Patients suffering from diabetes mellitus are also at a higher risk for urosepsis. When diagnosing elderly patients, one has to consider that the classic symptoms can be masked by multimorbidity, or septic encephalopathy and acute confusion (delirium) may be the only symptoms. Body temperature is lower in elderly patients and does not necessarily rise to 38°C or more in the acute phase. In patients older than 75 years who are suspicious for sepsis, temperatures as low as 37.4°C should be rated as fever. Treatment of urosepsis basically includes clearing the focus, antimicrobial treatment, stabilisation of circulation and replacement of failed organ functions. Initial empiric antibiotic treatment, depending on local resistance, should be done with acylaminopenicilline and beta-lactamase inhibitors (e. g. piperacillin/combactam or tazobactam or group 3 cephalosporins

  3. The patient's view.

    PubMed

    Rachagan, S S; Sharon, K

    2003-03-01

    The medical practitioner has always had to juggle several roles. First and foremost, the doctor is a healer, a provider of curative services. Second, he is an examiner, an assessor of the patient's health status. Third, he is a researcher, always trying to push the boundaries of medical knowledge. Fourth, he is a rationer of services, he decides how best to apportion the limited resources at his disposal. Traditionally, the patient-doctor relationship has been largely exclusive in nature and the doctor would quite comfortably slip in and out of these roles, his focus centred on his patient's interests. In this era of large corporate health care providers, multi-billion-biotechnology industry, mammoth pharmaceutical companies, medical insurance schemes and international trade instruments, it has become increasingly difficult for the doctor to juggle these four roles. He is constantly subjected to conflicting demands. Patients' interests do not always come first anymore and patients are beginning to realise this. They no longer trust the medical profession unreservedly. There has been steady erosion of the patient-doctor relationship most clearly evidenced by the rising tide of litigation against doctors. There needs to be a reappraisal of these roles that the doctor plays. The conflicts must be recognised and addressed. Patients need to be informed and their interests must be protected if the doctor-patient relationship is to be restored. Medical malpractice suits are on the increase. The tort system as it exists is failing both doctors and patients. The question we must ask is what are patients looking for when they sue doctors? Most of the time they need compensation for the injuries suffered. Sometimes they are looking for accountability, they want the doctor to be punished in some way. Sometimes they merely want to air their grievances and know that they are heard. The current system more often than not takes too long to compensate, the process is a gamble and

  4. Plastic Surgery for Ethnic Patients

    MedlinePlus

    ... Briefing Papers > Plastic Surgery for Ethnic Patients Briefing Paper: Plastic Surgery for Ethnic Patients More than 3. ... 2067-2071. Share Related Links Plastic Surgery Briefing Papers Menu Cosmetic Reconstructive Patient Safety Before & After Find ...

  5. Choosing effective patient education materials

    MedlinePlus

    ... to overcome a fear before being open to teaching. Respect the patient's limits. Offer the patient only ... deliver patient education. Examples include one-on-one teaching, demonstrations, and analogies or word pictures to explain ...

  6. Choosing effective patient education materials

    MedlinePlus

    Your patient's preferences can guide your choice of education materials and methods. Find out how your patient ... aware that you may need to adjust your education plan based on the patient's health status and ...

  7. Endoscopy in the obese patient.

    PubMed

    Schreiner, Mitchal A; Fennerty, M Brian

    2010-03-01

    Obese patients present many unique challenges to the endoscopist. Special consideration should be given to these patients, and endoscopists need to be aware of the additional challenges that may be present while performing endoscopic procedures on obese patients. This article reviews the special risks that obese patients face while undergoing endoscopy, endoscopic management of patients postbariatric surgery, and future role of endoscopy in the management of obese patients. PMID:20202582

  8. Mastocytosis among elderly patients

    PubMed Central

    Rouet, Audrey; Aouba, Achille; Damaj, Gandhi; Soucié, Erinn; Hanssens, Katia; Chandesris, Marie-Olivia; Livideanu, Cristina Bulai; Dutertre, Marine; Durieu, Isabelle; Grandpeix-Guyodo, Catherine; Barète, Stéphane; Bachmeyer, Claude; Soria, Angèle; Frenzel, Laurent; Fain, Olivier; Grosbois, Bernard; de Gennes, Christian; Hamidou, Mohamed; Arlet, Jean-Benoit; Launay, David; Lavigne, Christian; Arock, Michel; Lortholary, Olivier; Dubreuil, Patrice; Hermine, Olivier; Georgin-Lavialle, Sophie

    2016-01-01

    Abstract Mastocytosis is a heterogeneous group of diseases with a young median age at diagnosis. Usually indolent and self-limited in childhood, the disease can exhibit aggressive progression in mid-adulthood. Our objectives were to describe the characteristics of the disease when diagnosed among elderly patients, for which rare data are available. The French Reference Center conducted a retrospective multicenter study on 53 patients with mastocytosis >69 years of age, to describe their clinical, biological, and genetic features. The median age of our cohort of patients was 75 years. Mastocytosis variants included were cutaneous (n = 1), indolent systemic (n = 5), aggressive systemic (n = 11), associated with a hematological non-mast cell disease (n = 34), and mast cell leukemia (n = 2). Clinical manifestations were predominantly mast cell activation symptoms (75.5%), poor performance status (50.9%), hepatosplenomegaly (50.9%), skin involvement (49.1%), osteoporosis (47.2%), and portal hypertension and ascites (26.4%). The main biological features were anemia (79.2%), thrombocytopenia (50.9%), leucopenia (20.8%), and liver enzyme abnormalities (32.1%). Of the 40 patients tested, 34 (85%), 2 (5%), and 4 (10%) exhibited the KIT D816V mutant, other KIT mutations and the wild-type form of the KIT gene, respectively. Additional sequencing detected significant genetic defects in 17 of 26 (65.3%) of the patients with associated hematological non-mast cell disease, including TET2, SRSF2, IDH2, and ASLX1 mutations. Death occurred in 19 (35.8%) patients, within a median delay of 9 months, despite the different treatment options available. Mastocytosis among elderly patients has a challenging early detection, rare skin involvement, and/or limited skin disease; it is heterogeneous and has often an aggressive presentation with nonfortuitous associated myeloid lineage malignant clones, and thus a poor overall prognosis. PMID:27310990

  9. Cristallisation, syncristallisation, et alliages moléculaires entre le lorazépam et l'oxazépam

    NASA Astrophysics Data System (ADS)

    Mascherpa-Corral, D.; Mascherpa, G.; Chauvet, A.

    1993-04-01

    Le polymorphisme et pseudopolymorphisme du lorazépam et oxazépam ont été étudiés par analyse thermique, calorimétrie différentielle à balayage et diffraction de rayons X. Deux formes polymorphes du lorazépam et plusieurs mono et hemisolvates ont été isolés à partir de recristallisation dans divers soivants. Aucun polymorphisme ni solvate n'a été mis en évidence avec l'oxazépam. Les paramètres cristallographiques des phases isolées ont été déterminées. A 160 et 203°C, le lorazépam et l'oxazépam perdent respectivement une molécule d'eau pour donner après réarrangement la quinazolinecarboxaldéhyde correspondante. La syncristallisation des deux benzodiazépines dans le benzène conduit à des alliages moléculaires à miscibilité totale à l'état solide dans tout le domaine de concentration entre l'exazépam el la forme α du lorazépam, elle n'est que partielle avec la forme β. Thermal analysis, differential scanning calorimetry, and X-ray diffraction were carried out to study the polymorphism and pseudopolymorphism of lorazepam and oxazepam. Two polymorphic forms of lorazepam and several mono- or hemisolvates were obtained after recrystallization from various solvents. No polymorphic form or solvate has been found for oxazepam. The crystallographic parameters of these new phases were determined. Lorazepam and oxazepam can lose a molecule of water at 160 and 203°C, respectively, and rearrange to quinazolinecarboxaldehyde. Mixed crystals of the two benzodiazepines, after recrystallization from benzene, lead to molecular alloys with complete solid solubility between oxazepam and the α-form of lorazepam over the whole range of composition but only to partial solubility with the β-form of lorazepam.

  10. Transporting Forensic Psychiatric Patients.

    PubMed

    Dike, Charles C; Nicholson, Elizabeth; Young, John L

    2015-12-01

    Patients in a forensic psychiatric facility often require escorted transport to medical facilities for investigations or treatments of physical health ailments. Transporting these patients presents significant safety and custody challenges because of the nature of patients housed in forensic psychiatric facilities. A significant proportion of these patients may be transfers from the Department of Corrections (DOC) under legal mandates for psychiatric evaluation and treatment better provided in a hospital setting, and most of them will return to the DOC. Although departments of correction have protocols for escorting these potentially dangerous individuals, it is unclear whether receiving psychiatric hospitals have established procedures for maintaining the safety of others and custody of these individuals during transportation outside the hospital facility. The literature is sparse on precautions to be observed when transporting dangerous forensic psychiatric patients, including those with high escape risk. In this article, we describe one forensic inpatient facility's procedure for determining the appropriate level needed to transport these individuals outside of the forensic facility. We also describe the risk assessment procedure for determining level of transport. These are quality improvement measures resulting from a critical review of an incident of escape from the forensic facility several years ago. PMID:26668224

  11. Patient access innovations: integrating patients within the system of care.

    PubMed

    Marino, Daniel J; Faber, William; Duncan, Meredith

    2015-12-01

    Clinically integrated networks seeking to ensure in-network access and strengthen patient engagement should adopt five strategic areas of focus: Extend access beyond traditional models. Manage out-migration. Make it easy for patients to stay in the network. Build patient engagement into clinical care models. Explore innovative methods to engage patients. PMID:26793943

  12. Perinatal Patient Safety Project

    PubMed Central

    Nunes, Julie; McFerran, Sharon

    2005-01-01

    The Perinatal Patient Safety Project (PPSP) was created as a systemic strategy for creating high-reliability perinatal units by preventing identified causes of perinatal events in the clinical setting. With developmental funding from a Garfield grant, implementation of the PPSP has been completed at four pilot sites in the Kaiser Permanente Northern California (KPNC) Region. Its success has resulted in implementation at all perinatal units in the KPNC Region as well as being promoted by National Risk Management for nationwide implementation. PPSP emphasizes structured communication, multidisciplinary rounds, a definition of fetal well-being, and practicing for emergencies. Steps taken to create high reliability perinatal care include improved communication, patient safety focus, and satisfaction among perinatal patients, providers, and staff. PMID:21660157

  13. [Respecting patient intimacy].

    PubMed

    2014-04-01

    Transparency as a general rule for all our professional acts casts doubts about the statement of the Hippocratic Oath that says "Whatever I see or hear in the lives of my patients, I will keep secret, as considering all such things to be private". Medical secrecy protects the intimacy of patients, who reveal to their physicians their most hidden secrets aiming to recover their health. Therefore, physicians should receive those secrets with reverence and care, as servers and not as their owners. The values associated with the respect for personal intimacy are the anthropological basis of medical confidentiality. A medical act is performed by definition between two equally honorable individuals. Therefore, the professional honors the trust of his patient, maintaining strict confidence of what is revealed. Therefore, medical secrecy must be strengthened rather than weakened, pursuing common wealth and dignity. PMID:25117042

  14. [Toxoplasmosis in immunocompromised patients].

    PubMed

    Machala, L; Kodym, P; Malý, M; Geleneky, M; Beran, O; Jilich, D

    2015-06-01

    In humans, toxoplasmosis mostly occurs as a latent infection, but in immunocompromised individuals, the agent may reactivate and cause severe to life-threatening disease. HIV positive individuals and transplant recipients, in particular hematopoietic stem cell transplant and heart transplant recipients, are at highest risk. The disease most often affects the central nervous system but can involve any organ. Because of the alteration of the immune response in these patients, the serodiagnosis is not reliable and direct detection of the causative agent is needed--namely by microscopy and DNA PCR. If inadequately treated or left untreated, toxoplasmosis generally has a fatal prognosis in immunocompromised patients and therefore, the treatment must be started as early and energetically as possible. The gold standard both in the treatment of reactivation and secondary prophylaxis is the pyrimethamine-sulfadiazine combination while co-trimoxazole can be used in the primary prophylaxis for high-risk patients. PMID:26099608

  15. Patient Portals: An Underused Resource for Improving Patient Engagement.

    PubMed

    Tulu, Bengisu; Trudel, John; Strong, Diane M; Johnson, Sharon A; Sundaresan, Devi; Garber, Lawrence

    2016-01-01

    The potential of patient portals to improve patient engagement and health outcomes has been discussed for more than a decade. The slow growth in patient portal adoption rates among patients and providers in the United States, despite external incentives, indicates that this is a complex issue. We examined evidence of patient portal use and effects with a focus on the pulmonary domain. We found a paucity of studies of patient portal use in pulmonary practice, and highlight gaps for future research. We also report on the experience of a pulmonary department using a patient portal to highlight the potential of these systems. PMID:26066707

  16. Three patients with arteritis.

    PubMed

    Eke, F; Balfe, J W; Hardy, B E

    1984-09-01

    Three boys were treated for arteritis of the aorta and great vessels and bilateral renal artery stenosis. One presented at age 6 months with failure to thrive, excessive sweating, and vomiting: hypertension and cardiac failure were subsequently diagnosed. The two older boys (7 and 14 years) presented with symptomless hypertension. The clinical and angiographic findings in the three patients suggest that the illness may have been Takayasu's arteritis, which should be included in the differential diagnosis of hypertension in infancy and childhood. Renal autotransplantation was performed in all three patients with good results. Early renal autotransplantation may reduce the morbidity associated with this disease. PMID:6148918

  17. Constructions of the patient in healthcare communications: six patient figures.

    PubMed

    Pors, Anja Svejgaard

    2016-04-11

    Purpose - The purpose of this paper is to examine how strategic, patient-centred communication plays a part in the discursive management of expectations posed to patients and healthcare organizations. Design/methodology/approach - The paper provides an analysis of four documents collected as part of an ethnographic case study regarding "The Perspective of the Patient" - a Danish Hospital's patient-centred communication programme. Mapping methods inspired by Grounded Theory are used to qualify the analysis. Findings - The paper shows that strategic patient-centred communication addresses both a care-oriented approach to the patient and deploys market perceptions of patients. Market and care is seen as co-existing organizing modes that entail expectations to the patient. In the communication programme the patient is constructed in six information-seeking patient figures: affective patient; target group patient; citizen with rights; patient as a competent resource; user as active partner; and consumer. As a result, the patient-centred communication programme renders the patient as a flexible figure able to fit organizational demands of both care orientation and market concerns. Originality/value - This study contributes to qualitative research in organizational health communication by combining two subfields - patient-centredness and health communication - in an empirical study of how market and care are intertwined in a patient-centred communication programme. The argument goes beyond the prevalent prescriptive approaches to patient-centredness and healthcare communication, instead providing a critical analytical perspective on strategic communication and patient-centredness and showing how expectations are posed to both patient and organization. PMID:27052626

  18. Hospital Patients Are Adult Learners.

    ERIC Educational Resources Information Center

    Caffarella, Rosemary S.

    Patient education is recognized by health care providers and patients themselves as an important component of adequate health care for hospital patients. Through this informational process, patients receive information about specific health problems, learn the necessary competencies to deal with them, and develop accepting attitudes toward the…

  19. Patient Education Strategies in Dermatology

    PubMed Central

    Holder, Jessica L.

    2009-01-01

    Patient education is an important aspect of patient care in dermatology. Successful education increases patient satisfaction and results in improved outcomes and adherence. This article discusses the role of patient education in dermatology. Specifically, Part I of the review examines evidence demonstrating the benefits of patient education and recognizes the challenges that limit effective patient education. These challenges can be summarized as barriers to understanding, poor patient recall, conflicting information, and barriers to physician delivery. Further descriptions and an assessment of these limitations along with methods to combat them are included in the review. PMID:20725581

  20. Insomnia in cancer patients.

    PubMed

    O'Donnell, Joseph F

    2004-01-01

    Insomnia affects up to 50% of patients with cancer, but has received little attention from the oncology community compared with other symptoms such as pain and fatigue. Insomnia and subsequent sleep disturbances can lead to fatigue, mood disturbances, and contribute to immunosuppression, which can have a profound impact on quality of life and perhaps affect the course of disease. Insomnia in cancer patients must be distinguished from cancer-related fatigue. Although they are 2 distinct conditions, insomnia and fatigue are interrelated. Insomnia often leads to daytime fatigue that interferes with normal functioning. Conversely, daytime fatigue can lead to behaviors such as napping, which result in insomnia. The primary goal of insomnia treatment should first be to relieve any underlying disorder (eg, cancer pain, depression, anxiety) that may be causing the sleep disturbance. Because insomnia in this patient population may be due to a variety of causes, treatment must be multimodal and include both pharmacologic and nonpharmacologic therapies. A plan that combines attention to sleep hygiene and cognitive-behavioral therapy with prescription of hypnotic medications can help relieve the symptoms of insomnia in cancer patients and improve their quality of life. PMID:15675652

  1. Discharging older patients.

    PubMed

    2016-09-01

    Significant numbers of older people with dementia use general hospital services, and ensuring the safe and appropriate discharge home of patients with poor cognition, impaired judgement, misperception or reduced risk awareness is complex and challenging for many healthcare professionals. PMID:27615354

  2. [Healthcare patient loyalty].

    PubMed

    Ameri, Cinzia; Fiorini, Fulvio

    2016-01-01

    If the "old economy" preached standardization of products/services in order to reduce costs, the "new economy" is based on the recognition of the needs and the management of information. It is aimed at providing better and more usable services. One scenario is a national health service with regional management but based on competition between hospitals/companies.This led to a different handling of the user/patient, which has become the center of the health system: marketing seeks to retain the patient, trying to push a client-patient to not change their healthcare service provider. In costs terms, it is more economical to retain a customer rather than acquire a new one: a satisfied customer is also the best sounding board for each company. Customer equity is the management of relations with patients which can result in a greater customer value: it is possible to recognize an equity of the value, of the brand and of the report. Loyalty uses various marketing activities (basic, responsive, responsible, proactive and collaborative): each hospital/company chooses different actions depending on how many resources it plans to invest in loyalty. PMID:27374397

  3. The Adolescent Patient.

    ERIC Educational Resources Information Center

    Daniel, William A., Jr.

    Written to orient the physician and paramedical personnel to the adolescent patient, the book provides information concerning the changes of adolescence, and age-related problems and illnesses. Part 1 discusses the essence of adolescence by describing physical, mental, and emotional growth and development. Part 2, the major section, consists of 21…

  4. [Aphasia in elderly patients].

    PubMed

    Moreaud, Olivier; David, Danielle; Brutti-Mairesse, Marie-Pierre; Debray, Matthieu; Mémin, Armelle

    2010-03-01

    Aphasia is common in elderly patients in the context of vascular or neurodegenerative disorders. In some cases, aphasia is an isolated symptom, occurring suddenly after a stroke, or developing progressively as a primary progressive aphasia. The diagnosis and treatment are then very similar in older and younger patients. Therapy may be more complicated because of the high prevalence, in older patients, of associated non linguistic symptoms (attentional and dysexecutive symptoms, behavioral and psychological symptoms or sensorial deficits), fatigability, and comprehension deficits. It may then become very difficult to recognize aphasia among all these disorders and to appreciate the physiopathology. A complete evaluation of language, cognitive functions, psychopathology, and behavior is very helpful, as are neuroimaging techniques (MRI is the most relevant). A good knowledge of classical aphasic pictures associated with stroke, Alzheimer disease or related disorders, is highly recommended. Rehabilitation must be proposed even for older patients, so far as aphasia alters the communication abilities. It must be kept in mind that associated symptoms may limit considerably the therapy. PMID:20215098

  5. Teleophthalmology: improving patient outcomes?

    PubMed

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients' assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  6. [Patients' University, illness and learning].

    PubMed

    Tourette-Turgis, Catherine

    2015-10-01

    The Patients' University, a pilot project at the Université Pierre et Marie Curie, in Paris, enables patients-experts to follow a degree program in patient therapeutic education (University Diploma and Master). Recently, graduate patients and patients directly concerned proposed to co-create a new university certificate for treatment pathway coordinators for breast cancer, rounding out the 120-hour university certificate program on healthcare democracy and meeting the recommendations of the new cancer plan. PMID:26455618

  7. Training Patient and Family Storytellers and Patient and Family Faculty

    PubMed Central

    Morrise, Lisa; Stevens, Katy Jo

    2013-01-01

    Narrative medicine has become a prominent method of developing more empathetic relationships between medical clinicians and patients, on the basis of a deeper understanding of the patient experience. Beyond its usefulness during clinical encounters, patient storytelling can inform processes and procedures in Advisory Councils, Committee Meetings, and Family as Faculty settings, leading to improved quality and safety in health care. Armed with a better understanding of the patient experience, clinicians and administrators can make decisions, hopefully in collaboration with patients, that will enrich the patient experience and increase satisfaction among patients, families, and staff. Patient and family storytelling is a key component of the collaboration that is ideal when an organization seeks to deliver patient- and family-centered care. Providing patients and families with training will make the narratives they share more powerful. Health care organizations will find that purposeful storytelling can be an invaluable aspect of a patient- and family-centered culture. Well-delivered storytelling will support quality- and safety-improvement efforts and contribute to improved patient satisfaction. This article provides instruction for teaching patients and families how to tell stories with purpose and offers advice about how to support patients, families, and clinicians participating in this effort. PMID:24355906

  8. [Patient-reported and patient-weighted outcomes in ophthalmology].

    PubMed

    Scheibler, F; Finger, R P; Grosselfinger, R; Dintsios, C-M

    2010-03-01

    Considering patients' values and preferences in comparative effectiveness research (CER) is one of the main challenges in ophthalmology (value-based medicine). This article defines core terms in CER. The concept of patient-relevant (or patient-important) outcomes is distinguished from patient-reported outcomes (PRO) by means of examples in the field of ophthalmology. In order to be able to give a consistant recommendation if an intervention leads to conflicting results for different outcomes (trade-off), a ranking of outcomes will be necessary. Examples of studies in glaucoma patients are provided that demonstrate the possibilities of ranking of outcomes based on patient preferences. PMID:20024566

  9. Relation entre les caractéristiques des table-bancs et les mesures anthropométriques des écoliers au Benin

    PubMed Central

    Falola, Stève Marjelin; Gouthon, Polycarpe; Falola, Jean-Marie; Fiogbe, Michel Armand; Nigan, Issiako Bio

    2014-01-01

    Introduction Le mobilier scolaire et la posture assise en classe sont souvent impliqués dans l'apparition des douleurs rachidiennes, influant de fait sur la qualité des tâches réalisées par les apprenants. Aucune étude n'a encore vérifié le degré d'adéquation entre les caractéristiques du mobilier et celles des écoliers au Bénin. L'objectif de cette étude transversale est donc de déterminer la relation entre les dimensions des table-bancs utilisées en classe et les mesures anthropométriques des écoliers au Bénin. Methods Elle a été réalisée avec un échantillon probabiliste de 678 écoliers, âgés de 4 à 17 ans. Les mesures anthropométriques des écoliers et les mensurations relatives aux longueurs, largeurs et hauteurs des table-bancs ont été mesurées, puis intégrées aux équations proposées dans la littérature. Les pourcentages des valeurs situées hors des limitesacceptables, dérivées de l'application des équations ont été calculés. Results La largeur et la hauteur des table-bancs utilisées par les écoliers étaient plus élevées (p < 0,05) que les valeurs de référence recommandées par les structures officielles de contrôle et de production des mobiliers scolaires au Bénin. Quel que soit le sexe, il y avait une inadéquation entre la largeur du banc et la longueur fesse-poplité, puis entre la hauteur de la table et la distance coude-bancdes écoliers. Conclusion Les résultats suggèrent de prendre en compte l’évolution des mesures anthropométriques des écoliers dans la confection des table-bancs, afin de promouvoir de bonnes postures assises en classe et de réduire le risque de troubles du rachis. PMID:25317232

  10. Patient (customer) expectations in hospitals.

    PubMed

    Bostan, Sedat; Acuner, Taner; Yilmaz, Gökhan

    2007-06-01

    The expectations of patient are one of the determining factors of healthcare service. The purpose of this study is to measure the Patients' Expectations, based on Patient's Rights. This study was done with Likert-Survey in Trabzon population. The analyses showed that the level of the expectations of the patient was high on the factor of receiving information and at an acceptable level on the other factors. Statistical meaningfulness was determined between age, sex, education, health insurance, and the income of the family and the expectations of the patients (p<0.05). According to this study, the current legal regulations have higher standards than the expectations of the patients. The reason that the satisfaction of the patients high level is interpreted due to the fact that the level of the expectation is low. It is suggested that the educational and public awareness studies on the patients' rights must be done in order to increase the expectations of the patients. PMID:17028043

  11. Gastric Cancer in Young Patients

    PubMed Central

    Dhobi, Manzoor A.; Wani, Khursheed Alam; Parray, Fazl Qadir; Wani, Rouf A.; Peer, G. Q.; Abdullah, Safiya; Wani, Imtiyaz A.; Wani, Muneer A.; Shah, Mubashir A.; Thakur, Natasha

    2013-01-01

    Aim. The aim of this study was to see the clinical, pathological, and demographic profile of young patients with stomach carcinoma besides association with p53. Patients and Methods. Prospective study of young patients with stomach carcinoma from January 2005 to December 2009. A total of 50 patients with age less than 40 years were studied. Results. Male female ratio was 1 : 1.08 in young patients and 2.5 : 1 in older patients. A positive family history of stomach cancer in the first degree relatives was present in 10% of young patients. Resection was possible only in 50% young patients. 26% young patients underwent only palliative gastrojejunostomy. The most common operation was lower partial gastrectomy in 68%. Amongst the intraoperative findings peritoneal metastasis was seen in 17.4% in young patients. 50% young patients presented in stage IV as per AJCC classification (P value .004; sig.). None of the patients presented as stage 1 disease in young group. Conclusion. Early detection of stomach carcinoma is very important in all patients but in young patients it is of paramount importance. PMID:24381753

  12. Melanoma in Black Patients

    PubMed Central

    Smith, Robert J.

    1982-01-01

    Melanoma in black patients is uncommon but not rare. This paper reports six cases seen in one general surgeon's practice in Arkansas during a 14-year period. A review of the current literature regarding melanoma in blacks is given. Characteristically, melanoma in blacks is found on the soles of the feet, palms of the hands, or mucous membranes. The tumor has a deadly potential unless it is treated at an early stage; four of the patients reported have died of metastatic disease. A public health program is needed to make physicians and the public aware of the incidence and location of this tumor. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:7120473

  13. Evaluating respiratory patient disability.

    PubMed

    Ruiz Manzano, Juan; Alfageme Michavila, Inmaculada; Chiner Vives, Eusebi; Martínez González, Cristina

    2012-08-01

    The evaluation of the disabilities of patients with respiratory disease is regulated by the Spanish Ministry of Labor and Social Security, as are disabilities of any other type. We believe, however, that in respiratory pathologies this evaluation is especially complicated because, as they are chronic processes, they inter-relate with other systems. Furthermore, they tend to have occasional exacerbations; therefore, normal periods may alternate with other periods of important functional limitations. The present document arises from the desire of SEPAR to update this topic and to respond to the requests of respiratory disease patient associations who have asked us to do so. In this paper, we analyze the current situation of work disability legislation as well as the determination of degrees and percentages, including the current criteria for assigning disabilities due to respiratory tract deficiencies. Lastly, we propose work guidelines that would improve the existing scenario and outline this evaluation for specific pathologies. PMID:22341300

  14. Patient with inoperable pheochromocytoma

    PubMed Central

    Brancíková, D.; Mechl, Z.; Adam, Z.; Jandáková, E.; Pavlovský, Z.; Válek, V.; Andrašina, Z.

    2015-01-01

    Malignant pheochromocytoma is a tumour with a very low incidence that occurs sporadically or in the presence of multiple endocrine neoplasia. We present the case of a woman with a sporadic occurrence of pheochromocytoma diagnosed in the phase of multiple dissemination in the abdominal cavity and overexpressing adrenaline, noradrenaline, and dopamine. Local transarterial chemoembolization and systemic treatment with lanreotide resulted in a very good response, a decrease in the production of catecholamines for 12 months and a partial decrease for another 8 months, with stabilization of disease determined by imaging. Systemic treatment with tegafur resulted in disease stabilization lasting 50 months, after which the drug was discontinued because of adverse effects. Maintenance therapy with lanreotide continues, and no disease progression has been observed for 4 months. The treatment algorithm for such patients is multidisciplinary and must always take into account the current scope of the disease, intercurrence, and the general condition of the patient. PMID:26089731

  15. Patient with inoperable pheochromocytoma.

    PubMed

    Brancíková, D; Mechl, Z; Adam, Z; Jandáková, E; Pavlovský, Z; Válek, V; Andrašina, Z

    2015-06-01

    Malignant pheochromocytoma is a tumour with a very low incidence that occurs sporadically or in the presence of multiple endocrine neoplasia. We present the case of a woman with a sporadic occurrence of pheochromocytoma diagnosed in the phase of multiple dissemination in the abdominal cavity and overexpressing adrenaline, noradrenaline, and dopamine. Local transarterial chemoembolization and systemic treatment with lanreotide resulted in a very good response, a decrease in the production of catecholamines for 12 months and a partial decrease for another 8 months, with stabilization of disease determined by imaging. Systemic treatment with tegafur resulted in disease stabilization lasting 50 months, after which the drug was discontinued because of adverse effects. Maintenance therapy with lanreotide continues, and no disease progression has been observed for 4 months. The treatment algorithm for such patients is multidisciplinary and must always take into account the current scope of the disease, intercurrence, and the general condition of the patient. PMID:26089731

  16. Visualising patient flow.

    PubMed

    Jensen, Andrew; Boyle, Justin; Khanna, Sankalp

    2012-01-01

    We describe the development of a method to distil routinely collected clinical data into patient flow information to aid hospital bed management. Using data from state-wide emergency department and inpatient clinical information systems, a user-friendly interface was developed to visualise patient flow conditions for a particular hospital. The historical snapshots employ a variable time scale, allowing flow to be visualised across a day, week, month or year. Flow information includes occupancy, arrival and departure rates, length-of-stay and access block observations, which can be filtered by age, departure status, diagnosis, elective status, triage category, and admission unit. The tool may be helpful in supporting hospital bed managers in their daily decision making. PMID:22797023

  17. Mucormycosis in immunochallenged patients

    PubMed Central

    Pak, Jane; Tucci, Veronica T; Vincent, Albert L; Sandin, Ramon L; Greene, John N

    2008-01-01

    Mucorales species are deadly opportunistic fungi with a rapidly invasive nature. A rare disease, mucormycosis is most commonly reported in patients with diabetes mellitus, because the favorable carbohydrate-rich environment allows the Mucorales fungi to flourish, especially in the setting of ketoacidosis. However, case reports over the past 20 years show that a growing number of cases of mucormycosis are occurring during treatment following bone marrow transplants (BMT) and hematological malignancies (HM) such as leukemia and lymphoma. This is due to the prolonged treatment of these patients with steroids and immunosuppressive agents. Liposomal amphotericin B treatment and posaconazole are two pharmacologic agents that seem to be effective against mucormycosis, but the inherently rapid onset and course of the disease, in conjunction with the difficulty in correctly identifying it, hinder prompt institution of appropriate antifungal therapy. This review of the literature discusses the clinical presentation, diagnosis, and treatment of mucormycosis among the BMT and HM populations. PMID:19561989

  18. Teleophthalmology: improving patient outcomes?

    PubMed Central

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  19. Patient Safety in Surgery

    PubMed Central

    Makary, Martin A.; Sexton, J Bryan; Freischlag, Julie A.; Millman, E Anne; Pryor, David; Holzmueller, Christine; Pronovost, Peter J.

    2006-01-01

    Background: Improving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) culture are increasingly being adopted, but a reliable means of measuring their impact on front-line providers does not exist. Methods: We developed a surgery-specific safety questionnaire (SAQ) and administered it to 2769 eligible caregivers at 60 hospitals. Survey questions included the appropriateness of handling medical errors, knowledge of reporting systems, and perceptions of safety in the operating room. MANOVA and ANOVA were performed to compare safety results by hospital and by an individual's position in the OR using a composite score. Multilevel confirmatory factor analysis was performed to validate the structure of the scale at the operating room level of analysis. Results: The overall response rate was 77.1% (2135 of 2769), with a range of 57% to 100%. Factor analysis of the survey items demonstrated high face validity and internal consistency (α = 0.76). The safety climate scale was robust and internally consistent overall and across positions. Scores varied widely by hospital [MANOVA omnibus F (59, 1910) = 3.85, P < 0.001], but not position [ANOVA F (4, 1910) = 1.64, P = 0.16], surgeon (mean = 73.91), technician (mean = 70.26), anesthesiologist (mean = 71.57), CRNA (mean = 71.03), and nurse (mean = 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%. Conclusions: Safety climate in surgical departments can be validly measured and varies widely among hospitals, providing the opportunity to benchmark performance. Scores on the SAQ can serve to evaluate interventions to improve patient safety. PMID:16632997

  20. "The impatient patient".

    PubMed

    Bos, Lodewijk; Carroll, Denis; Marsh, Andy

    2008-01-01

    Modern Healthcare Systems that have embraced ICT and Internet technologies (referred to as Health 1.0) are evolving towards self management but from a clinical knowledge perspective. In contrast, from a user experience perspective, and using the latest web 2.0 technologies, the developing healthcare social networking communities (referred to as Health 2.0) are evolving towards becoming online medical portals. The growing Grand Challenge for healthcare is therefore: how will health care services (Health 1.0) work together with user-generated health care (Health 2.0) in a consumer market place delivering self management services for a healthier lifestyle and medical compliance. What is foreseen is that the self care information tool of the future will be a combination between the patient's observation record and the Internet, with the doctor and the patient positioned together at the intersection but not having to pay attention to the technology. This article deals with various aspects related to this Grand Challenge like the paradigm shift towards a needs-led and consumer-oriented healthcare, the role, supply and quality of information and the changing doctor-patient relationship. PMID:18560062

  1. Trusting patients, trusting nurses.

    PubMed

    Sellman, Derek

    2007-01-01

    The general expectation that patients should be willing to trust nurses is rarely explored or challenged despite claims of diminishing public trust in social and professional institutions. Everyday meanings of trust take account of circumstance and suggest that our understanding of what it means to trust is contextually bound. However, in the context of health care, to trust implies a particular understanding which becomes apparent when abuses of this trust are reported and acknowledged as scandals. The predominant assumption in the literature that trust is something that occurs between equally competent adults cannot explain trust in nursing precisely because of the unequal power relationships between patients on the one hand and healthcare professionals on the other. Moreover, the tendency to conflate terms such as trust, reliance, confidence and so on suggests that confusion permeates discussions of trust in nursing. In this paper, I argue in support of Annette Baier's requirement of good will (or lack of ill will) as the essential feature of trust, and outline how this account (i) enables us to make the necessary distinctions between trust on the one hand and 'trust pretenders' on the other; and (ii) lays the foundations for understanding trust in relationships, such as those between patients and nurses, where power differentials exist. PMID:17238998

  2. Tolerability and patient compliance.

    PubMed

    Roose, S P

    1999-01-01

    Currently available antidepressants interact with several types of receptors, which may explain both wanted and unwanted effects of these drugs. These effects are different and distinctive, and knowledge about them may help clinicians understand differences between compounds in terms of their tolerability profiles. Given roughly comparable efficacy, tolerability profile is the critical determinant in selecting an antidepressant medication for a particular patient. In addition, tolerability is inseparably linked to patient compliance, both in acute and long-term treatment, and ultimately to overall success of treatment. Refinement in pharmacologic profiles of all newly introduced antidepressants resulted in overall advantages in tolerability in comparison with older tricyclic compounds. However, differences in receptor interactions between antidepressants are directly reflected in tolerability (adverse event) profiles. Among new antidepressants, mirtazapine and the selective serotonin reuptake inhibitors share favorable overall tolerability and safety, especially with respect to low premature termination rates because of adverse events, cardiac safety, and safety in overdose. However, the different pharmacologic profile of mirtazapine is reflected in its different tolerability profile. Because of interactions with the histamine (H1) receptor, mirtazapine may be related to transient initial somnolence and weight gain in some patients. Its serotonin-2 (5-HT2)-blocking properties may account for lack of sexual dysfunction, insomnia, nervousness, and agitation. Mirtazapine's 5-HT3-blocking properties are unique among all currently available antidepressants and may account for lack of gastrointestinal adverse events. PMID:10446736

  3. COPD: the patient perspective

    PubMed Central

    Jones, Paul W; Watz, Henrik; Wouters, Emiel FM; Cazzola, Mario

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease characterized by nonreversible airway obstruction. Well-characterized symptoms such as exertional dyspnea and fatigue have a negative impact on patients’ quality of life (QoL) and restrict physical activity in daily life. The impact of COPD symptoms on QoL is often underestimated; for example, 36% of patients who describe their symptoms as being mild-to-moderate also admit to being too breathless to leave the house. Additionally, early morning and nighttime symptoms are a particular problem. Methods are available to allow clinicians to accurately assess COPD symptoms, including patient questionnaires. Integrated approaches to COPD management, particularly pulmonary rehabilitation, are effective strategies for addressing symptoms, improving exercise capacity and, potentially, also increasing physical activity. Inhaled bronchodilators continue to be the mainstay of drug therapy in COPD, where options can be tailored to meet patients’ needs with careful selection of the inhaled medication and the device used for its delivery. Overall, an integrated approach to disease management should be considered for improving QoL and subsequent patient outcomes in COPD. PMID:26937186

  4. Analysis of Patient Service Time in Ambulatory Clinics: Patient Tracking

    PubMed Central

    Zerbe, Tony R.; Zerbe, Shirleen D.

    1990-01-01

    Historically, analysis of patient service time (patient tracking) in ambulatory clinics has been performed manually. A case study of Eye and Ear Clinic in Pittsburgh, PA, revealed that this approach to patient data collection was prone to clerical error and did not satisfy the clinic's information-processing needs. Initial attempts at automation identified the features required of a successful computerized scheduling and patient tracking system. These essential features are being designed into a prototype system using a local area network platform. The software for this system employs bar code technology to log patients' movement. The resultant data permits analysis of clinic operation and rapid response to unforseen events. Patient information is presented in a color-coded format to permit-at-a-glance comprehension of data on multiple patients (up to 76) simultaneously. A scheduling module projects patients' arrival time and ensures availability of critical resources.

  5. [Tracheostomy in pediatrics patients].

    PubMed

    Fantoni, A; Ripamonti, D

    2002-05-01

    This is a case study of 79 children who under-went a tracheostomy with three different techniques, used in succession on three different groups of patients: surgical, percutaneous with progressive probes and translaryngeal technique. The pediatric patient, only under the age of 10, starts showing clear-cut anatomical differences compared to an adult, which gradually become more marked the younger the patient is. The causes of increased difficulties that can normally be found in these patients are obviously due to the reduced diameter of the airway and, above all, the high degree of pliability of the cartilaginous frame. After the discovery that even minimal external pressure can cause the collapse of the tracheal walls, it was decided to adopt the systematic use of a rigid bronchoscope, in order to be able to offer internal support to the anterior wall. The following advantages were obtained in the various techniques: In surgery it permitted the reduction, through the protrusion of the trachea, of the size of the operatory field, of the tracheal opening and consequently of the local trauma. It also caused less bleeding and reduced the risk of lesion to the pleural dome which are very frequent when a bronchoscope is not used. In the percutaneous method the bronchoscope allowed the application of the technique without complications, even in infants of only a few months' old, because it eliminated tracheal squashing, caused by the introduction of the needle, dilators and especially cannula, and the relative danger of lesion to the posterior wall of the trachea. This complication which was always impending in the original technique, which does not involve the use of a rigid bronchoscope, is the main reason which lead to the ban on PDT for patients younger than 16-18. In the translaryngeal method the advantages are of minor importance because they are limited to the initial stage of the procedure, the introduction of the needle and guide wire which are quicker and more

  6. The challenge of patient adherence.

    PubMed

    Martin, Leslie R; Williams, Summer L; Haskard, Kelly B; Dimatteo, M Robin

    2005-09-01

    Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors. These include realistic assessment of patients' knowledge and understanding of the regimen, clear and effective communication between health professionals and their patients, and the nurturance of trust in the therapeutic relationship. Patients must be given the opportunity to tell the story of their unique illness experiences. Knowing the patient as a person allows the health professional to understand elements that are crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social supports, and emotional health challenges, particularly depression. Physician-patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence. Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and improves patients' healthcare outcomes. PMID:18360559

  7. Patterns of Physician-Patient Communication Associated with Patient Satisfaction.

    ERIC Educational Resources Information Center

    Williams, M. Lee; Clampitt, Phillip G.

    Using data drawn from ten initial physician/patient interviews, an original category system was employed to analyze patterns of physician/patient communication. Static analysis, interaction analysis, and Markov chain analysis were used to discover the underlying communication patterns associated with patient satisfaction. Results revealed that…

  8. Health literacy and patient portals.

    PubMed

    Gu, Yulong; Orr, Martin; Warren, Jim

    2015-06-01

    Health literacy has been described as the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Improving health literacy may serve to promote concordance with therapy, engage patients in their own health care, and improve health outcomes. Patient portal technology aims at enabling patients and families to have easy access to key information in their own medical records and to communicate with their health care providers electronically. However, there is a gap in our understanding of how portals will improve patient outcome. The authors believe patient portal technology presents an opportunity to improve patient concordance with prescribed therapy, if adequate support is provided to equip patients (and family/carers) with the knowledge needed to utilise the health information available via the portals. Research is needed to understand what a health consumer will use patient portals for and how to support a user to realise the technology's potential. PMID:26125067

  9. Cancer Patients and Fungal Infections

    MedlinePlus

    ... mould-related diseases in immunocompromised patients. Journal of Antimicrobial Chemotherapy 2011;66:i5-i14. Ribaud P. Fungal ... al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update ...

  10. What makes a patient unhappy.

    PubMed

    Tobin, Howard A

    2008-05-01

    The best way to avoid an unhappy postoperative patient is to do everything one can to optimize the preoperative consultation and select patients carefully. This article draws on the judgment of a cosmetic surgeon with years of experience. By focusing on the individual unique needs of each patient, and by not being afraid to say no, the wise surgeon can expect a very high satisfaction rate from patients. PMID:18355697

  11. Patients and their families.

    PubMed

    Firth, P

    2006-01-01

    The focus of this chapter is on how clinicians can understand and communicate with the families of patients suffering from cancer. Most doctors and nurses do not have training in this area and are uncomfortable when conducting interviews with whole families. The need to extend our skills in the family context reflects the changes in the way care is provided to patients with a serious illness. We recognise the part families play in providing care and the subsequent effects on family life. The influence of systemic thinking and social construction theories has led to the acknowledgement that we are all part of systems which interact with each other and it is no longer appropriate to see the patient in isolation. The chapter will look at ideas from family therapy which can help us assess and intervene when necessary. The patient suffering from a life-threatening illness such as cancer looks to his family and friends for care and support. The management and course of the illness is affected by the involvement of the family and how they manage the stress and the effects of illness on a family member (Wright and Leahey 2000). Duhamel and Dupuis (2003) point out that there are three important factors in the management of the illness: the effects of family stress, the needs of the family as caregivers, and the effects of the role and how the family cope with the way the patient experiences his illness. This presents professionals working in the field with challenges they are often ill-equipped to deal with. Most healthcare workers have inadequate training in understanding family dynamics and even less knowledge about how to communicate effectively with whole families. Consequently, many healthcare professionals avoid couple and family interviews, feeling inadequate and helpless like the families themselves. I will address some of these issues in the chapter, firstly by examining what we now regard as the family and then by using ideas from systemic theory I will look at

  12. Hospital Libraries in Patient's Education.

    ERIC Educational Resources Information Center

    Iroka, Luke A.

    1988-01-01

    Reviews the positive effects of patient education, including the physician patient relationship, improvements in health status, and cost effectiveness. The status of hospital libraries in Nigeria is described, and suggestions for the implementation of patient education programs are made. (5 references) (CLB)

  13. Professional Preparation in Patient Education.

    ERIC Educational Resources Information Center

    Pigg, R. Morgan, Jr.

    Information on Indiana University's course in patient education is presented, along with sources of additional information on patient education and a summary of a national survey on professional preparation in patient education. An outline of the following course topics is presented: past and current developments, health care delivery, patient…

  14. Patient perception of wound photography.

    PubMed

    Wang, Sheila C; Anderson, John Ae; Jones, Duncan Vb; Evans, Robyn

    2016-06-01

    The objectives of this study were to provide an assessment of photographic documentation of the wound from the patients' perspective and to evaluate whether this could improve patients' understanding of and involvement in their wound care. Our results revealed that most patients visiting the wound care clinic have difficult-to-see wounds (86%). Only 20% of patients monitor their wounds and instead rely on clinic or nurse visits to track the healing progress. There was a significant association between patients' ability to see their wound and their subsequent memory of the wound's appearance. This was especially true for patients who had recently begun visiting the wound care clinic. This relationship was not present in patients who had visited the clinic for 3  or more years. Patients reported that the inability to see their wounds resulted in feeling a loss of autonomy. The majority of patients reported that photographing their wounds would help them to track the wound progress (81%) and would afford them more involvement in their own care (58%). This study provides a current representation of wound photography from the patients' perspective and reveals that it can motivate patients to become more involved in the management of their wounds - particularly for patients with difficult-to-see wounds. PMID:24872018

  15. Dysphagia in stroke patients

    PubMed Central

    Singh, S; Hamdy, S

    2006-01-01

    Swallowing musculature is asymmetrically represented in both motor cortices. Stroke affecting the hemisphere with the dominant swallowing projection results in dysphagia and clinical recovery has been correlated with compensatory changes in the previously non‐dominant, unaffected hemisphere. This asymmetric bilaterality may explain why up to half of stroke patients are dysphagic and why many will regain a safe swallow over a comparatively short period. Despite this propensity for recovery, dysphagia carries a sevenfold increased risk of aspiration pneumonia and is an independent predictor of mortality. The identification, clinical course, pathophysiology, and treatment of dysphagia after stroke are discussed in this review. PMID:16754707

  16. [Patients with sepsis].

    PubMed

    Oppert, M

    2016-05-01

    Sepsis is still the leading cause of mortality in noncardiac intensive care units. The new definition of sepsis emphasizes the importance of organ dysfunction. The Sepsis-related Organ Failure Assessment (SOFA) score is an indicator for organ dysfunction. The diagnosis of sepsis is for the most part made on clinical parameters with an altered mental status being a very sensitive indicator. Microbiological work-up is essential and two sets of blood cultures are the recommended minimum. Management includes prompt initiation of adequate antibiotic treatment and swift fluid resuscitation. Overinfusion is to be avoided as this itself can have a negative impact on patient outcome. PMID:27160262

  17. Strengthening patient-provider relationships.

    PubMed

    Wilkinson, Connie Rasmussen; Williams, Marjory

    2002-01-01

    In support of the Veterans Health Administration commitment to the promotion of shared decision-making between providers and patients, this study investigated the relationship between the provision of a patient appointment guidebook, designed to promote and support patient participation in the health care visit, and patient perceptions of primary care visit effectiveness. This study compared perceptions among 277 randomly selected patients randomly assigned to one of two groups. Patients assigned to an intervention group received a patient appointment guidebook along with the standard appointment reminder letter prior to the scheduled routine visit. Patients assigned to a control group received only the standard appointment reminder letter. Patient perceptions were assessed with a follow-up questionnaire designed to measure patient agreement with six statements pertaining to primary care visit effectiveness. No significant differences were noted in the proportion of patients in the two groups that agreed with any of the six statements pertaining to primary care visit effectiveness. Significant differences were noted, however, in the proportion of patients in the groups who received preventive health care interventions of influenza vaccination, pneumococcal vaccination, and gender-specific cancer screening. Approximately 37% of the patients in the intervention group provided positive comments about the patient appointment guidebook, while only 7% provided negative comments. Although statistically inconclusive, the narrative comments indicate that a patient appointment guidebook may assist veterans in preparing for primary care appointments. The lack of significant difference between the two groups on the measures of primary care visit effectiveness may be due, in part, to positive perceptions among the sample in general, as reflected by high levels of agreement and predominantly positive comments for both control and intervention groups. PMID:12048339

  18. The 'Patient experience' revolution.

    PubMed

    Hooten, Doug; Zavadsky, Matt

    2014-02-01

    We're arguably at the most pivotal time in our young profession. The ACA has provided EMS an unprecedented opportunity to become a part of the healthcare system, a move that many of us have dreamed about for decades. We need to pay attention to the changing dynamics of the environment in which we operate. The factors that currently impact hospitals, doctors and other healthcare providers will also impact us sooner than we think. Take the time to help shape our future and how we participate in this new healthcare system. It's time to focus on the patient and the patient's experience with our service. Wayne Gretzky said two important things during an interview when he was asked what makes him such a great hockey player. One was, "You miss 100% of the shots you don't take." The other was, "A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be. I skate to where the puck is going to be, not where it has been." Our advice to you is to go ahead, take the shot, get ahead of the other team and focus on improved customer satisfaction sooner rather than later. PMID:24660359

  19. Patients' perspectives on pain.

    PubMed

    Norrbrink, Cecilia; Löfgren, Monika; Hunter, Judith P; Ellis, Jaqueline

    2012-01-01

    Nociceptive and neuropathic pain (NP) are common consequences following spinal cord injury (SCI), with large impact on sleep, mood, work, and quality of life. NP affects 40% to 50% of individuals with SCI and is sometimes considered the major problem following SCI. Current treatment recommendations for SCI-NP primarily focus on pharmacological strategies suggesting the use of anticonvulsant and antidepressant drugs, followed by tramadol and opioid medications. Unfortunately, these are only partly successful in relieving pain. Qualitative studies report that individuals with SCI-related long-lasting pain seek alternatives to medication due to the limited efficacy, unwanted side effects, and perceived risk of dependency. They spend time and money searching for additional treatments. Many have learned coping strategies on their own, including various forms of warmth, relaxation, massage, stretching, distraction, and physical activity. Studies indicate that many individuals with SCI are dissatisfied with their pain management and with the information given to them about their pain, and they want to know more about causes and strategies to manage pain. They express a desire to improve communication with their physicians and learn about reliable alternative sources for obtaining information about their pain and pain management. The discrepancy between treatment algorithms and patient expectations is significant. Clinicians will benefit from hearing the patient´s voice. PMID:23459087

  20. Saving our smallest patients.

    PubMed

    Lynch, Thomas F; Kugler, Liz; Niedziela, Janine

    2014-01-01

    The feedback from the staff that participated in the Full Scale Drill was overwhelmingly positive. Working and becoming acquainted with members from other supporting departments is critical to a successful evacuation. They enjoyed being a part of the drill and expressed that having ownership of an evacuation plan is vital in the care of our babies. This turned out to be a remarkable team building exercise on many levels. The planning team achieved its overall goal of creating a sense of control over a potentially chaotic environment and now believes that they could execute an evacuation for any reason with maximum protection for their patients. In a similar way various groups in and outside of the Medical Center have an understanding of the complexities of this patient group and what would be needed to effectively support their needs in a disaster. The NICU/CCN Evacuation Committee looks back over almost a year of hard work with tremendous satisfaction and renewed confidence. PMID:25181794

  1. Patient Zero”:

    PubMed Central

    McKay, Richard A.

    2014-01-01

    Summary This article contextualizes the production and reception of And the Band Played On, Randy Shilts’s popular history of the initial recognition of the American AIDS epidemic. Published over twenty-five years ago, the book and its most notorious character, “Patient Zero,” are in particular need of a critical historical treatment. The article presents a more balanced consideration—a “patient’s view”—of Gaétan Dugas’s experience of the early years of AIDS. I oppose the assertion that Dugas, the so-called Patient Zero, ignored incontrovertible information about the condition and was intent on spreading his infection. Instead I argue that scientific ideas in 1982 and 1983 about AIDS and the transmissibility of a causative agent were later portrayed to be more self-evident than they were at the time. The article also traces how Shilts’s highly selective—and highly readable—characterization of Dugas rapidly became embedded in discussions about the need to criminalize the reckless transmission of HIV. PMID:24769806

  2. [Back pain: patients versus research].

    PubMed

    Theus, Renske; Zaat, Joost O M; Uijen, Annemarie; Enzing, Joost J

    2014-01-01

    In 2008, approximately 1,559,000 Dutch patients consulted their GP because of back pain. One out of 20 back pain patients is ultimately referred to a specialist, most often to a neurologist. A smaller number (also) go to a neurosurgeon or orthopaedist. Once referred, patients often receive treatments such as pain killers or discectomy. Scientific evidence in systematic reviews is scarce for the treatments we investigated because of small patient groups and a lack of randomised research. We made an infographic to show the numbers of patients with back pain who visit their GP or a specialist. PMID:24988162

  3. Progressive Care of Obese Patients.

    PubMed

    Dambaugh, Lori A; Ecklund, Margaret M

    2016-08-01

    Obese patients have complex needs that complicate their care during hospitalization. These patients often have comorbid conditions, including hypertension, heart failure, obstructive sleep apnea, pressure ulcers, and difficulty with mobility. Obese patients may be well served in the progressive care setting because they may require more intensive nursing care than can be delivered in a general care unit. Progressive care nurses have core competencies that enable them to safely and effectively care for obese patients. A plan of care with interdisciplinary collaboration illustrates the integrative care for obese progressive care patients. (Critical Care Nurse 2016; 36[4]:58-63). PMID:27481802

  4. Bibliotherapy in a Patients' Library *

    PubMed Central

    McDowell, David J.

    1971-01-01

    This paper describes the involvement of patients in the Patients' Library at McLean Hospital, and the relationship between them and the librarian in library activities. The publication of a patients' magazine is discussed, with case histories of persons who had taken part in its production. The Patients' Librarian has a personal role in patient therapy, and accounts are given of various activities such as play-reading, poetry-reading, and the discussion of poems by established writers, with therapeutic aims in view. Actual clinical experiences are given. PMID:5146769

  5. [Falls in patients with dementia].

    PubMed

    Yamaguchi, Kiyoshi

    2008-11-01

    People with cognitive impairment are at about 2 to 3 times higher risk of falling compared with cognitively intact elderly. Incidence of falls among patients with Alzheimer's disease (AD) is high, nevertheless the clinical feature common in patients with mild to moderate AD is the absence of motor impairment. Recent studies suggest that the divided attention markedly impairs the ability of patients with AD to regulate the gait. Falls are particularly common in Dementia with Lewy bodies (DLB) patients and may aid diagnosis, and the falls are associated with parkinsonism and other unclear factors. Treatment studies evaluating fall reduction strategies in dementia patients are a priority. PMID:18974447

  6. Patient-centered medicine and patient-oriented research: improving health outcomes for individual patients

    PubMed Central

    2013-01-01

    Background Patient-centered medicine is developing alongside the concepts of personalized medicine and tailored therapeutics. The main objective of patient-centered medicine is to improve health outcomes of individual patients in everyday clinical practice, taking into account the patient’s objectives, preferences, values as well as the available economic resources. Discussion Patient-centered medicine implies a paradigm shift in the relationship between doctors and patients, but also requires the development of patient-oriented research. Patient-oriented research should not be based on the evaluation of medical interventions in the average patient, but on the identification of the best intervention for every individual patient, the study of heterogeneity and the assignment of greater value to observations and exceptions. The development of information-based technologies can help to close the gap between clinical research and clinical practice, a fundamental step for any advance in this field. Summary Evidence-based medicine and patient centered medicine are not contradictory but complementary movements. It is not possible to practice patient-centered medicine that is not based on evidence, nor is it possible to practice evidence-based medicine at a distance from the individual patient. PMID:23294526

  7. Patient Perspectives on Biosimilar Insulin.

    PubMed

    Wilkins, Alasdair R; Venkat, Manu V; Brown, Adam S; Dong, Jessica P; Ran, Nina A; Hirsch, James S; Close, Kelly L

    2014-01-01

    Given that a new wave of biosimilar insulins will likely enter the market in coming years, it is important to understand patient perspectives on these biosimilars. A survey (N = 3214) conducted by the market research company dQ&A, which maintains a 10 000-patient panel of people with type 1 or type 2 diabetes in roughly equal measure, investigated these perspectives. The survey asked whether patients would switch to a hypothetical less expensive biosimilar insulin that was approved by their provider. Approximately 66% of respondents reported that they would "definitely" or "likely" use a biosimilar insulin, while 17% reported that they were "unlikely" to use or would "definitely not use" such a product. Type 2 diabetes patients demonstrated slightly more willingness to use biosimilars than type 1 diabetes patients. Common patient concerns included whether biosimilars would be as effective as reference products (~650 respondents), whether side effect profiles would deviate from those of reference products (~220 respondents), and the design of the delivery device (~50 respondents). While cost savings associated with biosimilar insulins could increase patient uptake, especially among patients without health insurance (some recent estimates suggest that biosimilars will come at a substantial discount), patients may still need assurance that a cheaper price tag is not necessarily associated with substandard quality. Overall, the dQ&A survey indicates that the majority of patients are willing to consider biosimilar insulins, but manufacturers will need to work proactively to address and assuage patient concerns regarding efficacy, safety, drug administration, and other factors. PMID:24876533

  8. The patient-centered movement.

    PubMed

    Capko, Judy

    2014-01-01

    Patient-centered care has been embraced by government, healthcare leaders, and major insurance plans. This movement began more than 10 years ago, but has expanded considerably in an effort to improve patient outcomes and control healthcare expenses. It is the focus of new payment models that pay physicians and hospitals based on clinical outcomes and patient satisfaction. Efforts contributing to this movement place great importance on the patient visit and interaction with the provider and staff. This includes how well they communicate with and engage patients, the choices they give patients, whether they involve patients in decision-making, and how they build a strong clinical partnership between physician and patients. Recognition programs have been created to give physicians the tools needed to accomplish this goal, including The Patient-Centered Medical Home and the Patient-Centered Specialty Practice. The anticipated gain is population health management and reduced capital expense for medical services. The patient-centered movement has gained momentum, will be watched closely, and is expected to revolutionize the healthcare delivery system in America. PMID:24696963

  9. Patient preparation and scanning techniques.

    PubMed

    Taylor, Carolyn M; Blum, Andrew; Abbara, Suhny

    2010-07-01

    Cardiac computed tomographic angiography (CCTA) is a unique diagnostic modality that can provide a comprehensive assessment of cardiac anatomy. Rapid advances in scanner and software technology have resulted in the ability to noninvasively image the coronary arteries. However, careful patient preparation and scanning technique is required to ensure optimal image quality while minimizing radiation dose delivered. Important components of patient preparation include knowledge of the indications and contraindications for CCTA, patient screening, patient premedication, patient positioning, prescan instruction, and electrocardiograph lead placement. Scanning technique should be determined on a patient by patient basis and tailored according to age and radiation risk, body mass index and chest circumference, heart rate and variability, presence of stents, and coronary calcification. PMID:20705165

  10. [Treatment of patients with osteoarthritis].

    PubMed

    Vargas Negrín, Francisco; Medina Abellán, María D; Hermosa Hernán, Juan Carlos; de Felipe Medina, Ricardo

    2014-01-01

    The therapeutic management of patients with osteoarthritis aims to decrease pain and inflammation, improve physical function, and to apply safe and effective treatments. A patient-centered approach implies the active participation of the patient in the design of the treatment plan and in timely and informed decision-making at all stages of the disease. The nucleus of treatment is patient education, physical activity and therapeutic exercise, together with weight control in overweight or obese patients. Self-care by the individual and by the family is fundamental in day-to-day patient management. The use of physical therapies, technical aids (walking sticks, etc.) and simple analgesics, opium alkaloids, and antiinflammatory drugs have demonstrated effectiveness in controlling pain, improving physical function and quality of life and their use is clearly indicated in the treatment of osteoarthritis. Conservative surgery and joint replacement is indicated when treatment goals are not achieved in specific patients. PMID:24467960

  11. Effect of Grapefruit Seed Extract on Thermal Inactivation of Listeria monocytogenes during Sous-Vide Processing of Two Marinated Mexican Meat Entrées.

    PubMed

    Valenzuela-Melendres, Martin; Peña-Ramos, E Aida; Juneja, Vijay K; Camou, Juan Pedro; Cumplido-Barbeitia, German

    2016-07-01

    D- and z-values for Listeria monocytogenes were obtained for two Mexican meat entrées: pork meat marinated in tomatillo (green tomato) sauce (PTS) and beef marinated in a red chili sauce (BRCS), with addition of 0, 200, and 800 ppm of grapefruit seed extract (GSE). Meat samples inoculated with L. monocytogenes were packaged in sterile bags, immersed in a water bath, and held at 55, 57.5, 60, and 62.5°C for different periods of time. Depending upon the temperature, D-values at 0 ppm of GSE ranged from 26.19 to 2.03 min in BRCS and 26.41 to 0.8 min in PTS. Adding 800 ppm of GSE to BRCS thermally treated at 55 and 62.5°C significantly decreased inactivation time by 35%. A reduction in time of 25.9, 10.6, and 40.1% at 55, 57.5, and 60°C, respectively, was observed in PTS with 800 ppm of GSE. The z-values of L. monocytogenes were not significantly affected by GSE addition; average z-values were 7.25 and 5.09°C for BRCS and PTS, respectively. Estimated thermal lethality for a 7-D log reduction of L. monocytogenes under commercial-size sous-vide conditions at a reference temperature of 55°C was reached at 78 and 71 min for BRCS without and with 800 ppm of GSE, respectively. For PTS, 7-D reduction was attained at 69 and 61 min without and with addition of 800 ppm of GSE, respectively. Supplementing both Mexican meat entrées (BRCS and PTS) with 800 ppm of GSE rendered L. monocytogenes cells more sensitive to the lethal effect of heat. The results of this study will assist the retail food industry in designing acceptance limits on critical control points pertaining to cooking regimes to effectively eliminate L. monocytogenes in BRCS and PTS sous-vide processed Mexican meat entrées. PMID:27357037

  12. Thrombosis in Lymphoma Patients and in Myeloma Patients.

    PubMed

    Yokoyama, Kenji

    2015-01-01

    The risk of venous thromboembolism (VTE) in patients with cancer is several-fold higher than that in individuals without cancer. Recent studies demonstrated a high incidence of VTE in patients with hematologic malignancies as well as in patients with solid cancers. The reported incidence of VTE in lymphoma is variable, ranging from less than 5% to 59.5%. The incidence of VTE is higher in non-Hodgkin lymphoma than it is in Hodgkin lymphoma. The incidence of VTE also varies according to the disease grade, the disease stage, the performance status of the patient, and the site of disease. Most VTE cases occur at the diagnosis of cancer or early in the course of cancer treatment. An elevated incidence of VTE is also reported in cases of myeloma. VTE occurs in approximately 5% of myeloma patients treated with conventional chemotherapy, and treatment of myeloma patients with immunomodulatory drugs (IMid)-based therapy increases the risk of VTE. Prophylactic aspirin or anticoagulant is used in myeloma patients treated with IMid-based therapy. Several reports have indicated that the incidence of VTE is relatively low in Asian patients treated with IMid-based therapy, and concomitant use of bortezomib reduces the risk of VTE. The incidence of arterial thrombosis is also increased in patients with myeloma and monoclonal gammopathy of undetermined significance. Further studies are needed to develop a predictive model for identifying patients with lymphoma and myeloma who are at high risk for developing thrombosis. PMID:26212069

  13. Thromboprophylaxis with dalteparin in medical patients: which patients benefit?

    PubMed

    Cohen, Alexander T; Turpie, Alexander G G; Leizorovicz, Alain; Olsson, Carl-Gustav; Vaitkus, Paul T; Goldhaber, Samuel Z

    2007-05-01

    It is unclear whether thromboprophylaxis produces a consistent risk reduction in different subgroups of medical patients at risk from venous thromboembolism. We performed a retrospective, post hoc analysis of 3706 patients enrolled in the PREVENT study. Patients were at least 40 years old with an acute medical condition requiring hospitalization for at least 4 days and had no more than 3 days of immobilization prior to enrolment. Patients received either subcutaneous dalteparin (5000 IU) or placebo once daily. The primary end point was the composite of symptomatic deep vein thrombosis (DVT), pulmonary embolism, asymptomatic proximal DVT, or sudden death. Primary diagnosis subgroups were acute congestive heart failure, acute respiratory failure, infectious disease, rheumatological disorders, or inflammatory bowel disease. All patients, except those with congestive heart or respiratory failure, had at least one additional risk factor for venous thromboembolism. A risk reduction was shown in patients receiving dalteparin versus placebo. The relative risk (RR) was 0.73 in patients with congestive heart failure, 0.72 for respiratory failure, 0.46 for infectious disease, and 0.97 for rheumatological disorders. The RR was 0.52 in patients aged > or = 75 years, 0.64 in obese patients, 0.34 for patients with varicose veins, and 0.71 in patients with chronic heart failure. No subgroup had a significantly different response from any other. Importantly, multivariate analysis showed that all patient groups benefited from thromboprophylaxis with dalteparin. Our findings, therefore, support the broad application of thromboprophylaxis in acutely ill hospitalized medical patients. PMID:17615800

  14. Genital reconstruction in exstrophy patients

    PubMed Central

    Nerli, R. B.; Shirol, S. S.; Guntaka, Ajay; Patil, Shivagouda; Hiremath, Murigendra B.

    2012-01-01

    Introduction: Surgery for bladder exstrophy has been evolving over the last four to five decades. Because survival has become almost universal, the focus has changed in the exstrophy-epispadias complex to improving quality of life. The most prevalent problem in the long-term function of exstrophy patients is the sexual activity of the adolescent and adult males. The penis in exstrophy patients appears short because of marked congenital deficiency of anterior corporal tissue. Many patients approach for genital reconstruction to improve cosmesis as well as to correct chordee. We report our series of male patients seeking genital reconstruction following exstrophy repair in the past. Materials and Methods: Fourteen adolescent/adult male patients attended urology services during the period January 2000-December 2009 seeking genital reconstruction following exstrophy repair in the past. Results: Three patients underwent epispadias repair, four patients had chordee correction with cosmetic excision of skin tags and seven patients underwent chordee correction with penile lengthening. All patients reported satisfaction in the answered questionnaire. Patients undergoing penile lengthening by partial corporal dissection achieved a mean increase in length of 1.614 ± 0.279 cm dorsally and 1.543 ± 0.230 cm ventrally. The satisfactory rate assessed by the Short Form-36 (SF-36) showed that irrespective of the different genital reconstructive procedures done, the patients were satisfied with cosmetic and functional outcome. Conclusions: Surgical procedures have transformed the management in these patients with bladder exstrophy. Bladders can be safely placed within the pelvis, with most patients achieving urinary continence and cosmetically acceptable external genitalia. Genital reconstruction in the form of correction of chordee, excision of ugly skin tags and lengthening of penis can be performed to give the patients a satisfactory cosmetic and functional system. PMID:23204655

  15. Simulation: improving patient outcomes.

    PubMed

    Smith, Abi; Siassakos, Dimitrios; Crofts, Joanna; Draycott, Tim

    2013-06-01

    Effective training has been shown to improve perinatal care and outcome, decrease litigation claims and reduce midwifery sick leave. To be effective, training should be incentivised, in a realistic context, and delivered to inter-professional teams similar to those delivering actual care. Teamwork training is a useful addition, but it should be based on the characteristics of effective teamwork as derived from the study of frontline teams. Implementation of simulation and teamwork training is challenging, with constraints on staff time, facilities and finances. Local adoption and adaptation of effective programmes can help keep costs down, and make them locally relevant whilst maintaining effectiveness. Training programmes need to evolve continually in line with new evidence. To do this, it is vital to monitor outcomes and robustly evaluate programmes for their impact on patient care and outcome, not just on participants. PMID:23721770

  16. [Management of splenectomized patients].

    PubMed

    Chambon, J P; Vallet, B; Caiazzo, R; Zerbib, P

    2003-09-01

    PARTIAL SPLENECTOMY: Partial resection is possible in certain indications for splenectomy. Partial splenectomy is the best way to prevent postsplenectomy infections, even though vaccination and antibiotic prophylaxis must be prescribed. This association is also necessary when the patient undergoes an autograft to reimplant splenic tissue or develops splenosis, i.e. fortuitous autotransplantation of splenic parenchyma. GUIDELINES FOR PLANNED SPLENECTOMY: Prophylactic vaccination should be performed 15 days, or 6 weeks, before surgery. Antibiotic prophylaxis includes a preoperative injection of cefazolin followed by intravenous amoxicillin, then Oracilline (Penicilline V) with resumption of oral intake. SURGICAL ASPECTS: Indications for laparoscopic surgery have broadened, laparotomy being reserved for the most difficult cases. Special care is recommended concerning complications, particularly respiratory disorders (pleural effusion, atelectasia) and acute pancreatitis. PMID:14631642

  17. [Nutrition for diabetic patients].

    PubMed

    Schindler, Karin; Brix, Johanna; Dämon, Sabine; Hoppichler, Friedrich; Kruschitz, Renate; Toplak, Hermann; Ludvik, Bernhard

    2016-04-01

    Evidence demonstrates that medical diabetes treatment has to be accompanied by lifestyle modifications. Structured nutrition interventions and increased physical activity will help patients to normalise, respectively maintain their body weight. The main target of a diabetes therapy is aimed at achieving normal or nearly normal blood glucose levels. Reaching this goal may be facilitated by the following nutritional patterns: Using mainly carbohydrates from vegetables, whole grains, legumes and fruits, Restriction of mono- and disaccharides are often important factors in normalising body weight and blood glucose, Reduction of dietary fat could be indicated. However, the primary goal is the limitation of saturated fatty acids which to high percentage are consumed with animal products. There is not sufficient evidence to recommend a dietary protein consumption of more than 20% of energy intake. Individuals with diabetes should be aware of the importance of acquiring daily vitamin and mineral requirements. Natural food sources should be preferred. PMID:27052240

  18. Prescription Opioid Analgesics: Promoting Patient Safety with Better Patient Education.

    PubMed

    Costello, Margaret

    2015-11-01

    Patients expect and deserve adequate postoperative pain relief. Opioid analgesics are widely used and effective in controlling postoperative pain, but their use poses risks that many patients don't understand and that all too often result in adverse outcomes. Inappropriate and often dangerous use of prescription medication has increased sharply in the past two decades in the United States. Patients and caregivers must have an adequate understanding of safe use, storage, and disposal of opioids to prevent adverse drug events in patients and others. Nurses play a key role in providing this patient education. This article provides a case study that highlights the risks and important aspects of opioid medication use in the postoperative patient. PMID:26510070

  19. [Vascular access in diabetic patients. Are these patients "difficult"?].

    PubMed

    Gołębiowski, Tomasz; Weyde, Wacław; Kusztal, Mariusz; Porażko, Tomasz; Augustyniak-Bartosik, Hanna; Madziarska, Katarzyna; Krajewska, Magdalena; Koniński, Przemysław; Sydor, Antoni; Letachowicz, Krzysztof; Klinger, Marian

    2015-01-01

    Diabetics with stage V chronic kidney disease (CKD) on hemodialysis (HD) are considered as "difficult patients", because of problems with creation of the vascular access. There is controversy regarding the results and recommendations for preparation of the vascular access in these patients. The aim of this retrospective study was to evaluate the results of creating different types of arteriovenous fistula (AVFs) in consecutive series of patients starting dialysis treatment. The analysis was performed in 741 patients (385 females and 356 males), average age 61.4±7 years, who started dialysis treatment in our department between January 2005 and December 2012. Native AVFs were created in all patients. No patients received an AVF requiring synthetic graft material. The number of patients with diabetic nephropathy was 166 (22.4%). Among them, 30 (18%) had type 1 diabetes and 136 (82%) type 2. In this group the occurrence of calcification in the forearm artery was estimated on the basis of physical examination, Allan's test, Doppler ultrasound and forearm X-ray. In a subgroup of patients with atherosclerotic changes in the arterial system the frequency of failed AVFs was analyzed. These results were compared with the group without diabetes. The number of procedures necessary for successfu AVF creation and type of access was counted in both groups. The assessment of the procedure frequency and AVF location in diabetic and in non-diabetic patients was made by χ² test with Yates correction. In the group of 166 patients with diabetes, in 100 cases (60%) atherosclerotic changes in forearm arteries were observed. In a subgroup of 30 patients with type 1 diabetes atherosclerosis was observed in 17 adults (57%). In this subgroup creation of a suitable forearm AVF in the first procedure in 9 patients was possible and in the other 8 cases the atherosclerotic changes necessitated repeated procedures and were an important obstacle to create the AVF. In the subgroup of 136

  20. Lipoplasty in the bulimic patient.

    PubMed

    Willard, S G; McDermott, B E; Woodhouse, L M

    1996-08-01

    Recent cases in our Eating Disorders Clinic suggest that patients diagnosed with bulimia nervosa seeking surgical fat removal may be exhibiting a variant of the purging behavior seen in bulimic patients. These same patients exhibit historical or concurrent abuse of laxatives and/or diuretics or self-induced vomiting in a pathologic attempt to obtain or maintain an idealized body image. This paper presents two case studies that illustrate the bulimic patient's compulsive quest for lipectomy with unrealistic expectations that surgical alteration of the body will be an emotional and physical panacea. Plastic surgeons must be cautioned regarding this potential manifestation of bulimia nervosa and the dangers inherent in colluding with the patient in a pathologic request for surgery. It is important for plastic surgeons to recognize appropriate use of lipectomy as an alternative to traditional purging behavior in the bulimic patient. PMID:8764715

  1. Thyroid Disease in the Older Patient

    MedlinePlus

    ... these patients, without treatment unless they are symptomatic. HYPOTHYROIDISM IN THE OLDER PATIENT Hypothyroidism is very common ... is given. TREATMENT OF THE OLDER PATIENT WITH HYPOTHYROIDISM As with the younger patient, pure synthetic thyroxine ( ...

  2. Implementing national patient safety alerts.

    PubMed

    Moore, Sally; Taylor, Natalie; Lawton, Rebecca; Slater, Beverley

    National patient safety alerts are sometimes difficult to implement in an effective way. All trusts have to declare compliance with alerts as part of a three-step process to improve patient safety. This article discusses an alternative way of implementing national patient safety alerts and describes how behaviour-change methods can be used to successfully implement lasting changes in practice at ward or departmental level. PMID:27145671

  3. Thromboprophylaxis in immobilized medical patients.

    PubMed

    Vaitkus, Paul T

    2004-03-30

    Venous thromboembolism accounts for a large number of preventable deaths. The majority of these events occur in medical patients, but medical thromboprophylaxis remains underutilised in this population. The purpose of this review is to examine the results of recent clinical trials of low molecular weight heparins in the prevention of venous thromboembolic disease in medical patients. The available data make a compelling case in favor of widespread use of low molecular weight heparin in medical patients. PMID:15096323

  4. [Sophrology for patients in oncology].

    PubMed

    Barré, Chantal; Falcou, Marie-Christine; Mosseri, Véronique; Carrié, Sylvie; Dolbeault, Sylvie

    2015-11-01

    It is important to support patients with cancer during their care pathway and even beyond. They undergo long and difficult treatments, all anxiety-causing situations and sources of stress. Sophrological techniques help patients to find calm, lessen their fears and offer them the opportunity to work on themselves through simple easily reproducible exercises. This observation has been verified by a study carried out at the Institut Curie with patients undergoing chemotherapy. PMID:26567064

  5. [Feasibility of tailored patient education].

    PubMed

    Tóth, Tamás; Dinya, Elek

    2013-03-17

    Patient education has an important role in the prevention and therapy. It enables the delivery of necessary information, development of skills and motivations and supporting to cope with the disease. Although many information sources are available, it is still necessary to provide organized patient education. Tailored patient education was proved to be more effective than using general information materials. The proper use of information technology enables the widespread and cost-effective implementation of tailored patient education. The authors analyse the components necessary for development of such a system. PMID:23477894

  6. Effective writing that attracts patients.

    PubMed

    Baum, Neil

    2015-01-01

    Doctors today not only must communicate verbally, they must also realize that the written word is important to their ability to connect with the patients that they already have and also to attract new patients. Doctors will be expected to write blogs, to create content for their Web sites, to write articles for local publications, and even to learn to express themselves in 140 characters or less (i.e., Twitter). This article presents 10 rules for selecting the right words to enhance your communication with existing patients and potentially to attract new patients to your practice. PMID:26062324

  7. Bed bathing patients in hospital.

    PubMed

    Downey, Lindsey; Lloyd, Hilary

    There are a number of circumstances that may affect an individual's ability to maintain personal hygiene. Hospitalised patients, and in particular those who are bedridden, may become dependent on nursing staff to carry out their hygiene needs. Assisting patients to maintain personal hygiene is a fundamental aspect of nursing care. However, it is a task often delegated to junior or newly qualified staff. This article focuses on the principles of bed bathing patients in hospital, correct procedure and the importance of maintaining patient dignity and respect in clinical practice. PMID:18543852

  8. Defining and Measuring Patient Satisfaction.

    PubMed

    Graham, Brent

    2016-09-01

    Reporting patient satisfaction has become an increasingly common component of studies evaluating treatment outcomes. However the construct of "patient satisfaction" is one that is complex and context dependent. While there is no question that careful, reliable, and valid measurement of this important aspect of patient care is required, tools for achieving this objective have not been fully developed. Measures of patient satisfaction that reflect the unique role of the hand in everyday life will require the same approach to instrument development as has been used to move forward the field of outcome measurement in general. PMID:27570227

  9. Patient involvement in patient safety: Protocol for developing an intervention using patient reports of organisational safety and patient incident reporting

    PubMed Central

    2011-01-01

    Background Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety - a patient measure of organisational safety (PMOS), and a patient incident reporting tool (PIRT) - to help the NHS prevent patient safety incidents by learning more about when and why they occur. Methods To develop the PMOS 1) literature will be reviewed to identify similar measures and key contributory factors to error; 2) four patient focus groups will ascertain practicality and feasibility; 3) 25 patient interviews will elicit approximately 60 items across 10 domains; 4) 10 patient and clinician interviews will test acceptability and understanding. Qualitative data will be analysed using thematic content analysis. To develop the PIRT 1) individual and then combined patient and clinician focus groups will provide guidance for the development of three potential reporting tools; 2) nine wards across three hospital directorates will pilot each of the tools for three months. The best performing tool will be identified from the frequency, volume and quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the PMOS and PIRT during their stay in hospital. A sub-sample (N = 50) will complete the PMOS again one week later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed by comparing reported incidents with those identified from case note review and the existing staff reporting scheme. In a subsequent study these tools will be used to provide information to wards/units about their priorities for patient

  10. Patient Education Leads to Better Care for Heart Patients.

    ERIC Educational Resources Information Center

    Rosenberg, Stanley G.

    The staff of a heart and circulatory disease program of a State department of health conducted a special project at a city hospital which showed that a well-organized treatment and education program for patients with congestive heart failure increased the patient's knowledge of his disease, medication, and diet as well as his adherence to a…

  11. Patient or customer?

    PubMed

    Parker, J M

    1999-01-01

    This paper investigates caring in practice within the context of the global imperative of increasing rationalisation of care based on an economic ethic. The notion of the global marketplace has spread to the domain of health services, so that 'health' has come to be seen as a commodity, with the body as its site, and the 'patient' a customer; clinicians work to construct standard pathways through the healthcare supermarket. The challenge for nurses is to work within but also to challenge and resist the reductionist impetus of economically based and commercially driven approaches to health care. They must retain the sense of the value of the wholeness of the person, the deeply personal and profoundly significant professional-recipient relationship, and find ways of demonstrating their capacity to deliver high-quality care in a cost-effective way. Proper and appropriate accountability is a key strategy to maintaining quality nursing as a significant aspect of care. The expansion of the role of the advanced practice nurse is very useful in providing holistic and cost-effective care, though there are currently limitations to scope of practice that need to be removed. The metaphor of the marketplace, underpinned by powerful global economic forces, can draw us into unthinking compliance with its imperatives--but other metaphors are available. Metaphor and creativity are linked, and we need to consider how the creative use of language can facilitate the emergence of new ways of understanding in health care. PMID:10401282

  12. Self-image and perception of mother and father in psychotic and borderline patients.

    PubMed

    Armelius, K; Granberg

    2000-02-01

    eine mangelnde Separation von ihren Müttern und eine geringe Differenzierung zwischen Autonomie und Kontrolle. Es wird außerdem diskutiert, wie die Ergebnisse auf die realen Beziehungen der Patienten zu anderen Menschen Einflus nehmen könnten. Des patients psychotiques et Borderline ont évalué leur image d'eux-mêmes et leur perception de leur mère et père à l'aide du modèle de l'Analyse Structural du Comportement Social (SASB. Les patients Borderline avaient des imagess plus négatives d'eux-mêmes et de leurs parents, surtout de leur père, que les patients psychotiques et les sujets normaux, alors que les patients psychotiques se jugeaient à peine différemment des sujets normaux. L'image de soi était en relation avec les images des deux parents pour les patients Borderline et pour les sujets normaux, alors que pour les patients psychotiques, seulement l'image de la mère jouait un rôle pour leur image. En plus, les patients psychotiques ne différenciaient pas entre les pôles de contrôle et d'autonomie dans l'image de soi introjectée. Nous en avons conclu que les patients Borderline se caractérisent par un attachement négatif, et les patients psychotiques par une faible séparation de la mère ainsi qu'une différenciation modeste entre autonomie et contrôle. L'influence de ceci sur les relations des patients avec les autrs est discutée dans cet article. Pacientes limítrofes y psicóticos evaluaron su autoimagen y la percepción que tenían de sus padres usando el modelo de Análisis estructural del comportamiento social (SASB). Los pacientes limítrofes registraron imágenes más negativas de sí mismos y de sus progenitores, especialmente de su padre, que los pacientes psicóticos y los normales, mientras que las evaluaciones de los pacientes psicóticos no difirieron mucho de las de los sujetos normales. La autoimagen tuvo relación con la imagen de ambos progenitores tanto en el caso de los pacientes limítrofes como de los sujetos normales

  13. What Do Patients Want? Patient Preference in Wound Care

    PubMed Central

    Corbett, Lisa Q.; Ennis, William J.

    2014-01-01

    Patient preferences are statements made or actions taken by consumers that reflect their desirability of a range of health options. The concept occupies an increasingly prominent place at the center of healthcare reform, and is connected to all aspects of healthcare, including discovery, research, delivery, outcome, and payment. Patient preference research has focused on shared decisions, decisional aids, and clinical practice guideline development, with limited study in acute and chronic wound care populations. The wound care community has focused primarily on patient focused symptoms and quality of life measurement. With increasing recognition of wound care as a medical specialty and as a public health concern that consumes extensive resources, attention to the preferences of end-users with wounds is necessary. This article will provide an overview of related patient-centered concepts and begin to establish a framework for consideration of patient preference in wound care. PMID:25126474

  14. Adequacy of dialysis: the patient's role and patient concerns.

    PubMed

    Newmann, John M; Litchfield, William E

    2005-03-01

    The patient's role in adequacy of hemodialysis is demanding and complex. It requires meticulous attention to initiating, accepting, and maintaining extraordinary behavioral change. This includes the following: (1) major alteration of dietary habits, often contrary to a patient's familial and cultural customs; (2) compliance with a new, voluminous medication routine, often straining personal finances; (3) reallocation of time for transportation, treatment, and partial recovery, frequently consuming a minimum of 6 to 8 hours 3 days each week; (4) psychologic adjustment to unaccustomed chronic dependency on, and accountability to, an array of variably experienced and competent renal care staff; (5) skills, seldom taught, required to communicate clearly and regularly with overworked medical professionals who are often much younger with less life experience; and (6) additional commitment to compensating for the physical fatigue that routinely accompanies hemodialysis. Reasonable behavioral modification in these 6 categories is likely to increase the chances of a patient fulfilling his role in adequacy of dialysis. Some patients, however committed the staff have been in assisting them, may show little interest in dialysis adequacy and the patient's role. Other patients periodically may fail in their role unless the renal care team recognizes the patient as an individual who is included as an important team member. The patient requires consistent and repeated education about their disease, treatment, and risks and benefits of adherence. The unique, unnatural requirements of adequate chronic hemodialysis require this patient support from the renal staff, enhanced by continuous sensitive attention, empathy, and persuasion. This will help the patient achieve success in their role. PMID:15791563

  15. Anaesthetic management of neurosurgical patients.

    PubMed

    Himmelseher, S; Pfenninger, E

    2001-10-01

    Anaesthetic care of neurosurgical patients increasingly involves management issues that apply not only to 'asleep patients', but also to 'awake and waking-up patients' during and after intracranial operations. On one hand, awake brain surgery poses unique anaesthetic challenges for the provision of awake brain mapping, which requires that a part of the procedure is performed under conscious patient sedation. Recent case reports suggest that local infiltration anaesthesia combined with sedative regimens using short-acting drugs and improved monitoring devices have assumed increasing importance. These techniques may optimize rapid adjustments of the narcotic depth, providing analgesia and patient immobility yet permitting a swift return to cooperative patient alertness for functional brain tests. Regional anaesthesia and peripheral nerve blocks were used to prevent uncontrolled movements in special cases of intractable seizures. However, few of these strategies have been evaluated in controlled trials. Awake craniotomy for tumour removal is performed as early discharge surgery. Meticulous consideration of postoperative patient safety is therefore strongly advised. On the other hand, waking-up patients or the emergence from general anaesthesia after brain surgery is still an area with considerable variation in clinical practice. Developments indicate that fast-acting anaesthetic agents and prophylactic strategies to prevent postoperative complications minimize the adverse effects of anaesthesia on the recovery process. Recent data do not advocate a delay in extubating patients when neurological impairment is the only reason for prolonged intubation. An appropriate choice of sedatives and analgesics during mechanical ventilation of neurosurgical patients allows for a narrower range of wake-up time, and weaning protocols incorporating respiratory and neurological measures may improve outcome. In conclusion, despite a lack of key evidence to request 'fast

  16. National survey of hospital patients.

    PubMed Central

    Bruster, S.; Jarman, B.; Bosanquet, N.; Weston, D.; Erens, R.; Delbanco, T. L.

    1994-01-01

    OBJECTIVE--To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems. DESIGN--Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital. SUBJECTS--5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards. MAIN OUTCOME MEASURES--Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals. RESULTS--Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers. CONCLUSIONS--This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened

  17. Patient Perspectives on Biosimilar Insulin

    PubMed Central

    Wilkins, Alasdair R.; Venkat, Manu V.; Brown, Adam S.; Dong, Jessica P.; Ran, Nina A.; Hirsch, James S.

    2014-01-01

    Given that a new wave of biosimilar insulins will likely enter the market in coming years, it is important to understand patient perspectives on these biosimilars. A survey (N = 3214) conducted by the market research company dQ&A, which maintains a 10 000-patient panel of people with type 1 or type 2 diabetes in roughly equal measure, investigated these perspectives. The survey asked whether patients would switch to a hypothetical less expensive biosimilar insulin that was approved by their provider. Approximately 66% of respondents reported that they would “definitely” or “likely” use a biosimilar insulin, while 17% reported that they were “unlikely” to use or would “definitely not use” such a product. Type 2 diabetes patients demonstrated slightly more willingness to use biosimilars than type 1 diabetes patients. Common patient concerns included whether biosimilars would be as effective as reference products (~650 respondents), whether side effect profiles would deviate from those of reference products (~220 respondents), and the design of the delivery device (~50 respondents). While cost savings associated with biosimilar insulins could increase patient uptake, especially among patients without health insurance (some recent estimates suggest that biosimilars will come at a substantial discount), patients may still need assurance that a cheaper price tag is not necessarily associated with substandard quality. Overall, the dQ&A survey indicates that the majority of patients are willing to consider biosimilar insulins, but manufacturers will need to work proactively to address and assuage patient concerns regarding efficacy, safety, drug administration, and other factors. PMID:24876533

  18. Blood transfusion: patient identification and empowerment.

    PubMed

    Stout, Lynn; Joseph, Sundari

    Positive patient identification is pivotal to several steps of the transfusion process; it is integral to ensuring that the correct blood is given to the correct patient. If patient misidentification occurs, this has potentially fatal consequences for patients. Historically patient involvement in healthcare has focused on clinical decision making, where the patient, having been provided with medical information, is encouraged to become involved in the decisions related to their individualised treatment. This article explores the aspects of patient contribution to patient safety relating to positive patient identification in transfusion. When involving patients in their care, however, clinicians must recognise the diversity of patients and the capacity of the patient to be involved. It must not be assumed that all patients will be willing or indeed able to participate. Additionally, clinicians' attitudes to patient involvement in patient safety can determine whether cultural change is successful. PMID:26878405

  19. Patient preference: a comparison of electronic patient-completed questionnaires with paper among cancer patients.

    PubMed

    Martin, P; Brown, M C; Espin-Garcia, O; Cuffe, S; Pringle, D; Mahler, M; Villeneuve, J; Niu, C; Charow, R; Lam, C; Shani, R M; Hon, H; Otsuka, M; Xu, W; Alibhai, S; Jenkinson, J; Liu, G

    2016-03-01

    In this study, we compared cancer patients preference for computerised (tablet/web-based) surveys versus paper. We also assessed whether the understanding of a cancer-related topic, pharmacogenomics is affected by the survey format, and examined differences in demographic and medical characteristics which may affect patient preference and understanding. Three hundred and four cancer patients completed a tablet-administered survey and another 153 patients completed a paper-based survey. Patients who participated in the tablet survey were questioned regarding their preference for survey format administration (paper, tablet and web-based). Understanding was assessed with a 'direct' method, by asking patients to assess their understanding of genetic testing, and with a 'composite' score. Patients preferred administration with tablet (71%) compared with web-based (12%) and paper (17%). Patients <65 years old, non-Caucasians and white-collar professionals significantly preferred the computerised format following multivariate analysis. There was no significant difference in understanding between the paper and tablet survey with direct questioning or composite score. Age (<65 years) and white-collar professionals were associated with increased understanding (both P = 0.03). There was no significant difference in understanding between the tablet and print survey in a multivariate analysis. Patients overwhelmingly preferred computerised surveys and understanding of pharmacogenomics was not affected by survey format. PMID:25899560

  20. Idiom Comprehension in Aphasic Patients

    ERIC Educational Resources Information Center

    Papagno, Costanza; Tabossi, Patrizia; Colombo, Maria Rosa; Zampetti, Patrizia

    2004-01-01

    Idiom comprehension was assessed in 10 aphasic patients with semantic deficits by means of a string-to-picture matching task. Patients were also submitted to an oral explanation of the same idioms, and to a word comprehension task. The stimuli of this last task were the words following the verb in the idioms. Idiom comprehension was severely…

  1. Pharmacotherapeutics for the AIDS Patient.

    ERIC Educational Resources Information Center

    Fife, Kenneth H.

    1991-01-01

    Anticipated shifts in the demographics of the Acquired Immune Deficiency Syndrome (AIDS) epidemic are examined, current state-of-the-art AIDS patient management is summarized, and some unique facets of drug therapy in the AIDS patient are discussed, including adverse reactions, complex drug interactions, use of investigational drugs, and…

  2. Art Therapy with Laryngectomy Patients.

    ERIC Educational Resources Information Center

    Anand, Susan Ainlay; Anand, Vinod K.

    1997-01-01

    Reports on the experiences of patients with laryngeal cancer who used art therapy. Drawing on 14 years of experience and 109 laryngeal cancer patients, describes treatment results and the case material substantiating the distinct role of art therapy. Provides an overview of the special medical and therapeutic needs of this group. (RJM)

  3. The Coronary Patient in Industry

    NASA Technical Reports Server (NTRS)

    Schuster, B.

    1971-01-01

    The coronary patient, as he pertains to industry particularly NASA, is discussed. Concepts of precoronary care, acute attacks which may develop while on the job, and the return of the cardiac patient to work are covered. Major emphasis was on the prevention of sudden death due to coronary disease.

  4. Optimizing patient-ventilator synchrony.

    PubMed

    Epstein, S K

    2001-01-01

    Mechanical ventilation assumes the work of breathing, improves gas exchange, and unloads the respiratory muscles, all of which require good synchronization between the patient and the ventilator. Causes for patient-ventilator dyssynchrony include both patient factors (abnormalities of respiratory drive and abnormal respiratory mechanics) and ventilator factors (triggering, flow delivery, breath termination criteria, the level and mode of ventilator support, and imposed work of breathing). Although patient-ventilator dyssynchrony can often be detected on physical exam, careful analysis of ventilator waveforms (pressure-time, flow-time) allows for more precise definition of the underlying cause. Patient-ventilator interaction can be improved by reversing patient factors that alter respiratory drive or elevate patient ventilatory requirements and by correcting factors that contribute to dynamic hyperinflation. Proper setting of the ventilator using sensitive triggering mechanisms, satisfactory flow rates, adequate delivered minute ventilation, matching machine T(I) to neural T(I), and applying modes that overcome the imposed work of breathing, further optimize patient-ventilator synchrony. PMID:16088669

  5. Mycobacterium arupense in Cancer Patients

    PubMed Central

    Al Hamal, Zainab; Jordan, Mary; Hachem, Ray Y.; Alawami, Hussain M.; Alburki, Abdussalam M.; Yousif, Ammar; Deshmukh, Poonam; Jiang, Ying; Chaftari, Ann-Marie; Raad, Issam I.

    2016-01-01

    Abstract Mycobacterium arupense is a slow-growing, nonchromogenic, acid-fast bacillus. Its clinical spectrum, epidemiology, and frequency of colonization versus true infection remain unknown. We evaluated the clinical significance of M arupense and positive cultures from cancer patients. We retrospectively reviewed records of all cancer patients treated at our institution between 2007 and 2014 to identify those who had positive cultures for M arupense. Mycobacterium arupense was identified by sequencing the 16S rRNA and hsp65 genes. A total of 53patients had positive cultures, 100% of which were isolated from respiratory specimens. Of these, 7 patients met the American Thoracic Society/Infectious Diseases Society of America criteria for a definitive diagnosis of M arupense infection, 14 cases were considered to be probable infections, and 29 cases were considered to be possible infections. Of the included patients, 13 received therapy for M arupense infection and 40 did not. The outcomes of treated and untreated patients did not differ significantly. No relapses of M arupense infection. In addition, there were no M arupense-related deaths in either group. In cancer patients, M arupense appears to be mostly a commensal organism rather than a pathogen. Patients who did or did not receive treatment had similar outcomes. Validation of these findings in a larger prospective trial is warranted. PMID:27057825

  6. Viscoelastic cushion for patient support

    NASA Technical Reports Server (NTRS)

    Sauers, D. G.

    1971-01-01

    Flexible container, filled with liquid, provides supportive device which conforms to patient's anatomy. Uniform cushion pressure prevents formation of decubitus ulcers, while the porous sponge substructure damps fluid movement through cushion response so that patient is not dumped when his weight shifts.

  7. Patient's breath controls comfort devices

    NASA Technical Reports Server (NTRS)

    Schrader, M.; Carpenter, B.; Nichols, C. D.

    1972-01-01

    Patient assist system for totally disabled persons was developed which permits a person, so paralyzed as to be unable to move, to activate by breathing, a call system to summon assistance, turn the page of a book, ajust his bed, or do any one of a number of other things. System consists of patient assist control and breath actuated switch.

  8. Virtual Patients in Geriatric Education

    ERIC Educational Resources Information Center

    Tan, Zaldy S.; Mulhausen, Paul L.; Smith, Stephen R.; Ruiz, Jorge G.

    2010-01-01

    The virtual patient is a case-based computer program that combines textual information with multimedia elements such as audio, graphics, and animation. It is increasingly being utilized as a teaching modality by medical educators in various fields of instruction. The inherent complexity of older patients and the shortage of geriatrics educators…

  9. Patient Disclosure of Medical Misdeeds

    ERIC Educational Resources Information Center

    Bergen, Clara; Stivers, Tanya

    2013-01-01

    Modern patients walk a tightrope between respecting medical authority and acting as knowledgeable advocates regarding health issues, with the agency and responsibilities that come with this. This article uses conversation analysis to explore this balance in relation to patient disclosures of medical misdeeds in video-recorded primary care medical…

  10. Patient Relations and Workplace Communication.

    ERIC Educational Resources Information Center

    Career Resources Development Center, Inc., San Francisco, CA.

    The workbook contains lessons and exercises in patient relations and workplace communication in a medical services office, particularly for interactions involving one or more non-native speaker of English. Seven units address these topics: (1) greetings and basic assistance, greeting established patients, and measuring height and weight and taking…

  11. Coping strategies in melanoma patients.

    PubMed

    Trapp, Michael; Trapp, Eva-Maria; Richtig, Erika; Egger, Josef Wilhelm; Zampetti, Anna; Sampogna, Francesca; Rohrer, Peter Michael; Komericki, Peter; Strimitzer, Tanja; Linder, Michael Dennis

    2012-11-01

    An observational, questionnaire-based, cross-sectional study was performed to assess whether differences in coping behaviour (positive and negative strategies) between patients with either a recent diagnosis of malignant melanoma (MM) or with benign dermatological disease, were predictive of the diagnosis. Coping strategies were assessed with the German version of the stress-coping questionnaire (SVF 120) in 46 inpatients for whom surgery was planned at the Department of Dermatology, Medical University of Graz, Austria. Subjects were divided into two groups: patients with non-metastatic MM, and patients with benign dermatological diseases (controls). The risk for the diagnosis "melanoma" decreased with higher values of "situation control" (p = 0.007) and increased with higher values of resignation (p = 0.035) and trivialisation (p = 0.039). More-over, the risk for having a MM with thickness > 1 mm decreased in patients with higher values in positive coping strategies (p < 0.34). These results suggest differences in coping behaviour between patients with MM and those with benign skin diseases and, amidst patients with MM, between patients with different MM thickness; the results may hence lead to earlier, more specific and more effective psychological interventions to improve coping in patients with MM, as differences in coping behaviour seem to appear even in the non-metastatic stage of the disease. PMID:22772950

  12. Defining patient-nurse boundaries.

    PubMed

    Barrow, Rebecca; Mee, Steve; Buckley, Alison; Corless, Louise

    This series exploring how narratives can be used to reflect on practice has focused on patient narratives. This sixth article uses nurse narratives to explore professional boundaries between patients and nurses. These can be difficult to negotiate and can depend on individual circumstances: what may be appropriate in one situation may be unacceptable in another. PMID:27295800

  13. Are rhinoplasty patients potentially mad?

    PubMed

    Slator, R; Harris, D L

    1992-01-01

    Rhinoplasty patients have long been considered to be psychologically unstable and therefore a "risky" group upon which to operate. Patients who had rhinoplastic operations more than 5 years ago were contacted by post and their psychological health assessed by the use of psychometric tests. The results show no evidence to support earlier suggestions that requests for rhinoplasty may be early symptoms of severe psychiatric disease. However, several points do emerge. Male patients show more symptoms of anxiety and depression than normal, and female patients who give no history of injury preceding their operation behave in a more extrovert and sociable manner than normal. Furthermore, patients of both sexes who give no history of injury before their operation, even though pleased with the operative results, are more self-conscious of their appearance than those who were injured prior to their rhinoplasty. PMID:1623348

  14. Psychodynamic Psychotherapy for Cancer Patients

    PubMed Central

    Straker, Norman

    1998-01-01

    Psychodynamic psychotherapy is effective as an approach to understanding the psychological conflicts and the psychiatric symptoms of cancer patients as well as to planning useful psychological interventions. The author recommends that the psychotherapist who treats cancer patients be familiar with the following: 1) the natural course and treatment of the illness, 2) a flexible approach in accord with the medical status of the patient, 3) a common sense approach to defenses, 4) a concern with quality-of-life issues, and 5) counter- transference issues as they relate to the treatment of very sick patients. Case reports illustrate the unique problems facing psychotherapists who are treating cancer patients. Further, these cases show the effective use of psychodynamic principles to inform the therapist of successful psychotherapeutic interventions. PMID:9407471

  15. The cost of patient safety.

    PubMed

    Hoeltge, Gerald A

    2004-01-01

    To ensure patient safety, it costs an organization time, money, and commitment. The clinical laboratory may promote patient safety or may contribute to medical error. Laboratory errors put a patient at risk at any point along the path of workflow. The cost of an initiative in patient safety may be considered from four perspectives: compliance, feasibility, present risk, and financial. Three examples are offered to illustrate the use of these approaches. Most patient-safety strategies in laboratory medicine are not expensive. They are affordable with a structured outlay of existing resources and a willingness to follow defined work practices without exception. More extensive projects, especially those that cross jurisdictional lines within an organization, do require comprehensive project management. Management ofboth kinds of initiatives is addressed by NCCLS' documents on quality practice. PMID:15597552

  16. Endodontics and the ageing patient.

    PubMed

    Johnstone, M; Parashos, P

    2015-03-01

    Patients are living longer and the rate of edentulism is decreasing. Endodontic treatment is an essential part of maintaining the health and well-being of the elderly. Retention of natural teeth improves the quality of life and the overall health and longevity of ageing patients. Also, teeth that might be otherwise extracted may be strategically valuable to retain a prosthesis, and elderly patients are more likely to have medical complications that may prevent dental extractions from being safely performed. The technical goals of endodontic treatment in the elderly are the same as those for younger patients. However, the pulpo-dentinal complex undergoes calcific changes over time, which may pose challenges for the clinician. The purposes of this review are to discuss age changes in the pulp and the challenges posed by diagnosing, treatment planning and treating the elderly endodontic patient. PMID:25762039

  17. Mediating consolation with suicidal patients.

    PubMed

    Gilje, Fredricka; Talseth, Anne-Grethe

    2007-07-01

    Psychiatric nurses frequently encounter suicidal patients. Caring for such patients often raises ethical questions and dilemmas. The research question for this study was: 'What understandings are revealed in texts about consolation and psychiatric nurses' responses to suicidal patients?' A Gadamerian approach guided re-interpretation of published texts. Through synthesizing four interpretive phases, a comprehensive interpretation emerged. This revealed being 'at home' with self, or an ethical way of being, as a hermeneutic understanding of a way to become ready to mediate consolation with suicidal patients. Trustworthiness was addressed by means of the qualities of auditability, credibility and confirmability. This re-interpretation adds to nursing knowledge, enhances understanding of previous research findings, provides pre-understanding for further research and reveals the value of hermeneutic inquiry in nursing. It also deepens understanding of a published model of consolation. These understandings may help to guide nurses who are struggling with suicidal patients. PMID:17562733

  18. Iranian patients' perspective of patients' rights: a qualitative study.

    PubMed

    Khaledi, Shahnaz; Moridi, Golrokh; Valiee, Sina

    2016-01-01

    There is an increasing emphasis on "protecting patient rights", which has a great influence on the patient's well-being. This study aimed to explore patients' perspectives of patients' rights in the hospitals of Kurdistan University of Medical Sciences in Iran. This qualitative study used the content analysis method. The data were collected through in-depth interviews, conducted in Persian at the internal and surgical wards from 2012 to 2013. Consequently, interviews continued to be conducted on 20 patients, using content analysis, until data saturation. The findings highlighted aspects of patients' rights and five themes emerged from the interviews: having one's dignity respected, receiving care of the requisite quality, being shown financial consideration, receiving adequate information, and having a desirable and pleasant environment. The patients believed that for their rights to be upheld, it is necessary that together with the provision of enough facilities and equipment, they need to be respected and offered ideal healthcare services. This could be achieved by removing barriers and facilitating procedures. PMID:26826656

  19. 'The patient': at the center of patient-reported outcomes.

    PubMed

    Awad, A George

    2015-01-01

    The recent emphasis of including patient reports in their own care management is reviewed in terms of the factors that contributed to its popularity. The role change of patients as being active participants in their own care as a result of the rising consumerism and advocacy has led to increased pressures for including patients in the therapeutic decision-making process. As consumers of clinical services, their perspectives and attitudes towards health and illness acquired more importance. The rising cost of healthcare has added another dimension in cost containment by empowering patients and sharing responsibility in their recovery, which hopefully can improve outcomes. Challenges in the development and implementation of patient-reported outcomes in psychiatry are reviewed and include the still unresolved subjective/objective dichotomy, identification of the most appropriate and relevant patient-reported outcomes. Few outcomes are identified and include: subjective tolerability of medication, self-reported health-related quality of life, preferences, patients' attitudes towards health and illness, satisfaction with medication and overall satisfaction of quality of care, and functional state, with particular focus on social functioning. PMID:26289737

  20. Patient Admission Preferences and Perceptions

    PubMed Central

    Wu, Clayton; Melnikow, Joy; Dinh, Tu; Holmes, James F.; Gaona, Samuel D.; Bottyan, Thomas; Paterniti, Debora; Nishijima, Daniel K.

    2015-01-01

    Introduction Understanding patient perceptions and preferences of hospital care is important to improve patients’ hospitalization experiences and satisfaction. The objective of this study was to investigate patient preferences and perceptions of hospital care, specifically differences between intensive care unit (ICU) and hospital floor admissions. Methods This was a cross-sectional survey of emergency department (ED) patients who were presented with a hypothetical scenario of a patient with mild traumatic brain injury (TBI). We surveyed their preferences and perceptions of hospital care related to this scenario. A closed-ended questionnaire provided quantitative data on patient preferences and perceptions of hospital care and an open-ended questionnaire evaluated factors that may not have been captured with the closed-ended questionnaire. Results Out of 302 study patients, the ability for family and friends to visit (83%), nurse availability (80%), and physician availability (79%) were the factors most commonly rated “very important,” while the cost of hospitalization (62%) and length of hospitalization (59%) were the factors least commonly rated “very important.” When asked to choose between the ICU and the floor if they were the patient in the scenario, 33 patients (10.9%) choose the ICU, 133 chose the floor (44.0%), and 136 (45.0%) had no preference. Conclusion Based on a hypothetical scenario of mild TBI, the majority of patients preferred admission to the floor or had no preference compared to admission to the ICU. Humanistic factors such as the availability of doctors and nurses and the ability to interact with family appear to have a greater priority than systematic factors of hospitalization, such as length and cost of hospitalization or length of time in the ED waiting for an in-patient bed. PMID:26587095

  1. Preoperative patient assessment: Identifying patients at high risk.

    PubMed

    Boehm, O; Baumgarten, G; Hoeft, A

    2016-06-01

    Postoperative mortality remains alarmingly high with a mortality rate ranging between 0.4% and 4%. A small subgroup of multimorbid and/or elderly patients undergoing different surgical procedures naturally confers the highest risk of complications and perioperative death. Therefore, preoperative assessment should identify these high-risk patients and stratify them to individualized monitoring and treatment throughout all phases of perioperative care. A "tailored" perioperative approach might help further reduce perioperative morbidity and mortality. This article aims to elucidate individual morbidity-specific risks. It further suggests approaches to detect patients at the risk of perioperative complications. PMID:27396802

  2. Confabulations in alcoholic Korsakoff patients.

    PubMed

    Borsutzky, Sabine; Fujiwara, Esther; Brand, Matthias; Markowitsch, Hans J

    2008-11-01

    Besides forgetting, memory is also prone to distortions, errors and illusions. Confabulation is one type of memory distortion that may occur in cases of brain damage. Although confabulations are described anecdotally in patients with alcoholic Korsakoff syndrome (KS), there are few systematic investigations of the presence and nature of these types of false memories in KS. Moreover, it is unclear whether KS patients' confabulations evenly affect all types of memories, or whether certain memory domains are more susceptible. Our study attempted to clarify two questions: first, whether confabulations are a critical feature of the cognitive impairment associated with long-term KS in a large sample of patients (N=42). Second, we investigated which memory domain is most likely affected by confabulations in KS. To elicit confabulations, we used a Confabulation Interview containing questions from different memory domains. We found that KS patients overall confabulated more compared to a group of healthy subjects. Furthermore, we found that patients confabulated most within the episodic/autobiographical memory domain. Our results imply that besides pronounced memory deficits typically associated with KS, confabulation can also be regarded as a clinical feature of the disease. The preponderance of episodic confabulation obtained here by using a standardized test, confirms anecdotic reports that KS patients confabulate in everyday life mainly with respect to their personal past and present. Thus, for a detailed description of the memory profile of KS patients, the screening of confabulation tendencies may be a useful supplementary clinical tool. PMID:18675286

  3. Identity disturbance in distant patients.

    PubMed

    Hoffman, Irwin

    2013-04-01

    Chronically distant, emotionally isolated patients often present with identity disturbance. Identity, it is argued, develops as a thematic pattern of narcissism, shaped by the nature of the mother's early libidinal influences on the child's sense of self. Identity provides a form of self-definition that addresses the question, Who am I? In the treatment of these patients, resistances to narcissistic vulnerabilities (narcissistic resistances) provide an illusory sense of security and induce the analyst to avoid attention to a central pathological problem: primitive and frightening needs for, and unconscious fantasies of, dependence on, and functionality for, another. Patients' avoidance of material and therapeutic interactions that deal with their dependencies are aspects of a tacit contract with the analyst to foreclose examination of their considerable problems with inner stability. Among these problems are anxieties regarding intrusion and loss of separateness. As analysis proceeds, elements of such a patient's identity become clarified and are used to understand and organize the material for both analyst and patient. This can allow the patient to articulate a more embodied and vital experience of individuality. A case is presented to illustrate the analysis of a patient using this approach. PMID:23526544

  4. [Adrenal insufficiency in cirrhotic patients].

    PubMed

    Orozco, Federico; Anders, María; Mella, José; Antinucci, Florencia; Pagano, Patricia; Esteban, Paula; Cartier, Mariano; Romero, Gustavo; Francini, Bettina; Mastai, Ricardo

    2016-01-01

    Relative adrenal insufficiency (RAI) is a common finding in cirrhotic patients with severe sepsis, and increased mortality. Its significance is unknown in stable conditions. The aim of this study was to evaluate the prevalence of RAI in stable cirrhotic patients at different stages of the disease. Also, the impact of RAI on the survival was evaluated and basal cortisol levels between plasma and saliva was correlated in control subjects and cirrhotic patients. Forty seven ambulatory patients and 16 control subjects were studied. RAI was defined as a serum cortisol increase of less than 9 υg/dl from baseline after the stimulation with 250 mg of synthetic ACTH. Twenty two had Child-Pugh = 8 and 25 = 9. The prevalence of RAI in patients with stable cirrhosis was 22%. A higher incidence of RAI was observed in patients with a Child-Pugh = 9 (8/32) than in those with = 8 (3/13, p < 0.05). A correlation between salivary cortisol and basal plasma cortisol (r = 0.6, p < 0.0004) was observed. Finally, survival at 1 year (97%) and 3 years (91%) was significantly higher without RAI than those who developed this complication (79% and 51%, p < 0.05, respectively). In summary, the prevalence of RAI is frequent in patients with stable cirrhosis and that it is related to the severity of liver diseaseand increased mortality. PMID:27576278

  5. Social anxiety in orthognathic patients.

    PubMed

    Ryan, F S; Moles, D R; Shute, J T; Clarke, A; Cunningham, S J

    2016-01-01

    There is evidence that patients seeking orthognathic treatment may be motivated by social anxiety disorder (SAD). The aim of this study was to investigate SAD in orthognathic patients using the Brief Fear of Negative Evaluation Scale (BFNES) and to compare these findings with those of the general population. This was a cross-sectional, questionnaire study conducted in two parts. Firstly, a national survey was conducted to yield data for the BFNES from a large, random sample of the UK general population. Secondly, orthognathic patients completed the BFNES. The BFNES scores are reported in two formats: the original 12-item scale (O-BFNES) and a shorter eight-item version (S-BFNES). With regards to the national survey, 1196 individuals participated. The mean O-BFNES score was 29.72 (standard deviation (SD) 9.39) and S-BFNES score was 15.59 (SD 7.67). With regards to the orthognathic sample, 61 patients participated. The mean O-BFNES score was 39.56 (SD 10.35) and the mean S-BFNES score was 24.21 (SD 8.41). Orthognathic patients had significantly higher scores than the general UK population (P<0.001), and multiple linear regression revealed that age, gender, and patient status were all independent predictors of BFNES scores. From the results of this study, orthognathic patients experience significantly higher levels of social anxiety than the general population. PMID:26304605

  6. Celebrity Patients, VIPs, and Potentates

    PubMed Central

    Groves, James E.; Dunderdale, Barbara A.; Stern, Theodore A.

    2002-01-01

    Background: During the second half of the 20th century, the literature on the doctor-patient relationship mainly dealt with the management of “difficult” (personality-disordered) patients. Similar problems, however, surround other types of “special” patients. Method: An overview and analysis of the literature were conducted. As a result, such patients can be subcategorized by their main presentations; each requires a specific management strategy. Results: Three types of “special” patients stir up irrational feelings in their caregivers. Sick celebrities threaten to focus public scrutiny on the private world of medical caregivers. VIPs generate awe in caregivers, with loss of the objectivity essential to the practice of scientific medicine. Potentates unearth narcissism in the caregiver-patient relationship, which triggers a struggle between power and shame. Pride, privacy, and the staff's need to be in control are all threatened by introduction of the special patient into medicine's closed culture. Conclusion: The privacy that is owed to sick celebrities should be extended to protect overexposed staff. The awe and loss of medical objectivity that VIPs generate are counteracted by team leadership dedicated to avoiding any deviation from standard clinical procedure. Moreover, the collective ill will surrounding potentates can be neutralized by reassuring them that they are “special”—and by caregivers mending their own vulnerable self-esteem. PMID:15014712

  7. HPV Carcinomas in Immunocompromised Patients

    PubMed Central

    Reusser, Nicole M.; Downing, Christopher; Guidry, Jacqueline; Tyring, Stephen K.

    2015-01-01

    Human papillomavirus (HPV) infection is the most common sexually transmitted disease worldwide and can result in pre-malignancies or overt malignancies of the skin and mucosal surfaces. HPV-related illnesses are an important personal and public health problem causing physical, mental, sexual and financial detriments. Moreover, this set of malignancies severely affects the immunosuppressed population, particularly HIV-positive patients and organ-transplant recipients. There is growing incidence of HPV-associated anogenital malignancies as well as a decrease in the average age of affected patients, likely related to the rising number of high-risk individuals. Squamous cell carcinoma is the most common type of HPV-related malignancy. Current treatment options for HPV infection and subsequent disease manifestations include imiquimod, retinoids, intralesional bleomycin, and cidofovir; however, primary prevention with HPV vaccination remains the most effective strategy. This review will discuss anogenital lesions in immunocompromised patients, cutaneous warts at nongenital sites, the association of HPV with skin cancer in immunocompromised patients, warts and carcinomas in organ-transplant patients, HIV-positive patients with HPV infections, and the management of cutaneous disease in the immunocompromised patient. PMID:26239127

  8. Interactive Visualization for Patient-to-Patient Comparison.

    PubMed

    Nguyen, Quang Vinh; Nelmes, Guy; Huang, Mao Lin; Simoff, Simeon; Catchpoole, Daniel

    2014-03-01

    A visual analysis approach and the developed supporting technology provide a comprehensive solution for analyzing large and complex integrated genomic and biomedical data. This paper presents a methodology that is implemented as an interactive visual analysis technology for extracting knowledge from complex genetic and clinical data and then visualizing it in a meaningful and interpretable way. By synergizing the domain knowledge into development and analysis processes, we have developed a comprehensive tool that supports a seamless patient-to-patient analysis, from an overview of the patient population in the similarity space to the detailed views of genes. The system consists of multiple components enabling the complete analysis process, including data mining, interactive visualization, analytical views, and gene comparison. We demonstrate our approach with medical scientists on a case study of childhood cancer patients on how they use the tool to confirm existing hypotheses and to discover new scientific insights. PMID:24748858

  9. Quality of Doctor-Patient Communication through the Eyes of the Patient: Variation According to the Patient's Educational Level

    ERIC Educational Resources Information Center

    Aelbrecht, Karolien; Rimondini, Michela; Bensing, Jozien; Moretti, Francesca; Willems, Sara; Mazzi, Mariangela; Fletcher, Ian; Deveugele, Myriam

    2015-01-01

    Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In…

  10. Patient perceptions of orthognathic surgery.

    PubMed

    Flanary, C M; Barnwell, G M; Alexander, J M

    1985-08-01

    A retrospective study of ninety orthognathic surgery patients was conducted to investigate (1) their presurgical concerns and motivations, (2) their preoperative preparation for surgery, and (3) their perceptions of the postsurgical outcome. All subjects completed a twenty-three-item questionnaire and Rotter's Locus of Control Inventory. Statistical date analyses were performed by means of frequency distributions, chi-square, Spearman's r, and Fisher's exact probability tests. The results are presented as thirteen tentative conclusions categorized into three broad areas: motivations and concerns, presurgical preparation, and postsurgical outcome. In the area of motivations and concerns, those with primarily esthetic motivations have less initial reticence toward having orthognathic surgery and less difficulty adjusting to their new appearance than those with strong functional incentives. Younger patients and those patients with strong cosmetic motivations are less concerned about surgical risks. Under the category of presurgical preparation, more females than males desire to speak to a previous orthognathic surgery patient. Patients who receive inadequate explanation of the surgical procedure are more likely to be emotionally unprepared. One of the leading factors in patient dissatisfaction with surgery is the patient's experience of postoperative "surprises." In the area of postsurgical outcome, two-jaw operations precipitate more pain complaints than single-arch procedures. With time, however, patients tend to forget the degree of postoperative pain. Maxillary surgical procedures lead to less severe pain complaints than mandibular procedures, but there are more initial complaints of breathing difficulties and sinus problems following maxillary procedures. Surgical goal fulfillment does not guarantee that a patient would re-elect to have the treatment. PMID:3861099

  11. Patient satisfaction with antihypertensive therapy.

    PubMed

    Chen, K; Chiou, C-F; Plauschinat, C A; Frech, F; Harper, A; Dubois, R

    2005-10-01

    The objective of the study was to assess factors associated with treatment satisfaction among patients receiving antihypertensive therapy. A weighted cross-sectional online survey was conducted with hypertensive patients participating in a chronic disease panel in the US. Patients on monotherapy with medications from the following classes were identified: ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta blockers (BBs), calcium channel blockers (CCBs), and diuretics. The control group included patients without treatment. Pairwise comparisons between groups were conducted for factors that may affect patients' satisfaction. The study population had a mean age of 54.7+/-14.2 years and was 56.7% female. Participants with blood pressure (BP) controlled to JNC 7 guidelines were more satisfied with their medication than those with uncontrolled BP (90.3 vs 71.5%, P<0.05). Patients who had not experienced adverse events had higher satisfaction than patients experiencing adverse events (90.9 vs 75.8%, P<0.05). The most frequently self-reported adverse events were frequent urination, sexual dysfunction, and fatigue ranging from 7.0 to 9.6% across classes. The adverse event rates differed by class and were lowest among the ARBs. Patients on ARBs were the most likely to have switched from a previous antihypertensive class as compared to other classes (57.1% ARBs vs 49.8% ACEIs, 38.7% diuretics, 36.3% CCBs, and 31.7% BBs). Physician recommendation was the most common reason for switching. In conclusion, the ability to effectively treat hypertension depends upon a patient's satisfaction with antihypertensive therapy, which may be improved by achieving BP control and minimizing the occurrence of adverse events. PMID:15951740

  12. Marginal ulcer in achlorhydric patients.

    PubMed Central

    Tauxe, R V; Wright, L F; Hirschowitz, B I

    1975-01-01

    Recurrent gastrojejunal ulceration is reported in three patients with histamine-fast achlorhydria. In none of these patients was extruding suture material responsible for the ulceration. However, all three patients had a history of alcohol abuse, and one abused aspirin as well. These cases demonstrate that achlorhydria does not protect against anastomotic ulceration. It is suggested that surgical manipulation produces an increased susceptibility to mucosal damage, and that it is erroneous to consider all anastomotic ulceration as a continuation or recurrence of acid peptic disease. PMID:1130864

  13. Comorbidities in patients with spondyloarthritis.

    PubMed

    van der Horst-Bruinsma, Irene E; Nurmohamed, Michael T; Landewé, Robert B M

    2012-08-01

    Chronic inflammatory spondyloarthritis involves axial symptoms of the spine and sacroiliac joints, or peripheral arthritis. Many patients suffer from extra-articular manifestations. With acute anterior uveitis, rapid treatment prevents synechiae. Other organs can be involved. Treatment includes exercise, nonsteroidal antiinflammatory drugs (if insufficient response, tumor necrosis factor blockers), and (with peripheral arthritis) sulfasalazine. Patients with ankylosing spondylitis have comorbidities and increased cardiovascular risk. For uveitis or inflammatory bowel disease, patients should be referred to an ophthalmologist or gastroenterologist. Cardiovascular risk may originate from atherosclerotic disease and cardiac manifestations. Epidemiological studies should be conducted before echocardiogram screening and cardiovascular risk management. PMID:23083753

  14. Respiratory Emergencies in Geriatric Patients.

    PubMed

    Tyler, Katren; Stevenson, Dane

    2016-02-01

    Acute dyspnea in older patients is a common presentation to the emergency department. Acute dyspnea in older adults is often the consequence of multiple overlapping disorders, such as pneumonia precipitating acute heart failure. Emergency physicians must be comfortable managing patients with acute dyspnea of uncertain cause and varying goals of care. In addition to the important role noninvasive ventilation (NIV) plays in full resuscitation, NIV can be useful as a method of providing supportive or nearly fully supportive care while more information is gathered from the patients and their loved ones. PMID:26614240

  15. Special Considerations in Trauma Patients.

    PubMed

    Abraham, Michael K; Aquino, Patrick R; Kuo, Dick C

    2015-11-01

    The emergent management of a traumatic injury can be an extremely intense situation. These assessments can be even more difficult when patients have an underlying psychiatric condition. After a protocoled evaluation of the traumatic injuries, the psychological manifestation of diseases can be addressed. The appropriate use of physical or chemical restraints to facilitate the work-up is paramount in the ability of the provider to protect patients and staff from agitated and traumatized patients. The emergency medicine provider should have a low threshold for including psychiatry in the treatment plans, as the long-term sequelae of these entities require specialized treatment. PMID:26493528

  16. Erectile dysfunction in COPD patients.

    PubMed

    Turan, Onur; Ure, Iyimser; Turan, Pakize Ayse

    2016-02-01

    Sexual dysfunction is a common problem in chronic obstructive pulmonary disease (COPD). We aimed to assess the presence of erectile dysfunction (ED) in COPD patients. Ninety-three outpatients who had been diagnosed as COPD and followed in Bolvadin State Hospital, Afyon, Turkey, were included in the study. All patients underwent pulmonary function tests and arterial blood gas analysis. They completed International Physical Activity Questionnaire (IPAQ), Medical Research Council (MRC) Dyspnea Scale, Short Form 36-item Scale (SF-36), and International Index of Erectile Function (IIEF) Questionnaire. The mean age of 10 (10.8%) mild, 46 (49.5%) moderate, 28 (30.1%) severe, and 9 (9.7%) very severe COPD patients was 61.4 ± 9.8 years. Varying degrees of ED were detected in 67.7% of COPD patients. All patients with hypoxemia had ED. IPAQ score and all SF-36 parameters were low in patients with ED, while MRC score was high. Forced expiratory volume in one second, forced vital capacity, partial pressure of oxygen in blood, oxygen (O2) saturation, IPAQ score, and role-physical parameters were statistically low in ED patients (p = 0.04, 0.02, <0.01, <0.01, 0.02, and 0.04, respectively); MRC score was statistically higher in patients with ED (p = 0.02). Patients with moderate and severe ED had statistically lower score of mental health (p < 0.01 and p = 0.02, respectively). There was a positive correlation between IIEF score and IPAQ scores (p < 0.01), MRC scores (p = 0.01), general health (p < 0.01), role-physical (p < 0.01), role-emotional (p < 0.01), physical functioning (p < 0.01), and mental health (p < 0.01) parameters in SF-36. ED is frequently seen in COPD patients. Hypoxemia, smoking, and limitation of physical activity are thought to be associated with ED in COPD as mechanisms. Quality of life and the functional capacity are negatively affected with the presence of ED. It is important for a physician to question the sexual functions in patients with COPD. The

  17. Neurology of the geriatric patient.

    PubMed

    Fenner, W R

    1988-05-01

    Owing to improvements in health care, more animals are living to advanced ages. Many abnormal neurologic conditions can affect these patients, but those most commonly associated with advancing years include degenerative, neoplastic, and idiopathic processes. An understanding of the "normal" age-related changes seen on a neurologic examination must be kept in mind when evaluating geriatric patients. Special care and consideration of the patient and client are often required in managing these cases, especially because treatment protocols are often unsuccessful or do not exist, resulting in a prognosis that is often poor at best. PMID:3289252

  18. Patient puzzle. Use systematic assessment to detect & correct patient conditions.

    PubMed

    Stoy, W A

    2001-01-01

    Medic 27 responds to a report of a fall victim at 27 West Pinnacle Lane. En route, the crew learns from dispatch that the patient fell approximately 25 feet from the roof of a three-story structure onto the roof of an adjacent garage. The caller reports the patient "going in and out of consciousness." The EMS crew requests the dispatch of a rescue unit and ladder company to assist on scene and the placement of a medical helicopter on standby. On scene, the patient's wife reports her husband accidentally disturbed a hornets' nest as he secured a weather vane to the top of the family home. She says the hornets stung her husband repeatedly. In his attempt to avoid the stings, his movements jarred the ladder, causing him to fall to the roof below. As you walk to the side of the patient's home, his wife adds that her husband has a cardiac condition and now complains of chest pain and trouble breathing. You wonder what you'll find when you reach the victim. Is he a medical patient with traumatic injuries or a trauma patient with medical complications? PMID:11213605

  19. Evidence-based patient education: knowledge transfer to endodontic patients.

    PubMed

    Sorrell, John T; McNeil, Daniel W; Gochenour, Lori L; Jackson, C Russell

    2009-11-01

    Evidence-based treatment is emphasized in oral health care, but there has been less focus on empirically demonstrating the effects of patient education. Attempts to educate patients must be empirically demonstrated in order to provide evidence-based guidance to practitioners and educators. We conducted two studies that assessed information acquisition during five-minute audiovisual films on oral hygiene procedures, endodontic procedures, and fear about pain during root canal therapy. A fifteen-item Dental Knowledge Questionnaire (DKQ), with three subscales each focusing on the content of one of the films, was developed and psychometrically evaluated. Study 1 included 268 undergraduates; study 2 involved 104 endodontic patients. Participants completed the DKQ, viewed one of the three films, and repeated the questionnaire. The effects of information on knowledge were assessed using 3 (film group) X 3 (subscale of the DKQ) X 2 (time) repeated measures ANOVAs. Scores improved in a content-specific fashion relevant to the film viewed among undergraduates, F(4, 263)=211.33, p<.001, partial eta(2)=.62 and endodontic patients, F(4, 99)=87.22, p<.001, partial eta(2)=.63. The results provide evidence for using brief informational film as an efficacious method to increase patient knowledge, at least in the short term. The DKQ is proposed as a tool to assess patient knowledge in the arenas of oral hygiene and endodontics. PMID:19910479

  20. Patient participation in pressure injury prevention: giving patient's a voice.

    PubMed

    Latimer, Sharon; Chaboyer, Wendy; Gillespie, Brigid

    2014-12-01

    Pressure injuries burden patients and healthcare organisations, with some preventative practices having little impact on prevalence reduction. Patient participation in care may be an effective pressure injury prevention strategy, yet patient preferences are unknown. The aim of this interpretive study was to describe patients' perceptions of their current and future role in pressure injury prevention. Semi-structured interviews were conducted with 20 adult inpatients recruited from four medical units, at two Australian metropolitan hospitals. Interview data were analysed using content analysis, with three categories emerging: 'experiencing pressure injuries'; 'participating in pressure injury prevention'; and 'resourcing pressure injury prevention and treatment'. These categories reflect the complex nature of participants' pressure injury experience. The findings suggest participants gather pressure injury knowledge from first-hand and vicarious experience; knowledge they bring to hospital. Most participants preferred a proactive pressure injury prevention role. Many identified barriers in the healthcare environment that impeded their participation and affected their experience of pressure injuries and pressure injury prevention. If patient participation as a pressure injury prevention strategy is to be considered, nurses and organisations need to view patients as partners. PMID:24117711

  1. [Coronary angioplasty in elderly patients].

    PubMed

    Liistro, Francesco; Colombo, Antonio

    2002-01-01

    Developed nations are experiencing an unprecedented growth in the number of elderly citizens. Thanks to the modernization of both society and medical care, over the past century, life expectancy in most countries has nearly doubled. The elderly (80 years or over) represent the fastest-growing segment of our population. Owing to their age, the elderly are more afflicted with chronic diseases, including coronary artery disease. Recently, clinicians became more aggressive in the use of invasive cardiovascular diagnostic tests in these patients. With regard to younger patients, we have a wealth of data from large, randomized trials that defined which subsets of patients benefit from revascularization therapies. However, because the very elderly were severely underrepresented in these randomized studies, we have almost no information concerning the choice of treatment in these patients. Initial results of percutaneous revascularization procedures in elderly patients come from retrospective analysis performed during the pre-stent era. In these studies a procedural mortality risk 5-fold higher in patients > 80 years compared with those < 60 is reported. With the advent of coronary stenting, a significant increase in the rate of procedural success and a reduction in the incidence of procedural mortality, acute myocardial infarction and emergency coronary artery bypass grafting were observed also in the elderly. These initial positive results prompted physicians to treat patients with impaired clinical conditions and with unfavorable angiographic characteristics, resulting in a long-term freedom from major adverse cardiac events comparable to those observed in younger patients (78% in patients < 70 years vs 75% in patients > 80 years). The comparison between the percutaneous approach and the surgical approach to coronary artery disease in the elderly has its major limitation in the lack of data from randomized trials. The available information suggests similar results with

  2. A Process Evaluation of an Efficacious Family-Based Intervention to Promote Healthy Eating: The Entre Familia: Reflejos de Salud Study.

    PubMed

    Schmied, Emily; Parada, Humberto; Horton, Lucy; Ibarra, Leticia; Ayala, Guadalupe

    2015-10-01

    Entre Familia: Reflejos de Salud was a successful family-based randomized controlled trial designed to improve dietary behaviors and intake among U.S. Latino families, specifically fruit and vegetable intake. The novel intervention design merged a community health worker (promotora) model with an entertainment-education component. This process evaluation examined intervention implementation and assessed relationships between implementation factors and dietary change. Participants included 180 mothers randomized to an intervention condition. Process evaluation measures were obtained from participant interviews and promotora notes and included fidelity, dose delivered (i.e., minutes of promotora in-person contact with families, number of promotora home visits), and dose received (i.e., participant use of and satisfaction with intervention materials). Outcome variables included changes in vegetable intake and the use of behavioral strategies to increase dietary fiber and decrease dietary fat intake. Participant satisfaction was high, and fidelity was achieved; 87.5% of families received the planned number of promotora home visits. In the multivariable model, satisfaction with intervention materials predicted more frequent use of strategies to increase dietary fiber (p ≤ .01). Trends suggested that keeping families in the prescribed intervention timeline and obtaining support from other social network members through sharing of program materials may improve changes. Study findings elucidate the relationship between specific intervention processes and dietary changes. PMID:25810469

  3. Uma Comparação entre Técnicas de Propagação de Erros em Astrofísica: Monte Carlo x Bootstrap

    NASA Astrophysics Data System (ADS)

    Zabot, Alexandre; Baptista, Raymundo

    2005-07-01

    Neste trabalho é feito um estudo comparativo entre dois algoritmos numéricos usados para propagação de erros em dados experimentais. Um deles é conhecido por Método de Monte carlo e o outro por Método de Bootstrap. Recentemente, Dhullon & Watson argüiram que a aplicação do método de Monte Carlo introduz ruído nos dados, e propuseram então a utilização do Bootstrap como alternativa capaz de produzir resultados superiores. O objetivo deste trabalho é testar a validade dessa afirmação. As duas técnicas foram aplicadas a três problemas diferentes: o ajsute de modelos de emissão LTE simples e atmosfera estelar a espectros estelares observados e o ajuste de curvas de luz de eclipses de Variáveis Cataclísmicas para a detemrinação da distribuição radial de brilho dos seus discos de acréscimo. Os métodos foram testados quanto à sua robusteza, ou seja, a capacidade de prover resultados coerentes enre si. Além disso, as soluções dos métodos foram comparadas. Os resultados indicam que não existe evidência de superioridade de um métodos em relação ao outro.

  4. Effects of comfort warming on preoperative patients.

    PubMed

    Wagner, Doreen; Byrne, Michelle; Kolcaba, Katharine

    2006-09-01

    THERMAL COMFORT IS ONE DIMENSION of overall patient comfort, and it usually is addressed by covering the patient with warmed cotton blankets. WARMING HELPS A PATIENT maintain normothermia and appears to decrease patient anxiety. AN STUDY WAS CONDUCTED in a preoperative setting to compare the effects of preoperative warming with warmed cotton blankets versus patient-controlled warming gowns on patients' perceptions of thermal comfort and anxiety. BOTH WARMING INTERVENTIONS had a positive effect on patients' thermal comfort and sense of well-being. Patients who used the patient-controlled warming gown also experienced a significant reduction in preoperative anxiety. PMID:17004666

  5. 38 CFR 17.33 - Patients' rights.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Patient Rights § 17.33 Patients' rights. (a) General. (1) Patients have a right to be treated with dignity... privacy with regard to their personal needs. (2) Patients have a right to receive, to the extent of... purposes. (4) No patient in the Department of Veterans Affairs medical care system, except as...

  6. 38 CFR 17.33 - Patients' rights.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Patient Rights § 17.33 Patients' rights. (a) General. (1) Patients have a right to be treated with dignity... privacy with regard to their personal needs. (2) Patients have a right to receive, to the extent of... purposes. (4) No patient in the Department of Veterans Affairs medical care system, except as...

  7. 38 CFR 17.33 - Patients' rights.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Patient Rights § 17.33 Patients' rights. (a) General. (1) Patients have a right to be treated with dignity... privacy with regard to their personal needs. (2) Patients have a right to receive, to the extent of... purposes. (4) No patient in the Department of Veterans Affairs medical care system, except as...

  8. 38 CFR 17.33 - Patients' rights.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Patient Rights § 17.33 Patients' rights. (a) General. (1) Patients have a right to be treated with dignity... privacy with regard to their personal needs. (2) Patients have a right to receive, to the extent of... purposes. (4) No patient in the Department of Veterans Affairs medical care system, except as...

  9. Developing patient-centered teams: The role of sharing stories about patients and patient care.

    PubMed

    Bennett, Ariana H; Hassinger, Jane A; Martin, Lisa A; Harris, Lisa H; Gold, Marji

    2015-09-01

    Research indicates that health care teams are good for staff, patients, and organizations. The characteristics that make teams effective include shared objectives, mutual respect, clarity of roles, communication, trust, and collaboration. We were interested in examining how teams develop these positive characteristics. This paper explores the role of sharing stories about patients in developing patient-centered teams. Data for this paper came from 1 primary care clinic as part of a larger Providers Share Workshop study conducted by the University of Michigan. Each workshop included 5 facilitated group sessions in which staff met to talk about their work. This paper analyzes qualitative data from the workshops. Through an iterative process, research team members identified major themes, developed a coding scheme, and coded transcripts for qualitative data analysis. One of the most powerful ways group members connected was through sharing stories about their patients. Sharing clinical cases and stories helped participants bond around their shared mission of patient-centered care, build supportive relationships, enhance compassion for patients, communicate and resolve conflict, better understand workflows and job roles, develop trust, and increase morale. These attributes highlighted by participants correspond to those documented in the literature as important elements of teambuilding and key indicators of team effectiveness. The sharing of stories about patients seems to be a promising tool for positive team development in a primary care clinical setting and should be investigated further. PMID:26348238

  10. Helping Patients To Quit Smoking

    PubMed Central

    Bass, Frederic

    1989-01-01

    Years ago, the tobacco leaf offered its users many social and ceremonial benefits. But today, throughout the world, the manufactured cigarette wreaks biological havoc. Clinically, physicians can make a small, but significant, contribution to their patients' stopping smoking. Family physicians who want to offer systematic aid to their smoking patients should assess the amount of time and energy they are willing to invest in patients' smoking and the probable rewards of such efforts. Behavioural change comprises four stages: a pre-motivational phase, a motivational phase, a behavioural-change phase, and a maintenance phase. Anyone who has ever smoked belongs to one of these phases and should be treated accordingly. Paradoxically, the physician should support consonant smoking (the patient freely choosing to smoke) except when the smoker is actively engaged in changing behaviour. PMID:21248907

  11. Implant rehabilitation in bruxism patient

    PubMed Central

    Goiato, Marcelo Coelho; Sonego, Mariana Vilela; dos Santos, Daniela Micheline; da Silva, Emily Vivianne Freitas

    2014-01-01

    A white female patient presented to the university clinic to obtain implant retained prostheses. She had an edentulous maxillary jaw and presented three teeth with poor prognosis (33, 34 and 43). The alveolar bone and the surrounding tissues were healthy. The patient did not report any relevant medical history contraindicating routine dental treatment or implant surgery, but self-reported a dental history of asymptomatic nocturnal bruxism. The treatment plan was set and two Branemark protocols supported by six implants in each arch were installed after a 6-month healing period. A soft occlusal splint was made due to the patient's history of bruxism, and the lack of its use by the patient resulted in an acrylic fracture. The prosthesis was repaired and the importance of using the occlusal splint was restated. In the 4-year follow-up no fractures were reported. PMID:24907215

  12. Examination of the adolescent patient.

    PubMed

    Hampton, H L

    2000-03-01

    Adolescent patients need knowledge and motivation to practice a healthy lifestyle. The provider of adolescent health care is uniquely qualified to provide factual health information and practical advice. Enlisting parental support for confidential adolescent health services usually is not problematic when parents and health care providers share common goals and responsibility. The health care provider must develop rapport to foster high-risk health behavior disclosure and must promote health messages that are stronger than those received from peers, television, movies, and magazines. Adolescents who elect to abstain from sexual activity need as much support as sexually active patients. Depression, substance abuse, and eating disorders must be recognized and treated. Preventative health care services for adolescents can be optimized when office staff understand the special needs of these young women. The physician's concerns regarding the health of adolescent patients will be welcomed by patients, their parents, and the community. PMID:10693179

  13. Time out for patient safety.

    PubMed

    Meginniss, Anne; Damian, Frances; Falvo, Francine

    2012-01-01

    "Time out for patient safety" is a simple and effective tool to improve communication among caregivers based on the use of critical language that has been effective in the perioperative setting, airline industry, and military. In the emergency department it is non threatening and focuses attention on safe patient care. "Time out for patient safety" complements the use of other standardized communication techniques such as SBAR in clinical situations in which immediate intervention is mandatory for patient safety.This communication tool was presented to the multidisciplinary staff and has been embedded in the Emergency Department's simulation program for newly graduated nurses. The concept was well received by the group.Future research is needed to address outcomes for effectiveness. PMID:21764112

  14. Should Immunocompromised Patients Have Pets?

    PubMed Central

    Steele, Russell W.

    2008-01-01

    Purpose: To evaluate the risks and benefits of pet ownership by immunodeficient patients, focusing primarily on organisms that colonize animals and are transmitted to humans. Those diseases that are known to be progressive or more severe in patients with altered immune function are emphasized. Methods: A review of the medical and veterinary literature pertaining to zoonoses transmitted by domestic animals was completed. Information pertaining to issues involving immunosuppressed patients including AIDS was carefully evaluated and summarized for inclusion. Results: There are significant clinical and psychosocial benefits to pet ownership. However, numerous diseases can be acquired from these animals which may be more severe in immunocompromised individuals. Conclusion: Simple guidelines for pet ownership by immunosuppressed patients can be implemented to reduce their risk of disease and allow them to safely interchange with their pets. PMID:21603465

  15. Which therapy for which patient?

    PubMed

    Pierangeli, G; Cevoli, S; Sancisi, E; Grimaldi, D; Zanigni, S; Montagna, P; Cortelli, P

    2006-05-01

    Prophylactic treatment is mainly intended to reduce the frequency of migraine attacks, enhance response to acute medications, improve patient function and reduce disability. Sufficient evidence and consensus exist to recommend propranolol, timolol, amitriptyline, pizotifen, divalproex, sodium valproate and topiramate as first line agents for migraine prevention. These drugs can halve the frequency of attacks in 50% of patients. The anticipated benefit must be weighed against the adverse effects associated with each agent in determining the optimal preventive regimen for individual patients considering any comorbid conditions that are often present. The decision to treat and the choice of prophylactic drug must be taken with the patient. It is important to balance expectations and therapeutic realities for each particular drug. Recent data on the effect of prophylactic treatment on trigeminovascular activation and on cortical spreading depression emphasise the importance of developing research on migraine-preventive drugs. PMID:16688621

  16. The patient with daily headaches.

    PubMed

    Maizels, Morris

    2004-12-15

    The term "chronic daily headache" (CDH) describes a variety of headache types, of which chronic migraine is the most common. Daily headaches often are disabling and may be challenging to diagnose and treat. Medication overuse, or drug rebound headache, is the most treatable cause of refractory daily headache. A pathologic underlying cause should be considered in patients with recent-onset daily headache, a change from a previous headache pattern, or associated neurologic or systemic symptoms. Treatment of CDH focuses on reduction of headache triggers and use of preventive medication, most commonly anti-depressants, antiepileptic drugs, and beta blockers. Medication overuse must be treated with discontinuation of symptomatic medicines, a transitional therapy, and long-term prophylaxis. Anxiety and depression are common in patients with CDH and should be identified and treated. Although the condition is challenging, appropriate treatment of patients with CDH can bring about significant improvement in the patient's quality-of-life. PMID:15617293

  17. Polypharmacy in heart failure patients.

    PubMed

    Mastromarino, Vittoria; Casenghi, Matteo; Testa, Marco; Gabriele, Erica; Coluccia, Roberta; Rubattu, Speranza; Volpe, Massimo

    2014-06-01

    In heart failure (HF), the progressive use of multiple drugs and a complex therapeutic regimen is common and is recommended by international guidelines. With HF being a common disease in the elderly, patients often have numerous comorbidities that require additional specific treatment, thus producing a heavy pill burden. Polypharmacy, defined as the chronic use of five or more medications, is an underestimated problem in the management of HF patients. However, polypharmacy has an important impact on HF treatment, as it often leads to inappropriate drug prescription, poor adherence to pharmacological therapies, drug-drug interactions, and adverse effects. The growing complexity of HF patients, whose mean age increases progressively and who present multiple comorbidities, suggests the need for newer models of primary care to improve the management of HF patients. Self-care, telemonitoring, and natriuretic peptide-guided therapy represent promising new HF care models to face the complexity of the disease and its therapeutic regimen. PMID:24493574

  18. Turning patients over in bed

    MedlinePlus

    ... This helps the skin stay healthy and prevents bedsores. Turning a patient is a good time to ... M, et al. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College ...

  19. Turning patients over in bed

    MedlinePlus

    ... so the person is not at risk of rolling out of the bed. The patient's bottom arm ... M, et al. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American ...

  20. [The nurse and patient's nudity].

    PubMed

    dos Santos, Regina Maria; Viana, Ivea Rayane M N; da Silva, Josefa Rita; Trezza, Maria Cristina Soares Figueiredo; Leite, Joséte Luzia

    2010-01-01

    This is a qualitative study about the relationship among nurses of a university hospital and their patients when they need to undress those patients to take care. The purpose was to analyze speech of seven nurses in this situation. The information was taken by transcribing the semi-structured interviews which were analyzed according Michel Foucault's thought. The results demonstrated that the relationship among nurses and patients at the time when nudity is needed to perform nursing care is full of power, to which the nurses don't feel always prepared. Also the nurses don't think that, acting as they act, they exert power over the patients. It is suggested to Nursing schools to perform seminars about the care with the naked body. PMID:21308217

  1. Hospitalized Patients and Fungal Infections

    MedlinePlus

    ... but can also be caused by fungi. Hospital construction. Hospital staff do everything they can to prevent ... patients staying at hospitals where there is ongoing construction or renovation. 5 This is thought to be ...

  2. [Perioperative Management of PD Patients].

    PubMed

    Reichmann, H

    2016-07-01

    Both patients and caregivers but also treating physicians are concerned about complications along with surgical interventions. A major problem is abrupt cessation of anti-Parkinson medication, which leads to manifold disturbances, sometimes even to an akinetic crisis. There are several means to guarantee continuous dopaminergic stimulation even in patients that are not allowed to take medication orally before they undergo surgery. Amongst others rectally applied levodopa, amantadine infusions, and especially the use of a rotigotine patch are good means to overcome oral intake. Perioperative management is important due to the fact that in Germany alone each year more than 10 000 PD patients undergo surgery. Main reasons for this are fractures, but also elective interventions. Further emergency situations that cause treatment as an inpatient are psychosis, motoric disability, but also pneumonia and cardiovascular disturbances. In contrast PD patients suffer less often from cancer. PMID:27276074

  3. Noma in an immunocompromised patient.

    PubMed

    Silva, Igor Henrique Morais; Faria, Andreza Barkokebas S de; Fonseca, Deborah Daniela Diniz; Aguiar, Carlos Menezes; Carvalho, Alessandra Tavares; Gueiros, Luiz Alcino; Leao, Jair Carneiro

    2013-01-01

    Noma (also known as cancrum oris) is classified by the World Health Organization as a necrotizing ulcerative stomatitis, an invasive acute infection which affects the orofacial tissues. Patients who are subject to such risk factors as severe malnutrition or alteration of the immune system are predominantly affected. This article presents a case of noma in a 62-year-old immunocompromised patient with pain and tooth mobility in the mandibular region, ulceration, bleeding, gingival inflammatory secretion, and oral malodor. The signs and symptoms were controlled only after the intravenous administration of 500 mg tid of imipenem/cilastatin sodium and 2 g qd of vancomycin. After infection control was maintained, the patient was directed to surgery for removal of bone sequestration and curettage of the maxillary sinus. The patient was prescribed 1 g qd of oral clindamycin for 3 months postsurgery. PMID:24192747

  4. Transfusion medicine in trauma patients

    PubMed Central

    Murthi, Sarah B; Dutton, Richard P; Edelman, Bennett B; Scalea, Thomas M; Hess, John R

    2011-01-01

    Injured patients stress the transfusion service with frequent demands for uncrossmatched red cells and plasma, occasional requirements for large amounts of blood products and the need for new and better blood products. Transfusion services stress trauma centers with demands for strict accountability for individual blood component units and adherence to indications in a clinical field where research has been difficult, and guidance opinion-based. New data suggest that the most severely injured patients arrive at the trauma center already coagulopathic and that these patients benefit from prompt, specific, corrective treatment. This research is clarifying trauma system requirements for new blood products and blood-product usage patterns, but the inability to obtain informed consent from severely injured patients remains an obstacle to further research. PMID:21083009

  5. Preventing Infections in Cancer Patients

    MedlinePlus

    ... 14 of these patients dies. What Is an Infection? You get an infection when germs enter your ... the flu. How Does the Body Normally Fight Infections? The immune system helps your body protect itself ...

  6. Corneal temperature in schizophrenia patients.

    PubMed

    Shiloh, Roni; Munitz, Hanan; Portuguese, Shirley; Gross-Isseroff, Ruth; Sigler, Mayanit; Bodinger, Liron; Katz, Nachum; Stryjer, Rafael; Hermesh, Haggai; Weizman, Abraham

    2005-12-01

    Most data imply that dopaminergic transmission is essential for proper hypothalamic-mediated core temperature regulation. Altered central dopaminergic transmission is suggested to be involved in the pathophysiology of schizophrenia. Thus, hypothetically, schizophrenia patients might be at increased risk of developing thermoregulatory dysregulation manifested by alterations in core temperature, as well as in peripheral tissue, the temperature of which has been shown to correlate with core temperature (e.g. cornea). Previous small pilot studies of ours showed that schizophrenia patients may exhibit corneal temperature abnormalities. Hence, we assessed corneal temperature in a controlled sample of drug-free ( n =11) and medicated ( n =28) schizophrenia patients compared to healthy comparison subjects ( n =9), using a FLIR thermal imaging camera. Drug-free schizophrenia patients exhibited significantly higher corneal temperature compared to healthy subjects, typical antipsychotic drug (APD)-treated patients ( n =16) and atypical APD-treated patients ( n =12) (37.08+/-1.46 degrees C vs. 33.37+/-2.51 degrees C, 31.08+/-1.43 degrees C and 31.67+/-0.44 degrees C respectively, p <0.0001; p <0.001 vs. each group separately). The healthy comparison subjects and the atypical APD-treated patients exhibited comparable corneal temperatures and these two groups exhibited higher corneal temperatures compared to the typical APD-treated patients ( p <0.01 and p =0.051 respectively). In conclusion, this study indicates that drug-free schizophrenia patients exhibit substantially higher corneal temperature compared to healthy comparison subjects or medicated patients, and that APDs may decrease corneal temperature either to normal (atypical APD) or to subnormal (typical APD) values. The relevance of these phenomena to the pathophysiology of schizophrenia, the biological mechanism underlying drug-induced corneal temperature alterations, the possible role of temperature-lowering drugs

  7. Patients' perceptions of psychotropic drugs

    PubMed Central

    Helman, Cecil G.

    1981-01-01

    This pilot study examined patients' perceptions of, and attitudes towards, psychotropic drug-taking. Fifty chronic users of benzodiazepines in two Middlesex group practices were interviewed, and data were collected on their knowledge, experience and expectations of these drugs. The data suggest that psychotropic drug-taking has become an important part of many patients' self-image and of their social relationships, and that these factors should be taken into account when dealing with psychological dependence on psychotropic drugs. PMID:7265056

  8. [Patients, doctors and the internet].

    PubMed

    Jeannot, Jean Gabriel; Bischoff, Thomas

    2015-05-13

    The majority of the Swiss population uses the internet to seek information about health. The objective is to be better informed, before or after the consultation. Doctors can advise their information-seeking patients about high quality websites, be it medical portals or websites dedicated to a specific pathology. Doctors should not see the internet as a threat but rather as an opportunity to strengthen the doctor-patient relationship. PMID:26118229

  9. Is My Patient An Athlete?

    PubMed Central

    Bullard, Jack

    1974-01-01

    This article outlines the ways in which the practice of medicine is affected by patients' participation in sports, or indeed any form of physical exercise. Several instances are cited where the patient's need for a quick recovery will materially affect the treatment he is given. The family physician must be aware of these instances, from the post coronary exercise program to premenstrual tension in an Olympic athlete. PMID:20469053

  10. Adenomyosis: What the Patient Needs.

    PubMed

    Alabiso, Giulia; Alio, Luigi; Arena, Saverio; Barbasetti di Prun, Allegra; Bergamini, Valentino; Berlanda, Nicola; Busacca, Mauro; Candiani, Massimo; Centini, Gabriele; Di Cello, Annalisa; Exacoustos, Caterina; Fedele, Luigi; Fuggetta, Eliana; Gabbi, Laura; Geraci, Elisa; Imperiale, Ludovica; Lavarini, Elena; Incandela, Domenico; Lazzeri, Lucia; Luisi, Stefano; Maiorana, Antonio; Maneschi, Francesco; Mannini, Luca; Mattei, Alberto; Muzii, Ludovico; Pagliardini, Luca; Perandini, Alessio; Perelli, Federica; Pinzauti, Serena; Porpora, Maria Grazia; Remorgida, Valentino; Leone Roberti Maggiore, Umberto; Seracchioli, Renato; Solima, Eugenio; Somigliana, Edgardo; Tosti, Claudia; Venturella, Roberta; Vercellini, Paolo; Viganò, Paola; Vignali, Michele; Zannoni, Letizia; Zullo, Fulvio; Zupi, Errico

    2016-01-01

    A panel of experts in the field of endometriosis expressed their opinions on management options in a 28-year-old patient, attempting pregnancy for 1 year, with severe cyclic pelvic pain and with clinical examination and imaging techniques suggestive of adenomyosis. Many questions this paradigmatic patient may pose to the clinician are addressed, and all clinical scenarios are discussed. A decision algorithm derived from this discussion is also proposed. PMID:26772777

  11. SUICIDAL COMMUNICATION IN PSYCHIATRIC PATIENTS

    PubMed Central

    Anand, R.; Trivedi, J.K.; Gupta, S.C.

    1983-01-01

    In this enquiry a cross-sectional study of hospitalized psychiatric patients was undertaken to assess prevalence and nature of suicidal behaviour. We have been able to delineate these subjects into three categories i.e. non-communicators, partial communicators and definite communicators on the basis of their scores upon 31ucid.il intent questionnaire. A follow up study of these patients which is in progress may further provide knowledge about relationship between predictive criterion and their final outcome. PMID:21847269

  12. Inspiration of psychotherapists by patients.

    PubMed

    Messner, E

    1976-12-01

    Many patients possess such exemplary traits and virtues that their psychotherapists are inspired to emulate them. This process can benefit the clinician and reinforce the therapeutic alliance, rapport, and the spirit of reciprocity; however, it can also arouse responses by the clinician that are therapeutically detrimental. Awareness of this hazard can enable the clinican to avert it and enhance the benefits provided by the patient's outstanding strengths. PMID:984249

  13. Patient Simulators Train Emergency Caregivers

    NASA Technical Reports Server (NTRS)

    2014-01-01

    Johnson Space Center teamed up with Sarasota, Florida-based METI (now CAE Healthcare) through the STTR program to ruggedize the company’s patient simulators for training astronauts in microgravity environments. The design modifications were implemented in future patient simulators that are now used to train first responders in the US military as well as fire departments and other agencies that work in disaster zones.

  14. Psychoeducation. Patient education gets respect.

    PubMed

    London, Fran

    2008-04-01

    Even those who are not psychiatric nurses find themselves caring for patients with psychiatric disorders. Adults with a mental health and/or substance abuse diagnosis accounted for 1 of 4 hospital stays in 2004. Whether the patient's problem is physical, mental, or both, most care is self-care. Psychoeducation improves health outcomes by optimizing self-care skills, engaging family and community supports, and promoting early recognition of problems and appropriate interventions. PMID:18408511

  15. Donor commitment and patient needs.

    PubMed

    Bakken, R; van Walraven, A-M; Egeland, T

    2004-01-01

    The article discusses views and recommendations of the World Marrow Donor Association concerning ethical issues related to the donation of hematopoietic stem cell products with respect to recruitment, evaluation, workup, and follow-up of unrelated donors. Particular emphasis is placed upon commitment of individual donors, in particular, with respect to the needs of patients to find HLA-matched donors, who may be asked to donate stem cell and other cell products more than once for given patients. PMID:14628078

  16. Patient selection: indications and contraindications.

    PubMed

    Choy, D S; Botsford, J; Black, W A

    1995-06-01

    Patient selection is critical to the success of PLDD. In general, the herniation must have continuity with the parent disc; rupture of the annulus is not a contraindication. Several other orthopedic conditions constitute absolute or relative contraindications. All patients must be individualized. Our criteria for inclusion is undergoing continuing change. What is unacceptable now may, with modifications, become acceptable in the future. It is important not to adopt a fixed position at this early stage of PLDD. PMID:10150640

  17. Hypnotherapy and the Suicidal Patient

    PubMed Central

    Glick, Daniel

    1973-01-01

    Three cases are presented in which a family physician treats a suicidal patient by the hypnotherapeutic method described. It is postulated that such a method may be quick, effective, and relatively safe method for a diagnostic and therapeutic approach in family practice. In the hypnotic state, the patient is hypersuggestible and can accept suggestions which meet her unconscious needs to be loved as an individual within the milieu of the ego state at the time her psychopathology occurred. PMID:20468906

  18. [Anal cancer in HIV patients].

    PubMed

    Quéro, Laurent; Duval, Xavier; Abramowitz, Laurent

    2014-11-01

    Despite effective highly active antiretroviral treatment, anal cancer incidence has recently strongly increased in HIV-infected population. Treatment strategy in HIV-infected patients does not differ from general population. HIV-infected patients treated by chemo-radiotherapy are exposed to high-grade toxicities and should be closely monitored to deliver the optimal treatment. Close collaboration between oncologist and infectiologist is highly recommended to adjust antiretroviral therapy if necessary. PMID:25418596

  19. Nutritional Considerations for Cancer Patients

    PubMed Central

    Chen, Angela

    1985-01-01

    Although weight loss is a frequent, though not invariable, component of the cancer syndrome, the associated malnutrition is a poor prognostic sign among both children and adults. This article describes the possible mechanisms of cancer cachexia; reviews the present state of nutritional support in cancer patients; identifies nutritional problems and workable approaches during the pre- and post-treatment periods; discusses the unconventional nutritional practices commonly encountered and lists resource materials for patients and families. PMID:21274086

  20. Leiomyomas in patients receiving Tamoxifen.

    PubMed

    Leo, L; Lanza, A; Re, A; Tessarolo, M; Bellino, R; Lauricella, A; Wierdis, T

    1994-01-01

    In literature there have been only 8 cases of unavoidable laparotomy due to uterine leiomyomas performed in patients with breast cancer on Tamoxifen (TAM). Our article describes two cases of rapidly growing leiomyomas in patients treated with TAM: one of these underwent abdominal hysterectomy while the second stopped taking TAM and began therapy with Triptorelin. This therapeutical alternative could be a useful choice. PMID:8070124

  1. Hypothermia and the trauma patient

    PubMed Central

    Kirkpatrick, Andrew W.; Chun, Rosaleen; Brown, Ross; Simons, Richard K.

    Hypothermia has profound effects on every system in the body, causing an overall slowing of enzymatic reactions and reduced metabolic requirements. Hypothermic, acutely injured patients with multisystem trauma have adverse outcomes when compared with normothermic control patients. Trauma patients are inherently predisposed to hypothermia from a variety of intrinsic and iatrogenic causes. Coagulation and cardiac sequelae are the most pertinent physiological concerns. Hypothermia and coagulopathy often mandate a simplified approach to complex surgical problems. A modification of traditional classification systems of hypothermia, applicable to trauma patients is suggested. There are few controlled investigations, but clinical opinion strongly supports the active prevention of hypothermia in the acutely traumatized patient. Preventive measures are simple and inexpensive, but the active reversal of hypothermia is much more complicated, often invasive and controversial. The ideal method of rewarming is unclear but must be individualized to the patient and is institution specific. An algorithm reflecting newer approaches to traumatic injury and technical advances in equipment and techniques is suggested. Conversely, hypothermia has selected clinical benefits when appropriately used in cases of trauma. Severe hypothermia has allowed remarkable survivals in the course of accidental circulatory arrest. The selective application of mild hypothermia in severe traumatic brain injury is an area with promise. Deliberate circulatory arrest with hypothermic cerebral protection has also been used for seemingly unrepairable injuries and is the focus of ongoing research. PMID:10526517

  2. Peripapillary Retinoschisis in Glaucoma Patients

    PubMed Central

    Bayraktar, Serife; Cebeci, Zafer; Kabaalioglu, Melis; Ciloglu, Serife; Kir, Nur; Izgi, Belgin

    2016-01-01

    Purpose. To investigate peripapillary retinoschisis and its effect on retinal nerve fiber layer (RNFL) thickness measurements by using spectral-domain optical coherence tomography (SD-OCT) in glaucomatous eyes. Methods. Circumpapillary RNFL (cpRNFL) B-scan images of 940 glaucoma patients (Group 1) and 801 glaucoma-suspect patients (Group 2) obtained by SD-OCT were reviewed. The structural and clinical characteristics of the retinoschisis were investigated. The RNFL thickness measurements taken at the time of retinoschisis diagnosis and at the follow-up visits were also compared. Results. Twenty-nine retinoschisis areas were found in 26 of the 940 glaucoma patients (3.1%) in Group 1 and seven areas were found in 801 patients (0.87%) in Group 2. In glaucomatous eyes, the retinoschisis was attached to the optic disc and overlapped with the RNFL defect. At the time of retinoschisis, the RNFL thickness was statistically greater in the inferior temporal quadrant when compared with the follow-up scans (p < 0.001). No macular involvement or retinal detachment was observed. Conclusion. The present study investigated 33 peripapillary retinoschisis patients. Increase in RNFL thickness measurements was observed at the time of retinoschisis. It is important to examine the cpRNFL B-scan images of glaucoma patients so that the RNFL thickness is not overestimated. PMID:27069674

  3. [Fertility in testicular cancer patients].

    PubMed

    Shin, Takeshi; Miyata, Akane; Arai, Gaku; Okada, Hiroshi

    2015-03-01

    Testicular cancer(TC)is the most common and curable cancer affecting men of reproductive age. Successful treatment approaches have resulted in longer life expectancy in TC survivors. The most frequently used treatment for TC is a combination of inguinal orchiectomy, and either radiotherapy or cisplatin-based chemotherapy. In many TC patients, sperm quality is already abnormal and there may even be a lack of viable spermatozoa at the time of diagnosis. Therefore, the effect of cancer treatment on fertility is a potentially significant issue. Fertility preservation in these men has become essential and needs to be discussed prior to the start of cancer treatment. The only currently established fertility preservation method is the cryopreservation of sperm before therapy. For most patients seeking cryopreservation, the semen sample is collected via masturbation. If the patient is unable to ejaculate for any reason, other techniques such as vibratory stimulation and electroejaculation can be performed. In azoospermic or severely oligozoospermic patients, testicular sperm extraction at the time of the inguinal orchiectomy is a useful technique for obtaining spermatozoa before cytotoxic therapy. We herein present an overview of the current topics on fertility in TC patients, including the effects of surgery, chemotherapy, and radiation therapy. We also describe the strategy for fertility preservation in these patients. PMID:25812494

  4. The Zest for Patient Empowerment

    PubMed Central

    Thawani, Vijay

    2016-01-01

    Patient Empowerment (PE) can be considered as an active and self-determining role of patient than a passive recipient of health related services. It encourages the provider–patient relationship to blossom and helps in clearing patients’ doubts, confusion and fears to bring in clarity, relief and assurance. For the active involvement of the patient’s in own health management they need to be awakened, motivated, educated and enlightened to enable them to exercise their rights. Active patient involvement in the decision-making achieves favourable health outcome. In an empowerment based approach, the focus is not on defining a particular type of behaviour, but on how the behaviour is defined as a goal to be achieved by a particular individual. As a result of their empowerment process, the patients can better self-manage their illness and their lives. Thus empowerment of the patients will positively help medical uprising of the community by creating an educated, health aware, informed and health conscious mass. PMID:27504307

  5. Transfusion issues in cancer patients.

    PubMed

    Federici, Augusto B; Vanelli, Chiara; Arrigoni, Luisa

    2012-04-01

    Allogeneic blood transfusion (ABT) therapy plays a major role in the case of patients with cancer. Packed red blood cells (PRBC) are given for increased oxygen-carrying capacity, platelets concentrates (PC) and fresh frozen plasma (FFP) for the cessation and prevention of bleeding due to thrombocytopenia and other defects of hemostasis associated with neoplasia. All these blood components can induce complications and/or adverse reactions in cancer patients including transfusion-associated graft versus host disease (TA-GVHD), transfusion transmitted diseases, alloimmunization to blood cell antigens, pulmonary decompensation, immunomodulation. Therefore, specific modifications such as leukocyte-reduction and irradiation of the blood components to be transfused in cancer patients should be introduced to reduce the risk of these complications. Patients undergoing hematopoietic progenitor cell (HPC) transplantation are a unique group and present complex concerns related to transfusion, including major and minor ABO incompatibility and chimeric blood cells. Therefore, transfusion for patients undergoing treatment with cellular therapies requires careful blood component selection. The process of HPC infusion itself carries many risks including DMSO toxicity and hemolytic reactions. In all areas of transfusion therapy, new advances such as pathogen inactivation and synthetic alternatives to blood components should help to increase the safety and tolerance of transfusion in cancer patients. PMID:22682136

  6. ETHICAL MODELS OF PHYSICIAN--PATIENT RELATIONSHIP REVISITED WITH REGARD TO PATIENT AUTONOMY, VALUES AND PATIENT EDUCATION.

    PubMed

    Borza, Liana Rada; Gavrilovici, Cristina; Stockman, René

    2015-01-01

    The present paper revisits the ethical models of patient--physician relationship from the perspective of patient autonomy and values. It seems that the four traditional models of physician--patient relationship proposed by Emanuel & Emanuel in 1992 closely link patient values and patient autonomy. On the other hand, their reinterpretation provided by Agarwal & Murinson twenty years later emphasizes the independent expression of values and autonomy in individual patients. Additionally, patient education has been assumed to join patient values and patient autonomy. Moreover, several authors have noted that, over the past few decades, patient autonomy has gradually replaced the paternalistic approach based on the premise that the physician knows what is best for the patient. Neither the paternalistic model of physician-patient relationship, nor the informative model is considered to be satisfactory, as the paternalistic model excludes patient values from decision making, while the informative model excludes physician values from decision making. However, the deliberative model of patient-physician interaction represents an adequate alternative to the two unsatisfactory approaches by promoting shared decision making between the physician and the patient. It has also been suggested that the deliberative model would be ideal for exercising patient autonomy in chronic care and that the ethical role of patient education would be to make the deliberative model applicable to chronic care. In this regard, studies have indicated that the use of decision support interventions might increase the deliberative capacity of chronic patients. PMID:26204658

  7. Regional anesthesia for the trauma patient: improving patient outcomes.

    PubMed

    Gadsden, Jeff; Warlick, Alicia

    2015-01-01

    Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. PMID:26316813

  8. Regional anesthesia for the trauma patient: improving patient outcomes

    PubMed Central

    Gadsden, Jeff; Warlick, Alicia

    2015-01-01

    Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. PMID:26316813

  9. Postoperative analgesia in elderly patients.

    PubMed

    Falzone, Elisabeth; Hoffmann, Clément; Keita, Hawa

    2013-02-01

    Elderly people represent the fastest-growing segment of our society and undergo surgery more frequently than other age groups. Effective postoperative analgesia is essential in these patients because inadequate pain control after surgery is associated with adverse outcomes in elderly patients. However, management of postoperative pain in older patients may be complicated by a number of factors, including a higher risk of age- and disease-related changes in physiology and disease-drug and drug-drug interactions. Physiological changes related to aging need to be carefully considered because aging is individualized and progressive. Assessment of pain management needs to include chronological age, biological age with regard to renal, liver and cardiac functions, and the individual profile of pathology and prescribed medications. In addition, ways in which pain should be assessed, particularly in patients with cognitive impairment, must be considered. Cognitively intact older patients can use most commonly used unidimensional pain scales such as the visual analogue scale (VAS), verbal rating scale (VRS), numeric rating scale (NRS) and facial pain scale (FPS). VRS and NRS are the most appropriate pain scales for the elderly. In older patients with mild to moderate cognitive impairment, the VRS is a better tool. For severe cognitively impaired older patients, behavioural scales validated in the postoperative context, such as Doloplus-2 or Algoplus, are appropriate. For postoperative pain treatment, most drugs (e.g. paracetamol, nonsteroidal anti-inflammatory drugs, nefopam, tramadol, codeine, morphine, local anaesthetics), techniques (e.g. intravenous morphine titration, subcutaneous morphine, intravenous or epidural patient-controlled analgesia, intrathecal morphine, peripheral nerve block) and strategies (e.g. anticipated intraoperative analgesia or multimodal analgesia) used for acute pain management can be used in older patients. However, in view of pharmacokinetic

  10. Antimicrobial Dose in Obese Patient

    PubMed Central

    Kassab, Sawsan; Syed Sulaiman, Syed Azhar; Abdul Aziz, Noorizan

    2007-01-01

    Introduction Obesity is a chronic disease that has become one of major public health issue in Malaysia because of its association with other disease states including cardiovascular disease and diabetes. Despite continuous efforts to educate the public about the health risks associated with obesity, prevalence of the disease continues to increase. Dosing of many medications are based on weight, limited data are available on how antimicrobial agents should be dosed in obesity. The aim of this case presentation is to discuss dose of antibiotic in obese patient. Case report: Patient: GMN, Malay, Female, 45 year old, 150kg, transferred from medical ward to ICU with problems of fever, orthopnea, sepsis secondary to nosocomial pneumonia. She was admitted to hospital a week ago for SOB on exertion, cyanosis, mildly dyspneic, somasthenia, bilateral ankle swelling. There was no fever, cough, chest pain, clubbing, flapping tremor. Her grand father has pre-morbid history of obesity, HPT, DM and asthma. She was non alcoholic, smoker, and not on diet control. The diagnosis Pickwickian syndrome was made. Patient was treated with IV Dopamine 11mcg/kg/min, IV Morphine 4mg/h. IV GTN 15mcg/min, IV Ca gluconate 10g/24h for 3/7, IV Zantac 50mg tds, IV Augmentin 1.2g tds, IV Lasix 40mg od, IV Plasil 10mg tds, S.c heparin 5000IU bd. patient become stable and moved to medical ward to continue her treatment. Discussion: The altered physiologic function seen in obese patients is a concern in patients receiving antimicrobial agents because therapeutic outcomes depend on achieving a minimum inhibitory concentration (MIC). The therapeutic effect of any drug can be altered when any of the 4 pharmacokinetic processes (absorption, distribution, metabolism, or elimination) are altered. Decreased blood flow rates and increased renal clearance in obese patients can affect drug distribution and elimination. Changes in serum protein levels can change the metabolism and distribution of drugs that are

  11. [Nutritional support in stroke patients].

    PubMed

    Burgos Peláez, Rosa; Segurola Gurrutxaga, Hegoi; Bretón Lesmes, Irene

    2014-01-01

    Stroke is a public health problem of the first order. In developed countries is one of the leading causes of death, along with cardiovascular disease and cancer. In addition, stroke is the leading cause of permanent disability in adulthood. Many of the patients who survive do so with significant sequelae that limit them in their activities of daily living. Most strokes (80-85%) are due to ischemia, while the rest are hemorrhagic. We have identified many modifiable risk factors, some with an important relationship with dietary factors or comorbidities in wich the diet has a significant impact. The incidence of malnutrition in stroke patients is not well known, but most likely impacts on patient prognosis. Furthermore, the nutritional status of patients admitted for stroke often deteriorates during hospitalization. It is necessary to perform a nutritional assessment of the patient in the early hours of admission, to determine both the nutritional status and the presence of dysphagia. Dysphagia, through alteration of the safety and efficacy of swallowing, is a complication that has an implication for nutritional support, and must be treated to prevent aspiration pneumonia, which is the leading cause of mortality in the stroke patient. Nutritional support should begin in the early hours. In patients with no or mild dysphagia that can be controlled by modifying the texture of the diet, they will start oral diet and oral nutritional supplementation will be used if the patient does not meet their nutritional requirements. There is no evidence to support the use of nutritional supplements routinely. Patients with severe dysphagia, or decreased level of consciousness will require enteral nutrition. Current evidence indicates that early nutrition should be initiated through a nasogastric tube, with any advantages of early feeding gastrostomy. Gastrostomy will be planned when the enteral nutrition support will be expected for long-term (4 weeks). Much evidence points to the

  12. Depression and Anxiety in Migraine Patients

    MedlinePlus

    ... Depression and Anxiety in Migraine Patients Print Email Depression and Anxiety in Migraine Patients ACHE Newsletter Sign ... newsletter by entering your e-mail address below. Depression and Anxiety in Migraine Patients Todd A. Smitherman, ...

  13. Depression and Anxiety in Migraine Patients

    MedlinePlus

    ... Depression and Anxiety in Migraine Patients Depression and Anxiety in Migraine Patients Todd A. Smitherman, PhD and ... if you experience these symptoms. Migraine, Depression, and Anxiety Many migraine patients suffer from symptoms of depression ...

  14. Perioperative care of the elderly patient.

    PubMed

    Palmer, Robert M

    2006-03-01

    Perioperative management is typically more complicated in older patients than in younger patients and requires more assessment and evaluation before surgery as well as precautionary steps after surgery to manage these high-risk patients. PMID:16570559

  15. Treating drug-dependent patients in hospitals.

    PubMed

    Skene, Loane; Keays, David; Gardner, Bruce

    2002-08-01

    Are hospital staff legally permitted to test drug-dependent patients for drugs or infectious disease without the patient's consent in order to treat the patient or to protect themselves or other patients? What should staff do with "suspicious" items in the patient's possession (drugs, credit cards in different names, firearms)? Can drug-dependent patients lawfully use illicit drugs in hospital? Who should supply and administer them? PMID:12242876

  16. Patient-Physician Web Messaging

    PubMed Central

    Liederman, Eric M; Lee, Jerry C; Baquero, Victor H; Seites, Paul G

    2005-01-01

    BACKGROUND Patients want electronic access to providers. Providers fear being overwhelmed by unreimbursed messages. OBJECTIVE Measure the effects of patient-physician web messaging on primary care practices. DESIGN/SETTING Retrospective analysis of 6 case and 9 control internal medicine (IM) and family practice (FP) physicians' message volume, and a survey of 5,971 patients' web messaging with 267 providers and staff in 16 community primary care clinics in the Sacramento, CA region. MEASUREMENTS AND MAIN RESULTS Case telephone volume was 18.2% lower (P =.002) and fell 6.50 times faster than control. Case total telephone plus web message volume was 13.7% lower (P =.025) and fell 5.84 times faster than control. Surveys were responded to by 40.3% (1,743/4,320) of patients and 61.4% (164/267) of providers and staff. Patients were overwhelmingly satisfied and providers and staff were generally satisfied; both found the system easy to use. Patient satisfaction correlated strongly with provider response time (Γ=0.557), and provider/staff satisfaction with computer skills (Γ=0.626) (Goodman-Kruskal Gamma [Γ] measure of ordinal association). CONCLUSIONS Secure web messaging improves on e-mail with encryption, access controls, message templates, customized message and prescription routing, knowledge content, and reimbursement. Further study is needed to determine whether reducing telephone traffic through the use of web messaging decreases provider interruptions and increases clinical efficiency during the workday. Satisfaction with web messaging may increase patient retention. PMID:15693928

  17. Managing diabetes in dialysis patients.

    PubMed

    O'Toole, Sam M; Fan, Stanley L; Yaqoob, M Magdi; Chowdhury, Tahseen A

    2012-03-01

    Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with

  18. Survival of Sami cancer patients

    PubMed Central

    Soininen, Leena; Pokhrel, Arun; Dyba, Tadek; Pukkala, Eero; Hakulinen, Timo

    2012-01-01

    Objectives The incidence of cancer among the indigenous Sami people of Northern Finland is lower than among the Finnish general population. The survival of Sami cancer patients is not known, and therefore it is the object of this study. Study design The cohort consisted of 2,091 Sami and 4,161 non-Sami who lived on 31 December 1978 in the two Sami municipalities of Inari and Utsjoki, which are located in Northern Finland and are 300–500 km away from the nearest central hospital. The survival experience of Sami and non-Sami cancer patients diagnosed in this cohort during 1979–2009 was compared with that of the Finnish patients outside the cohort. Methods The Sami and non-Sami cancer patients were matched to other Finnish cancer patients for gender, age and year of diagnosis and for the site of cancer. An additional matching was done for the stage at diagnosis. Cancer-specific survival analyses were made using the Kaplan–Meier method and Cox regression modelling. Results There were 204 Sami and 391 non-Sami cancer cases in the cohort, 20,181 matched controls without matching with stage, and 7,874 stage-matched controls. In the cancer-specific analysis without stage variable, the hazard ratio for Sami was 1.05 (95% confidence interval 0.85–1.30) and for non-Sami 1.02 (0.86–1.20), indicating no difference between the survival of those groups and other patients in Finland. Likewise, when the same was done by also matching the stage, there was no difference in cancer survival. Conclusion Long distances to medical care or Sami ethnicity have no influence on the cancer patient survival in Northern Finland. PMID:22765936

  19. Assessment of Patient Reported Outcomes (PROs) in Melanoma Patients

    PubMed Central

    Cormier, Janice N.; Askew, Robert L.

    2010-01-01

    SYNOPSIS Assessment of patient reported outcomes (PROs) has been shown to provide important information to assist with clinical decision-making. There has been significant progress in the field of PROs over the last two decades with the introduction of a variety of validated disease- and symptom-specific instruments. The Functional Assessment of Cancer Therapy-Melanoma (FACT-M) is a melanoma-specific module to accompany the FACT-General which has been validated to assess health-related quality of life (HRQOL) for patients with all stages of melanoma. Melanoma-specific health state utilities, which are essential for calculating quality adjusted life years and performing cost-effectiveness studies, have also been reported from a number of studies. Assessment of PROs should be incorporated into routine clinical practice to inform clinicians and researchers of the patient perspective for clinical decision-making and to evaluate the effects of psychosocial and medical interventions. PMID:21111967

  20. Thymectomy: Common Questions Patients Ask about Thymectomies

    MedlinePlus

    ... and to improve their lives through programs of patient services, public information, medical research, professional education, advocacy and patient care. This publication is intended to provide the ...

  1. Reducing patient suffering through compassionate connected care.

    PubMed

    Dempsey, Christina; Wojciechowski, Sharyl; McConville, Elizabeth; Drain, Maxwell

    2014-10-01

    Patient experience continues to play an increasingly critical role in quality outcomes and reimbursement. Nurse executives are tasked with helping direct-care nurses connect with patients to improve care experiences. Connecting with patients in compassionate ways to alleviate inherent patient suffering and prevent avoidable suffering is key to improving the patient experience. The Compassionate Connected Care framework identifies strategies for meeting the challenges of connecting with patients and reducing suffering. Methods integrate clinical, operational, cultural, and behavioral aspects of care to target patient needs based on condition. Caregivers learn to better express empathy and compassion to patients, and nurse leaders are better equipped to engage nurses at the bedside. PMID:25208270

  2. Bedside evaluation of dizzy patients.

    PubMed

    Huh, Young-Eun; Kim, Ji-Soo

    2013-10-01

    In recent decades there has been marked progress in the imaging and laboratory evaluation of dizzy patients. However, detailed history taking and comprehensive bedside neurotological evaluation remain crucial for a diagnosis of dizziness. Bedside neurotological evaluation should include examinations for ocular alignment, spontaneous and gaze-evoked nystagmus, the vestibulo-ocular reflex, saccades, smooth pursuit, and balance. In patients with acute spontaneous vertigo, negative head impulse test, direction-changing nystagmus, and skew deviation mostly indicate central vestibular disorders. In contrast, patients with unilateral peripheral deafferentation invariably have a positive head impulse test and mixed horizontal-torsional nystagmus beating away from the lesion side. Since suppression by visual fixation is the rule in peripheral nystagmus and is frequent even in central nystagmus, removal of visual fixation using Frenzel glasses is required for the proper evaluation of central as well as peripheral nystagmus. Head-shaking, cranial vibration, hyperventilation, pressure to the external auditory canal, and loud sounds may disclose underlying vestibular dysfunction by inducing nystagmus or modulating the spontaneous nystagmus. In patients with positional vertigo, the diagnosis can be made by determining patterns of the nystagmus induced during various positional maneuvers that include straight head hanging, the Dix-Hallpike maneuver, supine head roll, and head turning and bending while sitting. Abnormal smooth pursuit and saccades, and severe imbalance also indicate central pathologies. Physicians should be familiar with bedside neurotological examinations and be aware of the clinical implications of the findings when evaluating dizzy patients. PMID:24285961

  3. [Multifocal tuberculosis in immunocompetent patients].

    PubMed

    Rezgui, Amel; Fredj, Fatma Ben; Mzabi, Anis; Karmani, Monia; Laouani, Chadia

    2016-01-01

    Multifocal tuberculosis is defined as the presence of lesions affecting at least two extrapulmonary sites, with or without pulmonary involvement. This retrospective study of 10 cases aims to investigate the clinical and evolutionary characteristics of multifocal tuberculosis. It included 41 cases with tuberculosis collected between 1999 and 2013. Ten patients had multifocal tuberculosis (24%): 9 women and 1 man, the average age was 50 years (30-68 years). Our patients were correctly BCG vaccinated. The evaluation of immunodepression was negative in all patients. 7 cases had lymph node tuberculosis, 3 cases digestive tuberculosis, 2 cases pericardial tuberculosis, 2 cases osteoarticular tuberculosis, 1 case brain tuberculosis, 2 cases urinary tuberculosis, 4 cases urogenital tuberculosis, 1 case adrenal tuberculosis, 1 case cutaneous and 1 case muscle tuberculosis. All patients received anti-tuberculosis treatment for a mean duration of 10 months, with good evolution. Multifocal tuberculosis is difficult to diagnose. It can affect immunocompetent patients but often has good prognosis. Anti-tuberculosis therapy must be initiated as soon as possible to avoid sequelae. PMID:27583077

  4. Patients' satisfaction with facial prostheses.

    PubMed

    Wondergem, Marloes; Lieben, George; Bouman, Shirley; van den Brekel, Michiel W M; Lohuis, Peter J F M

    2016-05-01

    We assessed the "impact on wellbeing" and "satisfaction" of patients who had a facial prosthesis (of the ear, nose, or orbit) fitted in The Netherlands Cancer Institute. Patients had either an adhesive-retained or an implant-retained facial prosthesis between 1951 and 2011. We did a cross-sectional survey of 104 patients, then gave a questionnaire to the final study group of 71 (68%), a year or more later. All were satisfied with their prostheses (visual analogue scale (VAS): mean (SD) 8.1(1.5). The implant-retained group were the most satisfied (p=0.022), and the adhesive-retained group felt more self-conscious (p=0.013). Three-quarters of all patients said that the prosthesis was not painful and there were no problems with the way it functioned. A well-designed facial prosthesis has obvious benefits, but there were no appreciable differences between the two groups. Each patient must make a careful decision about which type of prosthesis to choose, taking into account the quality of their remaining tissue, the site of the defect, and their general health. PMID:26508540

  5. Syncope in Patients with Pacemakers

    PubMed Central

    Sutton, Richard

    2015-01-01

    Syncope in a pacemaker patient is a serious symptom but it is rarely due a pacemaker system malfunction. Syncope occurs in about 5 % of patients paced for atrioventricular (AV) block in 5 years, 18% in those paced for sinus node disease in 10 years, 20 % of those paced for carotid sinus syndrome in 5 years and 5–55 % of those older patients paced for vasovagal syncope in 2 years. The vastly different results in vasovagal syncope depend on the results of tilt testing, where those with negative tests approach results in pacing for AV block and those with a positive tilt test show no better results than with no pacemaker. The implication of tilt results is that a hypotensive tendency is clearly demonstrated by tilt positivity pointing to syncope recurrence with hypotension. This problem may be addressed by treatment with vasoconstrictor drugs in those who are suited or, more commonly, a reduction or cessation of hypotensive therapy in hypertensive patients. Other causes of syncope such as tachyarrhythmias are rare. The clinical approach to patients who report syncope is detailed. PMID:26835124

  6. Patient perspectives on radiation dose.

    PubMed

    Graff, Joyce

    2014-03-01

    People with genetic cancer syndromes have a special interest in imaging. They also have special risk factors with respect to radiation. They need to utilize the potential of imaging while keeping in mind concerns about cumulative radiation exposure. Before imaging, early detection of problems was limited. With imaging, issues can be identified when they are small and a good plan of action can be developed early. Operations can be planned and metastatic cancer avoided. The positive contribution of imaging to the care of these patients can be profound. However, this additional surveillance is not without cost. An average patient with 1 of these syndromes will undergo 100 or more scans in their lifetime. Imaging professionals should be able to describe the risks and benefits of each scan in terms that the patient and the ordering physician can understand to make smart decisions about the ordering of scans. Why CT versus MRI? When are x-ray or ultrasound appropriate, and when are they not? What are the costs and the medical risks for the patient? What value does this picture add for the physician? Is there a way to answer the medical question with a test other than a scan? Medicine is a team sport, and the patient is an integral member of the team. PMID:24589397

  7. [COMMUNICATION WITH TERMINALLY ILL PATIENT].

    PubMed

    2014-12-01

    The communication is a essential therapeutic instrument in every process of relationship in the team patient-family, and mainly in the transmission of bad news. The communication is not just a simple transmission of information. It is a process whose goal is to enable the adaptation of the patient and family to their actual situation and where the "what", "how" and "how much do you want to know", are belonged to the own patient. Along this article, we will expose some thoughts that the team has to take into account when informing the patient. We are going to explain the SPIKES protocol, or its Spanish version EPICEE. 6-step protocol, based on those recommended by the experts to deliver bad news procedures. And finally we'll talk about the conspiracy of silence, one of the most common and difficult situations to handle in day to day due to paternalism by professionals and families, in which they prefer to hide the situation to the patient, thinking it's the best for him. PMID:26121886

  8. Aztreonam pharmacokinetics in burn patients.

    PubMed Central

    Friedrich, L V; White, R L; Kays, M B; Brundage, D M; Yarbrough, D

    1991-01-01

    The pharmacokinetics of aztreonam in eight adult patients with severe burn injuries (total body surface area burn, 49% +/- 21% [mean +/- standard deviation]) were studied. The time of initiation of study following burn injury was 7.0 +/- 1.4 days. Four patients at first dose and at steady state were studied. Aztreonam concentrations were measured by high-performance liquid chromatography, and a two-compartment model was used to fit the data. No significant differences in any pharmacokinetic parameters between first dose and steady state were observed. Volume of distribution of the central compartment after first dose (0.14 liters/kg) and volume of distribution at steady state (0.31 liters/kg) were approximately 30% higher than those reported for other patient populations. Total drug clearance and renal drug clearance when normalized to creatinine clearance (CLCR) were similar to those previously reported for other critically ill patients. CLCR was strongly correlated with renal drug clearance (r = 0.94) and total drug clearance (r = 0.95). The extent and degree of burn (percent second or third degree burn) were poorly correlated with all pharmacokinetic parameters with the exception of the volume of distribution at steady state, which was correlated with both total body surface area burn (r = 0.95) and percent second degree burn (r = 0.83). Aztreonam pharmacokinetics are altered as a result of thermal injury; however, CLCR can be used to assess the clearance of aztreonam in burn patients. PMID:2014982

  9. Hypogonadism in male cancer patients.

    PubMed

    Burney, Basil O; Garcia, Jose M

    2012-09-01

    Prevalence of hypogonadism in men with cancer has been reported between 40% and 90%, which is significantly higher than in the general population. Hypogonadism is likely to affect the quality of life in these patients by contributing to non-specific symptoms, including decreased energy, anorexia, sarcopenia, weight loss, depression, insomnia, fatigue, weakness, and sexual dysfunction. Pathogenesis of hypogonadism in cancer patients is thought to be multi-factorial. Inflammation may play an important role, but leptin, opioids, ghrelin, and high-dose chemotherapy through different mechanisms have all been implicated as the cause. Hypogonadism is also associated with poor survival in cancer patients. Data looking into the treatment of hypogonadal male cancer patients with testosterone are limited. However, improvements in body weight, muscle strength, lean body mass, and quality of life have been shown in hypogonadal men with other chronic diseases on testosterone replacement therapy. Prospective and interventional trials are needed to test the efficacy and safety of testosterone treatment in improving quality of life of these patients. PMID:22528986

  10. Invasive Aspergillosis in Hematological Patients.

    PubMed

    Kimura, Shun-Ichi

    2016-01-01

    Invasive aspergillosis (IA) is still one of the leading causes of morbidity and mortality in hematological patients, although its outcome has been improving. Prolonged and profound neutropenia in patients receiving intensive chemotherapy for acute leukemia and stem cell transplantation is a major risk factor for IA. Allogeneic stem cell transplant recipients with graft-versus-host disease and corticosteroid use are also at high risk. Management in a protective environment with high efficiency particular air (HEPA) filter is generally recommended to prevent aspergillosis in patients with prolonged and profound neutropenia. Antifungal prophylaxis against Aspergillus species should be considered in patients with past history of aspergillosis or colonization of Aspergillus species, at facilities with high incidence of IA and those without a protective environment. Early diagnosis and prompt antifungal treatment is important to improve outcome. Imaging studies such as computed tomography and biomarkers such as galactomannan antigen and β-D-glucan are useful for early diagnosis. Empirical antifungal treatment based on persistent or recurrent fever during neutropenia despite broad-spectrum antibiotic therapy is generally recommended in high-risk patients. Alternatively, a preemptive treatment strategy has recently been proposed in the context of progress in the early diagnosis of IA based on the results of imaging studies and biomarkers. Voriconazole is recommended for initial therapy for IA. Liposomal amphotericin B is considered as alternative initial therapy. Combination antifungal therapy of echinocandin with voriconazole or liposomal amphotericin B could be a choice for refractory cases. PMID:27251320

  11. Gas Gangrene in Orthopaedic Patients

    PubMed Central

    Ying, Zhimin; Zhang, Min; Yan, Shigui; Zhu, Zhong

    2013-01-01

    Clostridial myonecrosis is most often seen in settings of trauma, surgery, malignancy, and other underlying immunocompromised conditions. Since 1953 cases of gas gangrene have been reported in orthopaedic patients including open fractures, closed fractures, and orthopaedic surgeries. We present a case of 55-year-old obese woman who developed rapidly progressive gas gangrene in her right leg accompanied by tibial plateau fracture without skin lacerations. She was diagnosed with clostridial myonecrosis and above-the-knee amputation was carried out. This patient made full recovery within three weeks of the initial episode. We identified a total of 50 cases of gas gangrene in orthopaedic patients. Several factors, if available, were analyzed for each case: age, cause of injury, fracture location, pathogen, and outcome. Based on our case report and the literature review, emergency clinicians should be aware of this severe and potentially fatal infectious disease and should not delay treatment or prompt orthopedic surgery consultation. PMID:24288638

  12. Creating a patient education tool.

    PubMed

    Stonecypher, Karen

    2009-10-01

    Developing a patient education tool based on low literacy levels, behavioral theories, role modeling, and The Joint Commission's standards was the primary objective of this project. The initial goal was merely to develop a population-appropriate patient education tool. This led to a process whereby significant knowledge was gained by all to enrich overall professional development. An interdisciplinary team developed a low-literacy, self-management book for patients who had suffered a stroke. Team experts were responsible for the development of specific subject matter. Editing addressed the message, readability, typeface and font size, and charts and illustrations. Collaboration with the National Stroke Association guided the didactic pedagogical content presented. A well-known cartoonist who was a U.S. military veteran was willing to work with the team to develop the illustrations. PMID:19831328

  13. [Drug rehabilitation in stroke patients].

    PubMed

    Skoromets, A A; Koval'chuk, V V

    2007-01-01

    An influence of different drugs on functional rehabilitation in post-stroke patients has been studied. We tested for efficacy medications with nootropic, metabolic and antioxidative activity as well as pathogenetic and symptomatic remedies for differential therapy of ischemic and haemorrhagic stroke (IS, HS). We analyzed 1920 stroke patients, including 1520 with IS and 400 with HS. The functional rehabilitation depending on different drugs was followed up 1 year after stroke using Barthel, Lindmark and Scandinavian scales for stroke. Moreover, we suggested a coefficient for calculating of drug efficacy. The results of the study revealed that the use of some traditional drugs was not well founded. The most efficient medications in the treatment of IS proved to be actovegin, instenon, berlition, rheopolyglucin and gliatilin. The beneficial effect on rehabilitation of patients with HS was found only for actovegin. PMID:18379517

  14. Patients as partners in innovation.

    PubMed

    Barnett, Sean J; Katz, Aviva

    2015-06-01

    As the culture of medical practice has evolved, so has the relationship between the physician and patient. This is decidedly true with regards to the introduction of innovative therapies, especially in the surgical arena. A critical challenge is identifying and defining innovative therapy. Is the proposed treatment an incremental change, a research proposal, or more commonly someplace in between? This gray area creates a transition zone commonly referred to as innovative therapy. Given the complexities of the current landscape of innovation, innovation therapy committees may provide a mechanism to help to guide both physicians and patients through such difficult topics as the process of informed consent, managing conflicts of interest, and how to evaluate the outcomes of innovative therapies. As surgical innovation remains critical to the advancement of care, it must occur in a transparent partnership with patients, under the eye of guiding entities, aimed at ultimately improving outcomes and care. PMID:25976152

  15. Counselling patients with hepatitis C.

    PubMed

    Zarski, J P; Leroy, V

    1999-01-01

    Hepatitis C virus (HCV) is usually but not exclusively transmitted by the parenteral route. Some precautions are recommended for infected patients as well as his/her close contacts and family members. The risk of sexual transmission and from household contacts is very low. Use of condoms is only recommended in cases of multiple partners and for those at high risk of transmission. Some personal objects should not be shared, i.e. razors, toothbrushes and nail clippers, but it is not necessary to avoid sharing eating utensils. Sexual partners may be tested for anti-HCV HCV-positive individuals should refrain from donating blood, organs and tissue. Clear and evidenced-based information should be provided to patients as to the means of prevention with special attention to individual risk groups such as IV drug abusers. The risk of HCV transmission after needlestick injury, although low, justifies universal precaution measurements for health-care workers. Nosocomial transmission has been described after medical procedures, especially haemodialysis and endoscopy. Thus, disinfection procedures as well as universal precautions are essential for all health-care workers. It is also important for HCV patients to inform health-care workers beforehand about their HCV status. Perinatal transmission is rare and is usually related to the degree of maternal viral load. Pregnancy is not contra-indicated in HCV. infected individuals and breast-feeding is allowed. Finally, HCV patients with active disease should be advised to refrain from alcohol intake, especially during antiviral therapy. After HCV infection it is necessary to consider not only diagnostic and therapeutic steps but also the risk of transmission in the patient's circle and consequences for the patient. PMID:10622576

  16. Alexithymia in chronic urticaria patients.

    PubMed

    Barbosa, Filipe; Freitas, João; Barbosa, Antonio

    2011-03-01

    Alexithymia has been described as an important dimension in several medical and psychiatric diseases. Chronic urticaria (CU) is a chronic condition, in which treatment is difficult. Our aim is to determine the prevalence of alexithymia traits in patients with CU, and to identify the relationships between alexithymia and psychological variables and quality-of-life dimensions. Fifty-five sequential CU patients in a faculty ambulatory specialized consultation, with an average age of 44.92, were compared with 31 healthy volunteers. Both groups were studied by means of validated scales for alexithymia (Toronto Alexithymia Scale [TAS-20]), attachment (Adult Attachment Scale-R [AAS-R]), psychopathology (Brief Symptom Inventory [BSI]), personality dimensions (The NEO Five-Factor inventory [NEO-FFI]) and quality of life (Short Form-36 [SF-36]). The classification of CU reactions was obtained from the patient's history, physical examination, laboratory assessment and histopathologic findings. All the patients were under treatment with sedating H1-antihistamines, non-sedating H1-antihistamines combination of H1 and H2 blocker, 2 H1-antihistamines and 3 H1-antihistamines. High traits of alexithymia were found on CU patients (56.9%) as well as high symptom rates of anxiety. Alexithymia traits were significantly positively correlated with insecure attachment styles, with psychopathological symptoms, and with the defense mechanism turn against self. We also reported a significant negative correlation between alexithymia traits and the dimensions of quality of life. Insecure attachment styles were positively correlated with psychopathological symptoms and negatively correlated with quality of life. We did not find significant statistical correlations between alexithymia and clinical variables. CU patients present serious difficulty in dealing with emotion arousal. There is strong evidence of a psychosomatic specificity in CU, with marked alexithymic traits. PMID:21328149

  17. Cost trajectories for cancer patients

    PubMed Central

    Wodchis, W.P.; Arthurs, E.; Khan, A.I.; Gandhi, S.; MacKinnon, M.; Sussman, J.

    2016-01-01

    Background Health care spending is known to be highly skewed, with a small subset of the population consuming a disproportionate amount of health care resources. Patients with cancer are high-cost users because of high incremental health care costs for treatment and the growing prevalence of cancer. The objectives of the present study included characterizing cancer-patient trajectories by cost, and identifying the patient and health system characteristics associated with high health system costs after cancer treatment. Methods This retrospective cohort study identified Ontario adults newly diagnosed with cancer between 1 April 2009 and 30 September 2010. Costs of health care use before, during, and after cancer episodes were used to develop trajectories of care. Descriptive analyses examined differences between the trajectories in terms of clinical and health system characteristics, and a logistic regression approach identified predictors of being a high-cost user after a cancer episode. Results Ten trajectories were developed based on whether patients were high- or low-cost users before and after their cancer episode. The most common trajectory represented patients who were low-cost in the year before cancer, survived treatment, and continued to be low-cost in the year after cancer (31.4%); stage ii cancer of the male genital system was the most common diagnosis within that trajectory. Regression analyses identified increases in age and in multimorbidity and low continuity of care as the strongest predictors of high-cost status after cancer. Conclusions Findings highlight an opportunity to proactively identify patients who might transition to high-cost status after cancer treatment and to remediate that transition. PMID:26985150

  18. Candidemia in major burns patients.

    PubMed

    Renau Escrig, Ana I; Salavert, Miguel; Vivó, Carmen; Cantón, Emilia; Pérez Del Caz, M Dolores; Pemán, Javier

    2016-06-01

    Major burn patients have characteristics that make them especially susceptible to candidemia, but few studies focused on this have been published. The objectives were to evaluate the epidemiological, microbiological and clinical aspects of candidemia in major burn patients, determining factors associated with a poorer prognosis and mortality. We conducted a retrospective observational study of candidemia between 1996 and 2012 in major burn patients admitted to the La Fe University Hospital, Valencia, Spain. The study included 36 episodes of candidemia in the same number of patients, 55.6% men, mean age 37.33 years and low associated comorbidity. The incidence of candidemia varied between 0.26 and 6.09 episodes/1000 days stay in the different years studied. Candida albicans was the most common species (61.1%) followed by Candida parapsilosis (27.8%). Candidemia by C. krusei, C. glabrata or C. tropicalis were all identified after 2004. Central vascular catheter (CVC) was established as a potential source of candidemia in 36.1%, followed by skin and soft tissues of thermal injury (22.2%) and urinary tract (8.3%). Fluconazole was used in 19 patients (52.7%) and its in vitro resistance rate was 13.9%. The overall mortality was 47.2%, and mortality related to candidemia was 30.6%. Factors associated with increased mortality were those related to severe infection and shock. CVC was the most usual focus of candidemia. Fluconazole was the most common antifungal drug administered. The management of candidemia in major burn patients is still a challenge. PMID:26931414

  19. Hepatitis C in hemodialysis patients

    PubMed Central

    Marinaki, Smaragdi; Boletis, John N; Sakellariou, Stratigoula; Delladetsima, Ioanna K

    2015-01-01

    Despite reduction of hepatitis C prevalence after recognition of the virus and testing of blood products, hemodialysis (HD) patients still comprise a high risk group. The natural history of hepatitis C virus (HCV) infection in dialysis is not fully understood while the clinical outcome differs from that of the general population. HD patients show a milder liver disease with lower aminotransferase and viral levels depicted by milder histological features on liver biopsy. Furthermore, the “silent” clinical course is consistent with a slower disease progression and a lower frequency of cirrhosis and hepatocellular carcinoma. Potential explanations for the “beneficial” impact of uremia and hemodialysis on chronic HCV infection are impaired immunosurveillance leading to a less aggressive host response to the virus and intradialytic release of “hepatoprotective” cytokines such as interferon (IFN)-α and hepatocyte growth factor. However, chronic hepatitis C is associated with a higher liver disease related cardiovascular and all-cause mortality of HD patients. Therapy is indicated in selected patients groups including younger patients with low comorbidity burden and especially renal transplant candidates, preferably after performance of a liver biopsy. According to current recommendations, choice of treatment is IFN or pegylated interferon with a reported sustained viral response at 30%-40% and a withdrawal rate ranging from 17% to 30%. New data regarding combination therapy with low doses of ribavirin which provide higher standard variable rates and good safety results, offer another therapeutic option. The new protease inhibitors may be the future for HCV infected HD patients, though data are still lacking. PMID:25848478

  20. Seizure Treatment in Transplant Patients

    PubMed Central

    Shepard, Paul W.

    2013-01-01

    Opinion statement Solid organ transplantation is frequently complicated by a spectrum of seizure types, including single partial-onset or generalized tonic-clonic seizures, acute repetitive seizures or status epilepticus, and sometimes the evolution of symptomatic epilepsy. There is currently no specific evidence involving the transplant patient population to guide the selection, administration, or duration of antiepileptic drug (AED) therapy, so familiarity with clinical AED pharmacology and application of sound judgment are necessary for successful patient outcomes. An initial detailed search for symptomatic seizure etiologies, including metabolic, infectious, cerebrovascular, and calcineurin inhibitor treatment-related neuro-toxic complications such as posterior reversible encephalopathy syndrome (PRES), is imperative, as underlying central nervous system disorders may impose additional serious risks to cerebral or general health if not promptly detected and appropriately treated. The mainstay for post-transplant seizure management is AED therapy directed toward the suspected seizure type. Unfavorable drug interactions could place the transplanted organ at risk, so choosing an AED with limited interaction potential is also crucial. When the transplanted organ is dysfunctional or vulnerable to rejection, AEDs without substantial hepatic metabolism are favored in post-liver transplant patients, whereas after renal transplantation, AEDs with predominantly renal elimination may require dosage adjustment to prevent adverse effects. Levetiracetam, gabapentin, pregabalin, and lacosamide are drugs of choice for treatment of partial-onset seizures in post-transplant patients given their efficacy spectrum, generally excellent tolerability, and lack of drug interaction potential. Levetiracetam is the drug of choice for primary generalized seizures in post-transplant patients. When intravenous drugs are necessary for acute seizure management, benzodiazepines and

  1. Immunosuppression of the burned patient.

    PubMed

    Robins, E V

    1989-12-01

    The burn patient is highly susceptible to infection due to the loss of the skin as a barrier to microorganisms. Immune defenses are activated in response to the burn injury; however, some of these defenses are altered. Neutrophil chemotaxis is compromised by decreased perfusion caused by hypovolemia and the formation of microthrombi. Chemotaxis and phagocytosis are dependent on complement components that are reduced in a large burn wound. Neutrophil intracellular killing power is reduced as oxygen delivery to the wound is decreased. Humoral immunity is altered with the drop in IgG levels. Cell-mediated immunity is depressed and T cell lymphocyte counts are deceased. Suppressor T cells are generated. Specific sources of infection for the burn patient include the patient's own bacterial flora; hospital personnel; respiratory equipment; and catheters, both urinary and intravascular. The best control for burn wound infection is the closure of the wound by early excision and grafting. When lack of donor sites prohibits this surgical therapy, control centers on the environment and wound care techniques. The selection of wound topical antibiotics on the basis of visual inspection and surface culturing assists in the prevention of burn wound sepsis. When wound sepsis does occur, systemic antibiotics are instituted. Although burn wound sepsis is an obvious cause of death for the burn patient, it is not the primary cause. Increasing sophistication in fluid resuscitation and in intensive care therapy has resulted in patients living beyond the initial insult and the following few days. Burn patient mortality is now associated with a syndrome presenting clinically as sepsis but without any identifiable septic source.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2697225

  2. Le syndrome de cushing chez l'adolescent: à propos de 18 patients

    PubMed Central

    Haraj, Nassim Essabah; El Aziz, Siham; Chadli, Asma

    2015-01-01

    Le syndrome de Cushing est une pathologie rare mais grave chez l'enfant et l'adolescent. Elle diffère de la pathologie adulte par le mode de présentation et la prise en charge. Il s'agit d'une étude rétrospective des dossiers de patients suivis pour syndrome de Cushing au service d'endocrinologie de Casablanca entre 2002 - 2015, incluant les patients âgés au moment du diagnostic de moins de 22 ans, et ayant un suivi d'au moins 1 an. Au total 18 dossiers ont été inclus. L’âge moyen est de 19,55 ans, avec une prédominance féminine. La durée d’évolution moyenne est de 4,05 ans. Le tableau clinique est fait souvent d'une cassure de poids, une obésité ou une séborrhée et acné. La démarche diagnostique est comparable à celle de l'adulte. Sur le plan étiologique on retrouve une prédominance de la maladie de Cushing (15 patients). Sur le plan thérapeutique, 14 patients ont bénéficié d'une chirurgie hypophysaire, avec complément par radiothérapie chez 3 patients devant l’échec de la chirurgie, Une ablation d'une tumeur surrénalienne chez une patiente et une surrénalectomie bilatérale chez trois patients. L’évolution a été marquée par une guérison chez 9 patients et le décès chez 4 (suite à un syndrome de Nelson, infection sévère, choc hémorragique, corticosurrénalome). Les résultats de cette étude soulignent la gravité de cette maladie, ce qui nécessite d'organiser le suivi, en élaborant des programmes spécifiques de suivi médical et de prise en charge psychologique. PMID:26985265

  3. Infrared-Guided Patient Setup for Lung Cancer Patients

    SciTech Connect

    Lyatskaya, Yulia; James, Steven; Killoran, Joseph H.; Soto, Ricardo; Mamon, Harvey J.; Chin, Lee

    2008-07-15

    Purpose: To evaluate the utility of an infrared-guided patient setup (iGPS) system to reduce the uncertainties in the setup of lung cancer patients. Methods and Materials: A total of 15 patients were setup for lung irradiation using skin tattoos and lateral leveling marks. Daily electronic portal device images and iGPS marker locations were acquired and retrospectively reviewed. The iGPS-based shifts were compared with the daily electronic portal device image shifts using both the central axis iGPS marker and all five iGPS markers. For shift calculation using the five markers, rotational misalignment was included. The level of agreement between the iGPS and portal imaging to evaluate the setup was evaluated as the frequency of the shift difference in the range of 0-5 mm, 5-10 mm, and >10 mm. Results: Data were obtained for 450 treatment sessions for 15 patients. The difference in the isocenter shifts between the weekly vs. daily images was 0-5 mm in 42%, 5-10 mm in 30%, and >10 mm in 10% of the images. The shifts seen using the iGPS data were 0-5 mm in 81%, 5-10 mm in 14%, and >10 mm in 5%. Using only the central axis iGPS marker, the difference between the iGPS and portal images was <5 mm in 77%, 5-10 mm in 16%, and >10 mm in 7% in the left-right direction and 73%, 18%, and 9% in the superoinferior direction, respectively. When all five iGPS markers were used, the disagreements between the iGPS and portal image shifts >10 mm were reduced from 7% to 2% in the left-right direction and 9% to 3% in the superoinferior direction. Larger reductions were also seen (e.g., a reduction from 50% to 0% in 1 patient). Conclusion: The daily iGPS-based shifts correlated well with the daily electronic portal device-based shifts. When patient movement has nonlinear rotational components, a combination of surface markers and portal images might be particularly beneficial to improve the setup for lung cancer patients.

  4. Managing complications in cirrhotic patients

    PubMed Central

    Angeli, Paolo; Cordoba, Juan; Farges, Oliver; Valla, Dominique

    2015-01-01

    Liver cirrhosis is a serious and potentially life-threatening condition. This life-threatening condition usually arises from complications of cirrhosis. While variceal bleeding is the most acute and probably best studied, several other complications of liver cirrhosis are more insidious in their onset but nevertheless more important for the long-term management and outcome of these patients. This review summarizes the topics discussed during the UEG-EASL Hepatology postgraduate course of the United European Gastroenterology Week 2013 and discusses emergency surgical conditions in cirrhotic patients, the management of hepatic encephalopathy, ascites and hepatorenal syndrome, coagulation disorders, and liver cancer. PMID:25653862

  5. Ovarian stimulation in cancer patients.

    PubMed

    Cakmak, Hakan; Rosen, Mitchell P

    2013-05-01

    The patients referred for fertility preservation owing to a malignant disease do not represent the typical population of subfertile patients treated in IVF units. Cancer may affect multiple tissues throughout the body and can result in a variety of complications during controlled ovarian stimulation. Determination of the controlled ovarian stimulation protocol and gonadotropin dose for oocyte/embryo cryopreservation requires an individualized assessment. This review highlights the new protocols that are emerging to reduce time constraints and emphasizes management considerations to decrease complications. PMID:23635348

  6. The earliest gamma unit patients.

    PubMed

    Ganz, Jeremy C

    2014-01-01

    The inventors were very excited and drove the first patient from Stockholm over 100 km for the first treatment. The treatment was a technical success. The new machine was transported to Sophiahemmet (a private Stockholm hospital) and installed. A further eight patients were treated and assessed. At the start, there was no computerized treatment planning program, but this was soon developed and named KULA after the Swedish word for a sphere, since the actual treatment unit was spherical. The term Gamma Knife was first used later by the Pittsburgh group. PMID:25376571

  7. How to Feed Cleft Patient?

    PubMed Central

    Khan, Saima Yunus

    2013-01-01

    ABSTRACT Cleft lip and palate patients have all rights like other normal individuals, to enjoy the benefits of nourishment. Knowledge has to be there about the different feeding positions like straddle, dancer hand position along with the use of specially designed bottles and nipples. Parent's should be trained about the correct positions of feeding, in extreme of the cases in which parents are not able to follow these instructions, feeding obturators can be given. How to cite this article: Jindal MK, Khan SY. How to Feed Cleft Patient? Int J Clin Pediatr Dent 2013;6(2):100-103. PMID:25206201

  8. [Public patient education in pneumology].

    PubMed

    Wagner, A

    1992-10-01

    Since February 1990 public information evenings pertaining to respiratory tract diseases have been held every month in the cities of Fellbach, Backnang and at times in Waiblingen. These sessions have met with a great show of interest from patients, doctors and the public in general, as indicated by the consistently large number of over 100 participants. This continual educational work with its accompanying measures, such as, asthma-sport, breathing exercises, and books and videos on loan, represents an effective alternative to the formally structured, patient training programs limited to a specific time period. A broad range of effectiveness is attained by engaging public media in the informative process. PMID:1438125

  9. [Weight loss in cancer patients].

    PubMed

    Lordick, Florian; Hacker, Ulrich

    2016-02-01

    Cancer patients are regularly affected by malnutrition which often leads to a worsened quality of life and activity in daily living, more side effects and complications during anticancer treatment and shorter survival times. The early diagnosis and treatment of malnutrition are therefore relevant components of oncological treatment. The assessment of the nutritional status and determination of the body-mass-index should be done in every patient with cancer. The clinical examination delivers important findings and indications for malnutrition. Bioimpedance analysis can deliver additional objective information. The treatment of malnutrition should start early and follows a step-wise escalation reaching from nutritional counseling to enteral nutritional support to parenteral nutrition. PMID:26886037

  10. The patient-sensor interface

    PubMed Central

    Crockett, G. S.

    1970-01-01

    During the assessment of monitoring equipment on acute medical cases in a general ward, a quantitative investigation of technical faults revealed that 44% of these occurred at the patient-sensor interface. While the attachment of the equipment was accepted by the patient and was suitable for application by nursing staff, this degree of technical breakdown indicates that more progress is necessary in the design of this aspect of monitoring equipment before it is possible to have a reliable system. ImagesFig. 1 PMID:5476136

  11. Improving Patient's Primary Medication Adherence

    PubMed Central

    Leguelinel-Blache, Géraldine; Dubois, Florent; Bouvet, Sophie; Roux-Marson, Clarisse; Arnaud, Fabrice; Castelli, Christel; Ray, Valérie; Kinowski, Jean-Marie; Sotto, Albert

    2015-01-01

    Abstract Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge. This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge. We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10−7). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89). This study highlights that discharge counseling sessions are

  12. [Intelligent footwear for diabetic patients].

    PubMed

    Pataky, Zoltan; Grivon, Daniel; Civet, Yoan; Perriard, Yves

    2016-01-20

    The incidence of diabetic foot ulcerations and lower extremity amputations remains very high and inacceptable. The high risk of ulceration and consequent amputation is strongly related to difficulties to obtain foot off-loading, particularly on long term. Due to the complexity of their utilization, the available foot off-loading devices are underused both by health care providers and patients with very low therapeutic adherence. This article summarizes the foot off-loading in diabetic patients and describes the concept of intelligent footwear we developed, based on continuous measurements and permanent and automatic adaptations of the shoe insole's rigidity. PMID:26946791

  13. [Patient safety and risk management].

    PubMed

    Schrappe, Matthias

    2005-08-15

    Patient safety is the latest issue in the present stage of the German health care system, characterized by costs and quality both resulting in value of care. Patient safety defined as "absence of adverse events" represents an important problem, because 10% of in-house patients experience an adverse event, which in nearly 50% of the cases is due to an error (preventable adverse event). Threats and near misses are errors without a consecutive adverse event, much more common and better to integrate in the concept of risk management, which is based on thorough analysis and prevention of errors in medicine. Chart reviews show adverse events in between 3% and 11% of hospital patients, studies with direct observation result in higher estimates (17.7%). Nosocomial infections occur in 3-5%, adverse drug events in 0.17-6.5%, and adverse medical device events in up to 8% of patients. Medication errors (ordering, dosing, distribution) are present in up to 50% of all drug applications. Adverse drug events are important reasons for hospital admissions (3.2-10.8% of all admitted patients), other consequences of adverse drug events are severe disability and death. Mortality of adverse drug events is estimated between 0.04% and 0.95% of all patients. The introduction of risk management in the German health care system is one option to prevent a malpractice crisis similar to the situation in the US health care system in the 1990s. Errors are not to be considered only individual but also organizational failures. Critical incident report systems (CIRS) can help to increase the knowledge about errors, near misses and adverse events, so that prevention of errors can take place. On the organizational level, it is an issue of leaderchip to convince the members of the organization that prevention of errors has a higher priority than punishing and blaming. The medical and other professions, on the other side, have to change their self-understanding from the zero mistake philosophy to

  14. Space Technology for Patient Monitoring

    NASA Technical Reports Server (NTRS)

    1989-01-01

    A contract for the development of an astronaut monitoring system in the early days of the space program provided Mennen Medical, Inc. with a foundation in telemetry that led to the development of a computerized medical electronic system used by hospitals. Mennen was the first company to adopt solid state design in patient monitoring and to offer multipatient telemetry monitoring. Telemetry converts instrument data to electrical signals and relays them to a remote receiver where they are displayed. From a central station, a nurse can monitor several patients. Company products include VISTA systems and Horizon 2000 Monitor.

  15. Patient Satisfaction with Pain Level in Patients with Cancer.

    PubMed

    Golas, Mary; Park, Chang Gi; Wilkie, Diana J

    2016-06-01

    Interest in satisfaction with pain management as a pain-related outcome variable wavered when investigators found poor correlations with pain intensity when they measured satisfaction with pain management rather than satisfaction with pain level. The aim was to explore the relationship between satisfaction with pain level and pain intensity among patients receiving ongoing outpatient cancer care. In a comparative, secondary data analysis of a cross-sectional sample of 806 cancer patients (57% male, mean age 56 ± 13 years, 77% Caucasian), the authors measured satisfaction with pain level as a single item (yes, no, not sure) and pain intensity as an average of current, least, and worst pain intensity (all 0-10 scales) in the past 24 hours. Of the 806 participants, 447 (56%) subjects were satisfied with their pain level, 291 (36%) were not satisfied and 68 (8%) were not sure. Satisfaction was moderately correlated with API (rho = -0.43, p < .001). Patients satisfied with their pain levels reported statistically lower mean API scores (2.26 ± 1.70) than those who were not satisfied (4.68 ± 2.07) or not sure (4.21 ± 2.2.1), p < .001. With pair wise post hoc comparisons, mean API scores of satisfied patients were significantly lower than those who were not satisfied or not sure. In contrast with other researchers who have not found associations between satisfaction with pain management and pain intensity, the authors demonstrated that when satisfaction is measured specifically, patients with higher pain intensity are not satisfied. The authors recommend that researchers use "satisfaction with pain level" instead of "satisfaction with pain management" as the pain satisfaction outcome. PMID:27283267

  16. Comparisons between written and computerised patient histories.

    PubMed Central

    Quaak, M J; Westerman, R F; van Bemmel, J H

    1987-01-01

    Patient histories were obtained from 99 patients in three different ways: by a computerised patient interview (patient record), by the usual written interview (medical record), and by the transcribed record, which was a computerised version of the medical record. Patient complaints, diagnostic hypotheses, observer and record variations, and patients' and doctors' opinions were analysed for each record, and records were compared with the final diagnosis. About 40% of the data in the patient record were not present in the medical record. Two thirds of the patients said that they could express all or most of their complaints in the patient record. The doctors found that the medical record expressed the main complaints better (52%) than the patient record (15%) but that diagnostic hypotheses were more certain in the patient record (38%) than in the medical one (26%). The number of diagnostic hypotheses in the patient record was about 20% higher than that in the medical record. Intraobserver agreement (51%) was better than interobserver agreement (32%), while the inter-record agreement varied from 25% (between the medical and patient records) to 35% (between the transcribed and patient records). One third of final diagnoses were seen in the medical record, with 29% and 22% for the transcribed and patient records, respectively. Interobserver agreement in the final diagnosis was 35%. The results of the study suggest that computerised history taking is suitable for certain patients in addition to, and not as a substitute for, the oral interview with a doctor. PMID:3115371

  17. 21 CFR 880.2720 - Patient scale.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Patient scale. 880.2720 Section 880.2720 Food and... Patient scale. (a) Identification. A patient scale is a device intended for medical purposes that is used to measure the weight of a patient who cannot stand on a scale. This generic device includes...

  18. 21 CFR 880.2720 - Patient scale.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Patient scale. 880.2720 Section 880.2720 Food and... Patient scale. (a) Identification. A patient scale is a device intended for medical purposes that is used to measure the weight of a patient who cannot stand on a scale. This generic device includes...

  19. 21 CFR 880.2720 - Patient scale.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Patient scale. 880.2720 Section 880.2720 Food and... Patient scale. (a) Identification. A patient scale is a device intended for medical purposes that is used to measure the weight of a patient who cannot stand on a scale. This generic device includes...

  20. 21 CFR 880.2720 - Patient scale.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Patient scale. 880.2720 Section 880.2720 Food and... Patient scale. (a) Identification. A patient scale is a device intended for medical purposes that is used to measure the weight of a patient who cannot stand on a scale. This generic device includes...

  1. 21 CFR 880.2720 - Patient scale.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Patient scale. 880.2720 Section 880.2720 Food and... Patient scale. (a) Identification. A patient scale is a device intended for medical purposes that is used to measure the weight of a patient who cannot stand on a scale. This generic device includes...

  2. Deinstitutionalizing Elderly Patients: A Program of Resocialization

    ERIC Educational Resources Information Center

    Siegel, Barry; Lasker, Judith

    1978-01-01

    In a program of deinstitutionalization 61 elderly state hospital patients were successfully placed outside the institution. Changes in definition of the patients' situation, collective approach to resocialization, careful medical evaluation, and familiarity of patients with possible alternatives help reduce patients' commitment to the institution…

  3. Patients' Rights and Advocacy: For Hispanics?

    ERIC Educational Resources Information Center

    Andrade, Sally J., Ed.

    The monograph outlines key issues in the area of patients' rights and advocacy as they relate to Hispanic mental health clients or patients. Providing background material on patients' rights and advocacy in general, the first section includes a chronological history of major litigation, a discussion of patient advocacy, a discussion of a client's…

  4. Associação entre lipid accumulation product (LAP) e hirsutismo na síndrome do ovário policístico.

    PubMed

    Oliveira, Flávia Ribeiro de; Rezende, Mariana Bicalho; Faria, Nícolas Figueiredo; Dias, Tomás Ribeiro Gonçalves; Oliveira, Walter Carlos Santos de; Rocha, Ana Luiza Lunardi; Cândido, Ana Lúcia

    2016-02-01

    Objective Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder in women between menarche and menopause. Clinical hyperandrogenism is the most important diagnostic criterion of the syndrome, which manifests as hirsutism in 70% of cases. Hirsute carriers of PCOS have high cardiovascular risk. Lipid accumulation product (LAP) is an index for the evaluation of lipid accumulation in adults and the prediction of cardiovascular risk. The aim of this study was to evaluate the association between LAP and hirsutism in women with PCOS. Methods This was a cross-sectional observational study of a secondary database, which included 263 patients who had visited the Hyperandrogenism Outpatient Clinic from November 2009 to July 2014. The exclusion criteria were patients without Ferriman-Gallwey index (FGI) and/or LAP data. We used the Rotterdam criteria for the diagnosis of PCOS. All patients underwent medical assessment followed by measurement and recording of anthropometric data and the laboratory tests for measurement of the following: thyroid-stimulating hormone, follicle-stimulating hormone, prolactin, total testosterone, sex hormone binding globulin, 17-α-hydroxyprogesterone (follicular phase), glycohemoglobin A1c, and basal insulin. In addition, the subjects underwent lipid profiling and oral glucose tolerance tests. Other laboratory measurements were determined according to clinical criteria. LAP and the homeostatic model assessment index (HOMA-IR) were calculated using the data obtained. We divided patients into two groups: the PCOS group with normal LAP (< 34.5) and the PCOS group with altered LAP (> 34.5) to compare the occurrence of hirsutism. For statistical analysis, we used SPSS Statistics for Windows® and Microsoft Excel programs, with descriptive (frequencies, percentages, means, and standard deviations) and comparative analyses (Student's t-test and Chi-square test). We considered relations significant when the p-value was

  5. Patient safety: the what, how, and when.

    PubMed

    Albrecht, Roxie M

    2015-12-01

    Patient safety is a construct that implies behavior intended to minimize the risk of harm to patients through effectiveness and individual performance designed to avoid injuries to patients from the care that is intended to help them. The Accreditation Council for Graduate Medical Education has made patient safety a focused area in the new Clinical Learning Environment Review process. This lecture will focus on definitions of patient safety terminology; describe the culture of patient safety and a just culture; discuss what to report, who to report it too, and methods of conducting patient safety investigations. PMID:26522775

  6. The Wired Patient: Patterns of Electronic Patient Portal Use Among Patients With Cardiac Disease or Diabetes

    PubMed Central

    Weiner, Jonathan P; Shah, Nirav R; Stewart, Walter F

    2015-01-01

    Background As providers develop an electronic health record–based infrastructure, patients are increasingly using Web portals to access their health information and participate electronically in the health care process. Little is known about how such portals are actually used. Objective In this paper, our goal was to describe the types and patterns of portal users in an integrated delivery system. Methods We analyzed 12 months of data from Web server log files on 2282 patients using a Web-based portal to their electronic health record (EHR). We obtained data for patients with cardiovascular disease and/or diabetes who had a Geisinger Clinic primary care provider and were registered “MyGeisinger” Web portal users. Hierarchical cluster analysis was applied to longitudinal data to profile users based on their frequency, intensity, and consistency of use. User types were characterized by basic demographic data from the EHR. Results We identified eight distinct portal user groups. The two largest groups (41.98%, 948/2258 and 24.84%, 561/2258) logged into the portal infrequently but had markedly different levels of engagement with their medical record. Other distinct groups were characterized by tracking biometric measures (10.54%, 238/2258), sending electronic messages to their provider (9.25%, 209/2258), preparing for an office visit (5.98%, 135/2258), and tracking laboratory results (4.16%, 94/2258). Conclusions There are naturally occurring groups of EHR Web portal users within a population of adult primary care patients with chronic conditions. More than half of the patient cohort exhibited distinct patterns of portal use linked to key features. These patterns of portal access and interaction provide insight into opportunities for electronic patient engagement strategies. PMID:25707036

  7. [Patient evaluation and outcome measures].

    PubMed

    Nieto Pol, Enrique

    2014-01-01

    Both the initial evaluation and follow-up of patients with osteoarthritis require systematic evaluation of the indicators that provide information on the degree of involvement of the disease and allow its quantification. Reliable measures of disease progression help decision-making by clinicians and provide valid information on treatment response and the effectiveness of the distinct therapeutic interventions. The instruments recommended in research, as outcome measures in osteoarthritis, are pain evaluation, assessment of physical function, and self-reported global evaluation. In studies lasting more than 1 year, structural changes are evaluated through simple X-ray. Self-reported quality of life assessment and physician global assessment are also recommended as options. These indicators should be incorporated into routine clinical practice for adequate evaluation and correct follow-up of patients with osteoarthritis. The recommended pain evaluation method for use in clinical practice is the visual analog scale (VAS). The best instrument to evaluate physical function in patients with hip or knee osteoarthritis is the WOMAC scale (Western Ontario and McMaster Universities Osteoarthritis Index). For patient-reported global assessment in routine practice, the recommended scales are VAS or the SF-12 (12-item short-form health survey). PMID:24467959

  8. [DGRW-update: patient education].

    PubMed

    Faller, H; Reusch, A; Meng, K

    2011-10-01

    Patient education programmes, i. e. standardized, manualized, interactive group programmes aiming to increase self-management and empowerment, are a core element of medical rehabilitation for chronic conditions. In an update of the evidence of the effectiveness of patient education, its effectiveness was proven for a broad spectrum of chronic disorders, such as diabetes mellitus, chronic low back pain, rheumatoid arthritis, coronary heart disease, chronic heart failure, bronchial asthma, COPD, and cancer, as well as for the modification of health behaviours, such as diet and exercise. To sustain effects, aftercare interventions, such as support provided by phone, were found to be successful. Interventions targeted to particular patient groups according to gender, age, or migration background are also being developed more frequently. When evaluating educational interventions not only distal outcomes, such as quality of life and participation, should be used but also proximal outcomes such as self-management skills. A recent survey of patient education practice in medical rehabilitation revealed a continuing potential for optimization relative to manualization, evaluation and didactics. However, the dissemination of innovative programmes into rehabilitation routine presents a major challenge. PMID:21976261

  9. Bathing a patient in bed

    MedlinePlus

    ... to make sure you are not rubbing too hard. Make sure you rinse all the soap off, then pat the area dry. Apply lotion before covering the area up. Bring fresh, warm water to the patient's bedside with a clean washcloth ...

  10. Patient Compliance and Medication Perception.

    ERIC Educational Resources Information Center

    Buckalew, L. W.; Sallis, R. E.

    1986-01-01

    Addresses problem of patient noncompliance with regimens of prescribed medication, with attention to incidence and illogical nature of this behavior. Psychological theory of cognitive dissonance is suggested as appropriate to understanding some aspects of noncompliance because medicinal preparations represent stimuli that are not necessarily…

  11. Hospital treatment of HIV patients.

    PubMed

    Ola, Samuel Olawale

    2006-12-01

    Treatment of patients with HIV/AIDS in Nigeria has progressed from the stage of inactivity, unconcern, abandonment and neglect to the present stage of holistic care involving treatment of the infection with Highly Active Anti Retroviral Agents, complications of the disease and side effects of antiretroviral therapy as well as that of human behavioural responses towards the disease with hope and promising outcome. The goal of the treatment is to prolong the patient's life while maintaining the best possible quality of health and life. It is now a continuum of care between the hospital and the different sectors of the community. Hospital treatment of patients with HIV-AIDS is complex and yet a simple task if there is healthy interaction of the patients and health care providers in a milieu of well equipped hospital setting with available treatment facilities for proper management of diseases. Similarly, for the care to achieve its goal, it requires a joint participation of the community and the commitment of the government not only on curtailment of the reservoir of HIV infection by antiretroviral therapy but total eradication of diseases, poverty and ignorance in all its entirety. PMID:18050774

  12. Hypertension in Patients with Cancer

    PubMed Central

    de Souza, Vinicius Barbosa; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade

    2015-01-01

    There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality. PMID:25742420

  13. Haematuria in postrenal transplant patients.

    PubMed

    Wang, Ziting; Vathsala, Anantharaman; Tiong, Ho Yee

    2015-01-01

    Haematuria has a prevalence of 12% in the postrenal transplant patient population. It heralds potentially dangerous causes which could threaten graft loss. It is important to consider causes in light of the unique, urological, and immunological standpoints of these patients. We review the literature on common causes of haematuria in postrenal transplant patients and suggest the salient approach to the evaluation of this condition. A major cause of haematuria is urinary tract infections. There should be a higher index of suspicion for mycobacterial, fungal, and viral infection in this group of immunosuppressed patients. Measures recommended in the prevention of urinary tract infections include early removal of foreign bodies as well as prophylactic antibiotics during the early transplant phase. Another common cause of haematuria is that of malignancies, in particular, renal cell carcinomas. When surgically managing cancer in the setting of a renal transplant, one has to be mindful of the limited retropubic space and the need to protect the anastomoses. Other causes include graft rejections, recurrences of primary disease, and calculus formation. It is important to perform a comprehensive evaluation with the aid of an experienced multidisciplinary transplant team. PMID:25918706

  14. Seamless patient journeys the goal.

    PubMed

    Wiegand, Chris

    2016-02-01

    Chris Wiegand, CEO of Jibestream, a software development company for digital interactive technologies with bases in Toronto and Arlington, Virginia, explains how technologies including Wi-Fi, GPS, RFID, and Bluetooth LE are enhancing wayfinding in healthcare facilities, and, in the process, simplifying the patient journey and helping reduce the stress and anxiety often associated with a visit to the hospital. PMID:27017656

  15. Poetic Interventions with Forensic Patients.

    ERIC Educational Resources Information Center

    Berger, Art; Giovan, Marti

    1990-01-01

    Describes the use of poetry, music, and creative writing with forensic patients at a state mental health institute. Demonstrates that expressive interventions were helpful in group treatment by promoting verbalization, decision making, and the recognition of personal responsibility for incarceration. (SR)

  16. [Patient education in pediatric diabetology].

    PubMed

    Le Tallec, Claire

    2016-01-01

    Therapeutic education in paediatric diabetology consists of initial education and follow-up education. It can be individual or collective. It forms part of a planned and organised systemic approach, with a skills framework adapted to the patient's age. Supporting the families as well as schools is essential. PMID:26776688

  17. Counseling the Chronic Pain Patient.

    ERIC Educational Resources Information Center

    Weiner, Richard S.

    1981-01-01

    Discusses the provision of counseling services for chronic pain patients within comprehensive, multifaceted treatment program. Describes the counseling process, including orientation, evaluation, and clarification of client concerns. Cites the use of coping techniques such as relaxation training, biofeedback training, and pain coping skills. (RC)

  18. Patients, friends, and relationship boundaries.

    PubMed Central

    Rourke, J. T.; Smith, L. F.; Brown, J. B.

    1993-01-01

    When patient and physician are close friends, both professional and personal relationships can suffer. Jointly exploring and setting explicit boundaries can help avoid conflict and maintain these valuable relationships. This is particularly important when the physician practises in a small community where such concurrent relationships are unavoidable. PMID:8292931

  19. Sex Guilt in Abortion Patients

    ERIC Educational Resources Information Center

    Gerrard, Meg

    1977-01-01

    A measure of sex guilt was administered to clients of a university problem pregnancy counseling service who were planning to have abortions and to a group of sexually active nonpregnant university coeds. Sex guilt was found to be significantly higher for the abortion patients than for the nonpregnant group. (Author)

  20. Creating patient satisfaction and loyalty.

    PubMed

    Fisk, T A; Brown, C J; Cannizzaro, K G; Naftal, B

    1990-06-01

    Many hospitals are considering enhanced approaches to patient satisfaction measurement and guest relations--or service management. Some are building in-house satisfaction management systems. Others are evaluating the growing number of systems commercially available for purchase. The authors review the successful design, testing, introduction, and nearly 5-year use of an in-house system. PMID:10105197

  1. Patient perspectives of telemedicine quality

    PubMed Central

    LeRouge, Cynthia M; Garfield, Monica J; Hevner, Alan R

    2015-01-01

    Background The purpose of this study was to explore the quality attributes required for effective telemedicine encounters from the perspective of the patient. Methods We used a multi-method (direct observation, focus groups, survey) field study to collect data from patients who had experienced telemedicine encounters. Multi-perspectives (researcher and provider) were used to interpret a rich set of data from both a research and practice perspective. Results The result of this field study is a taxonomy of quality attributes for telemedicine service encounters that prioritizes the attributes from the patient perspective. We identify opportunities to control the level of quality for each attribute (ie, who is responsible for control of each attribute and when control can be exerted in relation to the encounter process). This analysis reveals that many quality attributes are in the hands of various stakeholders, and all attributes can be addressed proactively to some degree before the encounter begins. Conclusion Identification of the quality attributes important to a telemedicine encounter from a patient perspective enables one to better design telemedicine encounters. This preliminary work not only identifies such attributes, but also ascertains who is best able to address quality issues prior to an encounter. For practitioners, explicit representation of the quality attributes of technology-based systems and processes and insight on controlling key attributes are essential to implementation, utilization, management, and common understanding. PMID:25565781

  2. Orthogeriatric care: improving patient outcomes

    PubMed Central

    Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira, Eduardo; Cuesta-Peredó, David

    2016-01-01

    Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. PMID:27445466

  3. Odontogenic lesions in pediatric patients.

    PubMed

    Fang, Qi-Gen; Shi, Shuang; Sun, Chang-Fu

    2014-05-01

    The purpose was to evaluate our 20-year experience of pediatric odontogenic lesions. Pediatric patients with a diagnosis of odontogenic lesion were identified. Three hundred ten patients were odontogenic; dentigerous cyst was seen in 62.0% of the cases. Most (70.2%) of them occurred in mixed dentition period, and it had a male preponderance. Odontogenic keratocystic tumor occurred in the permanent dentition period. It had an equal site distribution. Odontoma was seen in 20.0% of the cases. Its site of predilection was the mandible. Ameloblastoma was the most common odontogenic tumor. Most of the cases occurred in the permanent dentition period. It affected the male and female equally. Calcifying epithelioma odontogenic tumor was seen in 11.8% of the cases. All the lesions occurred in the primary dentition period. It had no sex or site preponderance. Myxoma was seen in 3.6% of the cases. It was most common in the permanent dentition period, and it was more frequent in the male. Iliac crest bone graft was successfully performed in 28 patients, postoperative infection occurred in 2 patients, and no donor-site dysfunctions were reported. The observed differences in lesion type and distribution in this study compared with previous researches may be attributable to genetic and geographic variation in the populations studied. Iliac crest bone graft was suggested for pediatric mandible reconstruction. PMID:24785745

  4. Integrating Patients into Medical Education

    PubMed Central

    Fischer, Volkhard

    2012-01-01

    The discussions about medical education in the public focus upon quantity. The quality of the teaching process isn’t questioned. But the professionalization of medical education should start with a close look at bedside teaching because it is the core of training medical doctors. Patient-centered teaching: German medical leicensure act (Approbationsordnung) defines the quality of medical education by standard setting for group sizes and fixing the hours of bedside teaching. Although there are some fuzzy definitions it is possible to extract some special forms of bedside teaching. The capacity act (Kapazitätsverordnung) interprets these definitions for calculating the number of students who could be enrolled each year. Types of bedside teaching: The different forms of contact with patients which are necessary for a good medical education can be transformed into distinct types of courses. Our classification of courses with specific forms of patient contact is suitable to describe each German program of medical studies. This quantitative profile offers new opportunities for comparing medical education at the different faculties. Discussion: In many German medical schools the hours of bedside teaching are allocated in a verv pragmatical way according to the medical leicensure act. A more professional curriculum planning leads to a sophisticated use of these diverse forms of patient-centered teaching. Because this professional planning is better derived from the legal basis it offers new arguments against an economically oriented hospital management. PMID:22403598

  5. [Management of patients with stomas].

    PubMed

    Simon, Anne

    2016-01-01

    With the occurrence of an intestinal obstruction, many patients may need an intestinal stoma. This decision is often taken in an emergency context but may also be planned. The treatment will be multi-disciplinary involving the surgeon, anaesthetist, nurse, health care assistant, physiotherapist, dietician and stoma therapist. PMID:26743367

  6. BAYESIAN BICLUSTERING FOR PATIENT STRATIFICATION.

    PubMed

    Khakabimamaghani, Sahand; Ester, Martin

    2016-01-01

    The move from Empirical Medicine towards Personalized Medicine has attracted attention to Stratified Medicine (SM). Some methods are provided in the literature for patient stratification, which is the central task of SM, however, there are still significant open issues. First, it is still unclear if integrating different datatypes will help in detecting disease subtypes more accurately, and, if not, which datatype(s) are most useful for this task. Second, it is not clear how we can compare different methods of patient stratification. Third, as most of the proposed stratification methods are deterministic, there is a need for investigating the potential benefits of applying probabilistic methods. To address these issues, we introduce a novel integrative Bayesian biclustering method, called B2PS, for patient stratification and propose methods for evaluating the results. Our experimental results demonstrate the superiority of B2PS over a popular state-of-the-art method and the benefits of Bayesian approaches. Our results agree with the intuition that transcriptomic data forms a better basis for patient stratification than genomic data. PMID:26776199

  7. Haematuria in Postrenal Transplant Patients

    PubMed Central

    Wang, Ziting; Vathsala, Anantharaman; Tiong, Ho Yee

    2015-01-01

    Haematuria has a prevalence of 12% in the postrenal transplant patient population. It heralds potentially dangerous causes which could threaten graft loss. It is important to consider causes in light of the unique, urological, and immunological standpoints of these patients. We review the literature on common causes of haematuria in postrenal transplant patients and suggest the salient approach to the evaluation of this condition. A major cause of haematuria is urinary tract infections. There should be a higher index of suspicion for mycobacterial, fungal, and viral infection in this group of immunosuppressed patients. Measures recommended in the prevention of urinary tract infections include early removal of foreign bodies as well as prophylactic antibiotics during the early transplant phase. Another common cause of haematuria is that of malignancies, in particular, renal cell carcinomas. When surgically managing cancer in the setting of a renal transplant, one has to be mindful of the limited retropubic space and the need to protect the anastomoses. Other causes include graft rejections, recurrences of primary disease, and calculus formation. It is important to perform a comprehensive evaluation with the aid of an experienced multidisciplinary transplant team. PMID:25918706

  8. Cultural competence in patient education.

    PubMed

    Garity, J

    2000-03-01

    As a community health nurse, have you tested your cultural consideration quotient in patient education recently? Can you define the difference between ethnocentrism and multiculturalism? Do you find that you and your colleagues work with more or less transcultural nursing in your daily practice? Find out why cultural competence is vital to nurses' success in the 21st century. PMID:11009778

  9. A patient's view of asthma.

    PubMed Central

    Donaldson, J M

    1995-01-01

    A medical consultation is seen as a meeting between cultures which have developed from different standpoints. These cultures are described, as are the ways in which they may contribute to, or impede a full understanding between the doctor and the patient with asthma, or concerned parent. PMID:8537950

  10. Patient education and pediatric oncology.

    PubMed

    Kramer, R F; Perin, G

    1985-03-01

    An overview is provided of important principles and content useful in planning educational programs for pediatric oncology patients and their families. Implementation considerations, such as assessment of the learner, selection of appropriate teaching methods, and problems with the selection process are addressed. PMID:2579366

  11. Transfusion management of trauma patients.

    PubMed

    Shaz, Beth H; Dente, Christopher J; Harris, Robert S; MacLeod, Jana B; Hillyer, Christopher D

    2009-06-01

    The management of massively transfused trauma patients has improved with a better understanding of trauma-induced coagulopathy, the limitations of crystalloid infusion, and the implementation of massive transfusion protocols (MTPs), which encompass transfusion management and other patient care needs to mitigate the "lethal triad" of acidosis, hypothermia, and coagulopathy. MTPs are currently changing in the United States and worldwide because of recent data showing that earlier and more aggressive transfusion intervention and resuscitation with blood components that approximate whole blood significantly decrease mortality. In this context, MTPs are a key element of "damage control resuscitation," which is defined as the systematic approach to major trauma that addresses the lethal triad mentioned above. MTPs using adequate volumes of plasma, and thus coagulation factors, improve patient outcome. The ideal amounts of plasma, platelet, cryoprecipitate and other coagulation factors given in MTPs in relationship to the red blood cell transfusion volume are not known precisely, but until prospective, randomized, clinical trials are performed and more clinical data are obtained, current data support a target ratio of plasma:red blood cell:platelet transfusions of 1:1:1. Future prospective clinical trials will allow continued improvement in MTPs and thus in the overall management of patients with trauma. PMID:19448199

  12. Managing Bariatric Patients in Dentistry.

    PubMed

    Chandler, Debbie; Vallé-Jones, Richard

    2015-05-01

    Obesity is a growing issue across the world, presenting a range of challenges to society. Management of obese or bariatric patients in the dental environment has become more commonplace. This article considers an overview of obesity, reviews its dental impact and offers some solutions to minimising those challenges in the dental setting. PMID:26556254

  13. [Enriching patient care with aromatherapy].

    PubMed

    Sogno-Lalloz, Isabelle

    2014-01-01

    There are increasing numbers of initiatives in healthcare institutions focusing on the benefits of essential oils. Received positively by patients who appreciate the resulting wellbeing, these innovative approaches around aromatherapy are based on the initiative of pioneering caregivers. Following on from an international congress held each year in Grasse, this article presents some example schemes. PMID:25065196

  14. Imaging patients with cardiac trauma.

    PubMed

    Restrepo, Carlos S; Gutierrez, Fernando R; Marmol-Velez, Juan A; Ocazionez, Daniel; Martinez-Jimenez, Santiago

    2012-01-01

    In the United States, trauma is the leading cause of death among those who are 1-44 years old, with cardiovascular injuries representing the second most common cause of traumatic death after central nervous system injuries. Evaluation of trauma patients with suspected cardiac injury may be complex and include electrocardiography, measurement of cardiac biomarkers, and imaging examinations. Contrast material-enhanced computed tomography (CT) has become one of the most valuable imaging tools available for evaluating hemodynamically stable patients with suspected cardiac injury. The presence of hemopericardium, with or without cardiac tamponade, is one of the most significant findings of cardiac injury. Other complications that result from blunt cardiac injury, such as pericardial rupture and cardiac herniation, may be readily depicted at multidetector CT. Assessment of patients with cardiac injuries, particularly those with penetrating injuries, is a challenging and time-critical matter, with clinical and imaging findings having complementary roles in the formation of an accurate diagnosis. Patients who are hemodynamically stable, particularly those with penetrating cardiac injuries, also may benefit from a timely imaging examination. In addition to chest radiography, other available modalities such as transthoracic and transesophageal echocardiography, nuclear medicine, and magnetic resonance imaging may play a role in selected cases. PMID:22582351

  15. Patient selection for obesity surgery.

    PubMed

    Grace, D M

    1987-09-01

    Patients selected for gastroplasty should be at least 45 kg above ideal weight, between the ages of 18 and 50, and operated on in a center with good results, where team assessment and long-term follow-up is emphasized. Referral by a family doctor who provides local care and support is important. Medical complications need not be present because the idea is to prevent them, but problems such as sleep apnea, adult onset diabetes mellitus, hypertension, osteoarthritis, and infertility, which may be corrected by weight loss, increase the indication for gastroplasty. Patients should have social support and be intelligent enough to understand the postoperative diet and the need for regular follow-up. Those with a history of psychiatric admission require careful preoperative assessment by psychiatrist or psychologist and close follow-up and support. Patients should have made a good supervised attempt at dieting, have had stable weight for 3 to 5 years preoperatively, and have stopped smoking at least 6 weeks prior to operation. Tests to assess personality factors, eating habits, and motivation are developing, but more precise methods of selecting patients for gastroplasty and predicting successful and uncomplicated weight loss are still needed. PMID:3325422

  16. Exercise for the Overweight Patient.

    ERIC Educational Resources Information Center

    Work, Janis A.

    1990-01-01

    Exercise can help patients maintain lean body mass during weight loss. Although exercise is not extremely useful in shedding excess pounds, it helps keep off weight lost through calorie restriction. This article discusses the specifics of exercise prescription, types of exercise, motivation to exercise, and special problems such as diabetes. (SM)

  17. Addressing challenges and needs in patient education targeting hardly reached patients with chronic diseases

    PubMed Central

    Varming, Annemarie Reinhardt; Torenholt, Rikke; Møller, Birgitte Lund; Vestergaard, Susanne; Engelund, Gitte

    2015-01-01

    Some patients do not benefit from participation in patient education due to reasons related to disease burden, literacy, and socioeconomic challenges. In this communication, we address more specifically both the challenges that these hardly reached patients face in relation to patient education programs and the challenges educators face when conducting patient education with hardly reached patients. We define principles for the format and content of dialogue tools to better support this patient group within the population of individuals with diabetes. PMID:25729695

  18. Nurse Overestimation of Patients' Health Literacy

    PubMed Central

    Dickens, Carolyn; Lambert, Bruce L.; Cromwell, Terese; Piano, Mariann R.

    2013-01-01

    Patient education and effective communication are core elements of the nursing profession; therefore, awareness of a patient's health literacy is integral to patient care, safety, education, and counseling. Several past studies have suggested that health care providers overestimate their patient's health literacy. In this study, the authors compare inpatient nurses' estimate of their patient's health literacy to the patient's health literacy using Newest Vital Sign as the health literacy measurement. A total of 65 patients and 30 nurses were enrolled in this trial. The results demonstrate that nurses incorrectly identify patients with low health literacy. In addition, overestimates outnumber underestimates 6 to 1. The results reinforce previous evidence that health care providers overestimate a patient's health literacy. The overestimation of a patient's health literacy by nursing personnel may contribute to the widespread problem of poor health outcomes and hospital readmission rates. PMID:24093346

  19. Incidence of cardiac events in burned patients.

    PubMed

    Meyers, David G; Hoestje, Sara M; Korentager, Richard A

    2003-06-01

    Given the increased level of adrenergic stimulation in burn patients, it would be expected that they would experience an increased incidence of cardiac arrhythmias and other cardiac events. We performed a retrospective chart review of 56 acute burn patients matched by age, length of hospital stay, and sex to 56 trauma patients, all of whom had been continuously monitored electrocardiographically. Burn and trauma patients were similar in injury severity, admission laboratory values, and prior history of cardiopulmonary diseases. Arrhythmias were noted in 34% of burn patients and 28% of trauma patients. One myocardial infarction and six deaths occurred in burn patients. No myocardial infarctions or deaths were observed in trauma patients. A past history of cardiopulmonary disease increased the risk of myocardial infarction or death by 6.6 times. Cardiac arrhythmias and other events are relatively infrequent and benign in burn patients and are similar to those experienced by other patients with acute injuries. PMID:12781616

  20. Polypharmacy in the Aging Patient

    PubMed Central

    Lipska, Kasia J.; Krumholz, Harlan; Soones, Tacara; Lee, Sei J.

    2016-01-01

    IMPORTANCE There is substantial uncertainty about optimal glycemic control in older adults with type 2 diabetes mellitus. OBSERVATIONS Four large randomized clinical trials (RCTs), ranging in size from 1791 to 11440 patients, provide the majority of the evidence used to guide diabetes therapy. Most RCTs of intensive vs standard glycemic control excluded adults older than 80 years, used surrogate end points to evaluate microvascular outcomes and provided limited data on which subgroups are most likely to benefit or be harmed by specific therapies. Available data from randomized clinical trials suggest that intensive glycemic control does not reduce major macrovascular events in older adults for at least 10 years. Furthermore, intensive glycemic control does not lead to improved patient-centered microvascular outcomes for at least 8 years. Data from randomized clinical trials consistently suggest that intensive glycemic control immediately increases the risk of severe hypoglycemia 1.5- to 3-fold. Based on these data and observational studies, for the majority of adults older than 65 years, the harms associated with a hemoglobin A1c (HbA1c) target lower than 7.5% or higher than 9% are likely to outweigh the benefits. However, the optimal target depends on patient factors, medications used to reach the target, life expectancy, and patient preferences about treatment. If only medications with low treatment burden and hypoglycemia risk (such as metformin) are required, a lower HbA1c target may be appropriate. If patients strongly prefer to avoid injections or frequent fingerstick monitoring, a higher HbA1c target that obviates the need for insulin may be appropriate. CONCLUSIONS AND RELEVANCE High-quality evidence about glycemic treatment in older adults is lacking. Optimal decisions need to be made collaboratively with patients, incorporating the likelihood of benefits and harms and patient preferences about treatment and treatment burden. For the majority of older

  1. [Patients' rights--doctors' duties].

    PubMed

    Jaeger, L; Bertram, E; Grate, S; Mischkowsky, T; Paul, D; Probst, J; Scala, E; Wbllenweber, H D

    2015-06-01

    On 26 February 2013 the new "Law on Patients' Rights" (hereinafter also the "Law") became effective. This Law strengthens patients' rights vis-à-vis the insurdnce company and also regulates patients' rights regarding their relation to the doctor. This has consequences for the laws on medical liability all doctors must consider. The doctor's performance is and remains a service and such service does not hold any guarantee of success. Nevertheless, this Law primarily reads as a "law on the duties of physicians". To duly take into account these duties and to avoid mistakes and misinterpretation of the Law, the Ethics Committee of the Consortium of Osteosynthesis Trauma Germany (AOTRAUMA-D) has drafted comments on the Law. Brief summaries of its effects are to be found at the end of the respective comment under the heading "Consequences for Practice". The text of the law was influenced particularly by case law, as continuously developed by the German Federal Court of Justice ("BGH"). The implementation of the Law on Patients' Rights was effected by the newly inserted sections 630a to 630h of the German Civil Code (the "BGB"), which are analysed below. The following comments are addressed to physicians only and do not deal with the specific requirements and particularities of the other medical professions such as physiotherapy, midwifery and others so on. Special attention should be paid to the comments on the newly inserted Duty to inform, which has to be fullfilled prior to any diagnostic or therapeutic procedure (sec. 630c para 2 sentence 1 BGB). Under certain conditions the doctor also has to inform the patient about the circumstances that lead to the presumed occurance of a therapeutic or diagnostic malpractice (sec. 630c para. 2 sentence 2 BGB), based on the manifestation of an undesired event or an undesired outcome. As before, the patient's valid consent to any procedure (sec. 630d BGB) is directly linked to the comprehensive and timely provision of information

  2. Ocular toxoplasmosis in AIDS patients.

    PubMed Central

    Gagliuso, D J; Teich, S A; Friedman, A H; Orellana, J

    1990-01-01

    We describe 16 cases of ocular and, in some patients, associated CNS toxoplasmosis in AIDS patients. T gondii is commonly associated with infection in the immunocompromised host. The lesions are most often seen in the CNS and eyes; involvement in the brain, heart, lung, liver, spleen, and lymph nodes may be observed. CNS involvement by toxoplasmosis may be an initial manifestation of AIDS and may be associated with discrete or diffuse lesions. CT scan and MR imaging may demonstrate a multitude of lesions often displaying the characteristic ring-shaped enhancement after contrast injection. Ocular involvement by toxoplasmosis, though less common than CNS involvement, is characterized by several features. These may be manifested as single or multifocal retinal lesions in one or both eyes or massive areas of retinal necrosis. Invariably these lesions are unassociated with a pre-existing retinochoroidal scar suggesting that the lesions are a manifestation of acquired rather than congenital disease. Presence of IgM antibodies may support this observation although antibody levels in AIDS patients may not reflect the magnitude of disease. Vitreous reaction is often minimal. Anterior uveitis has been reported in one case. Treatment of the ocular infection with pyrimethamine, clindamycin and sulfadiazine is effective in over 75% of patients. Once resolution of the ocular infection is observed, maintenance therapy is continued as relapses occur in the absence of treatment. Corticosteroid treatment is unnecessary and its use has been associated with the development of CMV retinitis. Other retinal infections in AIDS patients which should be considered in the differential diagnosis include CMV, herpetic-associated ARN and syphilis. Concomitant CMV and toxoplasmosis in the same eye have been seen. Images FIGURE 1 FIGURE 2 A FIGURE 2 B FIGURE 3 A FIGURE 3 B FIGURE 4 A FIGURE 4 B FIGURE 5 A FIGURE 5 B FIGURE 6 FIGURE 7 FIGURE 8 A FIGURE 8 B FIGURE 9 A FIGURE 9 B FIGURE 9 C PMID

  3. [Intrahospital transportation of critical patients].

    PubMed

    Martínez Magro, M L; Lozano Quintana, M J; López Castillo, M T; Cuenca Solanas, M

    1995-01-01

    Critically ill patients often need to be transferred for a short period of time for diagnostical or therapeutical reasons to other areas outside the intensive care unit which are less safe than their own unit and suppose a potential risk of deterioration in the patient's status. We analyse prospectively the intrahospitalary transfer in 50 patients and study the hemodynamic, ventilatory and neurological variations before and after the transfer. 93.7% of our patients were transferred for diagnostical reasons, basically to the radiodiagnosis service (85.4% for TAC performance), only 6.25% were transferred for therapeutical reasons, all of them to the operating theatre. All the patients included in the study were subjected to: -mechanic ventilation, electrocardiographic monitoring (ECG), invasive arterial monitoring (TA), monitoring of arterial saturation of O2 using pulsioximetry, drugs infusion through volumetric bombs and intracraneal pressure monitoring through intra-ventricular catheter (in 18 cases). The intrahospitalary transfer was performed with: -Portable ventilator, ECG monitoring, TA, PIC and pulsioximetry. Before and after the transfer different parameters were registered: -Inspiratory fraction of O2 (FiO2), TA, cardiac frequency, PIC, arterial gasometry (pH, PAO2, PACO2). There were no complications in any of the cases, the gasometric alterations were due to the change of respiratory parameters for the transfer (increase of the FiO2 and prophylactic ventilation in all the cases). We recommend: -Use of the portable ventilator, volumetric bombs, hemodynamic monitoring and uninterrupted pulsioximetry and the presence of qualified staff (doctor and ICU nurse) during the transfer. PMID:7493286

  4. Oxidative Stress in Cystinosis Patients

    PubMed Central

    Vaisbich, Maria Helena; Pache de Faria Guimaraes, Luciana; Shimizu, Maria Heloisa Mazzola; Seguro, Antonio Carlos

    2011-01-01

    Background/Aims Nephropathic cystinosis (NC) is a severe systemic disease and cysteamine improves its prognosis. Lysosomal cystine accumulation is the hallmark of cystinosis and is regarded as the primary defect due to mutations in the CTNS gene. However, there is great evidence that cystine accumulation itself is not responsible for all abnormalities observed in NC. Studies have demonstrated altered ATP metabolism, increased apoptosis, and cell oxidation. An increased number of autophagosomes and autophagic vacuoles have been observed in cystinotic fibroblasts and renal epithelial cells, suggesting that altered autophagy plays a role in NC, leading to increased production of reactive oxygen species. Therefore, cystinosis patients can be more susceptible to oxidative stress (OS) and it can contribute to the progression of the renal disease. Our goal was to evaluate a marker of OS (serum TBARS) in NC children, and to compare the results with those observed in healthy controls and correlated with renal function parameters. Methods The study included patients aged under 18 years, with good adherence to the treatment and out of renal replacement therapy. The following parameters were evaluated: serum creatinine, BUN, creatinine clearance estimated by stature and serum TBARS levels. Results We selected 20 patients aged 8.0 ±3.6 years and observed serum TBARS levels of 4.03 ±1.02 nmol/ml. Serum TBARS levels in the 43 healthy controls, aged 7.4 ±1.1 years, were 1.60 ±0.04 nmol/ml. There was a significant difference between the plasma TBARS levels among the 2 groups (p < 0.0001). We detected no significant correlation between plasma TBARS levels and renal function. Conclusion An increased level of serum TBARS in patients with NC was observed and this abnormality was not correlated with the renal function status degree. This is the first report that shows increased oxidative stress in serum of NC patients. PMID:22470381

  5. Sleep disorders in hemodialysis patients.

    PubMed

    Sabry, Alaa A; Abo-Zenah, Hamdy; Wafa, Ehab; Mahmoud, Khaled; El-Dahshan, Khaled; Hassan, Ahmed; Abbas, Tarek Medhat; Saleh, Abd El-Baset M; Okasha, Kamal

    2010-03-01

    The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 +/- 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura University, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific questions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our patients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomnography, is necessary to confirm our results. Interventional studies for management of sleep disorders in HD patients are warranted. PMID:20228517

  6. Frequency of anemia in chronic psychiatry patients

    PubMed Central

    Korkmaz, Sevda; Yıldız, Sevler; Korucu, Tuba; Gundogan, Burcu; Sunbul, Zehra Emine; Korkmaz, Hasan; Atmaca, Murad

    2015-01-01

    Purpose Anemia could cause psychiatric symptoms such as cognitive function disorders and depression or could deteriorate an existing psychiatric condition when it is untreated. The objective of this study is to scrutinize the frequency of anemia in chronic psychiatric patients and the clinical and sociodemographic factors that could affect this frequency. Methods All inpatients in our clinic who satisfied the study criteria and received treatment between April 2014 and April 2015 were included in this cross-sectional study. Sociodemographic data for 378 patients included in the study and hemoglobin (Hb) and hematocrit values observed during their admission to the hospital were recorded in the forms. Male patients with an Hb level of <13 g/dL and nonpregnant female patients with an Hb level of <12 g/dL were considered as anemic. Findings Axis 1 diagnoses demonstrated that 172 patients had depressive disorder, 51 patients had bipolar disorder, 54 patients had psychotic disorder, 33 patients had conversion disorder, 19 patients had obsessive-compulsive disorder, 25 patients had generalized anxiety disorder, and 24 patients had other psychiatric conditions. It was also determined that 25.4% of the patients suffered from anemia. Thirty-five percent of females and 10% of males were considered as anemic. The frequency of anemia was the highest among psychotic disorder patients (35%), followed by generalized anxiety disorder patients (32%), and obsessive-compulsive disorder patients (26%). Anemia was diagnosed in 22% of depressive disorder patients, 25% of bipolar disorder patients, and 24% of conversion disorder patients. Results The prevalence of anemia among chronic psychiatry patients is more frequent than the general population. Thus, the study concluded that it would be beneficial to consider the physical symptoms and to conduct the required examinations to determine anemia among this patient group. PMID:26543367

  7. The soothing patients' anxiety 'SPA' experience.

    PubMed

    Harris, P

    2015-06-01

    This paper examines a blended approach to minimising patient anxiety levels prior to general anaesthesia for adult and paediatric patients with a learning disability by introducing reasonable adjustments and reasonable distractions. A therapeutic environment is created that promotes wellbeing; restrictive interventions are used only when there is potential for harm to the patient or others. The result can be excellent holistic individual patient care, the patient receiving 'added value' and a positive experience. PMID:26302589

  8. Treatment-resistant depression in Hispanic patients.

    PubMed

    Podawiltz, Alan; Culpepper, Larry

    2010-06-01

    About one-third of patients treated with antidepressants do not respond to initial treatment, and Spanish-speaking Hispanic patients with major depression may exhibit a worse response to initial medication than English-speaking patients. Patients and clinicians should be resolute and patient as different regimens are tried throughout the course of treatment. Other options include electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, and the medicinal food L-methylfolate. PMID:20573322

  9. A Reappraising of Cosmography: the Interface Between Astronomical and Geographic Studies. (Breton Title: Releitura do Conceito de Cosmografia: a Interface Entre os Estudos Astronômicos e Geográficos.) Una Relectura del Concepto de Cosmografía: la Interfase Entre los Estudios Astronómicos y Geográficos

    NASA Astrophysics Data System (ADS)

    Azevedo Sobreira, Paulo Henrique

    2012-12-01

    The concept of "Cosmography" is in disuse since the 80s of the last century, but the astronomical themes previously discussed in the school subjects of Geography and Cosmography remain in current textbooks. The use of term "Cosmography" was rescued in this research, and the study of its re-signification prompted the appearance of the term Geographic Cosmography. The Geographic Cosmography is a field of studies of the Geography, whose set of knowledge and skills is predominantly scholar. It studies the interface between terrestrial and celestial knowledge, and assigns a geographic significance to them. It examines human and natural relationships with Sidereal Space and its consequences for society and nature. O conceito de "Cosmografia" está em desuso desde os anos 80 do século XX, mas os temas astronômicos anteriormente abordados nas disciplinas escolares de Cosmografia e de Geografia permanecem nos atuais livros didáticos. O uso do termo "Cosmografia" foi resgatado nesta pesquisa e o estudo de sua ressignificação proporcionou o surgimento do termo Cosmografia Geográfica. A Cosmografia Geográfica é um campo de estudos da Geografia, cujo conjunto de conhecimentos e habilidades é predominantemente escolar. Estuda a interface entre os conhecimentos terrestres e os celestes e lhes atribui significância geográfica. Analisa as relações humanas e naturais com o Espaço Sideral e suas consequências para a sociedade e a natureza.

    Aunque el concepto de "Cosmografía" no se usa desde la década de los '80 del siglo pasado, los temas astronómicos que se enseñaban anteriormente en las asignaturas escolares de Cosmografía y de Geografía permanecen en los actuales libros didácticos. El uso del término "Cosmografía" fue rescatado en esta investigación y el estudio de su resignificación proporcionó el surgimiento del término Cosmografía Geográfica. La Cosmografía Geográfica es un campo de estudio de la Geografía, donde

  10. Accessing Patient Information for Probabilistic Patient Models Using Existing Standards.

    PubMed

    Gaebel, Jan; Cypko, Mario A; Lemke, Heinz U

    2016-01-01

    Clinical decision support systems (CDSS) are developed to facilitate physicians' decision making, particularly for complex, oncological diseases. Access to relevant patient specific information from electronic health records (EHR) is limited to the structure and transmission formats in the respective hospital information system. We propose a system-architecture for a standardized access to patient specific information for a CDSS for laryngeal cancer. Following the idea of a CDSS using Bayesian Networks, we developed an architecture concept applying clinical standards. We recommend the application of Arden Syntax for the definition and processing of needed medical knowledge and clinical information, as well as the use of HL7 FHIR to identify the relevant data elements in an EHR to increase the interoperability the CDSS. PMID:27139392

  11. Patient Cases 2. A Patient with Apparent Resistant Hypertension.

    PubMed

    Aguiar, Carlos

    2015-07-01

    True treatment-resistant hypertension (TRH) is defined by specific criteria and a failure to response to initial therapy options does not necessarily mean that a patient has TRH. In this case, a 44-year-old male was discharged on a fixed combination of valsartan/hydrochlorothiazide (HCTZ) 160/125 mg/day after presenting to the emergency room with paraesthesia of the upper left limb and recording a blood pressure (BP) of 190/110 mmHg. The patient had a number of other cardiovascular (CV) risk factors, and was determined to be at high risk of developing type 2 diabetes mellitus and of CV death. Carvedilol and atorvastatin were added, but 24-h ambulatory BP monitoring (ABPM) showed persistent hypertension. After specialist assessment, the patient's antihypertensive regimen was switched to a fixed-dose combination of olmesartan/HCTZ in the morning and a fixed-dose combination of olmesartan/amlodipine in the evening. Repeat ABPM 6 weeks later showed better BP control then previous ABPM. PMID:26072255

  12. [Reducing ambiguity: semantic statistical studies of "normal" probands, neurotic patients, borderline patients and schizophrenic patients].

    PubMed

    Leichsenring, F; Meyer, H A

    1994-01-01

    The present study tries to answer three questions: 1.) Do patients with neurotic disorders differ from normals by a stronger tendency to avoid or reduce ambiguity? 2.) Does the tendency to avoid or reduce ambiguity increase with increasing ambiguity of the stimulus? 3.) Does the avoidance or reduction of ambiguity increase with affects of anxiety and hostility? In order to answer these questions, Ertel's dogmatism-dictionary was applied to the answers of 30 normals, 30 patients with neurotic disorders, 30 borderline-patients, 25 acute and 25 chronic schizophrenics in the Holtzman Inkblot Technique (HIT). According to the results, (1) patients with neurotic disorders do not differ from normals by a stronger tendency to avoid or reduce ambiguity. 2.) The tendency to avoid or reduce ambiguity increases with measures of increasing stimulus ambiguity of the HIT cards in all diagnostic groups studied with the exception of chronic schizophrenics. As far as response ambiguity (variability of interpretation) is concerned, only in chronic schizophrenics the tendency to avoid or reduce ambiguity decreases with increasing response ambiguity. 3.) The avoidance or reduction of ambiguity increases with affects of anxiety and/or aggression assessed by HIT-measures in all diagnostic groups studied with the exception of normals and chronic schizophrenics. In both normals and chronic schizophrenics, the reduction of ambiguity decreases significantly with increasing anxiety, in chronic schizophrenics the reduction of ambiguity decreases significantly with an increase of low levels of aggression. PMID:7879407

  13. 76 FR 7855 - Patient Safety Organizations: Voluntary Delisting From Community Medical Foundation for Patient...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... safety of health care delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety... patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:......

  14. Etude des phenomenes chimiques au contact entre le bloc cathodique et la barre collectrice d'une cellule d'electrolyse d'aluminium

    NASA Astrophysics Data System (ADS)

    Lebeuf, Martin

    La production d'aluminium est une industrie importante au Québec. Les propriétés de ce métal le vouent à de multiples usages présents et futurs dans le cadre d'une économie moderne durable. Toutefois, le procédé Hall-Héroult est très énergivore et des progrès demeurent donc nécessaires pour en diminuer les coûts financiers et environnementaux. Parmi les améliorations envisageables de la cellule d'électrolyse se trouve le contact entre la cathode et la barre collectrice, qui doit offrir une faible résistivité au passage du courant électrique. En cours d'opération de la cellule, ce contact a tendance à se dégrader, générant des pertes énergétiques significatives. Les causes de cette dégradation, pouvant provenir de phénomènes chimiques, thermiques, mécaniques et/ou électriques, demeurent mal comprises. Le but du présent projet était donc d'étudier les phénomènes chimiques se produisant au contact bloc-barre de la cellule d'électrolyse Hall-Héroult. En premier lieu, un aspect crucial à considérer est la pénétration du bain électrolytique dans la cathode, car des composés de bain atteignent éventuellement la barre collectrice et peuvent y réagir. A cet effet, une méthode novatrice a été développée afin d'étudier les cathodes et la pénétration du bain dans celles-ci à l'aide de la microtomographie à rayons X. Cette méthode rapide et efficace s'est avérée fort utile dans le projet et a un potentiel important pour l'étude future des cathodes et des phénomènes qui s'y produisent. Ensuite, une cellule d'électrolyse rectangulaire à petite échelle a été développée. Plusieurs phénomènes observés 'en industrie sur des autopsies de cellules post-opération et rapportés dans la littérature ont été reproduis avec succès à l'aide de cette cellule expérimentale. Puis, des tests sans électrolyse, ciblant l'effet du bain électrolytique sur l'acier, ont aussi été conçus et complétés afin de s

  15. Patient Radiation Doses in Interventional Cardiology Procedures

    PubMed Central

    Pantos, Ioannis; Patatoukas, Georgios; Katritsis, Demosthenes G; Efstathopoulos, Efstathios

    2009-01-01

    Interventional cardiology procedures result in substantial patient radiation doses due to prolonged fluoroscopy time and radiographic exposure. The procedures that are most frequently performed are coronary angiography, percutaneous coronary interventions, diagnostic electrophysiology studies and radiofrequency catheter ablation. Patient radiation dose in these procedures can be assessed either by measurements on a series of patients in real clinical practice or measurements using patient-equivalent phantoms. In this article we review the derived doses at non-pediatric patients from 72 relevant studies published during the last 22 years in international scientific literature. Published results indicate that patient radiation doses vary widely among the different interventional cardiology procedures but also among equivalent studies. Discrepancies of the derived results are patient-, procedure-, physician-, and fluoroscopic equipmentrelated. Nevertheless, interventional cardiology procedures can subject patients to considerable radiation doses. Efforts to minimize patient exposure should always be undertaken. PMID:20066141

  16. Patient selection for skin-tightening procedures.

    PubMed

    Northington, Marian

    2014-09-01

    Noninvasive skin-tightening devices have become increasingly popular over the last decade to improve skin laxity with minimal risk and recovery time. Proper patient selection improves patient outcomes and satisfaction. There are many devices available for tightening including monopolar radiofrequency, bipolar radiofrequency, fractional radiofrequency devices, infrared devices, combined light and bipolar radiofrequency devices, and intense focused ultrasound devices. There have been shortcomings with tightening devices including inconsistent clinical outcomes. The question arises, why are there inconsistent results and variability among patient outcomes? Variability could be related to different devices, treatment protocols, body area treated, and patient selection. Patient age, degree of laxity, history of smoking, ethnicity, body mass index, and individual patient pain threshold could all possibly contribute to patient response to tightening devices. The literature does not elucidate consistently, which variables are the most important in predicting best patient response. Included is a review of the literature discussing skin tightening and patient selection. PMID:25196688

  17. Patient Experience in Health Center Medical Homes.

    PubMed

    Cook, Nicole; Hollar, Lucas; Isaac, Emmanuel; Paul, Ludmilla; Amofah, Anthony; Shi, Leiyu

    2015-12-01

    The Human Resource and Services Administration, Bureau of Primary Health Care Health Center program was developed to provide comprehensive, community-based quality primary care services, with an emphasis on meeting the needs of medically underserved populations. Health Centers have been leaders in adopting innovative approaches to improve quality care delivery, including the patient centered medical home (PCMH) model. Engaging patients through patient experience assessment is an important component of PCMH evaluation and a vital activity that can help drive patient-centered quality improvement initiatives. A total of 488 patients from five Health Center PCMHs in south Florida were surveyed in order to improve understanding of patient experience in Health Center PCMHs and to identify quality improvement opportunities. Overall patients reported very positive experience with patient-centeredness including being treated with courtesy and respect (85 % responded "always") and communication with their provider in a way that was easy to understand (87.7 % responded "always"). Opportunities for improvement included patient goal setting, referrals for patients with health conditions to workshops or educational programs, contact with the Health Center via phone and appointment availability. After adjusting for patient characteristics, results suggest that some patient experience components may be modified by educational attainment, years of care and race/ethnicity of patients. Findings are useful for informing quality improvement initiatives that, in conjunction with other patient engagement strategies, support Health Centers' ongoing transformation as PCMHs. PMID:26026275

  18. Cardiac Emergencies in Neurosurgical Patients

    PubMed Central

    Petropolis, Andrea; Cappellani, Ronald B.

    2015-01-01

    Perioperative safety concerns are a major area of interest in recent years. Severe cardiac perturbation such as cardiac arrest is one of the most dreaded complications in the intraoperative period; however, little is known about the management of these events in the patients undergoing elective neurosurgery. This special group needs further attention, as it is often neither feasible nor appropriate to apply conventional advanced cardiac life support algorithms in patients undergoing neurosurgery. Factors such as neurosurgical procedure and positioning can also have a significant effect on the occurrence of cardiac arrest. Therefore, the aim of this paper is to describe the various causes and management of cardiac emergencies with special reference to cardiac arrest during elective neurosurgical procedures, including discussion of position-related factors and resuscitative considerations in these situations. This will help to formulate possible guidelines for management of such events. PMID:25692145

  19. Why traumatized borderline patients relapse.

    PubMed

    Appelbaum, A H

    1996-01-01

    To be freed of longstanding painful symptoms or to become capable of functioning effectively has unconscious and sometimes conscious negative connotations for patients severely traumatized by childhood sexual abuse. These include rising expectations felt as coming both from within and without; disappointment that life can never make up for what has happened; loss of a justification for receiving care; fear that getting well invalidates the original trauma. Giving up illness may mean renouncing revenge and denying the seriousness of the childhood misery. To the extent that the torment of flashbacks and nightmares represents a continuation of the only family relationships the patient has known, losing these symptoms can feel as if being left entirely alone. The destructive impact of embittered and paranoid reactions unleashed by the experience of change for the better can be mitigated by the therapist's recognition of, and the focus upon, the negative meanings of progress toward health. PMID:9009374

  20. Semantic remote patient monitoring system.

    PubMed

    Shojanoori, Reza; Juric, Radmila

    2013-02-01

    We propose an automated and personalized remote patient monitoring (RPM) system, which is applied to care homes and is dependent on the manipulation of semantics describing situations during patient monitoring in ontological models. Decision making in RPM is based on reasoning performed upon ontologies, which secures the delivery of appropriate e-health services in care homes. Our working experiment shows an example of preventive e-healthcare, but it can be extended to any situation that requires either urgent action from healthcare professionals or a simple recommendation during RPM. We use Semantic Web technology and OWL/SWRL-enabled ontologies to illustrate the proposal and feasibility of implementing this RPM system as a software solution in pervasive healthcare. It will be of interest to healthcare professionals, who can directly shape and populate the proposed ontological model, and software engineers, who would consider using OWL/SWRL when creating e-health services in general. PMID:23363406

  1. Hypotensive Resuscitation among Trauma Patients

    PubMed Central

    Carrick, Matthew M.; Leonard, Jan; Slone, Denetta S.; Mains, Charles W.

    2016-01-01

    Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur. The randomized controlled trials examining restricted fluid resuscitation have demonstrated that aggressive fluid resuscitation in the prehospital and hospital setting leads to more complications than hypotensive resuscitation, with disparate findings on the survival benefit. Since the populations studied in each randomized controlled trial are slightly different, as is the timing of intervention and targeted vitals, there is still a need for a large, multicenter trial that can examine the benefit of hypotensive resuscitation in both blunt and penetrating trauma patients. PMID:27595109

  2. Should psychiatrists 'Google' their patients?

    PubMed

    Ashby, G Alice; O'Brien, Aileen; Bowman, Deborah; Hooper, Carwyn; Stevens, Toby; Lousada, Esther

    2015-12-01

    Since its beginnings in the 1980s the internet has come to shape our everyday lives, but doctors still seem rather afraid of it. This anxiety may be explained by the fact that researchers and regulatory bodies focus less on the way that the internet can be used to enhance clinical work and more on the potential and perceived risks that this technology poses in terms of boundary violations and accidental breaches of confidentiality. Some aspects of the internet's impact on medicine have been better researched than others, for example, whether email communication, social media and teleconferencing psychotherapy could be used to improve the delivery of care. However, few authors have considered the specific issue of searching online for information about patients and much of the guidance published by regulatory organisations eludes this issue. In this article we provide clinical examples where the question 'should I Google the patient?' may arise and present questions for future research. PMID:26755985

  3. Allergen immunotherapy in polysensitized patient.

    PubMed

    Hrubiško, M; Špičák, V

    2016-05-01

    Specific allergen immunotherapy (AIT) is the only therapeutic method with positive impact on natural course of allergic disease - affecting clinical development (including the progression of rhinitis to asthma) and new sensitisations. The actual problem is the increasing number of patients manifesting poly-sensitivity in allergy skin tests and / or in specific IgE tests. Usually, AIT is not recommended in such individuals. The objective we are facing is that in many patients tested as poly-reactive, we have to distinguish in which cases it is a true polysensitization, and when it is due to cross-reactivity of specific IgE antibodies induced by panallergens. This may really determine when AIT may be an appropriate course of action. The article focuses on this problem in more detail, applying the long time Czech and Slovak experience with allergy testing and allergen immunotherapy. PMID:27152601

  4. Breakthrough pain in cancer patients.

    PubMed

    Zeppetella, G

    2011-08-01

    Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain. A typical episode of breakthrough pain has a fast onset and short duration, yet despite the self-limiting nature of each breakthrough pain, the repeated episodes can have a significant effect on patients' quality of life. Normal-release oral opioids have been the mainstay pharmacological approach for patients who are receiving an around the clock opioid regimen, but the onset and duration of action of oral opioids such as morphine may not be suitable for treating many breakthrough pains. Efforts to provide non-parenteral opioid formulations that could provide more rapid, and more effective, relief of breakthrough pain have led to the development of transmucosal opioid formulations. PMID:21227666

  5. Intraosseous infusion in pediatric patients.

    PubMed

    Neal, C J; McKinley, D F

    1994-01-01

    In traumatically injured or medically unstable pediatric patients requiring resuscitation, gaining intravenous access often is frustrating for the physician and agonizing for the patient. Even when cardiopulmonary resuscitation is performed by trained professionals, cardiac arrests in children in the prehospital setting have a mortality of 79% to 100%. Immediate vascular access such as that obtained by intraosseous infusion improves survival. The intraosseous infusion technique uses the medullary cavity in the tibia as a "noncollapsible vein" for parenteral infusion. It is indicated in a child in shock or cardiac arrest when two attempts to access peripheral vasculature have failed or when more than 2 minutes have elapsed in the attempt to gain access. Epinephrine, bicarbonate, calcium, lidocaine, and volume expanders can be infused via the intraosseous route. Complications rarely occur. The technique described here is gaining acceptance in both prehospital and emergency department settings. PMID:8169160

  6. Ventilatory strategies in trauma patients.

    PubMed

    Arora, Shubhangi; Singh, Preet Mohinder; Trikha, Anjan

    2014-01-01

    Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS) secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tissue and the respiratory system takes a second place. The present article aims to delineate the strategies addressing practical problems and challenges faced by intensivists dealing with trauma patients with or without healthy lungs. The lung protective strategies along with newer trends in ventilation are discussed. Ventilatory management for specific organ system trauma are highlighted and their physiological base is presented. PMID:24550626

  7. [INFORMATION, A FUNDAMENTAL PATIENT RIGHT?].

    PubMed

    Mémeteau, Gérard

    2015-03-01

    Although expressed before the "Lambert" case, which has led us to think about refusal and assent in the context of internal rights, conventional rights--and in the context of the patient's bed!--these simple remarks present the patient's right to medical information as a so-called fundamental right. But it can only be understood with a view to a treatment or other medical act; otherwise it has no reason to be and is only an academic exercise, however exciting, but not much use by itself. What if we reversed the terms of the problem: the right of the doctor to information? (The beautiful thesis of Ph. Gaston, Paris 8, 2 December 2014). PMID:26606765

  8. Hypotensive Resuscitation among Trauma Patients.

    PubMed

    Carrick, Matthew M; Leonard, Jan; Slone, Denetta S; Mains, Charles W; Bar-Or, David

    2016-01-01

    Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur. The randomized controlled trials examining restricted fluid resuscitation have demonstrated that aggressive fluid resuscitation in the prehospital and hospital setting leads to more complications than hypotensive resuscitation, with disparate findings on the survival benefit. Since the populations studied in each randomized controlled trial are slightly different, as is the timing of intervention and targeted vitals, there is still a need for a large, multicenter trial that can examine the benefit of hypotensive resuscitation in both blunt and penetrating trauma patients. PMID:27595109

  9. Homocysteine levels in acromegaly patients.

    PubMed

    Hekimsoy, Zeliha; Ozmen, Bilgin; Ulusoy, Sadik

    2005-12-01

    Acromegaly is associated with a two to three-fold increase in mortality related predominantly to cardiovascular disease. The excess mortality is associated most closely with higher levels of growth hormone (GH). Survival in acromegaly may be normalized to a control age-matched rate by controlling GH levels; in particular, GH levels less than 2.5 ng/mL are associated with survival rates equal to those of the general population. Hyperhomocysteinemia has also been recognized as a risk factor for cardiovascular disease, yet there are limited data on the prevalence of hyperhomocysteinemia in patients with acromegaly. Eighteen acromegaly patients (7 male, 11 female, mean age 42.8 +/- 11.0 years) in our endocrine clinic consented to having the following tests performed: complete blood count (CBC), thyroid hormones, folic acid, vitamin B12, plasma homocysteine levels, uric acid, fibrinogen, CRP, fasting glucose, insulin, C-peptide, total serum cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, GH, insulin-like growth factor-1 (IGF-1) and GH levels after an oral glucose tolerance test (OGTT). By history, fourteen had macroadenomas and four had microadenomas; eight had hypertension; two had glucose intolerance, and four had diabetes. Fifteen had had transsphenoidal or transfrontal surgery: two had been cured, but 13 others were taking long-acting octreotide. Five patients had undergone radiotherapy and the acromegaly in two was treated primarily with long-acting octreotide. CBC, thyroid hormone, folic acid, and vit B12 levels were normal in all patients. We divided the patients into two groups according to mean GH levels after an OGTT: Group 1 (GH<2.5 ng/mL, n=10), and Group 2 (GH<2.5 ng/mL, n=8). Comparison of the two groups using Mann-Whitney U testing revealed statistically significant lower levels in Group 1 of the following parameters: GH (1.91 +/- 0.90 vs. 8.58 +/- 5.55 ng/mL, p=0.002), IGF-1 (338.30 +/- 217.90 vs. 509.60 +/- 293.58 ng/dL, p=0.06), GH after

  10. Influence du comportement des accompagnants sur le vécu des patients admis pour hémorragies digestives hautes au CHU campus de Lomé (Togo)

    PubMed Central

    Bagny, Aklesso; Dusabe, Angelique; Bouglouga, Oumboma; Lawson-ananisoh, Mawuli Late; Kaaga, Yeba Laconi; Djibril, Mohaman Awalou; Soedje, Kokou Mensah; Dassa, Simliwa Kolou; Redah, Datouda

    2014-01-01

    Introduction L'hémorragie digestive haute est une urgence, qui constitue souvent pour les patients un danger mortel suscitant inquiétude et agitation. Dans cet état, le patient dépend de ses accompagnants pour ses soins et pour honorer le traitement; mais souvent, il a été observé une discordance entre l'urgence et les comportements des accompagnants. Le but de cette étude était de décrire les facteurs socioéconomiques et psychologiques pouvant influencer les comportements des accompagnants des patients admis pour HDH, estimer l'indice de relation entre ces comportements et les facteurs associés d'une part et le vécu des patients admis pour HDH d'autre part. Méthodes Il s'agit d'une étude prospective menée de Septembre 2010 à Juin 2011 (soit 10 mois). Nous avions utilisé l'entretien semi-dirigé et l'observation directe pour collecter nos données, ces dernières avaient été traitées par les méthodes statistiques et d'analyse de contenu. Résultats Dans la présente étude, les comportements des accompagnants des patients admis pour HDH sont en majorité marqués par l'abandon (84%) et le manque de sollicitude (80,2%). Ces comportements sont souvent stimulés par les facteurs socioéconomiques tels que les difficultés économiques (83,2%), des conflits intrafamiliaux (85,1%) et des représentations (maladie incurable ou envoûtement) de la maladie par les accompagnants (73,3%) des cas. Quant aux patients, ils vivent ces comportements comme étant des menaces de mort ou des rejets (77,20%) et comme étant une dévalorisation ou une humiliation de la part de leurs accompagnants (70,30%). Les résultats confirment l'existence de lien significatif entre les comportements des accompagnants et les facteurs socio économiques, entre les comportements des accompagnants et des facteurs psychologiques, et entre le vécu des patients admis pour l'HDH et les comportements des accompagnants. Conclusion Des études ultérieures devraient aborder les points

  11. Oral complications in cancer patients

    SciTech Connect

    Carl, W.

    1983-02-01

    Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications.

  12. Headaches in patients with shunts.

    PubMed

    Rekate, Harold L; Kranz, Dory

    2009-03-01

    Headache is one of the most common afflictions suffered by humans. Headache in patients with a shunt triggers a series of events that includes utilization of expensive technologies and often potentially dangerous surgical intervention. The purpose of this study was to determine the incidence of headaches in patients with shunts and, hopefully, the relationship of those headache disorders to the treatment of hydrocephalus. The Hydrocephalus Association maintains a self-reporting database recorded from individuals treated for hydrocephalus and their families. This database was mined to determine the incidence of severe headaches requiring treatment and interfering with normal life in patients who have been treated for hydrocephalus. There were 1,242 responders between the ages of 19 months and 45 years of age. Of these, 1,233 answered the question, "Do you or your family member suffer from (does your child complain of) frequent or chronic headaches?" This subset forms the basis of this study. Three groups were defined by age: children (19 months-12 years), adolescents (13 years-19 years), and young adults (20 years-45 years). Most respondents were initially treated during infancy (before 18 months of age); 84% of children and 69% of both adolescents and young adults were treated very early in life. Severe headaches became a more frequent problem as the age of the population treated for hydrocephalus increased. In terms of frequency and severity of headaches, direct comparisons with epidemiologic studies of normal populations are difficult because of the limitations of data available in the database. However, it is likely that this population has a higher incidence of severe headaches than normal populations. The cost of management of headaches in this population is very high, and the patients are at risk throughout life. Early treatment decisions have a significant effect on later quality of life. Strategies that lead to normalization of cerebrospinal fluid dynamics

  13. [Injuries in the elderly patients].

    PubMed

    Hładki, Waldemar; Brongel, Leszek; Lorkowski, Jacek

    2006-01-01

    More and more higher development of civilisation causes constant lengthening of life in humans. Changes, which occur during growing old of organism predispose to increased risk of trauma. Financial cost of medical treatment of injuries in elderly are higher and higher. Degenerative disease of joints, osteoporosis, earlier body injuries and co-existing other diseases are important risk factors of trauma. Deficiencies of eyesight, hearing and prolonged time reaction are other strengthening risk of trauma. Falls and motor-vehicle accidents are the most frequent causes of trauma in elderly. Distal radius fracture, fracture of the proximal femur bone and compressive vertebral fracture of spine are typical fractures in the skeletal system. Head injuries are the most frequent cause of death in this group of patients. Limited functional reserves, especially in the respiratory and circulatory system brings difficulties in the treatment of even not dangerous injuries of chest and increases risks of infectious complications in respiratory system and finally may lead to organ failure. Elderly patients need more precise physical examination and diagnostics because essential information from the patient's history are often difficult to obtain. Indications to hospitalisation should be often widened even at not dangerous injuries, because the patients may demand intensive analgesic treatment and nursing. Necessity of care provided by other persons, poor care in household conditions, and inadequate social circumstances extend also indications to hospitalisation. There is a need to creation of nursing care departments for considerable group of injured persons who finished proper hospital-treatment, but because of the above-mentioned reasons cannot exist at home. PMID:17469514

  14. [Treatment of elderly diabetic patients].

    PubMed

    Rušavý, Zdeněk; Žourek, Michal

    2015-04-01

    Type 2 diabetes has become a pandemic disease over the past 50 years. Its incidence increases the most rapidly in the senior population, i.e. among people older than 65. In a number of countries 1/4 of the people with diabetes are now older than 65 years. Geriatrics now examines numerous differences regarding the senior patients, which often lead to somewhat different therapeutic procedures as compared to the treatment of other adult patients. This paper aims to show some different aspects of the treatment of an elderly patient with diabetes. The intensity of diabetes treatment in the elderly is mainly defined by the incidence of symptoms caused by diabetic decompensation which negatively affect quality of life and are likely to increase mortality. The treatment goals expressed by HbA1c, fasting and post-prandial glycemia, should be set individually based on age, initial HbA1c, present comorbidities and the level of frailty of an elderly patient. An effort to reduce weight regarding people at an older age is probably inappropriate and maybe even harmful, while physical activity reduces mortality and slows muscle catabolism at every age. Ideal is normal walking for 20-30 minutes a day. Except for "very fit elders" without renal insufficiency, the sulfonylurea treatment is unsuitable and perhaps even harmful. It significantly increases the incidence of different types of hypoglycemia and very likely overall mortality as well. The basis of diabetes treatment for the elderly is the effort to perform any regular exercise. In regard to medication treatment it is recommended to choose metformin or gliptin following the rule "start low, go slow", i.e. start with low medication doses and increase them at a slow pace. The main goal of the treatment is to maintain the good quality of life as long as possible, without symptoms associated with hyperglycemia with minimizing the risk of hypoglycemia development. PMID:25894262

  15. Gay patients. Context for care.

    PubMed Central

    Gibson, G.; Saunders, D. E.

    1994-01-01

    Gays and lesbians are a part of our society and our practices: real people with real lives, not stereotypes. Understanding their inner world and their social milieu is the first step to providing care that is holistic and appropriate. The "coming out" process and other unique health issues are described. Guidance is provided on how to identify and relate to gay and lesbian patients. PMID:8199524

  16. Prescribing for patients on dialysis

    PubMed Central

    Smyth, Brendan; Jones, Ceridwen; Saunders, John

    2016-01-01

    SUMMARY The pharmacokinetics of a drug may be altered in patients with renal impairment who require dialysis. Some drugs are contraindicated. The drug’s clearance and therapeutic index determine if a dose adjustment is needed. A lower dose or less frequent dosing may be required. Consult a reference source or the patient’s nephrologist before prescribing. Start at a low dose and increase gradually. If possible give once-daily drugs after dialysis. PMID:27041803

  17. [Destructive spondylarthropathy in dialysis patients].

    PubMed

    Stein, G; Schneider, A; Marzoll, I; Sperschneider, H; Ritz, E

    1991-01-01

    Back pain and a cervicobrachial syndrome, as well as progressive sensory and motor deficits as far as symptoms of paraplegia, developed in two dialysis patients two and five years after the start of dialysis. One was a 60-year-old woman with pyelonephritis, the other a 55-year-old man with glomerulonephritis. There were typical radiological signs of destructive spondylarthropathy (narrowed intervertebral spaces and slippage of the vertebral bodies). The female patient required several operations (spondylothesis and orthothesis) and both patients received daily 10,000 IU vitamin D and 3-4 g calcium carbonate. In the woman the destructive process no longer progressed one year after onset of symptoms, but she still required many analgesics. She died three months later of circulatory failure. The man died four weeks after the onset of symptoms from purulent meningitis. At autopsy only renal fibrous ostitis was still demonstrable. Amyloidosis resulting from an increase in beta 2-microglobulin level were excluded by both histological and immunohistochemical examinations. PMID:1985800

  18. The cardiac patient in Ramadan

    PubMed Central

    Chamsi-Pasha, Majed; Chamsi-Pasha, Hassan

    2016-01-01

    Ramadan is one of the five fundamental pillars of Islam. During this month, the majority of the 1.6 billion Muslims worldwide observe an absolute fast from dawn to sunset without any drink or food. Our review shows that the impact of fasting during Ramadan on patients with stable cardiac disease is minimal and does not lead to any increase in acute events. Most patients with the stable cardiac disease can fast safely. Most of the drug doses and their regimen are easily manageable during this month and may need not to be changed. Ramadan fasting is a healthy nonpharmacological means for improving cardiovascular risk factors. Most of the Muslims, who suffer from chronic diseases, insist on fasting Ramadan despite being exempted by religion. The Holy Quran specifically exempts the sick from fasting. This is particularly relevant if fasting worsens one's illness or delays recovery. Patients with unstable angina, recent myocardial infarction, uncontrolled hypertension, decompensated heart failure, recent cardiac intervention or cardiac surgery or any debilitating diseases should avoid fasting. PMID:27144139

  19. Obturator prosthesis for hemimaxillectomy patients

    PubMed Central

    Singh, Mayank; Bhushan, Akshay; Kumar, Narendra; Chand, Sharad

    2013-01-01

    Rehabilitation of hemimaxillectomy patients can be challenging. The most common problem with prosthetic treatment in such patients is in getting adequate retention, stability, and support. The size and location of the defect usually influences the amount of impairment and difficulty in prosthetic rehabilitation. The obturator prosthesis is commonly used as an effective means for rehabilitating hemimaxillectomy cases. In cases of large maxillary defects, movement of the obturator prosthesis is inevitable and requires a form of indirect retention to limit the rotation of the prosthesis. The goal of prosthodontics is rehabilitation of missing oral and extraoral structures along with restoration of the normal functions of mastication, speech, swallowing, appearance, and so on. Malignancies are common in the oral region, which are treated through surgical intervention. Surgical intervention creates communication between the oral cavity, nasal cavity, and maxillary sinus. In such cases, it is very difficult for the patient to perform various normal functions like mastication, swallowing, speaking, and so on. Prosthodontic rehabilitation with obturator prosthesis restores the missing structures and acts as a barrier between the communication among the various cavities. PMID:24163568

  20. Visualizing desirable patient healthcare experiences.

    PubMed

    Liu, Sandra S; Kim, Hyung T; Chen, Jie; An, Lingling

    2010-01-01

    High healthcare cost has drawn much attention and healthcare service providers (HSPs) are expected to deliver high-quality and consistent care. Therefore, an intimate understanding of the most desirable experience from a patient's and/or family's perspective as well as effective mapping and communication of such findings should facilitate HSPs' efforts in attaining sustainable competitive advantage in an increasingly discerning environment. This study describes (a) the critical quality attributes (CQAs) of the experience desired by patients and (b) the application of two visualization tools that are relatively new to the healthcare sector, namely the "spider-web diagram" and "promotion and detraction matrix." The visualization tools are tested with primary data collected from telephone surveys of 1,800 patients who had received care during calendar year 2005 at 6 of 61 hospitals within St. Louis, Missouri-based, Ascension Health. Five CQAs were found by factor analysis. The spider-web diagram illustrates that communication and empowerment and compassionate and respectful care are the most important CQAs, and accordingly, the promotion and detraction matrix shows those attributes that have the greatest effect for creating promoters, preventing detractors, and improving consumer's likelihood to recommend the healthcare provider. PMID:20155554

  1. Protein consumptions in stroke patients

    PubMed Central

    Maghsoudi, Zahra; Ghiasvand, Reza; Askari, Gholamreza; Darvishi, Leila; Ghasemi, Shekoofe; Hariri, Mitra; Hajishafiei, Maryam; khorvash, Fariborz; Iraj, Bijan

    2013-01-01

    Background: Stroke is one of the most common causes of disabilities and death all over the world. The mortality rate of stroke is predicted to be doubled by 2030 in the Middle East countries. Nutrition is an effective strategy in prevention and management of stroke. This study assessed the relationship between various protein types and stroke risk. Materials and Methods: This hospital-based case-control study was performed in a University hospital. The data regarding consumption of usual food intake of 69 cases (46 men and 23 women) and 60 controls (30 men and 30 women) was collected with a food frequency questionnaire (FFQ). The mean consumption of red and white meat and vegetable and processed proteins consumption were compared between two groups. Results: The percent of total of daily protein intake were lower in patients with stroke in both sexes (25.92% vs 30.55% in men and 30.7% vs 31.14% in women). Conclusion: Lower protein consumption may be observed in patients with stroke patients in both sex. PMID:23961286

  2. The cardiac patient in Ramadan.

    PubMed

    Chamsi-Pasha, Majed; Chamsi-Pasha, Hassan

    2016-01-01

    Ramadan is one of the five fundamental pillars of Islam. During this month, the majority of the 1.6 billion Muslims worldwide observe an absolute fast from dawn to sunset without any drink or food. Our review shows that the impact of fasting during Ramadan on patients with stable cardiac disease is minimal and does not lead to any increase in acute events. Most patients with the stable cardiac disease can fast safely. Most of the drug doses and their regimen are easily manageable during this month and may need not to be changed. Ramadan fasting is a healthy nonpharmacological means for improving cardiovascular risk factors. Most of the Muslims, who suffer from chronic diseases, insist on fasting Ramadan despite being exempted by religion. The Holy Quran specifically exempts the sick from fasting. This is particularly relevant if fasting worsens one's illness or delays recovery. Patients with unstable angina, recent myocardial infarction, uncontrolled hypertension, decompensated heart failure, recent cardiac intervention or cardiac surgery or any debilitating diseases should avoid fasting. PMID:27144139

  3. Support for patients loosing sight.

    PubMed

    Trauzettel-Klosinski, Susanne; Hahn, Gesa-Astrid

    2003-01-01

    This overview on support of patients loosing sight is based on a literature survey regarding reading disabilities and orientation and on results of experience trials performed at the University Eye Clinic Tübingen. In reading disorders, the main goal of rehabilitation is to regain or maintain the ability to read newspaper print. The fundament of rehabilitation is the use of optical and electronical devices and the application of specially designed training programs. The ability of a person with low vision to achieve successful orientation and mobility rehabilitation depends on residual vision, posture and balance, body image, auditory and tactile abilities, intelligence and personality. Rehabilitation efforts focus on the enhancement of residual vision applying magnifying contrast-enhancing and photomultiplying devices. The main pillar of orientation and mobility rehabilitation is a training especially designed for the patient's needs. Rehabilitation efforts must be tailored to the type of vision loss and to specific functional implications--the success rate is high. An optimal fitting of the required spectrum of low vision aids should be provided to the patient and importantly, professional teaching and training is recommended. Activities of daily living, orientation and mobility, and psychological concerns must be addressed. Close cooperation with other branches of rehabilitation is essential. PMID:12876839

  4. Rehabilitation of the burn patient

    PubMed Central

    Procter, Fiona

    2010-01-01

    Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term ‘Burns Rehabilitation’ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration PMID:21321643

  5. Camouflaging Agents for Vitiligo Patients.

    PubMed

    Hossain, Claudia; Porto, Dennis A; Hamzavi, Iltefat; Lim, Henry W

    2016-04-01

    Vitiligo is an acquired condition resulting in patches of depigmented skin that is cosmetically disfiguring and can subsequently be psychologically disturbing. For patients seeking to mask their vitiligo, camouflage options have historically been limited and been designated as a cosmetic, rather than a medical, concern. As research has indicated that proper concealment of vitiligo lesions can vastly improve quality of life, we believe it is essential that dermatologists become aware of all the options available to their patients and that discussions of camouflage options be broached from the first visit. Methods for concealment include cosmetic tattoos, dihydroxyacetone, general cosmetics, and various topical camouflage agents, including the newest product, Microskin™. We conducted a literature review of all of the available options for vitiligo concealment and evaluated their advantages and disadvantages. Ultimately, temporary methods of concealment are recommended; but the particular agent used can come from discussion with the patient based on the location of the lesions, degree of concealment desired, cost, and availability. PMID:27050692

  6. Quality Assurance: Patient Chart Reviews

    SciTech Connect

    Oginni, B. M.; Odero, D. O.

    2009-07-06

    Recent developments in radiation therapy have immensely impacted the way the radiation dose is delivered to patients undergoing radiation treatments. However, the fundamental quality assurance (QA) issues underlying the radiation therapy still remain the accuracy of the radiation dose and the radiation safety. One of the major duties of clinical medical physicists in the radiation therapy departments still revolves around ensuring the accuracy of dose delivery to the planning target volume (PTV), the reduction of unintended radiation to normal organs and minimization of the radiation exposure to the medical personnel based on ALARA (as low as reasonably achievable) principle. Many of the errors in radiation therapy can be minimized through a comprehensive program of periodic checks. One of the QA procedures on the patient comes in the form of chart reviews which could be in either electronic or paper-based format. We present the quality assurance procedures that have to be performed on the patient records from the beginning and periodically to the end of the treatment, based on the guidelines from the American Association of Physicists in Medicine (AAPM) and American College of Physicians (ACP)

  7. Patient satisfaction: ethnic origin or explanatory model?

    PubMed

    Callan, A; Littlewood, R

    1998-01-01

    Despite concern over their psychiatric treatment, little is known about black and ethnic minority patient satisfaction with psychiatric services and whether perceived 'ethnicity' or discrepant understanding of illness experience is most relevant. Twenty-one white British and 63 ethnic minority patients were interviewed for their opinions on psychiatric in-patient care, their treatment preferences and their explanatory models of their illness. The most significant association with satisfaction was not ethnic origin but the patient's explanatory model of their illness which showed little association with ethnicity whether patients were voluntary or involuntary. Satisfaction is most likely when there is concordance between the patient's and psychiatrist's explanatory model. PMID:9574847

  8. Bedside Reporting: Protocols for Improving Patient Care.

    PubMed

    Ferguson, Teresa D; Howell, Teresa L

    2015-12-01

    Bedside reporting continues to gain much attention and is being investigated to support the premise that "hand-off" communications enhance efficacy in delivery of patient care. Patient inclusion in shift reports enhances good patient outcomes, increased satisfaction with care delivery, enhanced accountability for nursing professionals, and improved communications between patients and their direct care providers. This article discusses the multiple benefits of dynamic dialogue between patients and the health care team, challenges often associated with bedside reporting, and protocols for managing bedside reporting with the major aim of improving patient care. Nursing research supporting the concept of bedside reporting is examined. PMID:26596661

  9. Patient advocacy: the role of the nurse.

    PubMed

    Choi, Pin Pin

    2015-06-10

    The role of nurses as patient advocates is well recognised by healthcare professionals, yet the processes and practices involved in patient advocacy are not clearly understood. A suboptimal level of advocacy is often apparent in the literature, encompassing paternalistic concepts of protecting patients from harm. This article examines the concept of patient advocacy and its relevance to nursing, associated goals and outcomes of advocacy and the processes and practices involved. It provides insights into how nurses practise patient advocacy in healthcare settings and how they may develop this role further, through formal education, workplace learning, role modelling by expert nurses and promoting an organisational culture conducive to patient advocacy. PMID:26058653

  10. 76 FR 9350 - Patient Safety Organizations: Voluntary Delisting From Rocky Mountain Patient Safety Organization

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-17

    ... Delisting From Rocky Mountain Patient Safety Organization AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of Delisting. SUMMARY: Rocky Mountain Patient Safety Organization: AHRQ has accepted a notification of voluntary relinquishment from Rocky Mountain Patient Safety Organization,...

  11. Dissociative symptomatology in cancer patients

    PubMed Central

    Civilotti, Cristina; Castelli, Lorys; Binaschi, Luca; Cussino, Martina; Tesio, Valentina; Di Fini, Giulia; Veglia, Fabio; Torta, Riccardo

    2015-01-01

    Introduction: The utilization of the post-traumatic stress disorder (PTSD) diagnostic spectrum is currently being debated to categorize psychological adjustment in cancer patients. The aims of this study were to: (1) evaluate the presence of cancer-related traumatic dissociative symptomatology in a sample of cancer patients; (2) examine the correlation of cancer-related dissociation and sociodemographic and medical variables, anxiety, depression, and post-traumatic stress symptomatology; (3) investigate the predictors of cancer-related dissociation. Methods: Ninety-two mixed cancer patients (mean age: 58.94, ds = 10.13) recruited from two hospitals in northern Italy were administered a questionnaire on sociodemographic and medical characteristics, the Karnofsky Scale to measure the level of patient activity and medical care requirements, the Hospital Anxiety and Depression Scale (HADS) to evaluate the presence of anxiety and depression, the Impact of Event Scale Revised (IES-R) to assess the severity of intrusion, avoidance, and hypervigilance, and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) to quantify the traumatic dissociative symptomatology. Results: 31.5% of participants report a PDEQ score above the cutoff. The results indicated that dissociative symptomatology was positively correlated with HADS scores (HADS-Anxiety: r = 0.476, p < 0.001; HADS-Depression: r = 0.364, p < 0.001) and with IES-R scores (IES-R-Intrusion: r = 0.698, p < 0.001; IES-R-Avoidance: r = 0.619, p < 0.001; IES-R- Hypervigilance: r = 0.681, p < 0.001). A stepwise regression analysis was performed in order to find the predictors of cancer-related traumatic dissociative symptomatology. The results converged on a three predictor model revealing that IES-R-Intrusion, IES-R-Avoidance, and IES-R-Hyperarousal accounted for 53.9% of the explained variance. Conclusion: These findings allow us to hypothesize a specific psychological reaction which may be ascribed to the traumatic

  12. Partnering With a Patient and Family Advisory Council to Improve Patient Care Experiences With Pain Management.

    PubMed

    Bookout, Michelle L; Staffileno, Beth A; Budzinsky, Christine M

    2016-04-01

    Patient-centered care is a key driver for the nation's health system, yet patient experience surveys indicate that hospitals are far from achieving favorable outcomes. Partnering with patients and families through a patient and family advisory council (PFAC) advances the practice of patient-centered care to improve outcomes and experiences. This article describes the process of implementing a PFAC and presents outcomes related to patients' perception of pain management in the acute care hospital setting. PMID:26963442

  13. Patients’ views on electronic patient information leaflets

    PubMed Central

    2015-01-01

    Background: Information in society and in health care is currently undergoing a transition from paper to digital formats, and the main source of information will probably be electronic in the future. Objective: To explore patients’ use and perceptions of the patient information leaflet included in the medication package, and their attitude towards a transition to an electronic version. Methods: The data was collected during October to November 2014 among individuals in South-Eastern Sweden, using a questionnaire (n=406, response rate 78%) and interviews (n=15). Results: The questionnaire showed that the majority of the respondents (52%) occasionally read the patient information leaflet, 37% always read it, and 11% never read it. Almost half of the patients (41%) were positive towards reading the patient information leaflet electronically while 32% were hesitant and 26% neutral. A majority of the patients would request to get the patient information leaflet printed at the pharmacy if it was not included in the package. There were differences in attitude related to age and gender. The interviews showed that patients had mixed views on a transition to an electronic patient information leaflet. The patients perceived several positive aspects with an electronic patient information leaflet but were concerned about elderly patients. Conclusion: Although many were positive towards reading the patient information leaflet electronically, the majority prefer the patient information leaflet in paper form. Providing appropriate and useful eHealth services for patients to access the patient information leaflet electronically, along with education, could prepare patients for a transition to electronic patient information leaflet. PMID:27382423

  14. Student Continuity with Patients: A System Delivery Innovation to Benefit Patient Care and Learning (Continuity Patient Benefit)

    PubMed Central

    Poncelet, Ann N.; Hudson, J. Nicky

    2015-01-01

    Medical education is continuing to evolve to meet the healthcare needs of the future. The longitudinal integrated clerkship (LIC) model is an important innovation in medical education. It has in its vision and structure “patient- and learner-centered education”, using longitudinal relationships between patients and students as a foundational element in its design. LIC students have shown more patient-centered attitudes and behaviors that persist after medical school. They remain connected with the patient experience of care, which supports empathy and student moral development. The time that LIC students spend acting independently with patients also supports the development of higher order clinical and cognitive skills and professional identity formation. Student participation in a more meaningful way in the care of their patients promotes patient wellbeing, and helps patients with transitions of care, communication and preventative care. Patients report feeling empowered to be more active agents in their own care and feel an accountability and pleasure in the training of new physicians. Focusing on the patient/student relationship as a foundational element of clinical education has meaningful benefits to the patient and student with the potential to improve patient care directly and in the future, as these students become physicians. PMID:27417783

  15. Le renforcement de l'interface entre les services de santé publique et de première ligne : enjeux et pistes de solution

    PubMed Central

    Paquette, Daniel; Reinharz, Daniel

    2009-01-01

    Le développement de liens étroits entre la santé publique et les services cliniques, notamment ceux offerts par les médecins de famille œuvrant en première ligne, est prôné dans tous systèmes de santé occidentaux. On suppose que les collaborations formant une telle interface ont des impacts positifs à la fois sur la qualité des soins, sur le fardeau des maladies et sur l'équité dans le système de santé. Si les acteurs des deux domaines admettent le bien-fondé de l'interface et favorisent en principe son développement, plusieurs barrières nuisent aux collaborations dans la réalité. Or, peu est connu sur ces barrières dans le système de santé québécois. Cette étude vise à répondre à ce manque d'information en étudiant l'interface à partir d'une perspective organisationnelle. Deux cadres conceptuels ont été utilisés, soit la typologie de Lasker (1997) et les archétypes de Hinings et Greenwood (1988). L'analyse met en évidence deux des six formes de collaboration proposées par la typologie utilisée, soit la coordination des services aux individus et la mise à profit des rencontres cliniques pour les fins de la santé publique. Les activités associées à ces formes de collaboration, qui sont importantes eu égard au mandat de la santé publique, comportent un intérêt essentiellement pour la santé publique et sont déterminées en pratique unilatéralement par cette dernière. En outre, le manque de coordination des activités qui impliquent une collaboration avec les médecins constitue un obstacle au développement de telles activités en créant des irritants pour les médecins. Il y a donc, dans le système de santé québécois, des possibilités de développement de l'interface là où la collaboration se fait également au profit du travail clinique et là où elle tient compte des contraintes du milieu clinique. PMID:20436801

  16. Pincharse sin infectarse: estrategias para prevenir la infección por el VIH y el VHC entre usuarios de drogas inyectables

    PubMed Central

    MATEU-GELABERT, P.; FRIEDMAN, S.; SANDOVAL, M.

    2011-01-01

    infectarse por el VIH (sólo un doble negativo tuvo un amplio conocimiento sobre la hepatitis C). Estas intencionalidades no son mutuamente excluyentes. La presencia de varias refuerza la puesta en práctica a diario de comportamientos que pueden ayudar al que se inyecta a mantenerse libre de infecciones durante años. Algunas prácticas que hemos identificado se implementan en grupo y se comunican de UDI a UDI, de esta manera se extienden entre algunas redes sociales de UDI. Conclusiones Los UDI que permanecen sin infectarse planean e implementan estrategias de prevención en circunstancias donde otros UDI aplican prácticas de riesgo. El mantenimiento de la no infección no es, por lo tanto, un resultado del azar, sino más bien el resultado del esfuerzo (agencia) de los UDI. Investigar y extender estas estrategias y tácticas a través de programas de prevención podría contribuir a la prevención del VIH y el VHC. PMID:21915175

  17. Lung Cancer Surgery Worthwhile for Older Patients

    MedlinePlus

    ... nlm.nih.gov/medlineplus/news/fullstory_158689.html Lung Cancer Surgery Worthwhile for Older Patients Study found those ... 2016 THURSDAY, May 5, 2016 (HealthDay News) -- Older lung cancer patients are surviving longer when they have lung ...

  18. Motivational Deficit in Depressed Cancer Patients.

    ERIC Educational Resources Information Center

    Layne, Christopher; And Others

    1985-01-01

    Tested accuracy of motivational theory of depression for adjustment disorder with depressed mood in 48 patients with terminal and nonterminal cancer. Results supported motivational theory: cancer patients exhibited low expectations and low values; hence, they were unmotivated and depressed. (NRB)

  19. A Hospital-based Patient Legal Clinic.

    PubMed

    Bishop, Liz; Shahkhan, Hana; Loff, Bebe

    2016-03-01

    The HeLP Patient Legal Clinic has provided free legal advice to public hospital patients with health-related problems since March 2014. This article reports on the findings of a study of the first six months of HeLP's operation. The study adopted qualitative methods informed by grounded theory and sought to understand patient and social worker experiences of HeLP. Interviews were conducted with 13 patients and 10 next of kin. Focus group discussions were carried out with 19 social workers who referred patients to HeLP. Locating the legal service in the hospital's social work department enabled and expedited access to legal advice; a team-based approach to patient problems emerged that enhanced patient outcomes; and provision of legal advice relieved the anxiety experienced by patients, allowing them to focus better on their health concern. PMID:27323643

  20. Lung Cancer Surgery Worthwhile for Older Patients

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_158689.html Lung Cancer Surgery Worthwhile for Older Patients Study found those ... 2016 THURSDAY, May 5, 2016 (HealthDay News) -- Older lung cancer patients are surviving longer when they have lung ...

  1. Patient Radiation Doses from Diagnostic Radiology.

    ERIC Educational Resources Information Center

    Hart, D.

    1996-01-01

    Explains how x-ray doses to patients are measured. Describes how different techniques expose patients to differing amounts of ionizing radiation. Compares these figures with other natural and man-made sources. (Author/MKR)

  2. Integrating protocol schedules with patients' personal calendars.

    PubMed

    Civan, Andrea; Gennari, John H; Pratt, Wanda

    2006-01-01

    We propose a new approach for integrating protocol care schedules into patients' personal calendars. This approach could provide patients with greater control over their current and future scheduling demands as they seek and receive protocol-based care. PMID:17238511

  3. Stem Cell Transplant Patients and Fungal Infections

    MedlinePlus

    ... Foodborne, Waterborne, and Environmental Diseases Mycotic Diseases Branch Stem Cell Transplant Patients and Fungal Infections Recommend on Facebook ... Mold . Top of Page Preventing fungal infections in stem cell transplant patients Fungi are difficult to avoid because ...

  4. RxHope: Patient Assistance Information

    MedlinePlus

    ... Arch Foundation Patient Assistance Program for Mirena Arestin Rx Access Co-Pay Ascend Therapeutics Patient Assistance Program ... Services (Hub) Aventis Behring Axcan ASSIST Program Axcan Rx Cost Reduction Program AZ&Me Prescription Savings Program ...

  5. Percentage of Surgical Patients Receiving Recommended Care

    MedlinePlus

    ... Recommended Care Percentage of Surgical Patients Receiving Recommended Care This is a composite measure based on individual ... Age Group Percentage of Surgical Patients Receiving Recommended Care by Age Group uzrc-9bvr Download these data » ...

  6. Forensic patients with organic brain disorders.

    PubMed

    Bastert, E; Schläfke, D

    2011-09-01

    Present literature states that people with acquired organic brain dysfunctions face problems with attention, executive functions and social interaction. During the past years an increasing number of patients with organic brain disorders have been committed into our forensic psychiatry. In current literature studies on this group of patients are underrepresented. This study wanted to verify the impairment of cognitive functions of this specific group of patients. Included were all patients of the forensic psychiatry in Rostock (Mecklenburg-Western-Pomerania) with a primary or secondary organic brain dysfunction who have been committed into the clinic since 2009. These patients went through an extensive neuropsychological test battery. It was found that patients affected by organic brain dysfunction achieve lower results in the neuropsychological testing than non impaired patients, but their results are not as below average than it would have been expected. Further studies should show, if these patients are able to improve their performance while successfully undergoing psychotherapy. PMID:21905991

  7. Coping Checklists for Patients and Caregivers

    MedlinePlus

    ... Support & Treatment » Treatments and Side Effects ... Checklists for Patients and Caregivers These checklists can help patients and caregivers spot signs of anxiety or depression in themselves or others, and learn about their ...

  8. Patient Teaching To Promote Behavioral Change.

    ERIC Educational Resources Information Center

    Saarmann, Lembi; Daugherty, JoAnn; Riegel, Barbara

    2000-01-01

    Patient education is an essential component of nurses' professional role. Research on effective patient teaching suggests the efficacy of a combined approach to behavior change: stages of change, motivational interviewing, and cognitive-behavioral therapy. (Contains 51 references.) (JOW)

  9. Patient Safety: Guide to Safe Plastic Surgery

    MedlinePlus

    ... and Consumer Information > Patient Safety Guide to Safe Plastic Surgery Patient Safety More Resources Choose a surgeon ... Important facts about the safety and risks of plastic surgery Questions to ask my plastic surgeon Choose ...

  10. Introducing Pharmacy Students to Patient Pathographies.

    ERIC Educational Resources Information Center

    Diggs, Amanda M.; Anderson-Harper, Heidi M.; Janer, Ann L.

    2000-01-01

    Pathography is defined as a personal account of illness written by the patient, a friend or relative. The authors advocate the use of patient pathography as an additional or alternative teaching tool for the medical history record. (Author/JM)

  11. Patient Engagement in Hospital Fall Prevention.

    PubMed

    Tzeng, Huey-Ming; Yin, Chang-Yi

    2015-01-01

    Injurious falls are the most prevalent in-hospital adverse event, and hospitalized patients are at a greater risk of falling than the general population. Patient engagement in hospital fall prevention could be a possible approach to reducing falls and fall-related injuries. To engage patients, bedside nursing staff must first understand the concept of patient centeredness and then incorporate patient centeredness in clinical practice. Clinicians should move from being experts to being enablers. To conceptualize the knowledge gaps identified, a conceptual model was developed to guide future research and quality improvement efforts in hospital settings. This model could be used as a guide to advance nursing leadership in hospital fall prevention via promoting patient engagement (e.g., developing patient-centered fall prevention interventions with patients' input). PMID:26845821

  12. Estimating patient-level nursing home costs.

    PubMed Central

    Schlenker, R E; Shaughnessy, P W; Yslas, I

    1985-01-01

    This article presents a methodology developed to estimate patient-level nursing home costs. Such estimates are difficult to obtain because most cost data for nursing homes are available from Medicare or Medicaid cost reports, which provide only average values per patient-day across all patients (or all of a particular payer's patients). The methodology presented in this article yields "resource consumption" (RC) measures of the variable cost of nursing staff care incurred in treating individual nursing home patients. Results from the application of the methodology are presented, using data collected in 1980 on a sample of 961 nursing home patients in 74 Colorado nursing homes. This type of approach could be used to link nursing home payments to the care needs of individual patients, thus improving the overall equity of the payment system and possibly reducing the access barriers facing especially Medicaid patients with high-cost care needs. PMID:3921494

  13. Improving Diabetes Care for Hospice Patients.

    PubMed

    Lee, Sei J; Jacobson, Margaret A; Johnston, C Bree

    2016-07-01

    Although type 2 diabetes guidelines recommend less aggressive glycemic control for patients with limited life expectancy, many hospice patients continue their glucose-lowering medications, resulting in an increased risk of hypoglycemia. Three common reasons for overly tight glycemic control in hospice patients include (1) discussions about reducing or stopping chronic medications are uncomfortable; (2) many patients and families believe that mild hyperglycemia can cause symptoms; and (3) until 2014, Healthcare Information and Data Information Set (HEDIS) quality indicators for glycemic control included hospice patients. To address these issues, we recommend (1) providers discuss with patients and families upon hospice enrollment that diabetes medications can be reduced or discontinued as their life-limiting disease progresses; (2) keeping blood glucose levels between 200 and 300 mg/dL; and (3) educate providers that HEDIS measures now exclude hospice patients. Implementing these recommendations should decrease the risk of hypoglycemia in hospice patients and improve their quality of life. PMID:25852204

  14. Infertility Patients' Mental Health Problems Often Unaddressed

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_160382.html Infertility Patients' Mental Health Problems Often Unaddressed 'We're ... California, San Francisco. Many studies have found that infertility patients often feel distressed. And, Pasch said, professional ...

  15. Eosinophilic Esophagitis in Pediatric and Adolescent Patients

    MedlinePlus

    ... and Adolescent Patients Eosinophilic Esophagitis in Pediatric and Adolescent Patients Basics Overview Eosinophilic esophagitis also known as ( ... children may have vomiting and abdominal pain, and adolescents may complain of the feeling of food getting ...

  16. Cognitive function in patients undergoing coronary angiography

    PubMed Central

    Devapalasundarum, A N; Silbert, B S; Evered, L A; Scott, D A; MacIsaac, A I; Maruff, P T

    2010-01-01

    Objective To measure cognition in patients before and after coronary angiography. Design Prospective observational cohort study. Setting University teaching hospital. Patients 56 patients presenting for elective coronary angiography. Main outcome measures Computerised cognitive test battery administered before coronary angiography, before discharge from hospital and 7 days after discharge. A matched healthy control group was used as a comparator. Results When analysed by group, coronary angiography patients performed worse than matched controls at each time point. When the cognitive change was examined for each individual, of the 48 patients tested at discharge, 19 (39.6%) were classified as having a new cognitive dysfunction, and of 49 patients tested at day 7, six (12.2%) were classified as having a new cognitive dysfunction. Conclusions The results confirm that cognitive function is decreased in patients who have cardiovascular disease. Furthermore, coronary angiography may exacerbate this impaired cognition in some patients.

  17. Pulling a patient up in bed

    MedlinePlus

    Moving a patient in bed ... takes at least two people to safely move a patient up in bed. Friction from rubbing can ... A slide sheet is the best way to prevent friction. If you do not have one, you ...

  18. Pulling a patient up in bed

    MedlinePlus

    Moving a patient in bed ... takes at least 2 people to safely move a patient up in bed. Friction from rubbing can ... A slide sheet is the best way to prevent friction. If you do not have one, you ...

  19. Patient flow scorecards capture complexity in the patient flow process.

    PubMed

    2014-07-01

    To get a larger, more holistic view of the patient flow process, a multidisciplinary improvement team at Children's Hospital of Philadelphia (CHOP) developed a five-domain patient flow scorecard. Each domain has several weighted sub-metrics that add up to 20 points, so the maximum number of points in the composite score is 100. Improvement team leaders say the approach has helped them home in on specific reasons for hold-ups so that resources can be focused in the most effective way. The "ED and ED-to-inpatient transition" domain includes eight sub-metrics that cover five specific time intervals, the leave-without-being-seen (LWBS) rate, and two adjustment measures that are used to account for high volumes and high admission rates from the ED. The other domains cover bed management, the discharge process, room turnover and environmental services, and scheduling and utilization. Administrators say it is important to establish metrics that can be captured easily along with entry points that tie in with workflows. PMID:24968570

  20. [The borderline patient. Diagnosis, psychodynamics and physician-patient relation].

    PubMed

    Brühlmann, T

    1995-06-01

    'Borderline' is a popular psychiatric diagnosis. The uses of the term are variable and often unclear. It is the goal of this presentation to elaborate a borderline concept for use in daily clinical practise. First, development of the term over the preanalytical, analytical and empirical areas is summarized. Next, the term of borderline for clinical practise is developed on the basis of characteristics and the global picture. Characteristics are: intensive, instable behaviour in relations, reduced control of impulse, disturbed affection and mood, psychotic manifestations, instable social adaptation. Diagnosis is founded on exploration of characteristics and on seizing of the global picture. The combination with other psychiatric disorders and separation from other personality disorders have to be considered with respect to differential diagnosis. The descriptive diagnosis has to be complemented from a psychodynamic point of view. The borderline patient has in his psychologic development failed to segregate sufficiently from his primary reference person. This results in a structural deficit and a weak ego. This latter is characterized by deficient integration and deficient separation, by disturbed perception of reality and by a non-specific general weakness of the ego. Finally, difficulties arising in the relations between physician and borderline patient are outlined. PMID:7784774

  1. Nystagmus in pediatric patients: interventions and patient-focused perspectives

    PubMed Central

    Penix, Kimberly; Swanson, Mark W; DeCarlo, Dawn K

    2015-01-01

    Nystagmus refers to involuntary, typically conjugate, often rhythmic oscillations of the eyes. The most common cause of nystagmus in children is infantile nystagmus syndrome (INS). INS presents within the first few months of life and is sometimes accompanied by an ocular condition associated with sensory impairment. Because this condition affects a person throughout life, it is important to understand the options available to manage it. This review focuses on the underlying nystagmus etiology, psychosocial and functional effects of nystagmus, as well as current principles of management, including optical, pharmacological, surgical, and rehabilitative options. Currently, the neural mechanisms underlying INS are not fully understood. Treatment options are designed to increase foveation duration or correct anomalous head postures; however, evidence is limited to mainly pre- and post-study designs with few objective comparisons of treatment strategies. Management of INS should be individualized. The decision on which treatment is best suited for a particular patient lies with the patient and his/her physician. PMID:26345377

  2. True heterotopic bone in the paralyzed patient

    SciTech Connect

    Blane, C.E.; Perkash, I.

    1981-10-01

    In past years the clinical and radiologic presentation of true heterotopic bone in the paralyzed patient has been confused with osteomyelitis, neoplasm, trauma, and thrombophlebitis. We reviewed 376 paralyzed patients' roentgenographic files and found 78 patients with soft tissue ossification unassociated with infection, neoplasm, or underlying fractures, which we called true heterotopic bone. From this population the usual spectrum of radiologic findings is described, so that the radiologist may separate roentgenographically a group of patients from other types of ectopic ossification.

  3. Relationship management and the borderline patient.

    PubMed Central

    Dawson, D. F.

    1993-01-01

    Treating a patient with borderline personality disorder is fraught with peril. Some psychotherapies and medications seem to make matters worse, yet these very patients are some of the most persistent in demanding help. This happens because the context of treatment, the traditional physician-patient social contract, and the personal and professional impulses of the physician can actually feed and reinforce the patient's pathological behaviour. Relationship management offers a way to understand the problem and to handle it. PMID:8495141

  4. Leukocyte Activation in Obese Patients

    PubMed Central

    Minervino, Daniele; Gumiero, Daniela; Nicolazzi, Maria Anna; Carnicelli, Annamaria; Fuorlo, Mariella; Guidone, Caterina; Di Gennaro, Leonardo; Fattorossi, Andrea; Mingrone, Geltrude; Landolfi, Raffaele

    2015-01-01

    Abstract The rising prevalence of obesity is a major global health problem. In severe obesity, bariatric surgery (BS) allows to obtain a significant weight loss and comorbidities improvement, among them one of the factors is the thrombotic risk. In this observational study, we measured indices of leukocyte activation in severely obese patients as markers of increased thrombotic risk in relation with serum markers of inflammation before and after BS. Frequency of polymorphonuclear neutrophil-platelet (PLT) and monocyte (MONO)-PLT aggregates as well as of tissue factor (TF) expressing MONOs was measured in the peripheral blood of 58 consecutive obese patients and 30 healthy controls. In 31 of the 58 obese patients, data obtained at the enrollment were compared with those obtained at 3, 6, and 12 months after BS. Compared with healthy controls, obese patients showed a higher frequency of polymorphonuclear leukocyte (PMNL)-PLT aggregates (7.47 ± 2.45 [6.82–8.11]% vs 5.85 ± 1.89 [5.14–6.55]%, P = 0.001), MONO-PLT aggregates (12.31 ± 7.33 [10.38–14.24]% vs 8.14 ± 2.22 [7.31–8.97]%, P < 0.001), and TF expressing MONOs (4.01 ± 2.11 [3.45–4.56]% vs 2.64 ± 1.65 [2.02–3.25]%, P = 0.002). PMNL-PLT and MONO-PLT aggregate frequency was positively correlated with TF expressing MONOs (R2 = 0.260, P = 0.049 and R2 = 0.318, P = 0.015, respectively). BS was performed in 31 patients and induced a significant reduction of the body mass index, and waist and hip circumferences. These effects were associated with a significant decrease of PMNL-PLT aggregates at 12 months (7.58 ± 2.27 [6.75–8.42]% vs 4.47 ± 1.11 [3.93–5.01]%, P < 0.001), and a reduction of TF expressing MONOs at 6 (3.82 ± 2.04 [3.07–4.57]% vs 1.60 ± 1.69 [0.30–2.90]%, P = 0.008) and 12 months (3.82 ± 2.04 [3.07–4.57]% vs 1.71 ± 0.54 [1.45–1.97]%, P = 0.001) after BS. These data suggest that leukocyte

  5. Capturing patient benefits of treatment.

    PubMed

    Carr, Alan; Wolfaardt, John; Garrett, Neal

    2011-01-01

    Findings from the Academy of Osseointegration State of the Science on Implant Dentistry Conference clearly demonstrate that data are lacking regarding both quality of design and adequate outcome measures (standardization, validity, and relevance to patient) to support an evidence-based systematic evaluation of implant efficacy. Despite the dearth of controlled trials and the variability in defining implant survival/success, the preponderance of evidence is viewed as lending support for consideration of dental implant therapy as a safe and predictable alternative to conventional restorations for many applications. However, this minimal conclusion undermines the best intentions of the dental profession, which is striving to substantiate to the patient, third-party providers, and the government the relative benefits and risks of various prosthetic treatment alternatives. The conclusions of multiple consensus conferences have repeatedly stressed that additional research with good strength of evidence following a broad spectrum of outcomes is vital to extend the breadth of conclusions regarding dental implant treatment efficacy. However, without a set of consensus-based core outcome measures addressing pertinent clinical and patient-centered factors, future expensive, time-consuming, and technically complex clinical studies may suffer the same critical flaws seen in the current body of research. It may be possible and useful to establish a core set of well-defined, discriminatory, and feasible outcome measures for common utilization and a hierarchy of additional recommended outcome measures for specific benefit categories. Such a standardized group of outcome measures would be likely to significantly enhance the potential for future research. In addition, with the formation of consensus guidelines, there would be an opportunity for scientific journals to promote the quality of implant dentistry research by suggesting the inclusion of these core outcome measures in

  6. Perioperative management of obese patients.

    PubMed

    Pelosi, Paolo; Gregoretti, Cesare

    2010-06-01

    Obesity is a metabolic disease that is on the increase all over the world. Up to 35% of the population in North America and 15-20% in Europe can be considered obese. Since these patients are characterised by several systemic physiopathological alterations, the perioperative management may present some problems, mainly related to their respiratory system. Body mass is an important determinant of respiratory function before and during anaesthesia not only in morbidly but also in moderately obese patients. These can manifest as (a) reduced lung volume with increased atelectasis; (b)derangements in respiratory system, lung and chest wall compliance and increased resistance; and (c) moderate to severe hypoxaemia. These physiological alterations are more marked in obese patients with hypercapnic syndrome or obstructive sleep apnoea syndrome. The suggested perioperative ventilation management includes (a) awake and/or facilitated endotracheal intubation by using a video-laryngoscope; (b) tidal volume of 6-10 ml kg(-1) ideal body weight, increasing respiratory rate to maintain physiological PaCO2, while avoiding intrinsic positive end-expiratory pressure (PEEPi); and (c) a recruitment manoeuvre (35-55 cmH2O for 6 s) followed by the application of an end-expiratory pressure (PEEP) of 10 cmH2O. The recruitment manoeuvre should always be performed only when a volemic and haemodynamic stabilisation is reached after induction of anaesthesia. In the postoperative period, beach chair position, aggressive physiotherapy, noninvasive respiratory support and short-term recovery in intermediate critical care units with care of fluid management and pain may be useful to reduce pulmonary complications. PMID:20608558

  7. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care.

    PubMed

    Simon, Melissa A; Samaras, Athena T; Nonzee, Narissa J; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S; Dong, XinQi

    2016-01-01

    Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients' interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus-community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented. PMID:27594792

  8. Hearing Restoration in Neurofibromatosis Type II Patients

    PubMed Central

    Lee, Jeon Mi; Chang, Jin Woo; Choi, Jae Young

    2016-01-01

    Patients with neurofibromatosis type II will eventually succumb to bilateral deafness. For patients with hearing loss, modern medical science technology can provide efficient hearing restoration through a number of various methods. In this article, several hearing restoration methods for patients with neurofibromatosis type II are introduced. PMID:27189272

  9. NASA's contributions to patient monitoring, appendix

    NASA Technical Reports Server (NTRS)

    Murray, D. M.; Siemens, W. D.

    1971-01-01

    Health care problems, and markets for patient monitoring equipment are discussed along with contributions to all phases of patient monitoring, and technology transfer to nonaerospace problems. Health care medical requirements, and NASA achievements in patient monitoring are described, and a summary of the technology transfer is included.

  10. Physician's Death Anxiety and Patient Outcomes.

    ERIC Educational Resources Information Center

    Schulz, Richard; Aderman, David

    1978-01-01

    It was shown that terminal patients of physicians with high death anxiety survive longer during their final hospital stay than terminal patients of physicians with low death anxiety. Physicians high in death anxiety seem to be less willing to accept patients' terminality and use heroic measures to keep them alive. (Author)

  11. Immunologic profile of patients with fibromyalgia.

    PubMed

    Smart, P A; Waylonis, G W; Hackshaw, K V

    1997-01-01

    Fibromyalgia is a musculoskeletal disorder characterized by generalized myalgias, arthralgias widespread tender points in discreet areas on examination. It is frequently accompanied by fatigue, stiffness, and a nonrestorative sleep pattern. These patients generally have a normal blood count and chemistry profile. There is a subset of people with fibromyalgia (FM) who test positive for the antinuclear antibody (ANA) and have constitutional symptoms that resemble those of patients with early lupus. We studied the immunologic profile of patients with FM who are ANA-positive (+). A retrospective review of patient records in a university-based rheumatology practice was conducted. In a group of 66 FM patients, 30% (20) were ANA+, with a 75% preponderance of the speckled pattern and 20% diffuse pattern. The remaining 5% were equally split between diffuse-speckled and speckled-nucleolar patterns. All had negative staining for extractable nuclear antibodies. The Smart Index (SI), a ratio of the sedimentation rate to one-half the patient's age, was developed to characterize each patient's inflammatory response. The FM patients who were ANA negative (-) had a mean SI of 0.55, whereas the FM patient's who were ANA+ had a SI of 1.07. These ANA+ patients represent a subgroup of patients who have FM with an inflammatory response profile larger than that of the ANA-patients. PMID:9207710

  12. A Practical Approach to Patient Teaching.

    ERIC Educational Resources Information Center

    Corkadel, Linda; McGlashan, ReNel

    1983-01-01

    The authors have developed a step-by-step plan designed to assist nurses to successfully integrate patient teaching into their practice. This plan includes an overview of patient teaching, identifies barriers to patient teaching, and presents a specific framework for establishing an effective program to minimize these barriers. (SSH)

  13. Cholecystectomy in Patients with Liver Cirrhosis

    PubMed Central

    Sadr-Azodi, Omid

    2015-01-01

    Background. The aim of this population-based study was to describe characteristics of patients with liver cirrhosis undergoing cholecystectomy and evaluate the risk for perioperative and postoperative complications during the 30-day postoperative period. Method. All laparoscopic and open cholecystectomy procedures registered between 2006 and 2011 in the Swedish Registry for Gallstone Surgery and ERCP (GallRiks) were included. Patients with liver cirrhosis were identified by linking data to the Swedish National Patient Registry (NPR). Results. Of 62,488 patients undergoing cholecystectomy, 77 (0.12%) had cirrhosis, of which 29 patients (37.7%) had decompensated cirrhosis. Patients with cirrhosis were older and had more often gallstone complications at the time for surgery. Postoperative complications were registered in 13 (16.9%) patients with liver cirrhosis and in 5,738 (9.2%) patients in the noncirrhotic group (P < 0.05). Univariable analysis showed that patients with liver cirrhosis are more likely to receive postoperative blood transfusion (OR = 4.4, CI 1.08–18.0, P < 0.05) and antibiotic treatment >1 day (OR = 2.3, CI 1.11–4.84, P < 0.05) than noncirrhotic patients. Conclusion. Patients with cirrhosis undergoing cholecystectomy have a higher incidence of postoperative complications than patients without cirrhosis. However, cholecystectomy is safe and if presented with adequate indication, surgery should not be delayed due to fears of surgical complications. PMID:26788053

  14. Implementing Patient Safety Initiatives in Rural Hospitals

    ERIC Educational Resources Information Center

    Klingner, Jill; Moscovice, Ira; Tupper, Judith; Coburn, Andrew; Wakefield, Mary

    2009-01-01

    Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for…

  15. Coma Patient Monitoring System Using Image Processing

    NASA Astrophysics Data System (ADS)

    Sankalp, Meenu

    2011-12-01

    COMA PATIENT MONITORING SYSTEM provides high quality healthcare services in the near future. To provide more convenient and comprehensive medical monitoring in big hospitals since it is tough job for medical personnel to monitor each patient for 24 hours.. The latest development in patient monitoring system can be used in Intensive Care Unit (ICU), Critical Care Unit (CCU), and Emergency Rooms of hospital. During treatment, the patient monitor is continuously monitoring the coma patient to transmit the important information. Also in the emergency cases, doctor are able to monitor patient condition efficiently to reduce time consumption, thus it provides more effective healthcare system. So due to importance of patient monitoring system, the continuous monitoring of the coma patient can be simplified. This paper investigates about the effects seen in the patient using "Coma Patient Monitoring System" which is a very advanced product related to physical changes in body movement of the patient and gives Warning in form of alarm and display on the LCD in less than one second time. It also passes a sms to a person sitting at the distant place if there exists any movement in any body part of the patient. The model for the system uses Keil software for the software implementation of the developed system.

  16. Hearing Restoration in Neurofibromatosis Type II Patients.

    PubMed

    Lee, Jeon Mi; Chang, Jin Woo; Choi, Jae Young; Chang, Won Seok; Moon, In Seok

    2016-07-01

    Patients with neurofibromatosis type II will eventually succumb to bilateral deafness. For patients with hearing loss, modern medical science technology can provide efficient hearing restoration through a number of various methods. In this article, several hearing restoration methods for patients with neurofibromatosis type II are introduced. PMID:27189272

  17. 21 CFR 880.6375 - Patient lubricant.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Patient lubricant. 880.6375 Section 880.6375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... § 880.6375 Patient lubricant. (a) Identification. A patient lubricant is a device intended for...

  18. 21 CFR 880.6375 - Patient lubricant.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Patient lubricant. 880.6375 Section 880.6375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... § 880.6375 Patient lubricant. (a) Identification. A patient lubricant is a device intended for...

  19. 21 CFR 880.6375 - Patient lubricant.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Patient lubricant. 880.6375 Section 880.6375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... § 880.6375 Patient lubricant. (a) Identification. A patient lubricant is a device intended for...

  20. 21 CFR 880.6375 - Patient lubricant.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Patient lubricant. 880.6375 Section 880.6375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... § 880.6375 Patient lubricant. (a) Identification. A patient lubricant is a device intended for...

  1. 21 CFR 880.6375 - Patient lubricant.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Patient lubricant. 880.6375 Section 880.6375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... § 880.6375 Patient lubricant. (a) Identification. A patient lubricant is a device intended for...

  2. Patient Education and Involvement in Care

    ERIC Educational Resources Information Center

    Andiric, Linda Reynolds

    2010-01-01

    A study conducted on patients who underwent total knee arthroplasty indicated that participants who were offered preadmission education for their procedure had statistically better outcomes than patients who had not attended an educational class. The study further focused on patients' confidence in their ability to take control of their health…

  3. Geriatric Staff Training for Patient Independence.

    ERIC Educational Resources Information Center

    Hickey, Tom

    The project investigated the effectiveness of an evironmental therapy training program for geriatric mental health workers when used in two different institutional settings. Site A was a State-operated facility for psychiatric in-patient care, accommodating 2,000 patients, with emphasis on maintenance and general patient welfare. Site B, a former…

  4. Patient Satisfaction after Total Knee Arthroplasty

    PubMed Central

    Choi, Young-Joon

    2016-01-01

    Total knee arthroplasty (TKA) is one of the most successful and effective surgical options to reduce pain and restore function for patients with severe osteoarthritis. The purpose of this article was to review and summarize the recent literatures regarding patient satisfaction after TKA and to analyze the various factors associated with patient dissatisfaction after TKA. Patient satisfaction is one of the many patient-reported outcome measures (PROMs). Patient satisfaction can be evaluated from two categories, determinants of satisfaction and components of satisfaction. The former have been described as all of the patient-related factors including age, gender, personality, patient expectations, medical and psychiatric comorbidity, patient's diagnosis leading to TKA and severity of arthropathy. The latter are all of the processes and technical aspects of TKA, ranging from the anesthetic and surgical factors, type of implants and postoperative rehabilitations. The surgeon- and patient-reported outcomes have been shown to be disparate occasionally. Among various factors that contribute to patient satisfaction, some factors can be managed by the surgeon, which should be improved through continuous research. Furthermore, extensive discussion and explanation before surgery will reduce patient dissatisfaction after TKA. PMID:26955608

  5. Patient Perceptions of Electronic Health Records

    ERIC Educational Resources Information Center

    Lulejian, Armine

    2011-01-01

    Research objective. Electronic Health Records (EHR) are expected to transform the way medicine is delivered with patients/consumers being the intended beneficiaries. However, little is known regarding patient knowledge and attitudes about EHRs. This study examined patient perceptions about EHR. Study design. Surveys were administered following…

  6. Medical decision making for the incompetent patient.

    PubMed

    Drane, J F; Roth, R B

    1987-12-01

    In America competent adult patients have a right to refuse unwanted medical treatments. For incompetent patients who have made no advance directive, the family ordinarily makes decisions about medical treatments. But in many healthcare facilities, problems arise in choosing a surrogate to make decisions for an incompetent patient and in working with that surrogate. Concrete, step-by-step procedures for resolving conflict are needed. Every effort should be made to have competent patients fill out advance directives or indicate their treatment preferences in the event of loss of competence. Family members may not override decisions made by competent patients, but anyone closely involved with the patients' care may question their competence. The physician generally assesses the patients' competence, but sometimes the courts are involved. The physician may be the appropriate person to choose a surrogate for a patient with limited competence or to make decisions for a totally incompetent patient. The surrogate may be a relative, close friend, physician who knows the patient well, or someone provided by the hospital or government. Treatment decisions are made within the surrogate-patient-physician triad. When different value judgments about the proper treatment conflict, the surrogate may have to mediate to restore physician-patient communication, or institutional proceedings through the ethics committee may be needed to resolve disputes quickly, amicably, and at low cost. As a last resort, the case may be referred to the courts. PMID:10285412

  7. 42 CFR 2.14 - Minor patients.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.14 Minor patients. (a) Definition of minor. As used in these regulations the term “minor” means a person who has not attained the age of majority... 42 Public Health 1 2014-10-01 2014-10-01 false Minor patients. 2.14 Section 2.14 Public...

  8. 42 CFR 2.14 - Minor patients.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Minor patients. 2.14 Section 2.14 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.14 Minor patients. (a) Definition of minor. As used in these regulations the term...

  9. 42 CFR 2.14 - Minor patients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.14 Minor patients. (a) Definition of minor. As used in these regulations the term “minor” means a person who has not attained the age of majority... 42 Public Health 1 2013-10-01 2013-10-01 false Minor patients. 2.14 Section 2.14 Public...

  10. 42 CFR 2.14 - Minor patients.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.14 Minor patients. (a) Definition of minor. As used in these regulations the term “minor” means a person who has not attained the age of majority... 42 Public Health 1 2012-10-01 2012-10-01 false Minor patients. 2.14 Section 2.14 Public...

  11. Thyroid function in patients with mycetoma.

    PubMed

    Fahal, A H; Omer, S M; el Razig, S A; Ali, A B; Mahdi, E M; Mahgoub, E S

    1995-07-01

    Thyroid function was assessed in seventy two patients with various types of mycetoma. There was no evidence of clinical or biochemical thyroid dysfunction in these patients. The symptoms encountered in some of the mycetoma patients mimic those of hypothyroidism should be attributed to other factors possibly mental depression and apathy. PMID:7498029

  12. [Treatments for otorhinolaryngological patients with psychiatric disorders].

    PubMed

    Nishio, Ayako; Sumi, Takuro; Yamada, Masato; Kuwahata, Yuko

    2013-02-01

    There are few systems in place for patients with psychiatric disorders who need treatments for physical complications. In Tokyo, "The Tokyo metropolitan psychiatric emergency system" was established in 1981, and Ome Municipal General Hospital participated in it. Under this system, fifteen patients with psychiatric disorders were treated for otorhinolaryngological diseases in our department from April 2005 to March 2011. We reviewed the fifteen patients. The coexisting psychiatric disorders were schizophrenia in twelve patients, and mental retardation, Korsakoff's syndrome, and Alzheimer's dementia in one patient each, respectively. All the patients had been receiving psychiatric treatment. The otorhinolaryngological diseases were head and neck cancer in nine patients, chronic sinusitis in three patients, and benign salivary gland tumor, cholesteatoma, and epistaxis in one patient each, respectively. Among the fifteen patients, thirteen could complete their treatment, but two dropped out due to exacerbation of their psychiatric symptoms. The therapeutic course is uncertain in otorhinolaryngological diseases occurring concomitantly with psychiatric disorders, especially in head and neck cancer, because it may be difficult to prioritize the problem when determining the treatment options and delivering the treatment. Thus, we should treat patients with psychiatric disorders carefully on a case-by-case basis depending on their psychiatric symptoms. It is also important to cooperate with psychiatrists and patients' families. PMID:23539958

  13. Removable partial overdentures for the irradiated patient

    SciTech Connect

    Rosenberg, S.W. )

    1990-10-01

    Patients who have received radiotherapy to the head and neck area must avoid dental extractions and seek simplicity in treatment and home care follow-up. For partially edentulous patients, removable partial overdenture therapy can fulfill these goals while maintaining the high level of function and aesthetics desired by patients.11 references.

  14. Vaccination recommendations for patients with neuromuscular disease.

    PubMed

    Esposito, Susanna; Bruno, Claudio; Berardinelli, Angela; Filosto, Massimiliano; Mongini, Tiziana; Morandi, Lucia; Musumeci, Olimpia; Pegoraro, Elena; Siciliano, Gabriele; Tonin, Paola; Marrosu, Gianni; Minetti, Carlo; Servida, Maura; Fiorillo, Chiara; Conforti, Giorgio; Scapolan, Silvia; Ansaldi, Filippo; Vianello, Andrea; Castaldi, Silvana; Principi, Nicola; Toscano, Antonio; Moggio, Maurizio

    2014-10-14

    Neuromuscular diseases (NMDs) encompass a broad spectrum of conditions. Because infections may be relevant to the final prognosis of most NMDs, vaccination appears to be the simplest and most effective solution for protecting NMD patients from vaccine-preventable infections. However, very few studies have evaluated the immunogenicity, safety, tolerability, and efficacy of different vaccines in NMD patients; therefore, detailed vaccination recommendations for NMD patients are not available. Here, we present vaccination recommendations from a group of Italian Scientific Societies for optimal disease prevention in NMD patients that maintain high safety levels. We found that NMD patients can be classified into two groups according to immune function: patients with normal immunity and patients who are immunocompromised, including those who intermittently or continuously take immunosuppressive therapy. Patients with normal immunity and do not take immunosuppressive therapy can be vaccinated as healthy subjects. In contrast, immunocompromised patients, including those who take immunosuppressive therapy, should receive all inactivated vaccines as well as influenza and pneumococcal vaccines; these patients should not be administered live attenuated vaccines. In all cases, the efficacy and long-term persistence of immunity from vaccination in NMD patients can be lower than in normal subjects. Household contacts of immunocompromised NMD patients should also be vaccinated appropriately. PMID:25223270

  15. Characteristics of Hospice Patients and their Caregivers.

    ERIC Educational Resources Information Center

    Bass, David M.; And Others

    1986-01-01

    Describes selected characteristics of 146 terminal patients enrolled in a home-based hospice program and similar characteristics of the patients' primary caregivers. Examines relationships between the characteristics of patients and caregivers and relationships between these characteristics and the rate at which various services were utilized.…

  16. Obstructive sleep apnea in atrial fibrillation patients.

    PubMed

    Arias, Miguel A; Alonso-Fernández, Alberto; García-Río, Francisco; Sánchez, Ana; López, Juana M; Pagola, Carlos

    2006-06-28

    A high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation. Our comments want to emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients. PMID:16309764

  17. Protocolized Resuscitation of Burn Patients.

    PubMed

    Cancio, Leopoldo C; Salinas, Jose; Kramer, George C

    2016-10-01

    Fluid resuscitation of burn patients is commonly initiated using modified Brooke or Parkland formula. The fluid infusion rate is titrated up or down hourly to maintain adequate urine output and other endpoints. Over-resuscitation leads to morbid complications. Adherence to paper-based protocols, flow sheets, and clinical practice guidelines is associated with decreased fluid resuscitation volumes and complications. Computerized tools assist providers. Although completely autonomous closed-loop control of resuscitation has been demonstrated in animal models of burn shock, the major advantages of open-loop and decision-support systems are identifying trends, enhancing situational awareness, and encouraging burn team communication. PMID:27600131

  18. New Help for MS Patients

    NASA Technical Reports Server (NTRS)

    1993-01-01

    The Mark VII MicroClimate Medical Personal Cooling system enables multiple sclerosis' victims, as well as cerebral palsy, spinabifida patients and others to lower their body temperatures. Although this is not a cure, cooling can produce a dramatic improvement in symptoms. The Multiple Sclerosis Association of America has placed cool suits in MS research care centers. This technology originated in the need for cooling systems in spa@esuits. "Cool Suits" are now used by hazardous materials workers, armored vehicle crews, firefighters and crop dusters. A surgical personal cooling system has also been developed for medical personnel working in hot operating room environments.

  19. Information retrieval for patient care.

    PubMed Central

    Gardner, M.

    1997-01-01

    Doctors need clinical information during most consultations with patients, and much of this need could be satisfied by material from online sources. Advances in data communication technologies mean that multimedia information can be transported rapidly to various clinical care locations. However, selecting the few items of information likely to be useful in a particular clinical situation from the mass of information available is a major problem. Current information retrieval systems are designed primarily for use in research rather than clinical care. The design, implementation, and critical evaluation of new information retrieval systems for clinical care should be guided by knowledgeable clinical users. PMID:9099122

  20. Septorhinoplasty in the Pediatric Patient.

    PubMed

    Bhuskute, Aditi; Sumiyoshi, Mika; Senders, Craig

    2016-08-01

    Pediatric septorhinoplasty has been an area of controversy because early surgical intervention can prevent normal growth. There are certain conditions where early correction of the nose is indicated, such as in cleft lip nasal deformities, severe traumatic deformities, and congenital nasal lesions. Animal and clinical studies have been helpful in elucidating certain areas of the nose that are potential growth zones that should be left undisturbed when performing nasal surgeries on pediatric patients. We discuss the timing, indications, and surgical technique in pediatric septorhinoplasty. PMID:27400839

  1. Imaging patients with renal impairment.

    PubMed

    Mathur, Mahan; Weinreb, Jeffrey C

    2016-06-01

    Imaging with intravascular contrast media is generally considered safe, particularly in patients without renal failure. However, as renal function deteriorates, the potential risk of nonallergic-type adverse events increases. This presents a unique challenge, particularly when the use of intravenous contrast media is deemed essential for diagnostic purposes. Following a discussion regarding the definition and epidemiology of kidney injury, this review focuses on the evolving understanding of both contrast-induced nephropathy and nephrogenic systemic fibrosis and discusses preventative strategies aimed at minimizing the risk of developing these entities. Alternative non-contrast imaging techniques are also discussed. PMID:27015867

  2. Delivering bad news to patients.

    PubMed

    Monden, Kimberley R; Gentry, Lonnie; Cox, Thomas R

    2016-01-01

    When physicians lack proper training, breaking bad news can lead to negative consequences for patients, families, and physicians. A questionnaire was used to determine whether a didactic program on delivering bad news was needed at our institution. Results revealed that 91% of respondents perceived delivering bad news as a very important skill, but only 40% felt they had the training to effectively deliver such news. We provide a brief review of different approaches to delivering bad news and advocate for training physicians in a comprehensive, structured model. PMID:26722188

  3. [Marital satisfaction in neurotic patients].

    PubMed

    Plháková, A; Osecká, L

    1994-06-01

    The authors compared marital satisfaction of men and women in the neurotic and the control group. The examined persons also evaluated satisfaction of their partners and in their parents' marriages. The results of the work suggest, that the neurotic patients were less satisfied in the marriage than the members of the control group. Further, it was found that men were more satisfied than women. Neurotic individuals evaluated their parents' marriages as less satisfactory than persons who had not been treated for neurosis. The results of the research provided evidence that there are some differences in an estimation of the partners' satisfaction between the neurotic and the control group. PMID:8055599

  4. Synergistic approach to patient dialysate

    PubMed Central

    Dragotoiu, A; Checheriţă, AI; Ciocâlteu, A; Rizeanu, S

    2015-01-01

    The stress a patient is subjected to during dialysis treatment can be reduced by using a synergetic approach by the medical team. The integration into therapy of the positive psychical resources such as: active positive coping mechanisms, individual or family mental resilience, improvement of the image and self-esteem, better tolerance to frustration can represent an important part in the improvement of the patient’s quality of life, determination of a positive approach of the situations both for him and close friends and relatives. PMID:26361514

  5. [Hyperprolactinemia in mentally ill patients].

    PubMed

    Carvalho, Manuel Maria de; Góis, Carlos

    2011-01-01

    Hyperprolactinemia is a common, but neglected, adverse effect of conventional antipschycotics and of some of the atypical antipshycotics. It occurs in almost 42% of men and in 75% of women with schizophrenia who are treated with prolactin-raising antipshycotics, even though it has aroused minimal interest within the scientific community when compared with extra-pyramidal effects. Conventional antipsychotics and some of the atypical antipsychotics, such as risperidone, paliperidone, amisulpride and zotepine, are frequently associated with the raise in prolactin plasma levels. Because of this increment in prolactin secretion, they are usually known as prolactin-raising antipshycotics. On the contrary, some of the atypical antipsychotics, such as clozapine, quetiapine, olanzapine, aripiprazole and ziprazidone, have a minimal or no significant effect in prolactin levels, being known as prolactin-sparing antipsychotics. Hyperprolactinemia clinical symptoms include gynaecomastia, galactorrhoea, menstrual irregularities, infertility, sexual dysfunction, acne and hirsutism. Some of these symptoms are due to the prolactin direct action in body tissues, while a couple of them can be due to a hypothalamic-pituitary-gonadal axis dysregulation mediated by the elevation of prolactin. Some studies seem to point the evidence of an association between hyperprolactinemia and long-term consequences, such as bone mineral density decrement and breast cancer. However, these results must be confirmed through further studies. Antipsychotic treatment is the most common cause of hyperprolactinemia in psychiatric patients. However, the evidence of a prolactin increased plasma level demands the differential diagnosis with other pathologies, such as hyphotalamic and pituitary neoplasic disease. The management of a patient with antipsychotic-induced hyperprolactinemia must be adapted to each patient and it may include a reduction in the dosage of the offending antipsychotic, switching to a

  6. [Hypertensive crisis in kidney patients].

    PubMed

    Scrivano, Jacopo; Giuliani, Anna; Pettorini, Laura; Punzo, Giorgio; Mene', Paolo; Pirozzi, Nicola

    2011-01-01

    The classification and management of hypertensive crisis have been recently reviewed in the context of both European and American guidelines. The key points for proper blood pressure control in severe arterial hypertension are: 1 - Distinction between urgent intervention and emergencies 2 - Choice of the best drug(s) 3 - Choice of the correct route of administration. In patients with renal disease, beside the common causes of hypertension/ hypertensive crises, kidney-specific causes should be taken into account such as renal parenchymal hypertension, renovascular hypertension, sclerodermic crises, and preeclampsia. PMID:22028263

  7. Ensuring patient safety blood transfusision.

    PubMed

    Higgins, Dan; Jones, David

    Blood transfusion is a relatively common procedure, and is a necessary skill for many nurses working in a range of clinical environments. Blood transfusion carries a degree of risk, and avoidable mistakes can result in serious or fatal consequences. Adverse events are largely associated with human error, so know-ledge and skills are essential. While local and national policies go some way to reducing clinical risk, a comprehensive knowledge of the blood grouping system and compatibility, and the ability to recognise, respond to and report reactions, are also necessary to optimise patient safety. An online Nursing Times Learning unit on safe blood transfusion will be launched next month. PMID:23505939

  8. Testing patient targeted therapies in patients with temporomandibular joint disorder with the arthrokinetic reflex: individual patient research.

    PubMed

    Demerjian, Garabed G; Barkhordarian, Andre; Chiappelli, Francesco

    2016-01-01

    Traditional research in the health sciences has involved control and experimental groups of patients, and descriptive and inferential statistical analyses performed on the measurements obtained from the samples in each group. As the novel model of translational healthcare, which integrates translational research and translational effectiveness, becomes increasingly established in modern contemporary medicine, healthcare continues to evolve into a model of care that is evidence-based, effectiveness-focused and patient-centered. Patient-centered care and patient-targeted therapies require the timely and critical development and validation of a new research paradigm, individual patient research (IPR), as opposed to the customary group research approach. Here, we propose a model of individual patient research to define and characterize the effectiveness of a novel therapeutic intervention for temporomandibular joint disorder. The intervention must be tailor-made for each individual patient, and the data from each patient must be analyzed individually. We propose that this endeavor is best achieved by means of an adaptive cluster randomized stepped wedge blinded controlled trial, because it permit individual patient outcomes research and analysis, ensures equipoise, and maintains adequate power. The patient targeted therapies section of the Journal of Translational Medicine must endeavor to facilitate the dissemination of studies that focus broadly on translational research for the ultimate benefit of individual patients. PMID:27484895

  9. Photovaporisation prostatique au laser chez les patients à haut risque hémorragique

    PubMed Central

    Bouabdallah, Zakaria; Kharbouchi, Amine; Colau, Alexandre; Cariou, Gerard

    2013-01-01

    Introduction Les patients sous traitement anticoagulant sont à risque élevé de saignement lors de la résection transurétrale de la prostate ou de l'adénomectomie par taille vésicale et ils se voient souvent récuser pour la chirurgie de l'hyperplasie bénigne de la prostate symptomatique. En Utilisant la photovaporisation de la prostate, les patients à haut risque peuvent subir en toute sécurité la chirurgie. Nous avons évalué l'innocuité et l'efficacité de la photovaporisation de la prostate (PVP) chez les patients sous anticoagulants en cours avec les dérivés de la coumarine, l'aspirine ou le clopidogrel, se plaignant de symptômes d'hypertrophie bénigne de la prostate. Méthodes Entre janvier 2009 et mai 2010, 47 hommes sous anticoagulation systémique ont subi une photovaporisation de la prostate. Les données ont été recueillies sur les caractéristiques démographiques, les comorbidités, les complications, la natrémie, l'hémoglobine, le débit urinaire maximal, le résidu post-mictionnel, l'IPSS et les complications. Résultats L'âge moyen était de 78 ans, le volume prostatique moyen était de 44g et le PSA était de 3.4ng/ml. Parmi les 10 patients (21.2%) étaient sous AVK, 27 (57.4%) étaient sous aspirine, 2 (4.2%) étaient sous clopidogrel, un sous fondaparinux et 6 (12.7%) étaient sous 2 anticoagulants ou plus. Le score ASA moyen était de 3. La durée moyenne de fonctionnement de l'appareil était de 38 minutes, l'énergie moyenne utilisée était de 200kJ. La durée moyenne d'hospitalisation était de 2 jours. Les complications survenant dans les 30 jours comprenaient une infection urinaire chez 5 patients (10.6%), une dysurie chez 4 patients et une hémorragie retardée chez 4 autres (8.5%). Un seul de ces patients a nécessité une transfusion sanguine et aucun patient n'a nécessité une réintervention. En 3 mois de suivi un seul patient a nécessité une incision du col vésical pour sclérose du col. Aucune incontinence

  10. Antibiotics and the burn patient.

    PubMed

    Ravat, François; Le-Floch, Ronan; Vinsonneau, Christophe; Ainaud, Pierre; Bertin-Maghit, Marc; Carsin, Hervé; Perro, Gérard

    2011-02-01

    Infection is a major problem in burn care and especially when it is due to bacteria with hospital-acquired multi-resistance to antibiotics. Moreover, when these bacteria are Gram-negative organisms, the most effective molecules are 20 years old and there is little hope of any new product available even in the distant future. Therefore, it is obvious that currently available antibiotics should not be misused. With this aim in mind, the following review was conducted by a group of experts from the French Society for Burn Injuries (SFETB). It examined key points addressing the management of antibiotics for burn patients: when to use or not, time of onset, bactericidia, combination, adaptation, de-escalation, treatment duration and regimen based on pharmacokinetic and pharmacodynamic characteristics of these compounds. The authors also considered antibioprophylaxis and some other key points such as: infection diagnosis criteria, bacterial inoculae and local treatment. French guidelines for the use of antibiotics in burn patients have been designed up from this work. PMID:20510518

  11. Rehabilitation of patients with glioma.

    PubMed

    Vargo, Mary; Henriksson, Roger; Salander, Pär

    2016-01-01

    Disabling sequelae occur in a majority of patients diagnosed with brain tumor, including glioma, such as cognitive deficits, weakness, and visual perceptual changes. Often, multiple impairments are present concurrently. Healthcare staff must be aware of the "biographic disruption" the patient with glioma has experienced. While prognostic considerations factor into rehabilitation goals and expectations, regardless of prognosis the treatment team must offer cohesive support, facilitating hope, function, and quality of life. Awareness of family and caregiver concerns plays an important role in the overall care. Inpatient rehabilitation, especially after surgical resection, has been shown to result in functional improvement and homegoing rates on a par with individuals with other neurologic conditions, such as stroke or traumatic brain injury. Community integration comprises a significant element of life satisfaction, as has been shown in childhood glioma survivors. Employment is often affected by the glioma diagnosis, but may be ameliorated, when appropriate, by addressing modifiable factors such as depression, fatigue, or sleep disturbance, or by workplace accommodations. Further research is needed into many facets of rehabilitation in the setting of glioma, including establishing better care models for consistently identifying and addressing functional limitations in this population, measuring outcomes of various levels of rehabilitation care, identifying optimal physical activity strategies, delineating the long-term effects of rehabilitation interventions, and exploring impact of rehabilitation interventions on caregiver burden. The effective elements of cognitive rehabilitation, including transition of cognitive strategies to everyday living, need to be better defined. PMID:26948361

  12. Kidney transplantation in obese patients

    PubMed Central

    Tran, Minh-Ha; Foster, Clarence E; Kalantar-Zadeh, Kamyar; Ichii, Hirohito

    2016-01-01

    The World Health Organization estimated that in 2014, over 600 million people met criteria for obesity. In 2011, over 30% of individuals undergoing kidney transplant had a body mass index (BMI) 35 kg/m2 or greater. A number of recent studies have confirmed the relationship between overweight/obesity and important comorbidities in kidney transplant patients. As with non-transplant surgeries, the rate of wound and soft tissue complications are increased following transplant as is the incidence of delayed graft function. These two issues appear to contribute to longer length of stay compared to normal BMI. New onset diabetes after transplant and cardiac outcomes also appear to be increased in the obese population. The impact of obesity on patient survival after kidney transplantation remains controversial, but appears to mirror the impact of extremes of BMI in non-transplant populations. Early experience with (open and laparoscopic) Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy support excellent weight loss (in the range of 50%-60% excess weight lost at 1 year), but experts have recommended the need for further studies. Long term nutrient deficiencies remain a concern but in general, these procedures do not appear to adversely impact absorption of immunosuppressive medications. In this study, we review the literature to arrive at a better understanding of the risks related to renal transplantation among individuals with obesity. PMID:27011911

  13. Depression in breast cancer patients.

    PubMed

    Cvetković, Jovana; Nenadović, Milutin

    2016-06-30

    Breast cancer is the third most common illness in the world and the most frequent malignant disease with women. Cytotoxic therapy is connected to significant psychiatric adverse effects, and the appearance of depressive symptoms is the most common. The main goal is determining the degree of depression with breast cancer patients in the oncology ward of the University Clinical Hospital in Niš and its connection to their marital status, age, level of education, economic status and the number of therapy cycles. This research is a prospective study. The statistical data analysis included measures of descriptive and analytical statistics. The presence of depressive symptoms of different intensity was showed in 76.00% of the interviewees in group I, and the second included 77.4%. The frequency distributions show that 27.084% interviewees from the first group showed signs of depressive symptoms, while the second included 25%. The intensity of these symptoms categorizes them into the group of moderate to significantly expressed depressive states, so they require therapeutic treatment. Depression is significantly more often recorded with cancer patients receiving cytotoxic therapy; mild depression is the most common, followed by moderate and severe depression. PMID:27138829

  14. Patient Preferences for OCD treatment

    PubMed Central

    Patel, Sapana R.; Simpson, Helen Blair

    2011-01-01

    Objective To explore preferences for the treatment of obsessive compulsive disorder (OCD). We hypothesized that OCD patients will select a combination of medication and psychotherapy as their most preferred choice overall. Methods The authors designed a treatment preference survey using two health economics methods, forced choice and contingent ranking methods, to elicit preferences for OCD treatment available in mainstream care (Serotonin Reuptake Inhibitors [SRIs]), Exposure and Ritual Prevention [EX/RP], and their combination), and for novel treatments under development at OCD research clinics. This survey was given by telephone to 89 individuals with OCD who called the OCD research clinic at the New York State Psychiatric Institute between July 2008 and January 2009. Results Most participants chose combination treatment (43%) or EX/RP (42%) over SRI medication (16%). Participants ranked investigational psychotherapy as their most preferred novel treatment (endorsed by 48% of participants) and deep brain stimulation as their least preferred novel treatment (endorsed by 77% of participants). Qualitative data suggest that prior treatment experience, concerns about medications, and logistical and practical concerns about treatment regimens affect preferences. Conclusions Patients with OCD have identifiable treatment preferences. In this sample of convenience, most preferred either combination treatment or psychotherapy. Future studies should investigate prospectively what modifies these preferences and how these preferences affect treatment outcome. PMID:21114948

  15. Caring for class III obese patients.

    PubMed

    Gardner, Lea Anne

    2013-11-01

    The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, and birthing centers, as well as some abortion facilities, must file information on medical errors.Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu. PMID:24149276

  16. Patient loyalty and the social media effect.

    PubMed

    Verkamp, Jamie

    2013-01-01

    In a changing healthcare environment, patient loyalty has never been more important. However, creating patient loyalty can mean more than providing quality health services within the four walls of the medical office. With patients turning to online sources and social media in search of advice and a better patient experience, we must now ensure that patients have meaningful engagements with us across the continuum of care, from the phone, to the office, to social media tools like Facebook and YouTube as we look to build loyalty and grow our referral volumes. PMID:24228370

  17. Meeting the special medicinal needs of patients.

    PubMed

    Griffith, Richard

    2016-09-01

    The clinical needs of patients can often be met by prescribing and administering a licensed medicine. District nurses will have some cases where a medicine cannot be used because the patient is unable to take it in its licensed form. In such situations, district nurses may be able to arrange for the patient to be supplied with an unlicensed medicine specifically made to meet that patient's special need. This article discusses the options available to district nurses to lawfully supply patients who have a special medication need due to, for example, an allergy to a particular ingredient or an inability to swallow solid oral medicines, such as tablets or capsules. PMID:27594064

  18. Patients' prerogatives and perceptions of benefit.

    PubMed Central

    Kee, F.

    1996-01-01

    Patients today demand more information about their treatment. Doctors, however, seem reluctant to cast aside ingrained habits of paternalism, believing they can best interpret therapeutic choices for their patients. Whether doctors can be more objective and effective than patients in interpreting the "probabilities" of medical evidence is open to question. On the other hand, the exercise of choice by patients may itself have a bearing on the probabilities of outcome. Involving patients more in making therapeutic choices is justified if doctors can present options in an unbiased and effective manner and if the process improves the outcome of the care delivered. PMID:8616314

  19. [Chronic heart failure in the elderly patient].

    PubMed

    Chivite, David; Franco, Jhonatan; Formiga, Francesc

    2015-01-01

    The prevalence and incidence of heart failure (HF) is increasing, especially in the elderly population, and is becoming a major geriatric problem. Elderly patients with HF usually show etiopathogenic, epidemiological, and even clinical characteristics significantly different from those present in younger patients. Their treatment, however, derives from clinical trials performed with only a few elderly subjects. Moreover, beyond the cardiovascular disease itself, it is essential to evaluate the patient as a whole, given the interrelationship between HF and the characteristic geriatric syndromes of the elderly patient. This review examines the peculiarities in the most prevalent "real world" HF patient. PMID:25962334

  20. [Sexual dysfunction among patients with psychiatric disorders].

    PubMed

    Soldati, Lorenzo

    2016-03-16

    Scientific literature shows that sexual dysfunction is more common in patients suffering from psychiatric illness as opposed to the general population. It also shows that the prevalence of sexual dysfunction is underestimated by professionals, partly because patients rarely talk spontaneously about their dysfunctions. However, sexual dysfunction has an impact on patients' mental health. Furthermore, some psychotropic medication, antidepressants and antipsychotics in particular, can hinder sexual functioning and induce sexual dysfunction. These harmful effects can, in turn, reduce patients' compliance with their medical treatments. It is therefore important that practitioners take into account their patients' sexual experience. PMID:27149715