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  1. 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…

  2. The Issue of Motivating Entre(Intra)Preneurial Behavior.

    ERIC Educational Resources Information Center

    Winslow, Erik K.

    1990-01-01

    Six principles of motivating entre(intra)preneurial behavior are considered including the climate must allow the expression of such activity; motivation is broadly distributed in the general population; behavior is a function of its consequences; and motivating environments have an aura of excitement and experimentation. (DB)

  3. La différence épidémiologique des hémorragies digestives hautes entre les hommes et les femmes

    PubMed Central

    El Mekkaoui, Amine; Saâda, Kaoutar; Mellouki, Ihssane; El Yousfi, Mounia; Aqodad, Nourdin; El Abkari, Mohammed; Ibrahimi, Adil; Benajah, Dafr-Allah

    2012-01-01

    Introduction Des différences épidémiologiques, étiologique voire pronostique des hémorragies digestives hautes (HDH) entre les deux sexes opposés ont été cité par différentes études. Méthodes Nous avons essayé de déceler ces différences à travers une analyse rétrospective nichée sur une étude prospective sur les hémorragies digestives hautes ayant inclus 945 patients. Résultats Six cents trente-sept patients étaient des hommes (67,4% Vs 32,6%). Un antécédent d'HDH était trouvé chez 24,2% des cas sans différence significative entre les deux sexes. L'âge de survenue de l'hémorragie était plus élevé chez les femmes que chez les hommes : 51,5 ans ± 18,8 Vs 47,8 ans ± 18,3 (p : 0,003). Les étiologies de l'HDH étaient différentes entre les deux sexes. Alors que l'hémorragie liée à l'HTP était la première cause chez la femme (38 % Vs 23,5 % chez l'homme, p<0,0001), c'est la pathologie ulcéreuse qui venait en premier chez l'homme (62 % Vs 36,7 % chez la femme, p<0,0001). Un besoin transfusionnel était noté chez 42,4 % des patients de sexe masculin contre 35,4 % des patientes avec un p = 0,03. Le taux de récidive et de décès global étaient de 7,5 % et de 5,7 % des cas respectivement, sans différence significative entre les deux sexes. Conclusion L'étude trouve un profil épidémiologique, clinique et étiologique différent selon le sexe des patients. PMID:23077715

  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. 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

  7. 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.

  8. 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

  9. [Management of diabetes in elderly cardiac patients].

    PubMed

    Raccah, D

    2006-11-01

    In 1998, data from the Assurance Maladie (national health insurance) showed that 11.2% of people over 65 years old, and thus corresponding to the World Health Organisation's definition of being elderly, were diabetic. More recently the Entred trial, a national sample representative of diabetics, clarified the characteristics, the state of health and the medical management of diabetes in patients aged over 65 years. Among the randomly selected 10,000 adults in this study, 5350 subjects (54% of the Entred population) were over 65 years old. Other studies indicate that more than a million subjects aged over 65 years are diabetic and that 25% of diabetics are aged over 75 years. The growing proportion of elderly people in the French population, plus the improvement in the detection and the better management of diabetes are bound to contribute to a further increase in the prevalence of diabetes in elderly subjects.

  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. Relaciones entre el sueño y la adicción

    PubMed Central

    Cañellas, Francesca; de Lecea, Luis

    2016-01-01

    Resumen La interacción entre los trastornos del sueño y el abuso de sustancias es ya conocida, pero seguramente más compleja de lo que se pensaba. Existe tanto una relación positiva entre tener un trastorno por uso de substancias y sufrir un trastorno de sueño, como viceversa. Los efectos sobre el sueño dependen de la substancia utilizada, pero se ha demostrado que tanto durante su uso como en período de abstinencia los consumidores tienen diferentes problemas de sueño y fundamentalmente un sueño más fragmentado. Sabemos que hay que tener en cuenta los problemas de sueño para evitar recaídas en la adicción. Investigaciones recientes indican que el sistema hipocretinérgico definido por el neuropéptido hipocretina/orexina (Hcrt/ox), localizado en el hipotálamo lateral e implicado entre otros en la regulación del ciclo sueño-vigilia, jugaría un papel importante en las conductas adictivas. Diferentes estudios han demostrado interacciones entre el sistema hipocretinérgico, los circuitos de respuesta aguda al estrés y los sistemas de recompensa. También sabemos que la activación optogenética selectiva del sistema hipocretinérgico incrementa la probabilidad de la transición del sueño a la vigilia, y también es suficiente para iniciar un comportamiento compulsivo de recaída adictiva. La activación del sistema hipocretinérgico podría explicar la hipervigilia asociada al estrés y a la adicción. El mayor conocimiento de esta interacción permitiría entender mejor los mecanismos de la adicción y encontrar nuevas estrategias para el tratamiento de las adicciones. PMID:23241715

  12. Mycoflora and mycotoxins natural occurrence in corn from entre rios province, Argentina.

    PubMed

    Am, P; LE, B; Sl, R; Hhl, G

    2001-03-01

    Corn samples were collected in 1999 from three departments of Entre Réos province, Argentina, and were surveyed for mould contamination and natural occurrence ofFusarium mycotoxins, ochratoxin A and aflatoxins.Fusarium verticillioides was the most prevalent fungal species recorded at all departments. Zearalenone, deoxynivalenol and ochratoxin A were not found in any samples. Only one of the 52 corn samples analysed was contaminated with aflatoxin B1 (17 μg/kg). Fumonisin B1 was found in 58 % of samples (range of positive samples: 47- 3,347 μg/kg), fumonisin B2 in 33.0 % (range of positive samples: 23-537 μg/kg) and fumonisin B3 in 25.0 % (range of positive samples: 24-287 μg/kg) of them. This is the first report on the natural occurrence of mycotoxins in corn from Entre Ríos province, Argentina. Levels of fumonisins were lower than detected in other Argentinian provinces. PMID:23605614

  13. Mycoflora and mycotoxins natural occurrence in corn from entre rios province, Argentina.

    PubMed

    Am, P; LE, B; Sl, R; Hhl, G

    2001-03-01

    Corn samples were collected in 1999 from three departments of Entre Réos province, Argentina, and were surveyed for mould contamination and natural occurrence ofFusarium mycotoxins, ochratoxin A and aflatoxins.Fusarium verticillioides was the most prevalent fungal species recorded at all departments. Zearalenone, deoxynivalenol and ochratoxin A were not found in any samples. Only one of the 52 corn samples analysed was contaminated with aflatoxin B1 (17 μg/kg). Fumonisin B1 was found in 58 % of samples (range of positive samples: 47- 3,347 μg/kg), fumonisin B2 in 33.0 % (range of positive samples: 23-537 μg/kg) and fumonisin B3 in 25.0 % (range of positive samples: 24-287 μg/kg) of them. This is the first report on the natural occurrence of mycotoxins in corn from Entre Ríos province, Argentina. Levels of fumonisins were lower than detected in other Argentinian provinces. PMID:23605615

  14. Patient Injuries?

    PubMed

    2015-01-01

    An injured patient may be the last thing dentists want to think about. However, in reality, patients can be injured during dental treatment or as the result of an incident such as a slip and fall in the office. Treatment-related injuries can run the gamut and include burns, lacerations, swallowed objects and allergic reactions, according to The Dentists Insurance Company.

  15. 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.

  16. 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

  17. L’expression verbale de la douleur chez l’enfant : Comparaison intermodale entre sensation de douleur et manipulation tactile

    PubMed Central

    Bienvenu, Margaux; Jacquet, Denis; Michelutti, Marjolaine; Wood, Chantal

    2011-01-01

    HISTORIQUE: La présente étude se situe dans le contexte de l’expression verbale de la douleur chez l’enfant. Elle porte plus particulièrement sur la dimension qualitative de la sensation de douleur. OBJECTIF: Nous cherchons à repérer les particularités de l’expression verbale relativement à l’aspect qualitatif de la douleur. MÉTHODOLOGIE: La recherche a été menée auprès de 60 patients de quatre à 18 ans ressentant de la douleur, rencontrés dans un hôpital universitaire pédiatrique. Elle confirme en premier lieu l’origine des descripteurs sensoriels de la douleur, qui renvoient aux expériences perceptives passées de l’enfant, non nécessairement liées à la douleur. Ces expériences sont qualifiées de prototypiques, dans la mesure où, bien qu’elles soient liées à des contextes de vie variés, le type de rapport au monde qu’elles provoquent ne varie pas. RÉSULTATS: Dans ce cadre, le pincement, le tiraillement, le tapement, l’écrasement et l’appuiement, le picotement et le serrement constituent chacune des expériences sensorielles et motrices particulières dont la structure de base ne varie pas d’un contexte à l’autre. En second lieu, les résultats obtenus montrent que dès quatre ans, l’enfant est en mesure de comparer, puis de reconnaître une analogie entre une expérience exclusivement tactile et sa sensation de douleur. CONCLUSION: Ces résultats mettent en lumière le rôle primordial du raisonnement analogique dans l’expression verbale de la douleur, ce qui amène à affirmer que le niveau de développement cognitif de l’enfant n’est pas une variable a priori déterminante lorsqu’il s’agit de qualifier sa douleur. PMID:21766069

  18. 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 ...

  19. 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

  20. 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.

  1. Patient Safety

    MedlinePlus

    You can help prevent medical errors by being an active member of your health care team. Research shows that patients who are more involved with their ... get better results. To reduce the risk of medical errors, you can Ask questions if you have doubts ...

  2. 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

  3. 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

  4. El espectro de KX TrA entre 1990 y 1996

    NASA Astrophysics Data System (ADS)

    Brandi, E.; García, L.; Ferrer, O.; Barbá, R.

    La estrella simbiótica KX TrA = He2-177 fue observada espectroscópicamente con el telescopio de 2.15 m del CASLEO entre los años 1990 y 1996, utilizándose resoluciones intermedia y alta. El rango espectral estudiado se extiende desde 4400 Åa 7200 Å. La historia fotométrica de KX TrA presenta explosiones del mismo tipo que las mostradas por la nova lenta RR Tel y su espectro de alta excitación, muy rico en líneas de emisión, es también similar al de RR Tel. Por lo tanto, es importante analizar la evolución espectral de KX TrA en el tiempo, prestando especial atención a los posibles cambios en los niveles de excitación. Las emisiones presentes corresponden a transiciones permitidas y prohibidas con un amplio rango de ionización, incluyéndose las anchas e intensas líneas originadas por scattering Raman de O VI en λλ 6825 y 7082 Å. En el período cubierto por nuestras observaciones se estudia la variación de la intensidad relativa de las emisiones, el comportamiento de las velocidades radiales y los cambios de perfiles de las líneas, especialmente en Hα y Hβ. El contínuo de la región roja observada indica un tipo espectral no más tardío que M3 para la componente gigante fría del sistema.

  5. Patient's perspective.

    PubMed

    Raffa, Robert B; Martin, Kathleen J

    2010-01-01

    An unknown, but significant subgroup (perhaps the majority), of patients who have undergone chemotherapy treatment for their cancer report a subsequent decline in cognitive performance (e.g., difficulty in balancing a checkbook; forgetting or mixing up names of friends or relatives, etc.). The condition has been termed chemo fog, chemo brain, or some similar term to reflect the fact that the symptoms are usually difficult to describe and involve domains of cognition such as attention, concentration, memory, speed of information processing, multitasking, or ability to organize information. The deficits are reported to persist. The magnitude of the negative impact on quality of life depends, as does the condition itself, on multiple and varied factors. This chapter relates the experience of one patient.

  6. Overwhelmed Patients

    PubMed Central

    Bohlen, Krista; Scoville, Elizabeth; Shippee, Nathan D.; May, Carl R.; Montori, Victor M.

    2012-01-01

    OBJECTIVE Patients with diabetes may experience high burden of treatment (BOT), including treatment-related effects and self-care demands. We examined whether patients with type 2 diabetes and their clinicians discuss BOT, the characteristics of their discussions, and their attempts to address BOT during visits. RESEARCH DESIGN AND METHODS Two coders independently reviewed videos of 46 primary care visits obtained during a practice-based trial and identified utterances concerning BOT, classifying them by topic and by whether BOT was addressed (i.e., whether statements emerged aimed at alleviating BOT). RESULTS Of the 46 visits, 43 (93.5%) contained BOT discussions. Both coders identified 83 discussions: 12 involving monitoring, 28 treatment administration, 19 access, and 24 treatment effects. BOT was unambiguously addressed only 30% of the time. CONCLUSIONS BOT discussions usually arise during visits but rarely beget problem-solving efforts. These discussions represent missed opportunities for reducing treatment-related disruptions in the lives of patients with diabetes, which may affect adherence and well-being. PMID:22100962

  7. Patient Advocate Foundation

    MedlinePlus

    ... Board Members Annual Reports & Financials Annual Patient Data Analysis Report About PAF's Patient Services Job & Volunteer Opportunities ... 06.16.2016 « PAF’s Releases 2015 Patient Data Analysis Report Illuminating Common Patient Issues 05.27.2016 « ...

  8. Servicio de Mapas en Internet para la Salud Ambiental en la Region Fronteriza Entre los Estados Unidos y Mexico

    USGS Publications Warehouse

    Buckler, Denny; Stefanov, Jim

    2004-01-01

    La region fronteriza de los Estados Unidos y Mexico abarca una gran diversidad de ambientes fisicos y habitaciones, entre los cuales estan los humedales, desiertos, pastos, montanas, y bosques. Estos a su vez son unicos en cuanto a su diversidad de recursos acuaticos minerales, y biologicos. La region se interconecta economica, politica, y socialmente debido a su herencia binacional. En 1995, cerca de 11 millones de habitantes vivian en la zona adyacente a la frontera. Un estudio sugiere que esa poblacion podria doblarse antes del ano 2020.

  9. [Patient advice].

    PubMed

    Lucio-Villegas Menéndez, M Eulalia; González, Laura López; Gutiérrez Pérez, M Isabel; Lluch, Natalia Aresté; Morató Agustí, M Luisa; Cachafeiro, Santiago Pérez

    2014-05-01

    In wound care, knowing what to do is as important as knowing what not to do. The first step is to evaluate the severity of the lesion and to know whether it is necessary to attend a health center or not. If the wound is simple, the recommended course of action is cleansing with serum or water after washing one's hands, followed by wound disinfection with the most appropriate antiseptic. Antiseptics not should be used for wound cleansing (physiological serum or tap water should be used) or for wound healing with granulation tissue. Equally, antiseptics should not be used in the ear or near the eyes; if there is accidental application, the eye should be washed in abundant water. Povidone iodine should not be used in pregnant women, nor should iodine preparations be used in neonates, in patients with thyroid alterations or in those allergic to iodine. Currently, merbromine/mercurochrome is not used because of its mercury content. Before an antiseptic is applied, all inorganic residues (foreign bodies) and dead tissue should be removed; detritus, slough, purulent exudate, scabs… This will aid healing and the action of antiseptics, since they become inactive in the presence of organic material.

  10. Informed consent: patient's right or patient's duty?

    PubMed

    Hull, R T

    1985-05-01

    The rule that a patient should give a free, fully-informed consent to any therapeutic intervention is traditionally thought to express merely a right of the patient against the physician, and a duty of the physician towards the patient. On this view, the patient may waive that right with impunity, a fact sometimes expressed in the notion of a right not to know. This paper argues that the rule also expresses a duty of the patient towards the physician and a right of the physician against the patient. The argument turns, first, on the truism that a physician has no obligation to commit a battery, or unauthorized touching, and, second, on the thesis that a patient necessarily cannot consent to something that is unknown to him. The conclusion is drawn that a patient is not free to receive treatment voluntarily without knowledgeably authorizing it.

  11. 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

  12. 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)

  13. 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 (

  14. 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

  15. [Patient education, perioperative management, patient support groups].

    PubMed

    Stöckli, M; Müller, B; Wagner, M

    2007-09-01

    In our division, highly qualified enterostomal therapists treat approximately 300 patients each year Patient care consists of extensive preoperative information, localization of the ideal stoma position and providing patient-education in stoma handling. A regular ambulatory consultation allows early recognition of typical stoma related complications and their effective treatment in a timely manner. Another important issue of our consulting service includes patients concerns, such as social integration and physical independence. The creation of a specialized center provides an efficient and continuous care of enterostomy patients and their relatives. Thus, initial fears and emotional crisis can be addressed and minimalized. It is our goal to provide individual and comprehensive service in order to accommodate our patients needs. PMID:18075148

  16. 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

  17. Competition entre les phases ferromagnetique metallique et ordre de charges a l'interface de manganites a magnetoresistance colossale

    NASA Astrophysics Data System (ADS)

    Laverdiere, Jonathan

    Dans la these qui suit, l'interaction entre deux manganites a magnetoresistance colossale domines par des phases antagonistes est etudiee a l'interface de bicouches. Un manganite isolant anti-ferromagnetique presentant une phase d'ordre de charges a basse temperature et un manganite metallique domine par les interactions ferromagnetiques. L'objectif est de verifier si l'interaction entre ces deux manganites est susceptible de soit 1) affaiblir la stabilite de l'ordre de charges ou soit 2) de rendre la phase metallique plus resistive afin d'ameliorer les proprietes de magnetoresistance colossale. Deux series de bicouches ont ete preparees par depot par ablation laser pulse et analysees avec une combinaison de plusieurs methodes experimentales telles que la mesure de resistance electrique, la spectroscopie Raman, la mesure d'aimantation et la diffraction des rayons X. Dans la premiere serie de bicouches, la configuration utilisee consiste en une couche tampon ferromagnetique sur laquelle une couche de manganite a ordre de charges est deposee. Il s'est avere que la phase d'ordre de charges n'est pas destabilisee par la phase ferromagnetique metallique dans une couche d'ordre de charges aussi mince que 10 nm. Les mesures de resistance montrent que la phase isolante demeure difficile a rendre metallique sous l'application d'un champ magnetique. La spectroscopie Raman montre egar lement une phase d'ordre de charges tres stable et suggere que les contraintes mecaniques appliquees par la couche tampon sont responsables de cette stabilite, malgre la presence de la phase ferromagnetique a proximite. Dans la deuxieme serie de bicouches, la configuration utilisee consiste en une couche tampon presentant de l'ordre de charges sur laquelle une couche ferromagnetique metallique est deposee. La diminution de l'epaisseur de la couche ferromagnetique metallique se repercute sur une diminution de la temperature de Curie et de la transition metal-isolant. Entre 4 et 5 nm, la

  18. 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...

  19. 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…

  20. Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji.

    PubMed

    Prasad, P; Gounder, S; Varman, S; Viney, K

    2014-09-21

    Contexte : Trois centres de traitement de la tuberculose (TB) dans le cadre du Programme national de Lutte contre la TB aux Fidji.Objectif : Déterminer la prévalence du diabète (DM) parmi les patients tuberculeux entre 2010 et 2012 et d'évaluer la conversion des frottis de crachats et les résultats du traitement de la TB en comparant les patients avec et sans DM.Schéma : Etude rétrospective descriptive basée sur les données recueillies en routine à partir des registres de la TB et des dossiers des patients hospitalisés.Résultats : De 577 patients tuberculeux identifiés, des informations relatives au DM étaient disponibles pour 567 d'entre eux (98%) ; parmi ceuxci, 68 (12%) étaient diabétiques. Le résultat du frottis à 2 mois était disponible pour 254 (82%) patients atteints de TB pulmonaire à frottis positif. Le taux de conversion du frottis (de positif à négatif) était identique chez tous les patients tuberculeux avec ou sans DM (78% contre 80% ; P = 0,66). Le résultat du traitement anti-tuberculeux était disponible pour 462 patients ; il n'y avait pas non plus de différence significative en termes de succès du traitement (91% chez les patients avec DM contre 84% chez les patients sans DM ; P = 0,06).Conclusion : Le DM est fréquent chez les patients tuberculeux aux Fidji. Le taux de conversion du frottis ne s'est cependant pas avéré différent chez les patients avec et sans DM, et il n'y a pas non plus eu de différence significative en termes de succès du traitement entre les deux groupes.

  1. 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

  2. High mortality in tuberculosis patients despite HIV interventions in Swaziland.

    PubMed

    Mchunu, G; van Griensven, J; Hinderaker, S G; Kizito, W; Sikhondze, W; Manzi, M; Dlamini, T; Harries, A D

    2016-06-21

    Contexte : Toutes les structures de santé offrant une prise en charge de la tuberculose (TB) au Swaziland.Objectif : Décrire l'impact des interventions pour le virus de l'immunodéficience humaine (VIH) sur les tendances des résultats du traitement de la TB en 2010–2013, au Swaziland. Décrire l'évolution de la notification des cas de TB, la couverture du test VIH, de le traitement antirétroviral (TAR) et du traitement préventif au cotrimoxazole (CPT) et la proportion de patients coinfectées par TB-VIH avec les mauvais résultats du traitement incluant la mortalité, les abandons et les échecs du traitement.Schéma : Etude descriptive rétrospective basée sur les données agrégées du programme national TB.Résultats : Entre 2010 et 2013, les notifications de cas de TB auSwaziland ont diminué de 40%, le test VIH a augmenté de 86% à 96%, la couverture du CPT a augmenté de 93% à 99% et la couverture du TAR parmi les patients tuberculeux est passée de 35% à 75%. Le taux de coinfection TB-VIH est resté autour de 70% et la proportion de cas de TB-VIH avec des résultats médiocres a diminué de 36% à 30% entre 2010 et 2013. La mortalité est restée élevée entre 14% et 16% pendant la période d'étude et les taux d'échec du traitement TB ont été stables dans le temps (<5%).Conclusion : En dépit d'une couverture élevée du CPT et du TAR parmi les patients TB-VIH, la mortalité est restée élevée. D'autres études sont nécessaires pour mieux définir les groupes de patients à haut risque, pour mieux comprendre les causes de décès et pour concevoir des interventions appropriées.

  3. The master patient index: split patient records.

    PubMed

    Wieners, W; Stewart, S P

    1988-11-01

    Systems integrators have overlooked the potential for corrupting the medical-record database through the creation of multiple (split) records for the individual patient. This article introduces a computer software technology that has been used at the University of California, San Francisco (UCSF) Medical Center to identify split patient records.

  4. Natural co-occurrence of fungi and mycotoxins in poultry feeds from Entre Ríos, Argentina.

    PubMed

    Monge, M P; Dalcero, A M; Magnoli, C E; Chiacchiera, S M

    2013-01-01

    A total of 120 pelleted poultry feed samples from Entre Ríos Province, Argentina, were evaluated. The aims were to investigate (1) the presence of relevant toxigenic fungi, as well as to determine the ability to produce aflatoxins (AFs) by Aspergillus section Flavi isolated strains; and (2) the natural co-occurrence of AFs, fumonisins (FBs), gliotoxin, diacetoxyscirpenol (DAS), HT-2 and T-2 toxin by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Total fungal counts were below the established value (1 × 10⁴ CFU g⁻¹). Aspergillus flavus and A. parasiticus were the only aflatoxigenic species isolated. Co-occurrence of fumonisin B₁ (FB₁), HT-2 and T-2 toxin was detected in 100% of the feeds, with mean levels from 4502 to 5813; 6.7 to 21.6 and 19.6 to 30.3 µg kg⁻¹, respectively. A large number of starter samples were co-contaminated with aflatoxin B₁ (AFB₁), FB₁, HT-2 and T-2 toxins. Gliotoxin and DAS were not found in this survey.

  5. Análisis de la correlación espacio-temporal entre ondas EIT y ondas Moreton

    NASA Astrophysics Data System (ADS)

    Borgazzi, A.; Rovira, M.; Stenborg, G.

    Observaciones de la atmósfera solar en distintas longitudes de onda han demostrado la presencia de fenómenos ondulatorios, tanto a nivel cromosférico como coronal. En el primero de los casos a las ondas observadas se las dió por llamar ondas Moreton, mientras que en el segundo ondas EIT. En el presente trabajo se abordará el estudio de la posible relación causal entre ambos fenómenos ondulatorios. Para concretar dicha meta se hará uso de un conjunto de observaciones del disco solar en Hα (para la determinación y análisis de las ondas Moreton) y en Fe XII (para la determinación y análisis de las ondas EIT). Los observables que se midan serán luego usados para la interpretación física del fenómeno en base a modelos teóricos existentes.

  6. 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

  7. 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

  8. [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

  9. National Patient Safety Foundation

    MedlinePlus

    ... Patient Safety Curriculum CPPS Review Course Patient Blood Management ... = null; var autoPlayDelaySeconds = 4; $navLeft.click(function() { currPanel--; $('#full-slider-nav-left').hide(); $('#full-slider- ...

  10. 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

  11. 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.

  12. [Patient safety in Sweden].

    PubMed

    Rutberg, H; Eckhardt, M; Biermann, O

    2015-01-01

    This article describes the patient safety work in Sweden and the cooperation between the Nordic countries in the area of patient safety. It depicts the national infrastructure, methods and partners in patient safety work as well as the development in key areas. Since 2000, the interest in patient safety and quality issues has significantly increased. A national study (2009) showed that more than 100,000 patients (8.6 %) experienced preventable harm in hospitals. Since 2007, all Swedish counties and regions work on the "National commitment for increased patient safety" to systematically minimize adverse events in the healthcare system. Also, a national strategy for patient safety has been proposed based on a new law regulating the responsibility for patient safety (2011) and a zero vision in terms of preventable harm and adverse events. The Nordic collaboration in this field currently focuses on the development of indicators and quality measurement with respect to nosocomial infections, harm in inpatient somatic care, patient safety culture, hospital mortality and polypharmacy in the elderly. The Nordic collaboration is driven by the development, exchange and documentation of experiences and evidence on patient safety indicators. The work presented in this article is only a part of the Swedish and the Nordic efforts related to patient safety and provides an interesting insight into how this work can be carried out.

  13. 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

  14. HACCP models for quality control of entrée production in hospital foodservice systems. I. Development of hazard analysis critical control point models.

    PubMed

    Bobeng, B J; David, B D

    1978-11-01

    HACCP models were developed as part of a research project for quality control of entrée production in three types of hospital foodservice systems: Conventional, cook/chill, and cook/freeze. Critical control points at process stages were identified. Time-temperature was a critical control point throughout entrée production in each model; time-temperature parameters were established for critical control points. Equipment sanitation and personnel sanitation are critical control points for which standards must be established by each foodservice system. Determination of the effectiveness of control measures included continuous monitoring of critical control points for time-temperature. Sanitation of equipment and personnel should be monitored using standards established by the foodservice system.

  15. 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

  16. 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.

  17. Ensuring patient safety.

    PubMed

    Novo, Ahmed; Masic, Izet

    2007-01-01

    Patient safety is key factor in the process of health care improvement. World Health Organization (WHO) as coordinating authority for health within the United Nations launched a World Alliance for Patient Safety dedicated to bringing significant benefits to patients. Patients for Patient Safety, one of ten action areas of the World Alliance, is designed to ensure that the perspective of patients and families, consumers and citizens, is a central reference point in shaping this important work. This action area is led by the patient safety consumer movement. In Bosnia and Herzegovina has not State Law to regulate patient safety, but Law on the System of Quality and Safety Improvement, and Accreditation in Healthcare in Federation of Bosnia and Herzegovina (FB&H) established Agency for Quality and Accreditation in the Health Care System of the FB&H as a competent entity in the field of improvement of quality and safety, and accreditation in healthcare. Beside the Agency, all service providers need to promote a culture of openness, fairness, accountability and transparency. Also, stakeholders involved in health care should recognize that patients can actively contribute to strengthening thũality and safety of health servicesthrough active participation and to insist on open dialogue, transparency and appropriate information on the potential risks that the health service incurs, as part of enhancing patient health literacy and involvement.

  18. Multicenter Patient Records Research

    PubMed Central

    Behlen, Fred M.; Johnson, Stephen B.

    1999-01-01

    The expanding health information infrastructure offers the promise of new medical knowledge drawn from patient records. Such promise will never be fulfilled, however, unless researchers first address policy issues regarding the rights and interests of both the patients and the institutions who hold their records. In this article, the authors analyze the interests of patients and institutions in light of public policy and institutional needs. They conclude that the multicenter study, with Institutional Review Board approval of each study at each site, protects the interests of both. “Anonymity” is no panacea, since patient records are so rich in information that they can never be truly anonymous. Researchers must earn and respect the trust of the public, as responsible stewards of facts about patients' lives. The authors find that computer security tools are needed to administer multicenter patient records studies and describe simple approaches that can be implemented using commercial database products. PMID:10579601

  19. 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

  20. Why measure patient satisfaction?

    PubMed

    Riskind, Patty; Fossey, Leslie; Brill, Kari

    2011-01-01

    A practice that consistently and continuously measures patient perceptions will be more efficient and effective in its daily operations. With pay-for-performance requirements on the horizon and consumer rating sites already publicizing impressions from physician encounters, a practice needs to know how it is performing through the eyes of the patients. Azalea Orthopedics has used patient feedback to coach its physicians on better patient communication. The Orthopaedic Institute has used patient satisfaction results to reduce wait times and measure the return on investment from its marketing efforts. Patient survey results that are put to work can enhance the efficiency and effectiveness of practice operations as well as position the practice for increased profitability. PMID:21506460

  1. 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)

  2. 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.

  3. Anesthesia for geriatric patients.

    PubMed

    Deiner, S; Silverstein, J H

    2011-02-01

    The number of elderly surgical patients will be increasing in Italy. Slowly, anesthesiologists are developing the expertise to care for these patients. The information available to apply to these cases is now the topic of a number of anesthesia textbooks dedicated to the elderly. In this article, we review some of the more recent findings and provide some tips to help guide the care of elderly patients. It is hoped that practitioners will use this information to improve the care of these patients and conduct additional research to further improve care in the future.

  4. 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

  5. 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.

  6. Caring for patients with surgically resectable cancers: experience from a specialised centre in rural Rwanda.

    PubMed

    Mubiligi, J M; Hedt-Gauthier, B; Mpunga, T; Tapela, N; Okao, P; Harries, A D; Edginton, M E; Driscoll, C; Mugabo, L; Riviello, R; Shulman, L N

    2014-06-21

    Contexte : Centre anticancéreux d'excellence de Butaro (BCCOE), District de Butera, Rwanda.Objectifs : Décrire les caractéristiques, la prise en charge et les résultats à 6 mois de patients adultes se présentant avec des cancers potentiellement extirpables par chirurgie.Schema : Etude rétrospective de cohorte des patients admis entre le 1er juillet et le 31 décembre 2012.Resultats : Sur 278 patients, 76,6% étaient des femmes, 51,4% étaient âgés entre 50 et 74 ans et 75% étaient référés d'un autre district ou d'un hôpital tertiaire du Rwanda. Parmi les 250 patients dont les traitements étaient connus, 115 (46%) ont bénéficié d'une intervention chirurgicale avec ou sans chimiothérapie/radiothérapie. Le temps médian écoulé entre l'admission et la chirurgie était de 21 jours (IQR 2 à 91). Le cancer du sein était le plus fréquent des cancers traités au BCCOE, tandis que les autres cancers (col utérin, colorectal et tumeur cérébrale ou cervicale) étaient généralement opérés dans des hôpitaux tertiaires. Quatre-vingt-dix-neuf patients n'ont eu aucun traitement ; 52% ont été référés à l'extérieur dans les 6 mois, généralement pour un traitement palliatif. A 6 mois, 6,8% étaient décédés ou perdus de vue.Conclusion : De nombreux patients référés au BCCOE pour cancer ont bénéficié d'une intervention chirurgicale. Cependant la prise en charge de tous les cas est confrontée à la limite de capacité chirurgicale et au problème des patients admis tardivement avec un cancer avancé et non extirpable. Cette étude met en lumière les opportunités et les défis de la prise en charge des cancers pour les hôpitaux situés en zone rurale.

  7. Collaborative activities and treatment outcomes in patients with HIV-associated tuberculosis in Viet Nam.

    PubMed

    Huyen, T T T; Nhung, N V; Shewade, H D; Hoa, N B; Harries, A D

    2016-03-21

    Contexte : Le programme national tuberculose (TB) au Viet Nam et à Ho Chi Minh ville (HCMC).Objectifs : Déterminer 1) au niveau national entre 2011 et 2013, la relation entre le test pour le virus de l'immunodéficience humaine (VIH), l'utilisation des interventions TB-VIH et les mauvais résultats du traitement de la TB parmi les patients TB-VIH, et 2) à HCMC en 2013, les caractéristiques des patients associées à un mauvais résultat.Schéma : Une étude écologique revoyant les données nationales agrégées et une étude de cohorte rétrospective dans HCMC.Résultats : Au niveau national, le test VIH est passé de 58% à 68% chez les patients tuberculeux et le traitement antirétroviral (ART) est passé chez les patients TB-VIH de 54% à 63% entre 2011 et 2013. Les mauvais résultats du traitement chez les patients TB-VIH ont augmenté de 24% à 27%, largement à cause des transferts (de 5% à 9%) et des décès. Les régions du Nord et des Highlands ont montré une faible utilisation des interventions TB-VIH. A HCMC, 303 (27%) patients TB-VIH sur 1110 ont eu un mauvais résultat avec un risque plus élevé observé parmi ceux qui avaient déjà eu un traitement de TB, ceux dont le diagnostic de VIH précédait l'apparition de la TB et ceux qui n'avaient jamais bénéficié du traitement par cotrimoxazole et de l'ART.Conclusion : En dépit de meilleurs taux de tests VIH et d'interventions TB-VIH, près de 26% des patients TB-VIH ont de mauvais résultats du traitement de la TB. Les facteurs de prédiction d'un risque plus élevé de mauvais résultats doivent être pris en compte si le Viet Nam souhaite mettre fin à l'épidémie de TB d'ici 2030.

  8. Do patients have duties?

    PubMed

    Evans, H M

    2007-12-01

    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.

  9. 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.

  10. 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…

  11. Dyspnea in dying patients.

    PubMed Central

    Hsu, D. H.

    1993-01-01

    Dyspnea is common in terminally ill patients and is often fairly difficult to control. If specific causes cannot be identified or treated, general measures to relieve symptoms should be used. Nondrug measures (eg, discussion and explanation with the patient) and drug measures (eg, morphine) can be used to control the dyspnea, although side effects, such as sedation, can be problematic. PMID:8348024

  12. 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

  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 mammography patients.

    PubMed

    Kamm, B L

    2000-01-01

    This article examines the barriers that prevent many women from undergoing mammography and strategies that can help them overcome those barriers. It also describes techniques for effective, individualized patient communication and education. Mammographers will learn how to ask the right questions, listen effectively for stated and unstated messages and determine which methods to use when communicating with different patients.

  15. [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.

  16. 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

  17. 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

  18. [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

  19. 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

  20. Patient data confidentiality and patient rights.

    PubMed

    Sadan, B

    2001-06-01

    There has been a recent trend to gather and record more comprehensive and more detailed personal medical information in computerized databases. Retrieval and access are much easier from electronic records than from hard copies stored in the archives of care-providing institutions. The Institute of Medicine voiced concern that these developments raised numerous problematic issues, the most disturbing of which is a much more widespread and systematic violation of privacy via what they called 'authorized abuse', i.e. authorized users abusing their access privileges. Other worries stemmed from the sharing of patient information among different entities. Multitudes of organizations receive information about patients' health records, often without their knowledge or consent. These include care providers, insurers, pharmacists, employers, life insurance companies and marketing firms. This article addresses the issues of medical data ownership and some health data-recording problems to which we propose co-ownership and co-documentation as part of the solution. We believe that a cooperative approach will help to maintain greater accuracy of personal medical data, written in language that can be shared and understood by the consumers and not one couched in terminology understandable only to professional personnel and to delegate the power to the patient to decide when and to whom to give authorization for its use by a third party and for research.

  1. 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.

  2. Nutrition in dialysis patients.

    PubMed

    Sharma, R K; Sahu, K M

    2001-04-01

    Adequate nutrition is very important for dialysis patients for a better overall outcome. Protein energy malnutrition is highly prevalent (25-50%) among dialysis patients and is associated with increased morbidity and mortality. Causes of malnutrition in dialysis patients include anorexia (inadequate calorie or protein intake), metabolic acidosis (stimulation of amino acid and protein degradation), and infection/inflammation (stimulation of protein degradation). Anorexia resulting into decreased intake is probably the most important factor. Nutritional assessment can be done by anthropometric measurements, laboratory parameters, subjective global assessment, dialysis malnutrition score, near infra-red interactance and other methods. Subjective global assessment is currently the most accepted one and classifies patients into three nutritional categories: Well nourished, moderately malnourished, and severely malnourished. Prevention of malnutrition by proper dietary counselling and adequate dietary intake starting from redialysis days is probably the most effective therapeutic approach. Other therapeutic approaches include adequate dialysis delivery, avoidance of acidaemia, aggressive treatment of catabolic illnesses and food supplements: Oral, enteral or parenteral, particulary intradialytic parenteral nutrition. Experimental approaches for treatment of malnutrition in dialysis patients include amino acids in peritoneal or haemodialysate, appetite stimulants and use of recombinant human growth hormone and insulin like growth factor I. There are few randomised controlled trials unequivocally proving the efficacy of any treatment modality. Large scale, randomised trials are urgently needed to establish effective therapy for malnutrition in dialysis patients. This applies more so for Indian patients.

  3. 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

  4. 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

  5. The pregnant dental patient.

    PubMed

    Singh, Medha

    2012-01-01

    When dealing with a pregnant patient, the dental practitioner should keep in mind the various physiological changes that occur in the pregnant female and the potential effects on the fetus in using various types of local anesthesia. This article reviews the current considerations in the use of local anesthesia in the pregnant dental patient, and the safety of local anesthetics, their dosage, and any adverse effect on mother and fetus. It also discusses various dental procedures and the trimester during which they can be performed. Lastly, this article talks about the complications that can occur with a pregnant dental patient in the dental chair.

  6. 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

  7. Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam.

    PubMed

    Phuong, N T M; Nhung, N V; Hoa, N B; Thuy, H T; Takarinda, K C; Tayler-Smith, K; Harries, A D

    2016-03-21

    Contexte : La prise en charge de la tuberculose (TB) pharmacorésistante au Viet Nam a bénéficié d'une accélération considérable depuis 2009.Objectifs : Documenter le nombre annuel de patients enrôlés pour un traitement de TB multirésistante (TB-MDR) entre 2010 et 2014, et déterminer les caractéristiques et les résultats du traitement des patients qui l'out commencé entre 2010 et 2012.Schéma : Etude rétrospective de cohorte basée sur les rapports nationaux et les données du système national de données électroniques pour la TB pharmacorésistante.Résultats : Le nombre de patients enrôlés chaque année pour traitement de TB-MDR a augmenté de 97 en 2010 à 1522 en 2014. La majorité des patients étaient des hommes d'âge moyen qui avaient une atteinte pulmonaire et chez qui un protocole de retraitement avait échoué ; 77% d'entre eux avaient reçu au moins deux traitements de TB. De bons résultats (guérison et achèvement du traitement) ont été obtenus chez 73% des patients. Les résultats défavorables incluaient les sujets perdus de vue (12,5%), les décès (8%) et les échecs (6,3%). Avoir eu plus de deux traitements préalables et être positif pour le virus de l'immunodéficience humaine étaient associés à des résultats défavorables.Conclusion : Un nombre croissant de patients est traité pour TB-MDR chaque année dans le cadre du programme national de prise en charge au Viet Nam, avec de bons résultats. Cependant, il est nécessaire d'augmenter la détection des cas (actuellement seulement 30% des 5100 cas de TB-MDR estimés par an), de réduire la proportion de résultats défavorables et d'améliorer le suivi et l'évaluation.

  8. 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.

  9. Sex Education for Patients

    PubMed Central

    Zitner, David

    1985-01-01

    Sex education evokes a wide variety of responses in the community and from teachers. Consequently, physicians have a responsibility to present sex education material in a factual, objective way. Many people are misinformed about sexual behavior. Physicians can help patients and the community by being aware of appropriate sex education for each age group. A curriculum for sex education, and opportunities to provide sex information for patients of different ages and stages in the lifecycle, are described. PMID:21274069

  10. 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.

  11. [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

  12. 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

  13. 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.

  14. 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

  15. Improving weekend patient handover.

    PubMed

    Ashton, Catherine

    2014-01-01

    The Royal College of Physicians state that 'handover, particularly of temporary 'on-call' responsibility, has been identified as a point at which errors are likely to occur' [1]. Working a weekend on-call covering medical wards is often busy and stressful for all junior doctors, with added pressure in trying to identify patients and tasks amongst several different pieces of paper and making important care escalation. All handover sheets from a random weekend were collected and studied. Only 57% of patients listed had the minimum expected 3 patient identifiers [2] included and just 11% had any indication of escalation planning. They were also often written on scrap pieces of paper and included varying levels of relevant patient background and information. After liaison with junior doctors and the handover committee, involving senior medical clinicians, a new handover sheet was created and uploaded onto the trust intranet, to rectify some of the problems identified. Junior doctors were also educated about the changes to weekend handover. At 2 months post-introduction, another set of weekend handover sheets were collected. All medical wards used the handover sheets for documentation of patients and tasks at a weekend and inclusion of 3 patient identifiers rose to 80%. There was also a big increase noted in clinical information and background included at weekend handover and anecdotally made weekend handover easier and less stressful. There was also increased consideration of escalation planning. The handover sheet is now being rolled out trust-wide in medicine and introduced to surgical colleagues.

  16. THE INTERSEXED PATIENT

    PubMed Central

    Stoller, Robert J.; Rosen, Alexander C.

    1959-01-01

    There are at present two opposing points of view on problems of dealing with the intersexed patient (not the typical homosexual or transvestite) who has clearcut anatomical or biochemical qualities of the opposite sex. The first is that in the growing child or adult coming for treatment, the sex the patient should adopt is the summation of somatic sex. The other is that the sex role should be assigned according to the predominant psychological identification already present. A case history of a middle-aged pseudohermaphrodite, castrated in youth but raised from birth as a female and living thus in “homosexual” relations with women until examined and interviewed at UCLA Medical Center is presented to illustrate the psychological problems in sexual identity with which the patient had to cope. Psychiatric investigation revealed how confused the patient's sex identity was until treatment by a team consisting of psychiatrist, psychologist and endocrinologist permitted the patient, even at so late a date, finally to establish what his gender is. The patient was able, despite early rearing as a female and a castrating operation, to swing to a more masculine identification. This was possible because of some uncertainty of sexual role from an early age. PMID:13834894

  17. [Nutrition and cancer patients].

    PubMed

    Katsuramaki, T; Hirata, K; Isobe, M

    1998-03-01

    Nutritional therapy for cancer patients includes various objectives such as improvement of cachexia, elucidation of the mechanism of malnutrition, development of therapy for anorexia, nutrition support during chemotherapy or radiotherapy, and inhibition of tumor growth under controlled caloric intake. This review describes recent remarkable developments in nutritional therapy for cancer patients. Cytokines such as interleukin (IL)-1, IL-6, and tumor necrosis factor which induce proteolysis and lipolysis are involved in the cause of malnutrition and cachexia in cancer patients. IL-1 also plays a significant role in the development of cancer anorexia via direct action in the brain. For anorexia therapy, progestogens have been shown to improve appetite and food intake in cancer patients. Moreover, glutamine supplementation improves the host protein metabolism without enhancement of tumor growth during chemotherapy. Among the effects of caloric intake on anticancer therapy, AO-90, a methionine-free intravenous amino acid solution, has been shown to increase the antitumor effect of 5-fluorouracil in clinical studies. From these observations, recent progress in nutritional therapy for cancer patients has been remarkable. Further study of nutritional therapy is required in order to maintain or improve the quality of life of cancer patients in the future.

  18. 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 ...

  19. [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

  20. HACCP models for quality control of entrée production in hospital foodservice systems. II. Quality assessment of beef loaves utilizing HACCP models.

    PubMed

    Bobeng, B J; David, B D

    1978-11-01

    HACCP models were developed for quality control of entrée production in three hospital foodservice systems: Conventional, cook/chill, and cook/freeze (1). The three systems were stimulated in a laboratory to evaluate the effectiveness of the HACCP models for quality control and to generate quantitative data for evaluating and comparing the quality of beef loaves produced under controlled conditions. Attributes measured were weight (yield) and microbiologic, nutritional, and sensory qualities. The only significant difference in the beef loaves among systems was sensory quality. Scores for overall acceptability of beef loaves in the conventional system were significantly greater (P less than 0.05) than for those of the cook/chill and cook/freeze systems. The HACCP models were effective quality control tools for entrée production; implementation of the HACCP system is recommended for hospital foodservices. The importance of the time-temperature critical point for monitoring control points in hospital foodservice systems is emphasized.

  1. 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

  2. Patient satisfaction with cataract surgery

    PubMed Central

    Wasfi, Ehab I; Pai, P; Abd-Elsayed, Alaa A

    2008-01-01

    Introduction Measuring the patient satisfaction is a very important issue that will help very much in improving the service provided to patients and improve the level of satisfaction. Aim To evaluate patient satisfaction with the cataract surgery service and identify any areas for improvement, determination of patient satisfaction with referral, out-patient consultation, pre-assessment clinic, surgery and post-operative care, also to report patients' comments relating to improvement in service provision. Methodology A retrospective study was undertaken for 150 patients underwent cataract surgery at Barrow General Hospital, UK, the survey sample was by postal questionnaires. We collected our data from the theatre lists for a period of 4 month. Results This study included 150 patients; the response rate was (72%) 108 patients, Most patients were referred from their general practitioner 86.1%, 93 (86.1%) patients were happy with the time interval from seeing their GP to eye clinic. In the eye out patient department many factors significantly affected the level of patient satisfaction, in general the more information provided for the patient the more the satisfaction. Conclusion Patient satisfaction is on important health outcome old understanding both the domains of satisfaction as well as their relative importance to patients is necessary to improve the overall quality of patient care. Meeting the doctor, presenting all relevant information and giving printed information are very important factors in improving the patient's satisfaction with cataract surgery. PMID:18950523

  3. 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.

  4. [Stigmatization in psoriasis patients].

    PubMed

    Petit, Véronique; Makara-Studzińska, Marta; Pietrzak, Aldona; Chodorowska, Grazyna

    2014-11-01

    Psoriasis is a chronic disease that affects the skin, nail plates and/or joints in which correlation between the onset of skin changes or more severe symptoms and the psychical condition of a patient is observed. At present it is assumed that stigmatization are events and situations in a person's life that are recognized by the society as those that stigmatize a given person and lead to their rejection and finally downgrade and ruin their social status. Opinions and behaviour patterns of the members of the society create the sigma feeling in a patient and affect his/her psyche. The aim of the present paper is the analysis of the latest data presented in the literature on the sigma feeling in psoriasis patients. In the study, the analysis of the types of stigmatization experienced by patients has been carried out. Life events influence the severity of psoriatic changes, but also psoriasis as a somatic disease affects the everyday life of a patient. Some reactions and behaviours of other people may create the feeling of rejection in social situations and the subjective feeling of being stigmatized. Then, as a result of the sigma feeling, the general health condition, functioning in the society and quality of life are affected. PMID:25546994

  5. 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

  6. Cancer patients caregivers comfort.

    PubMed

    de Araújo Lamino, Daniela; Turrini, Ruth Natalia Teresa; Kolcaba, Katharine

    2014-04-01

    Cross-sectional study, carried out at the outpatient clinic of an oncology hospital. Data were collected from 88 caregivers of cancer patients using the Caregiver General Comfort Questionnaire (GCQ) to assess the caregivers' comfort. The caregivers' GCQ score mean was 203.9; better comfort scores was associated with age, care time and current occupation; positive aspects of comfort were related to the fact that caregivers felt loved, to patients' physical and environmental comfort and to caregivers' spirituality. 203.9; better comfort scores were associated with age of the caregiver and current occupation; positive aspects of comfort were related to the fact that caregivers felt loved, to patients' physical and environmental comfort and to caregivers' spirituality. Caregivers, who didn't have a paid job or leisure's activities showed a worse GCQ. The GCQ scale can help to identify factors that interfere in caregivers' comfort, as well as needs that can be modified through health professionals' interventions.

  7. Anxiety in cancer patients

    PubMed Central

    Stark, D P H; House, A

    2000-01-01

    Anxiety is common in cancer patient populations, and must often initially be recognized and managed by cancer care professionals. This article reviews the recent oncology and mental health literature on anxiety. The aim is to help those involved in cancer patient care who are not specialists in mental health to understand the nature of anxiety, and discriminate morbid from normal anxiety. We review recent research into the association of anxiety with events during diagnosis and management of cancer, highlighting the importance of the meaning of events to an individual as an important factor in making people anxious. Lastly we review management strategies which might be used by cancer care professionals, in particular the importance of an awareness of specific patterns of communication which may alleviate or maintain anxiety for some cancer patients. © 2000 Cancer Research Campaign PMID:11044347

  8. [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

  9. [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

  10. [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.

  11. [Dizziness in geriatric patients].

    PubMed

    Kirchhoff, Marianne; Andersen, Hanne Elkjær

    2013-11-01

    Dizziness is a common complaint in geriatric patients. Age-related changes in organs of balance control make the elderly more susceptible to diseases affecting the same system causing symptoms as dizziness, balance disturbance, fall and syncope. Work-up should be multifactorial and is feasible in geriatric outpatient clinics. Evidence-based interventions are available. New studies have found high frequency of vestibular dysfunction among old fall patients and suggest an association between vestibular dysfunction and orthostatic hypotension. Further research in this area is needed. PMID:24629235

  12. Humidification for ventilated patients.

    PubMed

    Ballard, K; Cheeseman, W; Ripiner, T; Wells, S

    1992-03-01

    When a patient is intubated with an endotracheal tube for artificial ventilation the humidifying, warming and filtering functions of the nose and upper airways are bypassed. This article reviews the need for the provision of artificial humidification, optimal levels that should be provided and the two types of device which are available to achieve this, namely, the heat and moisture exchanging devices and the heated vaporising or nebulising humidifiers. Finally a study is presented which documents the exact level of moisture delivered to patients by the cascade water bath humidifier.

  13. [Anesthesia for ambulatory patients].

    PubMed

    Landauer, B

    1975-11-13

    The specific problems of outpatient anesthesia are discussed with respect to the patient's condition, the anesthesist's qualification and pharmacological properties of anesthetics used. Methohexitone seems to be the best choice for induction. Problems may arise from the use of Propanidid, Ketamin and Diazepam. Nitrousoxide and Enflurane are a suitable completion. Endotracheal intubation, if needed, is facilitated by Suxamethonium, which is rapidly eliminated. Practical aspects of timing, premedication, induction, maintenance and ending of anesthesia are pointed out. After 1-2 hours the patient can be allowed to leave the hospital accompanied by a responsible person. Driving a car is not recommended before 24 hours have elapsed since anesthesia.

  14. [Patients and the Web].

    PubMed

    Cluzeau, T; Mounier, N

    2010-10-01

    In recent years, Internet has become an indispensable tool for all types of information. Its importance has increased in medicine and particularly in human malignancies. The data issued by the Internet are many and varied sources ranging from official websites to patient's blogs. HIV infection is an infection highly publicized in recent years, we take the case of Hodgkin's disease associated with HIV to compare data from the Internet and scientific articles. The information from the Internet is mostly good but not updated and erroneous data are regularly found. This confirms that the consultation by a specialist doctor referral should remain the main source of information for the patient.

  15. Sarcopenia in Cancer Patients.

    PubMed

    Chindapasirt, Jarin

    2015-01-01

    Sarcopenia, characterized by a decline of skeletal muscle plus low muscle strength and/or physical performance, has emerged to be an important prognostic factor for advanced cancer patients. It is associated with poor performance status, toxicity from chemotherapy, and shorter time of tumor control. There is limited data about sarcopenia in cancer patients and associated factors. Moreover, the knowledge about the changes of muscle mass during chemotherapy and its impact to response and toxicity to chemotherapy is still lacking. This review aimed to provide understanding about sarcopenia and to emphasize its importance to cancer treatment.

  16. 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

  17. 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.

  18. Babesiosis in Immunocompetent Patients, Europe

    PubMed Central

    Zadeh, Mahsa Mohseni; Hansmann, Yves; Grawey, Isabelle; Christmann, Daniel; Aguillon, Sarah; Jouglin, Maggy; Chauvin, Alain; De Briel, Dominique

    2011-01-01

    We report 2 cases of babesiosis in immunocompetent patients in France. A severe influenza-like disease developed in both patients 2 weeks after they had been bitten by ticks. Diagnosis was obtained from blood smears, and Babesia divergens was identified by PCR in 1 case. Babesiosis in Europe occurs in healthy patients, not only in splenectomized patients. PMID:21192869

  19. The acutely injured patient.

    PubMed

    Baker, M S

    1990-05-01

    This article reviews the examination techniques and priorities for an injured patient. The format can be tailored to both the field setting and the hospital. Learning a concise method of examination and treatment is basic to trauma care and helps ensure that life-threatening injuries are not overlooked.

  20. Cryptosporidiosis in pediatric patients.

    PubMed

    Saredi, N; Bava, J

    1998-01-01

    Cryptosporidium was detected in 21 (3.8%) individual stool samples collected from 553 pediatric patients hospitalized in our center employing a Telemann concentration technique (formalin-ether-centrifugation) and stained with the modified Kinyoun method. The mean age of populations with Cryptosporidiosis (16 boys and 5 girls) was 11 months; 15 months for girls and 6.5 for boys. Ages of 81% of them were less than 19 months. Seventy-six per cent of patients lived on the outskirts of Buenos Aires and 71% lacked pretreated running water at home. In 62% of the cases parasitological diagnoses coincided with warm seasons. At diagnosis mucous (63%) or watery (36%) diarrhea was presented in 90% of the patients with a median of 5 (3-8) bowel movements per day. Fever was presented in 66% of patients while abdominal pain and vomits in 60% and 52%, respectively. The median time from hospitalization up to parasitologic diagnosis was 20 days. Concomitant diseases observed were malnutrition, acute leukemia, bronchiolitis, HIV infection, anemia, celiac disease, myelofibrosis, vitelline sac tumor, neutropenia, osteosarcoma and dehydration. Cryptosporidiosis in our environment seems to occur more frequently in children younger than 18 months of age; who present diarrhea; are immunodeficient; come from a low socioeconomical background; and who live in poor sanitary conditions with no potable running water.

  1. [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

  2. 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

  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. Prognosis of SMON patients.

    PubMed

    Sobue, I; Aoki, K; Ohtani, M

    1975-01-01

    The following points have become clear on prognosis of SMON through the analysis of 981 cases collected. 1) The prognosis of the old whose ages were 60 year old or over is not favorable, when compared with that of the young. However, there is no prognostic difference between male and female. 2) The cummulative death rate of SMON which was calculated by the life table method is approx twice as much as the generally expected value. 3) Approximately 80% of the patients showed some sort of improvement 7 to 12 months after the onset of the disease. The rate for 13 months or over if nearly the same. 4) The abdominal symptoms found at the time of the onset of the disease decreased markedly in the course of the disease. 5) Among neurological symptoms, the prognosis of motor disorders is more favorable. The complete recovery of sensory disturbances was extremely rare, but approx 60% showed more or less favorable in the course of the illness. Approximately 40% of the cases with visual disturbances completely recovered or showed favorable improvement, whereas 9% of them became worse. As for the prognosis of visual impairment, it is more serious than other symptoms. 6) The patients who had been administered clioquinol over long period displayed a higher rate of severe or moderate motor, sensory and visual disturbances, compared with the group with short-term administration of clioquinol. The death rate was also higher in the former group. 7) The rate of relapse as a whole was 16.7% and 68% of them was seen within 18 months after the onset. There is no difference in relapse according to sex. There was seen a high rate of relapse in the group of longterm administration of clioquinol. 8) A 10.5% of total cases were either unable to walk or in need of assistance in walking, whereas the rate of patients who cannot get dressed or who cannot defecate unassisted was lower. 9) Approximately 65% returned to the job in 12 months or more after the onset. The employment rate was not

  5. [The rights of psychiatric patients].

    PubMed

    Baudis, P

    1995-05-01

    The author gives a historical account of patient's rights and in particular the development of codes of rights of psychiatric patients during the past twenty years. He describes differences in attitudes to rights of psychiatric patients in different societies and the different emphasis on patient's rights, as compared with rights of society. Briefly the so far most elaborated account of rights of psychiatric patients submitted by the American Psychiatric Association is described.

  6. 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

  7. Patient Prioritization Preferences among Physiotherapy Entry-Level Students: The Importance of Chronic Pain.

    PubMed

    Laliberté, Maude; Ehrmann Feldman, Debbie

    2013-01-01

    Objectif : Étudier les préférences des étudiants en physiothérapie au niveau débutant sur le plan de l'attribution d'une priorité aux patients, en particulier aux patients vivant avec une douleur chronique. Méthode: Après une discussion en groupe, 249 étudiants canadiens en physiothérapie au niveau débutant ont rempli un questionnaire basé sur cinq scénarios distincts (cas de patients fictifs). On a demandé aux répondants d'attribuer une priorité aux patients (P1=priorité la plus élevée, P5=priorité la plus basse). Résultats : Les étudiants en physiothérapie ont accordé la priorité la plus élevée aux patients vivant avec de la douleur chronique et aux patients qui venaient de subir une intervention chirurgicale. Le patient âgé et le patient qui avait un déficit cognitif ont reçu une priorité plus basse. Conclusions : Les étudiants en physiothérapie accordent la plus grande priorité à un diagnostic de douleur chronique. Les publications montrent toutefois que la douleur chronique constitue la priorité la plus basse dans les outils de triage des départements de physiothérapie. Il pourrait y avoir un virage au niveau des préférences entre la période qui précède la pratique (étudiants) et celle qui la suit (clinicien) en ce qui a trait aux patients vivant avec une douleur chronique.

  8. 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

  9. Amorçage d'une décharge dans le vide entre deux electrodes d'argent ou des alliages argent-nickel

    NASA Astrophysics Data System (ADS)

    Zouache, N.; Lefort, A.

    1997-03-01

    Comparison of the characteristics of an electric are breakdown in vacuum between two silver or silver-nickel alloy electrodes prompted us to study the evolution of the breakdown voltage with electrode separation, with resistance value placed between the anode and the high voltage supply used for the breakdown, and with the effect of conditionning by heating in vacuum. The measurement of the commutation time and delay time, and the observations by a metallographic microscope of the electrodes surfaces after one breakdown, enabled us to evidence the origin of the electric arc for each of the studied materials. La comparaison des caractéristiques de l'amorçage d'un arc électrique dans le vide entre deux électrodes bombées de 8mm de diamètre et de rayon de courbure en surface de 16mm, constituées d'argent ou de son alliage avec le nickel, nous a amené à étudier l'évolution de la tension d'amorçage avec plusieurs paramètres : la distance inter-électrodes, les valeurs de la résistance intercalée entre la source haute tension servant au claquage et les électrodes et le conditionnement par chauffage sous vide des électrodes. La mesure du temps de commutation, du temps de retard et les observations au microscope métallographique de la surface des électrodes après un amorçage donnent des informations sur l'origine de l'arc électrique concernant chaque matériau étudié.

  10. Caracterisitiques des patients tuberculeux à l'ouest cameroun: 2000-2009

    PubMed Central

    Noubom, Michel; Nembot, Fabrice Djouma; Donfack, Hubert; Mfin, Patrick Stéphane Kouomboua; Tchasse, Floriane

    2013-01-01

    Introduction La tuberculose (TB) reste de nos jours un problème majeur de santé publique dans les pays en voie de développement. Elle devient de plus en plus importante à cause de l'infection au VIH. Cette étude avait pour but de caractériser les patients admis dans le plus grand Centre de Diagnostic et de Traitement de la Tuberculose (CDT) de l'Ouest Cameroun entre 2000 et 2009. Méthodes Les patients de 15 ans et plus admis au CDT de Baleng durant la période allant du 1er janvier 2000 au 31 décembre 2009 ont été inclus. Les données ont étés collectées grâce à une grille pré conçue. Le calcul des fréquences, moyennes et les comparaisons de groupes ont été faites pour ressortir les caractéristiques des participants. Résultats 2556 patients ont été inclus dans l’étude. 64,8% étaient de sexe masculin et l’âge médian étaient de 33ans. 2141 (83,7%) de patients présentaient une TPM+, 319 (12,5%) une TPM- et 96 (3,8%) une TEP. 64,7% des patients résidaient hors du district de santé d'implantation du CDT. 79,16% de patients tuberculeux ont fait le test de dépistage du VIH et la séroprévalence chez ceux testés était de 26,06%. Les différentes évolutions en fin de période de suivi de chaque patient ont été les suivantes: évolution favorable (guéri et traitement terminé) 1954(76,6%); perdus de vue 231(9,0%); décès 230(9,0%); transféré 92(3,6%); échec 49(1,9%). Conclusion Une proportion considérable de patients résident loin du CDT ce qui augmenterait le perdus de vue et les transferts pendant le traitement. En plus vulgariser les autres CDT de la région, il est nécessaire de renforcer le système de transfert pour éviter les perdus de vue entre deux CDT. PMID:24570799

  11. [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

  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. 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

  14. 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

  15. 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.

  16. 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

  17. Patient specific instrumentation.

    PubMed

    Lionberger, David R; Crocker, Catherine L; Chen, Vincent

    2014-09-01

    Patient specific instrumentation (PSI) has recently been developed as a replacement for traditional instrumentation in total knee arthroplasty (TKA). The study aim was to assess efficiency via the mean total OR time using the PSI versus computer-assisted (CAS) TKAs with accuracy as a secondary endpoint. Sixty patients were randomized to CAS or PSI. A formula was developed to derive a profit ratio (PR) that incorporated costs, revenue, and total OR time. The PSI cases were 1.45 times more profitable than CAS allowing for approximately 3 PSI cases versus 2 CAS cases in one 8 hour OR day. Results from this series show that PSI improves OR efficiency, but does not improve accuracy.

  18. [A dissociative patient].

    PubMed

    de Jongh, A; Abkhezr, S; Broers, D L M

    2009-08-01

    A 45-year-old woman attended a centre for special dental care. Initially, it seemed that the patient suffered from an extreme form of dental anxiety. However, the fact that she displayed 'dissociations' suggested that she had a severe psychiatric disorder, in this case Dissociative Identity Disorder. The key feature of this condition is a dysfunction of the normal integrative functions of identity, memory and consciousness. In such instances it is recommended to contact a psychologist or psychiatrist and the referring care provider to consider the consequences of the psychiatric condition regarding informed consent, treatment plan and actual treatment. Because it was not likely that the patient would respond to an intervention specifically aimed to reduce anxiety in the dental setting, dental treatment under general anesthesia was the best suited option.

  19. [The dementia patient caregiver].

    PubMed

    Bagnati, Pablo M

    2010-01-01

    Dementia results in an important economic, social and personal burden. To care for a patient with dementia can be a trascendent learning experience. At the same time, the caregiver's role can become strenuous physical and mental work. This article reviews the importance of assessing the caregiver from the moment of diagnostic work up, the stages the caregiver goes through in the disease evolution, and the "Caregiver syndrome" where the caregiver can become the "second victim" of dementia.

  20. 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

  1. [Sport for pacemaker patients].

    PubMed

    Israel, C W

    2012-06-01

    Sport activity is an important issue in many patients with a pacemaker either because they performed sport activities before pacemaker implantation to reduce the cardiovascular risk or to improve the course of an underlying cardiovascular disease (e.g. coronary artery disease, heart failure) by sports. Compared to patients with an implantable cardioverter defibrillator (ICD) the risks from underlying cardiovascular disease (e.g. ischemia, heart failure), arrhythmia, lead dysfunction or inappropriate therapy are less important or absent. Sport is contraindicated in dyspnea at rest, acute heart failure, new complex arrhythmia, acute myocarditis and acute myocardial infarction, valvular disease with indications for intervention and surgery and comorbidities which prevent physical activity. Patients with underlying cardiovascular disease (including hypertension) should preferably perform types and levels of physical activity that are aerobic (with dynamic exercise) such as running, swimming, cycling instead of sport with high anaerobic demands and high muscular workload. In heart failure, studies demonstrated advantages of isometric sport that increases the amount of muscle, thereby preventing cardiac cachexia. Sport with a risk of blows to the chest or physical contact (e.g. boxing, rugby, martial arts) should be avoided. Implantation, programming and follow-up should respect specific precautions to allow optimal physical activity with a pacemaker including implantation of bipolar leads on the side contralateral to the dominant hand, individual programming of the upper sensor and tracking rate and regular exercise testing. PMID:22854824

  2. Diabetic patients: Psychological aspects.

    PubMed

    Adili, Fatemeh; Larijani, Bagher; Haghighatpanah, Mohammadreza

    2006-11-01

    This study was undertaken to consider the psychological aspect of diabetes with regard to improving clinical outcomes. The review was limited to literature reports on the causes, solutions, and treatments of some common psychological problems known to complicate diabetes management. A literature search was undertaken using Pub-Med, CINAHL, Proquest, Elsevier, Blackwell Synergy, Ovid, Ebsco, Rose net, and Google websites, including studies published in English journals between 1995 and 2006. Therefore about 88 articles were selected based on the inclusion criteria. In earlier studies, relatively little empirical research was found to substantiate the effect of psychological counseling in complicated diabetes. The greatest deficits were seen in areas of mental health, self-esteem parent impact, and family cohesion. There were some different factors, which influence the psychological aspect of diabetic patients, such as age, gender, place of living, familial and social support, motivation, energy, life satisfaction, and lifestyle. There are various types of solutions for coping with the psychological problems in diabetic clients. The most essential solution lies in educating the patients and healthcare providers on the subject. Before initiating each educational intervention, a thorough assessment would be crucial. Treatment plans may benefit from cognitive behavior therapy (CBT), behavior family therapy, improving family communication, problem-solving skills, and providing motivation for diabetic patients. Moreover, it seems that the close collaboration between diabetologists and psychologists would be fruitful.

  3. Physician-Patient Communication and Patient Compliance: A Theoretical Orientation.

    ERIC Educational Resources Information Center

    Clampitt, Phillip G.; Williams, M. Lee

    This paper synthesizes much of the literature concerning physician/patient communication as it relates to patient compliance. Using the theoretical perspective that deals with belief, attitude, intention, and behavior (a perspective generated by Martin Fishbein and Icek Ajzen), a new theoretical orientation for predicting patient compliance is…

  4. 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 ...

  5. Overcoming barriers to patient safety.

    PubMed

    Kalisch, Beatrice J; Aebersold, Michelle

    2006-01-01

    Creating a culture of patient safety is a critical goal of all patient care unit staff. An analysis of the key barriers to patient safety on a typical inpatient unit in an acute care hospital (unclear unit values), the fear of punishment for errors, the lack of systematic analysis of mistakes, the complexity of the nurses' work, and inadequate teamwork are presented. Nine practices to overcome these barriers and achieve patient safety are discussed.

  6. Overcoming barriers to patient safety.

    PubMed

    Kalisch, Beatrice J; Aebersold, Michelle

    2006-01-01

    Creating a culture of patient safety is a critical goal of all patient care unit staff. An analysis of the key barriers to patient safety on a typical inpatient unit in an acute care hospital (unclear unit values), the fear of punishment for errors, the lack of systematic analysis of mistakes, the complexity of the nurses' work, and inadequate teamwork are presented. Nine practices to overcome these barriers and achieve patient safety are discussed. PMID:16786829

  7. Profile of Your Geriatric Patient

    PubMed Central

    Longhurst, Mark F.; Slade, Debra

    1990-01-01

    The family doctor cares for many geriatric patients. Many of these patients enter the family practice for the first time, having either recently moved to the area or to a nearby long-term care facility. Obtaining a meaningful patient profile is essential to the physicians' care, allowing future medical decisions to be made in the best interest of that person. Patients' beliefs motivate their functioning in a system. Any system has its own history, structure, and function. PMID:21234029

  8. Complications of patient selection: recognizing the difficult patient.

    PubMed

    Goode, Richard L

    2013-11-01

    This article reviews some basic principles of patient selection for facial plastic surgery. There are patients who are not good candidates, independent of the deformity and the ability of the surgeon. Reasons include subtle and not so subtle psychiatric disorders, unrealistic expectations, lack of communication despite multiple visits, and litigious patients. Complications or suboptimal results are not well handled in these patients and often produce an uncomfortable experience for the surgeon and staff in the postoperative period. These patients are best avoided or should be provided a much longer evaluation period prior to any surgery.

  9. 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)

  10. [Organizing patient education in cardiology].

    PubMed

    Fischer, Eric; Thieffry, Eliane

    2014-02-01

    A central element of the care management of patients with heart failure, therapeutic patient education mobilises caregivers into forming a multi-disciplinary team. In this article, a hospital team shares the different stages in the construction and implementation of a programme for use with hospitalised patients and in consultations. To do this, the nurses undertook training to acquire new educational skills.

  11. 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…

  12. 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.

  13. Caring for Latino patients.

    PubMed

    Juckett, Gregory

    2013-01-01

    Latinos comprise nearly 16 percent of the U.S. population, and this proportion is anticipated to increase to 30 percent by 2050. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. Barriers to care have resulted in striking disparities in quality of health care for these patients. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. The National Standards for Culturally and Linguistically Appropriate Services address these concerns with recommendations for culturally competent care, language services, and organizational support. Latinos have disproportionately higher rates of obesity and diabetes mellitus. Other health problems include stress, neurocysticercosis, and tuberculosis. It is important to explore the use of alternative therapies and belief in traditional folk illnesses, recognizing that health beliefs are dependent on education, socioeconomic status, and degree of acculturation. Many-but not all-folk and herbal treatments can be safely accommodated with conventional therapy. Physicians must be sensitive to Latino cultural values of simpatia (kindness), personalismo (relationship), respeto (respect), and modestia (modesty). The LEARN technique can facilitate cross-cultural interviews. Some cultural barriers may be overcome by using the "teach back" technique to ensure that directions are correctly understood and by creating a welcoming health care environment for Latino patients. PMID:23317025

  14. 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

  15. 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

  16. 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

  17. 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

  18. [Neurological complications in cancer patients].

    PubMed

    Hundsberger, Thomas; Roth, Patrick; Roelcke, Ulrich

    2014-08-20

    Neurological symptoms in cancer patients have a great impact on quality of life and need an interdisciplinary approach. They lead to significant impairment in activities of daily living (gait disorders, dizziness), a loss of patients independency (vegetative disturbances, wheel-chair dependency) and interfere with social activities (ban of driving in case of epilepsy). In this article we describe three main and serious neurological problems in the context of oncological patients. These are chemotherapy-induced polyneuropathy, malignant spinal cord compression and epileptic seizures. Our aim is to increase the awareness of neurological complications in cancer patients to improve patients care.

  19. 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

  20. [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.

  1. [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

  2. 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

  3. 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

  4. 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.

  5. 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.

  6. 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

  7. Chronic pain patient-spouse behavioral interactions predict patient disability.

    PubMed

    Romano, J M; Turner, J A; Jensen, M P; Friedman, L S; Bulcroft, R A; Hops, H; Wright, S F

    1995-12-01

    Based on behavioral theory, it has been hypothesized that spouse solicitous responses to the pain behaviors of chronic pain patients may contribute to the maintenance of pain behaviors and disability. Self-report data support this hypothesis, but direct observational measures have not been used to study this association. In this study, 50 chronic pain patients and their spouses were videotaped while engaging in common household activities. and patient pain behaviors and spouse solicitous behaviors were coded from the tapes. Spouse solicitous responses to non-verbal pain behaviors were significant predictors of physical disability in the more depressed patients, and were significant predictors of rate of non-verbal pain behavior in patients who reported greater pain. Spouse solicitous responses did not predict psychosocial dysfunction or total self-reported pain behaviors. The result support behavioral theory and indicate the need for further study of the association between spouse solicitousness and patient pain behaviors/disability.

  8. 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.

  9. [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

  10. [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

  11. 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

  12. Patient Navigators’ Reflections on the Navigator-Patient Relationship

    PubMed Central

    Phillips, Sara; Nonzee, Narissa; Tom, Laura; Murphy, Kara; Hajjar, Nadia; Bularzik, Charito; Dong, Xinqi

    2014-01-01

    Patient navigation emerged as a strategy to reduce cancer disparities among low-income and minority patients and has demonstrated efficacy in improving clinical outcomes. Observational studies have contributed valuable evaluations of navigation processes and tasks; however, few have offered in-depth reflections about the relationship between patient and navigator from the navigators’ perspective. These approaches have addressed the emotional and relational components of patient navigation through the lens of process factors, relegating the navigator-patient relationship to a siloed, compartmentalized functionality. To expand upon existing task-oriented definitions of navigation, we conducted qualitative interviews among community-based patient navigators who coordinated care for uninsured, predominantly Hispanic, women receiving cancer screening and follow-up care in a county outside Chicago. Interviews were recorded, transcribed, and analyzed for themes within the navigator-patient relationship domain. The main themes that emerged centered on relational roles, relational boundaries, and ideal navigator relational qualities. While patient navigators described engaging with patients in a manner similar to a friend, they stressed the importance of maintaining professional boundaries. Navigators’ support assisted patients in bridging their hospital and community lives, a result of navigators’ investment in both hemispheres. We conclude that the navigator-patient relationship is not a self-contained utility, but rather the medium through which all other navigator functions are enabled. These insights further characterize the navigator-patient relationship, which will help shape the development of future navigation programs and support the need for further research on the impact of relationship factors on clinical and psychosocial outcome measures. PMID:24493636

  13. Improving emergency department patient flow

    PubMed Central

    Jarvis, Paul Richard Edwin

    2016-01-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED’s capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

  14. Perceptions of patient provider agreements

    PubMed Central

    Albrecht, Jennifer S.; Khokhar, Bilal; Pradel, Françoise; Campbell, Michelle; Palmer, Jacqueline; Harris, Ilene; Palumbo, Francis

    2016-01-01

    Objectives Use of patient provider agreements (PPAs) is increasing, yet there is limited evidence on the effectiveness of PPAs to prevent prescription opioid misuse and diversion, and few guidelines for providers. We conducted eight focus groups to understand patient and prescriber perceptions of PPAs. Methods We recruited 40 patients who had been asked to sign a PPA and 40 prescribers who had administered at least one PPA. We developed topic guides for the two groups based on prior literature. Focus groups were audio-recorded and transcribed verbatim. Two investigators independently performed the content analysis of the transcripts and reached consensus on recurring themes. Key findings PPA use varied according to physician specialty. General practitioners used PPAs the least but reported increasing pressure from liability insurers to use them. Many patients reported signing a PPA in the emergency room of a hospital. Prescribers and patients reported a lack of understanding among patients concerning the purpose and content of the PPA. Prescribers questioned the legal status of the PPA, while patients believed that the PPA was a legal document intended to protect prescribers. Patients and prescribers valued PPA content items differently, although both groups agreed that signing a PPA would not prevent opioid misuse. Conclusions We identified several themes concerning the administration, content, effectiveness and utility of PPAs that highlight areas of research to improve PPAs. We also describe trends requiring further investigation. Understanding content of importance to patients will facilitate the development of a patient-centred PPA. PMID:27293486

  15. [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

  16. Developing a patient safety plan.

    PubMed

    Zimmerman, Rosanne; Ip, Ivan; Christoffersen, Emily; Shaver, Jill

    2008-01-01

    Many healthcare organizations are focused on the development of a strategic plan to enhance patient safety. The challenge is creating a plan that focuses on patient safety outcomes, integrating the multitude of internal and external drivers of patient safety, aligning improvement initiatives to create synergy and providing a framework for meaningful measurement of intermediate and long-term results while remaining consistent with an organizational mission, vision and strategic goals. This strategy-focused approach recognizes that patient safety initiatives completed in isolation will not provide consistent progress toward a goal, and that a balanced approach is required that includes the development and systematic execution of bundles of related initiatives. This article outlines the process used by Hamilton Health Sciences in adopting Kaplan and Norton's strategy map methodology underpinned by their balanced scorecard framework to create a comprehensive multi-year plan for patient safety that integrates best practice literature from patient safety, quality and organizational development. PMID:18382157

  17. 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 ( ...

  18. Communicating Bad News to Patients

    PubMed Central

    Premi, J. N.

    1981-01-01

    This article reviews the literature on doctor/patient communication, emphasizing the communication of bad news. Available information supports the view that patients want more information than they generally receive and that, contrary to popular belief, patients who are better informed benefit from the information they receive. Physicians are seen as taking a less professional approach to communication activities than to clinical problem solving. Some strategies for approaching the problems identified are outlined. PMID:11650449

  19. Medical Information and Patient Power

    PubMed Central

    Fisher, Julian H.

    1985-01-01

    The patient's right to know about his health and his medical care may benefit from new developments in information management for clinical care. While computer applications in patient care have to date been limited, forces within and around medicine have created a critical need for better clinical data management. The potential for these systems to serve not only the care providers but also the patients has only begun to be explored.

  20. 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.

  1. Conversations with chronic schizophrenic patients.

    PubMed

    Morgan, R

    1979-02-01

    An account is given of some of the topics discussed during a small informal weekly open group meeting of chronic schizophrenic patients, based on occasional notes compiled over eleven years. The main feature of the patients' condition as displayed was poverty--clinical, social, behavioural, material and financial--and certain features suggested an organic aetiology. Reasons are given for considering that the patients' condition was predominantly caused by schizophrenia rather than by institutionalism.

  2. [Team Care and Patient Safety].

    PubMed

    Hashimoto, Michio

    2015-07-01

    The purpose of patient safety management is to nurture an environment which provides optimal care for each patient through the cooperation of each healthcare staff member based on the idea of team care. This is based on the safety culture of an organization that places value on sharing information. Laboratory medicine is expected to become more important in the areas of staff, patient, and community education.

  3. [An evidence-based patient information and patient education programme: the SOR SAVOIR PATIENT].

    PubMed

    Carretier, Julien; Leichtnam-Dugarin, Line; Delavigne, Valérie; Brusco, Sylvie; Philip, Thierry; Fervers, Béatrice

    2004-04-01

    The development of good-quality patient information is a major challenge to improve quality of cancer care. The SOR SAVOIR PATIENT program aims to improve patients' understanding of cancer treatment and to facilitate their participation in clinical decisions. This programme develops evidence-based information for cancer patients based on clinical practice guidelines in oncology, the "Standards, Options and Recommendations" (SOR) which are used as primary information sources. "Translation" of SOR guidelines to laymen uses a multidisciplinary approach involving specialists in cancer care, psychologists, linguists and anthropologists. The development actively involves cancer patients using focus group methods, individual interviews and postal surveys. The SOR SAVOIR PATIENT program is conducted by the FNCLCC and the 20 French regional cancer centres, with active participation of specialists (public and private), learned societies and institutions, collaborating in multidisciplinary working groups. The leaflets Understanding scanner and Understanding Magnetic Resonance Imaging available in this edition of Bulletin du Cancer have been developed by a multidisciplinary group (radiologist, oncologist, methodologist, health care practioners, psychologist, linguist) and 30 patients, experienced patients and caregivers. These leaflets stem from a collection of patients documents on radiological examinations (Understanding mammography, Ultrasound, etc.) which have been developed to help patients and caregivers to better understand these examinations.

  4. Pharmacists see patients through discharge.

    PubMed

    2014-02-01

    At The Nebraska Medical Center in Omaha, pharmacists are part of a multidisciplinary team and see many patients in person starting on Day 1. Every patient history is either taken by a pharmacist or reviewed and approved by the pharmacists. They review the discharge prescriptions, conduct medication reconciliation, and educate the patients on their medications and the importance of taking them as directed. Case managers work with pharmacists to identify patients who are at high risk for readmissions and need follow-up calls and collaborated to develop a medication instruction sheet.

  5. Patient bill of rights 2001.

    PubMed

    Benjamin, G C

    2001-01-01

    Breaking gridlock on managed care reform, a bipartisan coalition in Congress introduced the newest version of a patient bill of rights. Unlike last year's ill-fated Norwood-Dingell bill, the Bipartisan Patient Protection Act of 2001 has strong bipartisan support; concern remains, however, on the provisions that allow patients to sue their managed care plan. The debate now focuses on the type of liability reform that Congress and the White House can agree on. If they are able to agree, a patient bill of rights may soon become law.

  6. Psychotherapy patient transfer: secondhand rose.

    PubMed

    Sederer, L

    1975-10-01

    The author uses the analogy of the marketplace to examine the dynamics of the transfer of psychotherapy patients in university clinic settings. The outgoing therapist is the seller, the prospective therapist the buyer, and the patient the commodity--the secondhand Rose. Marketing techniques that are used in this buyers' market allow no active patient participation and are therefore antithetical to the tenets of psychotherapy. The author suggests early clarification of therapeutic goals, assignment of therapists on the basis of patient choice, and explanation of time frames and limits as means for ameliorating the problems he describes.

  7. Fungal laryngitis in immunocompetent patients.

    PubMed

    Ravikumar, A; Prasanna Kumar, S; Somu, L; Sudhir, B

    2014-01-01

    The diagnosis of fungal laryngitis is often overlooked in immunocompetent patients because it is commonly considered a disease of the immunocompromised. Further confusion is caused by clinical and histological similarity to more common conditions like Leukoplakia. Demonstration of hyperkeratosis particularly if associated with intraepithelial neutrophils on biopsy should trigger a search for fungus using specialized stains. These patients usually present with hoarseness of voice. Pain is present inconsistently along with dysphagia and odynophagia. We present three cases of fungal laryngitis in immunocompetent patients out of which one underwent microlaryngeal surgery with excision biopsy. All these patients responded well with oral antifungal therapy.

  8. Mortality in heart failure patients.

    PubMed

    Bytyçi, Ibadete; Bajraktari, Gani

    2015-01-01

    Heart failure (HF) is a clinical syndrome, which is becoming a major public health problem in recent decades, due to its increasing prevalence, especially in the developed countries, mostly due to prolonged lifespan of the general population as well as the increased of HF patients. The HF treatment, particularly, new pharmacological and non-pharmacological agents, has markedly improved clinical outcomes of patients with HF including increased life expectancy and improved quality of life. However, despite the facts that mortality in HF patients has decreased, it still remains unacceptably high. This review of summarizes the evidence to date about the mortality of HF patients. Despite the impressive achievements in the pharmacological and non-pharmacological treatment of HF patients which has undeniably improved the survival of these patients, the mortality still remains high particularly among elderly, male and African-American patients. Patients with HF and reduced ejection fraction have higher mortality rates, most commonly due to cardiovascular causes, compared with patients HF and preserved ejection fraction. PMID:25550250

  9. 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.

  10. Candida infections among neutropenic patients

    PubMed Central

    Mohammadi, Rasoul; Foroughifar, Elham

    2016-01-01

    Background: Systemic candidiasis is a major complication in neutropenic cancer patients undergoing treatment. Most systemic fungal infections emerge from endogenous microflora so the aim of the present study was to identify Candida species isolated from the different regions of body in neutropenic patients in compare with the control group. Methods: A total of 309 neutropenic cancer patients and 584 patients without cancer (control group) entered in the study. Molecular identification of clinical isolates was performed by PCR-RFLP technique. Results: Twenty-two out of 309 patients had candidiasis (7.1%). Male to female ratio was 1/1 and age ranged from 23 to 66 years. Colorectal cancer and acute myeloid leukemia (AML) were the most common cancers. Candida albicans was the most prevalent Candida species among neutropenic patients (50%) and control group (57.9%). Mortality rate in cancer patients was 13.6% in comparison with control group (5.2%). Conclusion: Since candidiasis is an important cause of morbidity and mortality in neutropenic patients, precise identification of Candida species by molecular techniques can be useful for the appropriate selection of antifungal drugs particularly in high risk patients. PMID:27386056

  11. 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

  12. Government influence on patient organizations.

    PubMed

    Van de Bovenkamp, Hester M; Trappenburg, Margo J

    2011-12-01

    Patient organizations increasingly play an important role in health care decision-making in Western countries. The Netherlands is one of the countries where this trend has gone furthest. In the literature some problems are identified, such as instrumental use of patient organizations by care providers, health insurers and the pharmaceutical industry. To strengthen the position of patient organizations government funding is often recommended as a solution. In this paper we analyze the ties between Dutch government and Dutch patient organizations to learn more about the effects of such a relationship between government and this part of civil society. Our study is based on official government documents and existing empirical research on patient organizations. We found that government influence on patient organizations has become quite substantial with government influencing the organizational structure of patient organizations, the activities these organizations perform and even their ideology. Financing patient organizations offers the government an important means to hold them accountable. Although the ties between patient organizations and the government enable the former to play a role that can be valued as positive by both parties, we argue that they raise problems as well which warrant a discussion on how much government influence on civil society is acceptable.

  13. DENGUE INFECTION IN ELDERLY PATIENTS.

    PubMed

    Tiawilai, Thawat; Tiawilai, Anongrat; Nunthanid, Somboon

    2015-01-01

    From 2005 to 2013, there were 15 dengue patients aged over 60 years old who were admitted to Photharam Hospital, Ratchaburi, Thailand. Ten were females and five were males. Nine had dengue fever (DF), and 6 had dengue hemorrhagic fever (DHF). A trending shift in age group towards adults has been seen during the past decades. No deaths were seen in these elderly patients with dengue disease, indicating early recognition and effective management of these dengue patients. The trend towards higher age in dengue patients is a problem of concern, which needs further elaboration.

  14. 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…

  15. Études dynamiques des propriétés mécaniques et électriques des contacts entre solides

    NASA Astrophysics Data System (ADS)

    Mayer, Guy; Hauchecorne, Gérard

    1996-08-01

    Dynamical methods are used to study contacts between solids. We describe some devices for exciting and measuring periodical oscillations of a small object laying against a table. For small amplitude (simeq 10^{-8} cm) of relative motion, the normal modes of oscillation are harmonic and their frequencies give the derivative of the force versus displacement. The effects of a static force on those mutual frequencies give the second derivatives. In these modes of relative motion the strain potential energy is concentrated in the small volumes (simeq 10^{12} cm3) near the contacts. They show a rather strong damping coefficient which we have measured. For larger amplitudes of motion, various non-linear effects show up. We have studied with some care sub-harmonic generation. When both solids in contact are electrically conducting the impedance modulation induced by the mechanical oscillations has been measured and brings some more information. Hertz theory has guided us. The fractional exponents we observe in the relations force versus displacement for various contacts are reasonably close to the Hertzian predictions. The effect of a magnetic field on the mutual frequencies of two solids made of ferrite (Mn, Zn) has been found too strong to be accounted for easily. Nous étudions par des méthodes dynamiques le nature des contacts entre deux solides. Nous décrivons divers dispositifs permettant de provoquer et d'observer de petites oscillations périodiques d'un objet appuyé contre une table autour de sa positions d'équilibre statique. Pour des amplitudes de mouvement relatif petites, de l'ordre de l'Angström, les modes propres d'oscillation sont harmoniques et leur fréquence donne la dérivée de la force par rapport au déplacement. L'influence d'une force statique sur cette fréquence mutuelle donne la dérivée seconde. Dans ces modes de mouvement relatif l'énergie potentielle de déformation est localisée dans les très petits volumes proches des contacts

  16. A smoking cessation intervention among tuberculosis patients in rural China.

    PubMed

    Lin, Y; Wang, L-X; Qiu, L-X; Huang, Q; Shu, Q; Lin, H-X; Meng, X; Zeng, X-L; Xiao, L-X; Bam, T S; Chiang, C-Y

    2015-09-21

    Objectif : Evaluer la possibilité d'intégrer une intervention d'arrêt du tabac dans les services de routine de la tuberculose (TB).Méthode : Les patients tuberculeux consécutifs inscrits entre le 1(e) mars et le 31 août 2010 ont été enrôlés dans une intervention visant à promouvoir l'arrêt du tabac chez ceux qui disaient fumer pendant le traitement de leur TB. Des informations sur les effets sanitaires dangereux de la fumée de tabac et sur le fait de fumer en étant tuberculeux ont été fournies aux patients qui se sont dit fumeurs actuels. Le statut en matière de tabac a été réévalué à chaque visite de suivi pendant le traitement antituberculeux avec des messages sanitaires renforcés et des conseils visant à l'arrêt.Résultats : Sur 800 patients TB enrôlés, 572 (71,5%) étaient des hommes et 244 (30,5%) étaient des fumeurs actuels. Les femmes étaient plus souvent non fumeuses (100% contre 35,8% ; P < 0,001). Des 244 fumeurs actuels, 144 (59,0%) avaient commencé à fumer avant 20 ans, 197 (80,7%) consommaient ⩾20 cigarettes par jour, 211 (86,5%) étaient conscients de leur dépendance au tabac et 199 (81,6%) n'avaient jamais essayé d'arrêter avant le diagnostic de TB. Des 244 fumeurs actuels, 234 (95,9%) voulaient arrêter et 156 (66,7%) ont déclaré être toujours abstinents à 6 mois. Les défis à la mise en œuvre d'une intervention d'arrêt du tabac ont été identifiés.Conclusion : La majorité des fumeurs actuels parmi les patients TB voulaient arrêter et sont restés abstinents à la fin du traitement antituberculeux. Cette intervention devrait être étendue au pays tout entier.

  17. 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

  18. Patients as partners, patients as problem-solvers.

    PubMed

    Young, Amanda; Flower, Linda

    2002-01-01

    This article reports our ongoing work in developing a model of health care communication called collaborative interpretation, which we define as a rhetorical practice that generates building blocks for a more complete and coherent diagnostic story and for a collaborative treatment plan. It does this by situating patients as problem-solvers. Our study begins with an analysis of provider-patient interactions in a specific setting-the emergency department (ED) of an urban trauma-level hospital- where we observed patients and providers miscommunicating in at least 3 distinct areas: over the meaning of key terms, in the framing of the immediate problem, and over the perceived role of the ED in serving the individual and the community. From our observations, we argue that all of these miscommunications and missed opportunities are rooted in mismatched expectations on the part of both provider and patient and the lack of explicit comparison and negotiation of expectations-in other words, a failure to see the patient-provider interaction as a rhetorical, knowledge-building event. In the process of observing interactions, conversing with patients and providers, and working with a team of providers and patients, we have developed an operational model of communication that could narrow the gap between the lay public and the medical profession-a gap that is especially critical in intercultural settings like the one we have studied. This model of collaborative interpretation (CI) provides strategies to help patients to represent their medical problems in the context of their life experiences and to share the logic behind their health care decisions. In addition, CI helps both patient and provider identify their goals and expectations in treatment, the obstacles that each party perceives, and the available options. It is adaptableto various settings, including short, structured conversations in the emergency room, extended dialogue between a health educator and a patient in a

  19. 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

  20. 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.

  1. Preventing pitfalls in patient surveys.

    PubMed

    Steiber, S R

    1989-05-01

    Properly conceived, customer satisfaction surveys can yield the quantitative data needed to gauge patient satisfaction. But, as the author notes, these surveys can be "a veritable mine field of surprises for the uninitiated." This article, the last in a three-part series on measuring patient satisfaction, describes potential pitfalls and discusses the merits of in-person, mail and telephone surveys. PMID:10293191

  2. 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…

  3. Managing hyponatremia in neurosurgical patients.

    PubMed

    Kirkman, M A

    2014-03-01

    Hyponatremia is common in neurosurgical patients and is associated with significant morbidity and mortality. Despite significant research efforts to date, we still lack a complete understanding of the pathophysiological mechanisms underlying hyponatremia in this patient setting. The purpose of this narrative review is to provide an overview of our understanding of hyponatremia in neurosurgical patients, the management principles, and the challenges that arise for the physician managing such patients. Challenges to managing these patients include: the fact that the syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting (CSW) may actually represent parts of the same clinical spectrum; the difficulty in distinguishing between CSW, SIADH, and the hypovolemic hyponatremia resulting from a normal pressure natriuresis caused by the administration of large fluid volumes; and that hyponatremia can result from therapeutic agents used in these patients. Treatment of the hyponatremia depends on factors such as the underlying neurosurgical pathology, whether the hyponatremia is acute or chronic, and the fluid status of the patient. Hypertonic saline is a common treatment option. Other treatment options include vasopressin 2 receptor antagonists and steroids, but large prospective trials are required to suitably assess their efficacy and safety in the neurosurgical setting. Of all the challenges that hyponatremia in neurosurgical patients present, perhaps the most pressing is the need for a better understanding of the underlying pathophysiological mechanisms. Only once we begin to better understand this can more efficacious treatments be directed against hyponatremia in this important population.

  4. Inflatable stretcher to transport patients

    NASA Technical Reports Server (NTRS)

    Clark, C. C.; Gordon, F. T., Jr.; Schmidt, C. B.

    1970-01-01

    Inflatable plastic bag inside strong, inflexible outer bag facilitates emergency transport of seriously burned or disabled patients. When the bag is inflated the patient is completely immobilized and cushioned from external shock. Air for breathing, temperature controls and communications may be provided by appropriate plug-in connections.

  5. 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.

  6. Biotelemetry system for ambulatory patients

    NASA Technical Reports Server (NTRS)

    Fryer, T. B.

    1978-01-01

    Compact transmitter for multichannel telemetry of medical data is carried in patient's belt. Pulse-code modulation (PCM), is used for high-quality signal, and low-power CMOS integrated circuits make miniaturization possible. Transmitter is useful for electro-encephalograms (EEG) and electro-cardiograms (EKG) and other biomedical patient-monitoring situations.

  7. The Zest for Patient Empowerment.

    PubMed

    Raina, Rangeel Singh; Thawani, Vijay

    2016-06-01

    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

  8. 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.

  9. Optimal Nutrition in Hemodialysis Patients

    PubMed Central

    Ikizler, T. Alp

    2012-01-01

    Protein energy wasting (PEW) is highly prevalent in patients undergoing maintenance hemodialysis (MHD) patients. Importantly, there is a robust association between the extent of PEW and the risk of hospitalization and death in these patients, regardless of the nutritional marker used. The multiple etiologies of PEW in advanced kidney disease are still being elucidated. Apart from the multiple mechanisms that might lead to PEW, it appears that the common pathway for all the derangements is related to exaggerated protein degradation along with decreased protein synthesis. The hemodialysis procedure per se is an important contributor to this process. Metabolic and hormonal derangements such as acidosis, inflammation and resistance to anabolic properties of insulin resistance and growth hormone are all implicated for the development of PEW in MHD patients. Appropriate management of MHD patients at risk for PEW requires a comprehensive combination of strategies to diminish protein and energy depletion, and to institute therapies that will avoid further losses. The mainstay of nutritional treatment in MHD patients is provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition should be attempted in patients who cannot use the gastrointestinal tract efficiently. Other anabolic strategies such as exercise, anabolic hormones, anti-inflammatory therapies and appetite stimulants can be considered as complementary therapies in suitable patients. PMID:23439378

  10. Preventing pitfalls in patient surveys.

    PubMed

    Steiber, S R

    1989-05-01

    Properly conceived, customer satisfaction surveys can yield the quantitative data needed to gauge patient satisfaction. But, as the author notes, these surveys can be "a veritable mine field of surprises for the uninitiated." This article, the last in a three-part series on measuring patient satisfaction, describes potential pitfalls and discusses the merits of in-person, mail and telephone surveys.

  11. Patient safety: the doctor's perspective.

    PubMed

    Shemesh, David; Olsha, Oded; Goldin, Ilya; Danin, Sigalit

    2015-01-01

    Medical errors can be defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Beyond their economic cost and their cost in human lives, errors cause loss of trust in the healthcare system by patients and diminished satisfaction by both patients and health professionals. There are many evidence-based safety-oriented behaviours and interventions that are easily implemented, such as ultrasound-guided central venous catheter insertion, prevention of catheter-related bloodstream infection and more. In vascular access, the development of research in patient safety has raised a variety of issues requiring study in order to provide the optimal patient safety approach. Patients are major contributors to their own safety, and as such, physicians should develop a new approach to involve them in the cycle of decision making through every step of their treatment. There are many opportunities along this path for the patient to be engaged in safety behaviours and for the access team to ensure such behaviours by employing simple strategies. The advent of the access centre, based on multidisciplinary teamwork, has enhanced the potential to improve patient safety by prevention of errors in planning and performing access surgery, avoiding delay in treatment of access malfunction and improving communication between the team members. However, a significant effort in research is still needed in order to implement intervention by evidence-based data focused on patient safety. PMID:25751565

  12. 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…

  13. 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…

  14. Patient Education Workshop: Summary Report.

    ERIC Educational Resources Information Center

    Simmons, Jeannette

    This report describes activities of a workshop conducted for fourteen health education practitioners and administrators from a number of different hospital and health care settings and geographical regions to appraise the state of patient education programs. The initiation and growth of patient education programs in a variety of health care…

  15. Feeding device for glossectomy patients.

    PubMed

    Fleming, S M; Weaver, A W

    1983-04-01

    Instructions are provided for making a feeding spoon from a plastic syringe for use by patients who have had a glossectomy. This adaptation may be accomplished using only a hacksaw blade and sandpaper. Such a device may be indicated for patients who have had at least 60% of their tongue resected, but who are not at significant risk of aspiration. PMID:6838348

  16. Perioperative nutrition in cancer patients.

    PubMed

    Daly, J M; Redmond, H P; Gallagher, H

    1992-01-01

    Cancer patients have the highest incidence of protein-calorie malnutrition seen in hospitalized patients, with significant malnutrition occurring in more than 30% of cancer patients undergoing major upper gastrointestinal procedures. Clinically significant malnutrition occurs as a result of diminished nutrient intake, increased nutrient losses, and tumor-induced derangements in host metabolism. In the absence of adequate exogenous nutrients, the body utilizes endogenous substrates to satisfy the ongoing requirements of both host and tumor for energy and protein. In those patients with malignant obstruction of the gastrointestinal tract, the tumor itself may induce diminished nutrient intake. Present day treatment modalities including gastrointestinal resection, chemotherapy, and radiotherapy compound these metabolic derangements, further increasing the risk of postoperative morbidity and death. The presence of malnutrition in cancer patients has prognostic importance. In a review of more than 3000 cancer patients, DeWys and colleagues identified significantly improved survival in those patients without weight loss compared with those had lost 6% of their body weight (Am J Med 69:491-497, 1980). Other investigators have noted increased postoperative morbidity and mortality associated with malnutrition. Early hypotheses suggested that reversal of weight loss would improve survival. The development and refinements of enteral and parenteral nutrition have provided the opportunity for studying the relationship between nutritional supplementation and postoperative prognosis. Nutrition support is therefore often instituted to improve nutritional status and thereby reduce the risks of postoperative complications. This article addresses the beneficial role of preoperative nutrition therapy in cancer patients.

  17. 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…

  18. 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

  19. Patient safety: the doctor's perspective.

    PubMed

    Shemesh, David; Olsha, Oded; Goldin, Ilya; Danin, Sigalit

    2015-01-01

    Medical errors can be defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Beyond their economic cost and their cost in human lives, errors cause loss of trust in the healthcare system by patients and diminished satisfaction by both patients and health professionals. There are many evidence-based safety-oriented behaviours and interventions that are easily implemented, such as ultrasound-guided central venous catheter insertion, prevention of catheter-related bloodstream infection and more. In vascular access, the development of research in patient safety has raised a variety of issues requiring study in order to provide the optimal patient safety approach. Patients are major contributors to their own safety, and as such, physicians should develop a new approach to involve them in the cycle of decision making through every step of their treatment. There are many opportunities along this path for the patient to be engaged in safety behaviours and for the access team to ensure such behaviours by employing simple strategies. The advent of the access centre, based on multidisciplinary teamwork, has enhanced the potential to improve patient safety by prevention of errors in planning and performing access surgery, avoiding delay in treatment of access malfunction and improving communication between the team members. However, a significant effort in research is still needed in order to implement intervention by evidence-based data focused on patient safety.

  20. Patient Perspectives of Medical Confidentiality

    PubMed Central

    Sankar, Pamela; Mora, Susan; Merz, Jon F; Jones, Nora L

    2003-01-01

    OBJECTIVE To lay the groundwork for a better understanding of patient views on medical confidentiality. DESIGN Studies were found by searching medline, bioethicsline, and selected bibliographies. Articles concerning physician perspectives or implications of legal and administrative regulations were excluded. Only peer-reviewed journal articles reporting original research on patients' confidentiality views and conduct were included. MAIN RESULTS Many patients are unaware of or misunderstand their legal or ethical right to medical confidentiality protections, which leads them to both over- and underestimate confidentiality protections. The possibility that medical information might be revealed, intentionally or not, to acquaintances in a clinic or other social community troubles patients as much as information release to insurers or employers. A significant minority of patients distrust confidentiality protections, leading some to report that they delay or forgo medical care. If doubtful that confidentiality will be upheld, patients will act independently to protect information. CONCLUSIONS Our review found a wider variety of understandings and beliefs about medical confidentiality among patients than are often indicated in the writings of practitioners or legal experts. As medical confidentiality regulations evolve, these differences need to be recognized and accounted for in interactions between practitioners and patients. PMID:12911650

  1. [Takayasu arteritis in pediatric patients].

    PubMed

    Katsicas, María Martha; Pompozi, Luis; Russo, Ricardo

    2012-01-01

    Takayasu's arteritis is a chronic inflammatory disease that primarily affects the large vessels, such as the aorta and its branches. It represents the third most frequent vasculitis during pediatric age. Our objective was to describe clinical and complementary exams features as well as treatment modalities of a case series of pediatric patients. We present 11 patients (10 girls) with median age at onset of 8 years (range: 2-15). The median diagnosis delay was 16 months (range: 2-96). Clinical presentations were lower limb claudication, arterial hypertension, CNS involvement, presence of murmurs, systemic symptoms, lymphadenopathy, chest pain, abdominal pain and arthritis. Laboratory tests showed: elevated ESR, anemia and trombocytosis. Vascular imaging studies exhibited stenosis, dilatation, occlussion and aneurysms. The outcome of the disease was persistent active condition (1 patient), relapse (4 patients), remission (3 patients), motor sequelae (1 patient) and death (2 patients). All patients were treated with steroids and immunosuppressants. Takayasu 's arteritis is a condition that can potentially be life-threatening. The diagnosis should be suspected in a variety of clinical manifestations during childhood.

  2. 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.

  3. Communication and the Elderly Patient.

    ERIC Educational Resources Information Center

    Gasek, George

    Successful management of the elderly patient is related in part to how effectively he and members of the health care team can communicate with each other. If comprehension and/or expressive abilities are impaired, as they frequently are in the geriatric population, then efficient patient management becomes difficult. Unfortunately, this difficulty…

  4. Psychotherapy with the dying patient.

    PubMed

    Schwartz, A M; Karasu, T B

    1977-01-01

    This paper develops and describes encounters with dying patients and their families and looks for consesus of patterns and responses of possible help in confronting this situation. It offers positive suggestions for those providing care for dying patients but also acknowledges that only an intellectual grasp of the situation is not sufficient qualification for caring for the dying.

  5. Communicating with terminal cancer patients.

    PubMed

    Anderson, J L

    Communication between doctors and terminal cancer patients has been identified as a problem area in medical care. There have been attempts to overcome this problem by establishing new teaching programs; however, the most effective teaching methods are costly. A model is described that requires minimal staff involvement in teaching about communicating with terminal cancer patients.

  6. 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)

  7. Dengue infections in HIV patients.

    PubMed

    Siong, Wong Chia; Ching, Tan Huey; Jong, Go Chi; Pang, Chan Siew; Vernon, Lee Jian Ming; Sin, Leo Yee

    2008-03-01

    A retrospective review of hospital admission records was conducted on patients who were admitted to the Communicable Disease Center (CDC)/Tan Tock Seng Hospital, Singapore from 1 January 2004 to 31 December 2005. There were 5 HIV patients who were admitted with dengue infection during the study period. Their symptoms were generally mild and recovery was uneventful. None of the patients developed dengue hemorrhagic fever or dengue shock syndrome. The symptoms and signs of dengue infection in HIV patients are nonspecific. It is important for healthcare workers to maintain a high index of suspicion in order to make the diagnosis. Interactions between pathogenesis pathways or with antiviral treatments may have contributed to the apparently less severe dengue infections in HIV patients. This observation needs to be explored further.

  8. Patient With Borderline Personality Disorder

    PubMed Central

    Griffiths, Dorothy E.

    1989-01-01

    Every family practice includes people who are difficult to manage. Persons with a borderline personality disorder can be the most difficult of all. They will trust no one, and consequently few, if any, others will be able to tolerate their profoundly difficult interpersonal communication style. These patients will present to their family physician more and more often with a variety of somatic and emotional symptoms. They will demand, either verbally or silently, that these symptoms be relieved immediately. This increasing demand for immediate response may eventually cause the physician to reject the patient. An understanding of this condition and how it develops in infancy may enable the physician to help the patient. A family physician who can set appropriate limits to the patient's demands may slowly convince the patient that he can trust and not be hurt. PMID:21248944

  9. TRACE program: improving patient safety.

    PubMed

    Rinehart, Brenda

    2011-01-01

    The Tools for Radiation Awareness and Community Education (TRACE) program was designed as a two phase approach to radiation dose awareness and overall patient dose reduction achieved through patient and community education, physician awareness, staff training, and technological enhancements. It was made possible by the AHRA and Toshiba Putting Patients First grant program. Phase one of the program began by engaging radiation safety committee and management to address new radiation safety policy and procedures followed by patient and community education. Next, fluoroscopy dose reduction was addressed through physician awareness and dose notification. The final step was CT dose reduction through protocol changes. Phase two will contain three components: The implementation of software that will assist in recording and reporting dose; patient and referring physician notification for radiation dose >3 Gy; and CT dose reduction through technology and additional changes to protocols.

  10. '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

  11. Follow-up examinations: are multidrug-resistant tuberculosis patients in Uttar Pradesh, India, on track?

    PubMed

    Tripathi, U C; Nagaraja, S B; Tripathy, J P; Sahu, S K; Parmar, M; Rade, K; Bhatnagar, S; Ranjan, A; Sachdeva, K S

    2015-03-21

    Contexte : Tous les patients atteints de tuberculose multirésistante (TB-MDR) qui avaient achevé 6 mois de traitement dans le cadre du Programme National Révisé de Lutte contre la Tuberculose (RNTCP) dans l’Uttar Pradesh, le plus grand état dans le nord de l’Inde.Objectif : Déterminer la proportion de patients TB-MDR bénéficiant d’examens de suivi régulier et la vision des prestataires et des patients sur ces services de suivi.Méthodes : Une étude rétrospective de cohorte a été réalisée grâce à la revue des dossiers de 64 patients TB-MDR éligibles enregistrés entre avril et juin 2013 dans 11 districts de l’état. Les patients et le personnel du RNTCP des districts sélectionnés ont également été interviewés grâce à un questionnaire semi-structuré.Résultats : Au total, 34 (53,1%) patients ont bénéficié d’examens de culture de crachats au 3(e) mois, 43 (67,2%) au 4(e) mois, 36 (56,3%) au 5(e) mois et 37 (57,8%) au 6(e) mois. Les principaux facteurs associés à un suivi irrégulier émanant des entretiens étaient le nombre élevé de consultations, la distance à parcourir, les ruptures de stock dans les structures et le manque de connaissances des patients vis-à-vis du programme de suivi.Conclusion : La majorité des patients TB-MDR ont eu un suivi irrégulier. Les facteurs liés aux prestataires dépassent ceux liés aux patients en matière d’examens de suivi médiocres. Le RNTCP devrait se concentrer sur la décentralisation des services de suivi, assurer la logistique et le conseil centré sur le patient afin d’accroitre la régularité du suivi.

  12. Are HIV-positive presumptive tuberculosis patients without tuberculosis getting the care they need in Zimbabwe?

    PubMed

    Dlodlo, R A; Hwalima, Z E; Sithole, S; Takarinda, K C; Tayler-Smith, K; Harries, A D

    2015-12-21

    Contexte : Le centre de santé Emakhandeni, qui offre une prise en charge de la tuberculose (TB) et du virus de l'immunodéficience humaine (VIH) décentralisée et intégrée à Bulawayo, Zimbabwe.Objectifs : Comparer la prise en charge du VIH pour les patients présumés tuberculeux, avec et sans TB, enregistrés en 2013.Schéma : Etude rétrospective de cohorte basée sur les données de routine du programme.Résultats: Sur 422 patients présumés tuberculeux enregistrés, 26% étaient connus comme VIH positifs. Parmi les 315 patients restants, 255 (81%) ont eu un test VIH, dont 190 (75%) se sont avérés positifs. Parmi eux, 26% ont eu un diagnostic de TB et 71% n'ont pas été confirmés tuberculeux (les 3% restants n'ont eu aucun résultat de TB enregistré). Pour les 134 patients sans TB, les données d'éligibilité au traitement antirétroviral (ART) ont été notées chez 42 (31%) patients et 95% ont été éligibles à l'ART. La mise en œuvre du traitement préventif par cotrimoxazole (CPT) et l'ART a été notée pour respectivement 88% et 90% des patients VIH positifs avec TB, comparés à respectivement 40% et 38% des patients VIH positifs sans TB (P < 0,001).Conclusion : Les patients présumés TB mais non confirmés avaient un taux élevé de positivité au VIH et pour ceux dont les données étaient disponibles, la majorité était éligible à l'ART. Par contre, pour les patients VIH positifs sans une TB confirmée, le taux de mise en œuvre du traitement préventif par CPT et de l'ART a été médiocre. Une approche « tester et traiter » et de meilleurs liens entre les services pourraient sauver la vie de ces patients, surtout en Afrique australe où les taux de VIH et de TB sont très élevés.

  13. The transition from 'informed patient' care to 'patient informed' care.

    PubMed

    Gardiner, Ruth

    2008-01-01

    We are in the midst of a real change in the application of information technology to support the delivery of healthcare. We are seeing a shift from the 'informed patient' which has resulted from improved access to healthcare information, primarily from the Web, to the 'participative patient' as we move into Web 2.0 territory. The last decade has seen significant strides in the application of healthcare information to support patient care including: Increased access to healthcare related information by the patient through access to healthcare information on the Web (1.0). The development of electronic patient/health records. Improved access to knowledge for care professionals has enabled the dissipation of professional clinical skills with the introduction of nurse practitioners and increased use of therapies. Improved access to patient related information across disciplines is beginning to enable the shift from acute based to community based care. The introduction of home care technologies has enabled self monitoring in supporting self care. There are also developments in the way care is provided with an increasing diversity of healthcare providers with the challenges this has presented in exchanging patient related information to support continuity of care. We are now at another major turning point that could present greater challenges for healthcare professionals, organisations and the patient or client. These developments include: The application of information sharing services commonly referred to as Web 2.0. As a result we are seeing a transition from the 'informed patient' to the 'participative patient' that will present increasing challenges for healthcare professionals and healthcare organisations in adapting care to embrace this evolution. New entrants to the ehealth market are now emerging such as Google and Microsoft who are competing to 'own' the 'healthcare consumer'. Open source solutions for EPR/EHRs are now emerging that will challenge the

  14. [Allergic rhinitis in asthmatic patients].

    PubMed

    Reyes, Paola; Larreal, Yraima; Arias, Julia; Rincón, Enrique; Valero, Nereida

    2014-01-01

    Antecedentes: la rinitis alérgica y el asma bronquial son procesos inflamatorios crónicos de las vías respiratorias, con una correlación que varía entre 28 y 78%. Objetivos: determinar la prevalencia de rinitis alérgica en pacientes asmáticos y clasificarla según las guías Rinitis Alérgica y su Impacto en Asma (ARIA), así como detectar las concentraciones séricas de IgE total y la existencia de eosinofilia nasal y en sangre periférica. Material y método: estudio en el que pacientes asmáticos entre 7 y 14 años de edad, consultantes del servicio de Pediatría del Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Estado Zulia, Venezuela, fueron encuestados acerca de signos y síntomas sugerentes de rinitis alérgica y su efecto en la calidad de vida. Se tomaron muestras sanguíneas e hisopado nasal para hacer las determinaciones objeto de estudio. Resultados: se evaluaron 60 pacientes asmáticos, 73.3% del sexo masculino y 70% escolares. La prevalencia de rinitis alérgica se estableció en 93.3%, el tipo más frecuente según ARIA fue el intermitente leve, con 42.8%. El signo clínico más frecuente fueron las ojeras alérgicas (86.6%) y el síntoma predominante fue el goteo nasal acuoso (83.3%), la afectación en cuanto a calidad de vida estuvo representada por trastornos del sueño (39.2%). El 85.7% de los encuestados tuvo porcentajes de eosinófilos mayores a 3% y 75% tuvo valores mayores de 100 UI de IgE total sérica. El 61.9% de las muestras de moco nasal de pacientes con rinitis mostró porcentajes de eosinófilos mayores a 10%. Conclusión: existe alta prevalencia de rinitis alérgica en asmáticos confirmada mediante pruebas de laboratorio que evidencian una respuesta inflamatoria mediada por IgE.

  15. Promoting better care for stigmatised patients.

    PubMed

    Pottle, Jessica; Marotta, Jill

    2014-12-31

    This article discusses the role of nurses and nurse leaders in the prevention and resolution of patient stigmatisation. The multiple nurse, patient and environmental factors that contribute to difficulties in nurse-patient interactions are outlined. The antecedents and consequences of patient stigmatisation are discussed and leadership strategies for counteracting and preventing patient stigmatisation are explored. The reader is encouraged to reflect on the role of patient stigmatisation in nursing practice and consider ways to promote better care of stigmatised patients. PMID:25515484

  16. 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.

  17. 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

  18. Patient satisfaction: focusing on "excellent".

    PubMed

    Otani, Koichiro; Waterman, Brian; Faulkner, Kelly M; Boslaugh, Sarah; Burroughs, Thomas E; Dunagan, W Claiborne

    2009-01-01

    In an emerging competitive market such as healthcare, managers should focus on achieving excellent ratings to distinguish their organization from others. When it comes to customer loyalty, "excellent" has a different meaning. Customers who are merely satisfied often do not come back. The purpose of this study was to find out what influences adult patients to rate their overall experience as "excellent." The study used patient satisfaction data collected from one major academic hospital and four community hospitals. After conducting a multiple logistic regression analysis, certain attributes were shown to be more likely than others to influence patients to rate their experiences as excellent. The study revealed that staff care is the most influential attribute, followed by nursing care. These two attributes are distinctively stronger drivers of overall satisfaction than are the other attributes studied (i.e., physician care, admission process, room, and food). Staff care and nursing care are under the control of healthcare managers. If improvements are needed, they can be accomplished through training programs such as total quality management or continuous quality improvement, through which staff employees and nurses learn to be sensitive to patients' needs. Satisfying patients' needs is the first step toward having loyal patients, so hospitals that strive to ensure their patients are completely satisfied are more likely to prosper. PMID:19413164

  19. Virtual patients in geriatric education.

    PubMed

    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 have spurred the development of virtual patient programs to teach geriatrics at the medical undergraduate, graduate, and postgraduate levels. As an instructional tool, the Virtual Patient must be placed in the correct educational context to help educators identify opportunities for its proper use in the curriculum. In this review, the experiences of three medical schools in the development and application of geriatric virtual patients are described as case studies. In each case study, the challenges encountered and solutions developed are presented. Areas of future research in the use of virtual patients in geriatrics education include the determination of the optimal combination of features, the settings of use of virtual patient programs, the underlying pedagogy, and the limitations in its application in clinical instruction. PMID:20509062

  20. [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

  1. [Patients' increasing role in healthcare].

    PubMed

    Colombo, Cinzia

    2016-03-01

    Since the late '90s citizens have been increasingly involved in healthcare, thanks to a shift in access to healthcare information, greater patients' and citizens' awareness about their rights and needs, and a change in physicians' attitudes and behavior. At the same time, to ensure the sustainability of the national health services, patients' needs are increasingly being examined in relation to the services and interventions needed, and to foster informed demand by patients and citizens, and appropriate prescriptions by physicians. Nowadays, patients already have a section in an authoritative medical journal. Working with clinicians, they set research priorities and the outcomes to be studied. Especially in UK and USA, they are invited to participate in the design and development of trials and in deciding which trials should be funded. The situation varies widely in different countries, though involving citizens in healthcare decisions is a common mantra. Even when they consult a clinician, the patients' role has evolved. People ask for information more often and want an active part in decisions about their health. Physicians start to pay more attention to the person and the social context, feelings and emotions, and person-centered care has become a reference in the doctor-patient relationship. This article offers an overview of the changing roles of patients and citizens in healthcare.

  2. 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.

  3. 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

  4. 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…

  5. 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.

  6. 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

  7. Hyperkalaemia in patients in hospital.

    PubMed

    Moore, M L; Bailey, R R

    1989-10-25

    A survey of all laboratory blood specimens with a plasma potassium concentration greater than or equal to 5.5 mmol/L was conducted over a three month period. Of 331 specimens with hyperkalaemia, 71 were excluded because the specimens was haemolysed, old or contaminated. The laboratory served a population of 348,561 and during this time measured the plasma potassium on 25,016 occasions. Sixty-six outpatients and 20 neonates were not evaluated. The survey was undertaken on 86 of 102 inpatients (46 males), 48 of whom were over 66 years of age. Fifty-seven patients were admitted under a medical service and 29 under a surgical service. Fifty-nine had a single episode of hyperkalaemia. Thirty-two underwent a surgical procedure. The commonest contributing factor was impaired renal function which was present in 71 (83%) patients. Although a definitive causative role for drugs could be identified in only five patients, in 52 (60%) patients drugs were a contributing factor (potassium supplements 24, ACE inhibitors 16, nonsteroidal antiinflammatory drugs 12). Thirty-five of the 86 (41%) patients died during their hospital admission. Nineteen of the 35 deaths occurred within three days of the hyperkalaemia being recorded. A normal plasma potassium was eventually documented in 50 of the 86 patients. Of the remaining 36 patients, 25 (69%) subsequently died. In general the treatment of patients with hyperkalaemia focused on identifying and treating the underlying cause. Hyperkalaemia must always be considered seriously and regard given to the overall clinical status of the patient, with particular attention to drug therapy, renal and cardiac function, acid base status and the possibility of sepsis.

  8. Rheumatology outcomes: the patient's perspective.

    PubMed

    Carr, Alison; Hewlett, Sarah; Hughes, Rod; Mitchell, Helene; Ryan, Sarah; Carr, Maggie; Kirwan, John

    2003-04-01

    Our aim was to explore the patient's perspective of outcomes in rheumatoid arthritis (RA) to identify which outcomes are important to patients and how patients calibrate what constitutes a meaningful change in those outcomes. A qualitative study was performed using focus groups in 5 clinical centers in different geographical locations in the UK. Each group contained 6 to 9 patients with RA who were purposefully sampled to include men and women with a range of age, disease duration, functional disability, work disability, and current disease activity. Each focus group lasted around 1 h and addressed 3 questions: What outcomes from treatment are important to RA patients? What makes patients satisfied or dissatisfied with a treatment? How do patients decide that a treatment is working? Patients identified as important not only physical outcomes such as pain and disability, but also fatigue and a general feeling of wellness. The relative importance of these outcomes depended on the stage of disease and on specific situations, such as a disease flare. Satisfaction was influenced by communication, access to treatment, and treatment efficacy. Treatment efficacy was related to symptom reduction, with the magnitude of reduction necessary for efficacy dependent on the stage of disease. For example, large changes were deemed necessary with disease of long duration, while in early disease, even small changes could be important. Our data support existing knowledge of the importance of pain and mobility as treatment outcomes, but raise new and important issues: Some outcomes of importance to patients are not currently measured and there are no measures available to capture them. Existing measures need to be calibrated to take account of the differing importance of outcomes at different stages of disease and variations in the magnitude of change within the same outcome that indicate treatment efficacy. PMID:12672221

  9. 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

  10. Laparoscopic Cholecystectomy in Cirrhotic Patient

    PubMed Central

    Casaccia, Marco; Mazza, Davide; Toouli, James; Laura, Vanna; Fabiani, Pascal; Mouiel, Jean

    1996-01-01

    Cholecystectomy is associated with increased risk in patients with liver cirrhosis. Moreover, cirrhosis and portal hypertension have been considered relative or absolute contraindication to laparoscopic cholecystectomy. As experience with laparoscopic cholecystectomy increased, we decided to treat cirrhotic patients via this approach. Between January 1994 and April 1995, nine patients with a Child-Pugh's stage A cirrhosis underwent elective laparoscopic cholecystectomy with intraoperative cholangiography. There was no significant per- or post-operative bleeding and no blood transfusion was necessary. There was no mortality and very low morbidity. Median hospital stay was 3 days. This series suggests that wellcompensated cirrhosis can not be considered a contraindication to laparoscopic cholecystectomy. PMID:9184860

  11. Psychotherapy of the Postdysthymic Patient

    PubMed Central

    MARKOWITZ, JOHN C.

    1993-01-01

    Many patients with dysthymia respond to antidepressant pharmacotherapy. Psychotherapy of dysthymic patients has received less study, but it may have efficacy as a primary treatment or as complement to pharmacotherapy. This preliminary report offers an impression of the value of psychotherapy for 21 dysthymic responders to antidepressant medication. Successful pharmacotherapy appeared to relieve not only depressive symptoms, but also seemingly characterological traits. Yet patients who felt better than ever before lacked social skills whose development dysthymia had retarded. Case examples illustrate the importance of psychotherapy in developing personality and fostering appropriate risk-taking. Prescription of combined pharmaco- and psychotherapy may be appropriate in dysthymia. PMID:22700139

  12. The clinician as patient advocate.

    PubMed

    Gallagher, S M

    1998-02-01

    This article presents alternative strategies to traditional methods of patient advocacy. These alternative strategies are designed to improve the quality of patient care by appealing to the clinician's sense of ethical reasoning and responsibility rather than being strictly driven by the legal system. The author appeals to the clinician to effect an organization that encourages professional debate, promotes client:clinician communication, and builds an ethical culture within the workplace. By acknowledging patient's rights, clinician's duty, and institutional responsibility, clinician's are better prepared to engage in behaviors that encourage trust and collaboration between one another and their clients.

  13. Teaching the adult ostomy patient.

    PubMed

    O'Shea, H S

    2001-01-01

    Ostomy education is based on principles of adult learning, including assessment of the learners' readiness, ability, and need to learn. Such teaching incorporates specific strategies designed to promote cognitive, affective, and psychomotor learning and strategies to overcome potential cultural barriers. In addition, modifications may be included to meet the needs of aged or disabled patients who have cognitive deficits or low literacy skills. Finally, ostomy education must include an evaluation of its effectiveness. This article reviews general guidelines for planning, implementing, and evaluating patient education for adult patients with ostomies.

  14. Hormonal changes in headache patients.

    PubMed

    Elwan, O; Abdella, M; el Bayad, A B; Hamdy, S

    1991-11-01

    Seventy-three patients with headache underwent serum and cerebrospinal fluid (CSF) radioimmunoassays of follicle-stimulating hormone (FSH), luteinizing hormone (LH), cortisol and prolactin. Serum FSH showed significant increases in all headache patients while serum LH increased only in females. Such a rise of serum FSH and LH is attributed to disturbances of the sleep-wake cycle. On the other hand, serum cortisol was significantly decreased in the male headache patients, probably due to altered circadian rhythm. Serum prolactin remained within normal limits. CSF prolactin, FSH and LH showed detectable levels in all headache sufferers compared to undetectable levels in control subjects, while CSF cortisol was significantly reduced.

  15. With patient satisfaction under increasing scrutiny, consider patient callbacks.

    PubMed

    2011-07-01

    Under the final rules for Medicare's value-based purchasing program, one-third of the funding that is set aside to reward quality will be based on how patients rate their hospital experience. However, some EDs are already working to maximize patient satisfaction by implementing programs or policies whereby patients who have been discharged are routinely called to make sure their recovery is going well, as well as to intervene if there is an opportunity for service recovery. There are benefits to having ED clinicians make the follow-up calls themselves, but some health care organizations are also reaping benefits by having non-clinicians collect feedback on individual clinicians as well as specific facilities. In addition to potentially boosting quality and customer service, experts say callbacks are useful in curbing malpractice litigation. To avoid pushback among staff, consider beginning a program of patient callbacks by asking clinicians to call back just two patients per shift worked, and to share their experiences with colleagues. For maximum value, experts recommend that patient callbacks be made within one to four days of discharge. PMID:21749006

  16. 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

  17. Low prevalence of diabetes mellitus in patients with tuberculosis in Cotonou, Benin.

    PubMed

    Ade, S; Affolabi, D; Agodokpessi, G; Wachinou, P; Faïhun, F; Toundoh, N; Békou, W; Makpenon, A; Ade, G; Anagonou, S; Harries, A D

    2015-06-21

    Cadre : Les trois Centres de Dépistage et de Traitement de la Tuberculose (TB) de Cotonou, Bénin.Objectif : Déterminer la prévalence du diabète sucré (DM) parmi les patients tuberculeux à Cotonou.Méthode : Etude transversale avec enrôlement successif de tous les patients tuberculeux traités depuis au moins 2 semaines entre juin et juillet 2014, et mesure de leur glycémie à jeun. Le diagnostic de DM était retenu sur la base d'une glycémie veineuse à jeun ⩾ 7 mmol/l ou d'un antécédent de DM rapporté par le patient.Résultat : Au total, 159 patients étaient inclus : 114 nouveaux cas de TB pulmonaire à microscopie positive, 5 nouveaux cas de TB pulmonaire à microscopie négative, 8 cas de TB extrapulmonaire, 21 cas de retraitement à germes sensibles et 11 cas de TB multirésistante. D'eux, respectivement 31 (19%), 18 (11%) et 10 (6%) étaient co-infectés, fumeurs et hypertendus. Il y avait huit patients (5%) intolérants au glucose et trois (1.9%) diabétiques, dont un nouvellement diagnostiqué.Conclusion : A Cotonou, le DM ne semble pas être un facteur de risque majeur de développement d'une TB-maladie. Une étude à l'échelle nationale s'avère nécessaire pour cerner l'ampleur de cette affection parmi les tuberculeux dans tout le pays.

  18. Use of Subjective Global Assessment, Patient-Generated Subjective Global Assessment and Nutritional Risk Screening 2002 to evaluate the nutritional status of non-critically ill patients on parenteral nutrition.

    PubMed

    Badia-Tahull, M B; Cobo-Sacristán, S; Leiva-Badosa, E; Miquel-Zurita, M E; Méndez-Cabalerio, N; Jódar-Masanés, R; Llop-Talaverón, J

    2014-02-01

    Objetivo: Evaluar el estado nutricional de pacientes no críticos de cirugía digestiva, en el momento de iniciar la nutrición parenteral, utilizando tres tests de evaluación nutricional. Estudiar la correlación entre los tests y su asociación con los parámetros clínicos y de laboratorio utilizados para el seguimiento de estos pacientes. Métodos: Estudio prospectivo de 4 meses. Se recogen variables antropométricas y clínicas. Los resultados de Subjective Global Assessment, Patient-Generated Subjective Global Assessment y Nutritional Risk Screening 2002 se comparan mediante test kappa. La relación entre las variables clínicas y de laboratorio con Subjective Global Assessment se estudian con regresión multinominal; y con Patient-Generated Subjective Global Assessment y Nutritional Risk Screening mediante regresión lineal múltiple. Edad y sexo se introdujeron como variables de ajuste. Resultados: La desnutrición en 45 pacientes estudiados variaba entre el 51% y el 57%. Subjective Global Assessment correlacionaba bien con Patient-Generated Subjective Global Assessment y el Nutritional Risk Screening (= 0,531 p = 0,000). Nutritional Risk Screening 2002 mostró mejor asociación con variables clínicas y analíticas: peor estado nutricional en este test se asoció con peor comportamiento de albúmina (B = -0,087; CI = -0,169/-0,005]); prealbumina (B = -0,005; CI = [-0,011/ 0,001]), proteína C reactiva (B = 0,006;CI = [0,001/0,011]) y leucocitos (B = 0,134; CI = [0,031/0,237]) al final de la nutrición parenteral. Discusión: La mitad de los pacientes de cirugía digestiva presentan algún grado de desnutrición en el momento de iniciar la nutrición parenteral. El Nutritional Risk Screening 2002 se mostró como el test con mayor relación con las variables utilizadas en el seguimiento clínico de los pacientes con nutrición parenteral.

  19. Physicians Asking Patients About Guns: Promoting Patient Safety, Respecting Patient Rights.

    PubMed

    Parent, Brendan

    2016-10-01

    Recent debate on whether physicians should discuss gun ownership with their patients has centered on determining whether gun injuries are an issue of health or safety, and on protecting patient privacy. Yet, physicians' duties span personal health, public health, and safety spheres, and they often must address private patient matters. To prioritize gun safety and reduce gun injuries, the primary policy-driving question should be: will physician counseling on gun ownership effectively reduce gun-related injuries without interfering with the physician's other treatment obligations or compromising the physician-patient relationship? Existing data on physician-initiated conversations with patients about guns support a positive prevention effect. However, it is critical that physician-initiated discussions of safe gun practices are not motivated by, nor convey, disapproval of gun ownership. To be ethical, respectful, and efficient, the conversation should be standard between primary care providers and all of their patients (not limited to patient subsets); questions and education should be limited to topics of gun-ownership risks and storage practices; and the conversation must be framed without bias against gun ownership. PMID:27206538

  20. 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

  1. 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.

  2. Physicians Asking Patients About Guns: Promoting Patient Safety, Respecting Patient Rights.

    PubMed

    Parent, Brendan

    2016-10-01

    Recent debate on whether physicians should discuss gun ownership with their patients has centered on determining whether gun injuries are an issue of health or safety, and on protecting patient privacy. Yet, physicians' duties span personal health, public health, and safety spheres, and they often must address private patient matters. To prioritize gun safety and reduce gun injuries, the primary policy-driving question should be: will physician counseling on gun ownership effectively reduce gun-related injuries without interfering with the physician's other treatment obligations or compromising the physician-patient relationship? Existing data on physician-initiated conversations with patients about guns support a positive prevention effect. However, it is critical that physician-initiated discussions of safe gun practices are not motivated by, nor convey, disapproval of gun ownership. To be ethical, respectful, and efficient, the conversation should be standard between primary care providers and all of their patients (not limited to patient subsets); questions and education should be limited to topics of gun-ownership risks and storage practices; and the conversation must be framed without bias against gun ownership.

  3. [Shockwave lithotripsy in sialolithiasis patients].

    PubMed

    Abdusalamov, M R; Afanas'ev, V V; Gamataev, I I

    2014-01-01

    Shockwave lithotripsy was performed by various appliances in sialolithiasis patients. The best results were obtained by means of miniature appliances. Lithotripsy proved to be useful safe alternative for sialolithiasis treatment.

  4. Implant rehabilitation in bruxism patient.

    PubMed

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

    2014-06-06

    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.

  5. Implant rehabilitation in bruxism patient.

    PubMed

    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

  6. 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

  7. Paraneoplastic disorders in thymoma patients

    PubMed Central

    Lancaster, Eric; Evoli, Amelia

    2014-01-01

    Thymic malignancy is often associated with paraneoplastic neurological diseases (PNDs) and recognition of these disorders is important for physicians who treat these patients. The most common thymoma-associated PNDs are myasthenia gravis, acquired neuromyotonia (Isaacs' syndrome), encephalitis, Morvan's syndrome, and myositis. Diagnosis of these disorders is complex but often aided by testing for specific autoantibodies, including those to the acetylcholine receptor (AChR) for myasthenia gravis and to Caspr2, protein of the voltage-gated potassium channel (VGKC) complex, in patients with acquired neuromyotonia, Morvan's syndrome, or encephalitis. Patients who manifest these disorders should be screened for thymoma at diagnosis, and worsening of these PNDs may be associated with recurrent thymoma. These disorders can cause profound disability but usually respond to immunotherapy, and often improve with thymoma treatment. Close cooperation among a team of specialists is required to properly care for these patients. PMID:25396312

  8. [Social adaptation of epileptic patients].

    PubMed

    Boldyrev, A I

    1983-01-01

    A comparative analysis of the changes seen in the field of social adaptation of epileptics over the last 21 years disclosed an increase in occupational adaptation of such patients in conditions of common production. Thus, judging by the number of epileptic patients registered in the outpatient psychoneurologic centers in 1958, 1970 and 1979, there has been a 8.8%-increase in the proportion of those being employed. Among the patients who work as office employees, some 45% are engaged in occupations requiring a definite unimpaired developmental and intellectual level. 80% of the affected children attend nonspecialized schools. All this necessitates the reviewing of the current concepts about the severity, course, and prognosis of epilepsy. A joint impact of biological and social factors is shown to be important in the occupational adaptation of patients. Considerable attention is given to the role of environmental, including psychogenic factors in the formation of secondary neurotic and psychic disorders. PMID:6880517

  9. Pineal Calcification Among Black Patients

    PubMed Central

    Fan, Kuang-Jaw

    1983-01-01

    A postmortem histopathological study was done in 233 pineal glands of black patients. Among them, 70 percent showed microscopic evidence of calcification in the pineal parenchyma. The frequency of calcification increased with age. However, the severity of calcification reached the peak in the 60 to 69 year old age group and then gradually declined. As compared to males, females had slightly higher frequency and reached the peak of severity in younger age groups. When pineal calcification was compared among patients with various malignancies, a higher frequency and more severe calcification were observed in patients with carcinoma of the prostate and the pancreas. A lower frequency and less severe calcification were observed in patients with carcinoma of the breast and the cervix. The results of this study emphasize the important role of sex hormone in genesis of pineal calcification. PMID:6631985

  10. Turning patients over in bed

    MedlinePlus

    ... one foot ahead of the other, shift your weight to your front foot as you gently pull the patient's shoulder toward you. Then shift your weight to your back foot as you gently pull the person's ...

  11. Choosing effective patient education materials

    MedlinePlus

    ... varies from person to person. Using a mixed media approach often works best. Keep your assessment of the patient in mind. Consider factors such as literacy and culture as you develop a plan. Avoid ...

  12. 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

  13. Pineal calcification among black patients.

    PubMed

    Fan, K J

    1983-08-01

    A postmortem histopathological study was done in 233 pineal glands of black patients. Among them, 70 percent showed microscopic evidence of calcification in the pineal parenchyma. The frequency of calcification increased with age. However, the severity of calcification reached the peak in the 60 to 69 year old age group and then gradually declined. As compared to males, females had slightly higher frequency and reached the peak of severity in younger age groups. When pineal calcification was compared among patients with various malignancies, a higher frequency and more severe calcification were observed in patients with carcinoma of the prostate and the pancreas. A lower frequency and less severe calcification were observed in patients with carcinoma of the breast and the cervix. The results of this study emphasize the important role of sex hormone in genesis of pineal calcification.

  14. Bathing a patient in bed

    MedlinePlus

    Bed bath; Sponge bath ... Some patients cannot safely leave their beds to bathe. For these people, daily bed baths can help keep their skin healthy, control odor, and increase comfort. If moving the ...

  15. Fluconazole Pharmacokinetics in Burn Patients

    PubMed Central

    Boucher, Bradley A.; King, Stephen R.; Wandschneider, Heidi L.; Hickerson, William L.; Hanes, Scott D.; Herring, Vanessa L.; Canada, Todd W.; Hess, Mary M.

    1998-01-01

    The pharmacokinetics of fluconazole in nine adult patients with severe (30 to 95% total body surface area) burns were studied. There was no significant difference in half-life (t1/2), clearance (CL), or volume of distribution (V) over time in five patients on days 3 and 8 of the study (P > 0.05). Combined parameter estimates (means ± standard deviations) for all nine patients for the two study periods were as follows: t1/2, 24.4 ± 5.8 h; CL, 0.36 ± 0.09 ml/min/kg; and V, 0.72 ± 0.12 liters/kg. These estimates of t1/2 and CL in burn patients were approximately 13% shorter and 30% more rapid, respectively, than the most extreme estimates reported for other populations. PMID:9559811

  16. Characterizing depression in borderline patients.

    PubMed

    Soloff, P H; George, A; Nathan, R S; Schulz, P M

    1987-04-01

    The comorbidity of depression and borderline disorder was studied in 39 symptomatic borderline inpatients defined by the Diagnostic Interview for Borderlines using three independent methods for assessing depression and three definitions of depression. Evaluations were conducted by the Schedule for Affective Disorders and Schizophrenia interviews for Research Diagnostic Criteria (RDC) depressive disorders, by clinical ratings for atypical depressive disorder, and by self-rated questionnaires for hysteroid dysphoria. Diagnoses of an RDC depression were made in 25 (64.1%), atypical depressive disorder in 16 (41%), and hysteroid dysphoria in 25 (64.1%) of the borderline patients. Two depressive diagnoses were present in 64.1% of patients, while 17.9% of patients met criteria for all three depressive disorders. No one method accurately characterized depression in borderline patients.

  17. [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

  18. Representing the patient in data

    NASA Astrophysics Data System (ADS)

    Hoffman, Kenneth J.

    1996-02-01

    In today's world, medical information on patients is usually recorded by a variety of health care providers who write their thoughts either on paper or in a word processing program. Telemedicine and other high technology initiatives add to the existing information database. However, most stored data are not easily linked. This makes it difficult to do process evaluations and nearly impossible to determine treatment effectiveness. Any aggregate data analysis must rely on the very few standardized patient data points that may include some demographic information, diagnosis and codable procedures. This paper demonstrates the utility of business process reengineering techniques using Integrated Computer Assisted Manufacturing Definition modeling to create a data model in which patient information is used to build an analyzable database. This provides the infrastructure in which to store all patient data.

  19. 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 ...

  20. Vaccines for Patients with COPD.

    PubMed

    Moreno, Dolores; Barroso, Judith; Garcia, Alexis

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic obstruction of lung airflow limitation. This disease is currently the fourth higher cause of death in the world, and it is predicted to be the third by the year 2020. Patients with COPD are frequently exposed to Human Rhinovirus, Respiratory Syncytial and Influenza Virus, as well as to Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. These infectious agents are responsible for exacerbations increasing morbidity and mortality in COPD patients. Prevention of infectious exacerbations by vaccination would improve quality of life and patient survival. A literature search: "vaccination of COPD patients" was performed using Medline, the Cochrane Library and other Non-Indexed Citations for this review. This article presents a brief overview of the different studies found, on the new patents, and the future strategies on the field.

  1. 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.

  2. Connecting Patients With Specialty Products

    PubMed Central

    MCCAIN, JACK

    2012-01-01

    Previously, this series described distribution channels through which specialty drugs move to patients. This installment discusses changes and challenges that lie ahead, especially at the dispensing end. PMID:23091429

  3. [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

  4. Good customer service for patients.

    PubMed

    Foster, Sam

    2016-08-11

    Sam Foster, Chief Nurse at Heart of England NHS Foundation Trust, looks at what the NHS can learn about good customer service from the private sector, and how Always Events can improve patient care. PMID:27523767

  5. Infective endocarditis in elderly patients.

    PubMed

    Dhawan, Vinod K

    2002-03-15

    Infective endocarditis (IE) in elderly patients presents a unique diagnostic and therapeutic challenge. Atypical presentations frequently lead to delayed diagnosis and poor outcome. IE in elderly persons is somewhat more common among men. Underlying degenerative valvular disease, mitral valve prolapse, and the presence of a prosthetic valve are important risk factors predisposing elderly persons to IE. Streptococci and staphylococci are the predominant organisms, which are recovered from approximately 80% of elderly patients with IE. In older patients, IE occurs somewhat more frequently on the mitral valve than it does on the aortic valve. The presence of calcific valvular lesions and the prosthetic valves often confound the echocardiographic findings in elderly patients. A high index of suspicion and an aggressive diagnostic approach are required to ensure timely diagnosis and appropriate therapy.

  6. Patient-specific surgical simulation.

    PubMed

    Soler, Luc; Marescaux, Jacques

    2008-02-01

    Technological innovations of the twentieth century have provided medicine and surgery with new tools for education and therapy definition. Thus, by combining Medical Imaging and Virtual Reality, patient-specific applications providing preoperative surgical simulation have become possible.

  7. Patient-empowerment interactive technologies.

    PubMed

    Bruggers, Carol S; Altizer, Roger A; Kessler, Robert R; Caldwell, Craig B; Coppersmith, Kurt; Warner, Laura; Davies, Brandon; Paterson, Wade; Wilcken, Jordan; D'Ambrosio, Troy A; German, Massiell L; Hanson, Glen R; Gershan, Lynn A; Korenberg, Julie R; Bulaj, Grzegorz

    2012-09-19

    Video games capture the rapt attention of an individual player's mind and body, providing new opportunities for personalized health care. An example of therapeutic interactive technologies is an incentive-based video game that translates physical exercise into mental empowerment via motivational metaphoric visualization in order to help patients psychologically overcome cancer. Such nonpharmacological interventions may enhance patients' resilience toward various chronic disorders via neuronal mechanisms that activate positive emotions and the reward system.

  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. Hyperamylasemia in critically injured patients.

    PubMed

    Takahashi, M; Maemura, K; Sawada, Y; Yoshioka, T; Sugimoto, T

    1980-11-01

    We found that in traumatic shock patients without pancreatic injury, hyperamylasemia occurs in high frequency [49 of 61 (80%)]. Isoenzyme studies of 19 of these patients revealed 18 of them (94%) to have the salivary type of hyperamylasemia. Further, based on the results of the present study, the salivary gland as the organ of origin and the permeability of its cell membranes are suggested as the mechanism for traumatic hyperamylasemia.

  10. 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

  11. Pharmacometrics: Focus on the Patient

    PubMed Central

    Dumitrescu, T Pene; Fossler, MJ; Schmith, VD

    2015-01-01

    Pharmacometrics, whether using simple or complex models, has contributed to rational and efficient drug development,1–3 with the main focus on early drug development.4 This article describes why opportunities more directly focused on the patient abound in late stage development, illustrating the concept with three innovative examples which focus on benefits to patients, enabling drugs that are truly efficacious to reach the market faster in diseases with high unmet medical needs, while maintaining adequate safety. PMID:26225220

  12. 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

  13. Foldable Denture: For Microstomia Patient

    PubMed Central

    Kumar, Sandeep; Arora, Aman; Yadav, Reena

    2012-01-01

    Microstomia may result from surgical treatment of orofacial neoplasms, cleft lips, maxillofacial trauma, burns, radiotherapy, or scleroderma. A maximal oral opening that is smaller than the size of a complete denture can make prosthetic treatment challenging. This clinical paper presents the prosthodontic management of a total edentulous patient with microstomia. Sectional mandibular and maxillary trays and foldable mandibular and maxillary denture were fabricated for the total edentulous patient. PMID:22957279

  14. 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.

  15. 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

  16. 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

  17. 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

  18. Establishing an active patient partnership.

    PubMed

    Herrier, R N; Boyce, R W

    1995-04-01

    Pharmacists face many changes in the coming decade, some of which threaten their professional survival. Although uncertainty may currently prevail, one of these changes, the shift in the patient-health care professional relationship from the patient taking a passive role to an active partnering role, provides pharmacists with many opportunities to realize the vision of patient-centered care that has been advocated by pharmacy innovators and leaders for almost three decades. To take advantage of these changes, pharmacists must modify their practice paradigms and use their existing strengths, such as easy patient access and high levels of patient trust, to help develop a new model of pharmaceutical care. The concern that the magnitude of these changes will prevent successful practice transformations may be exaggerated. In reality, these proposed "new" roles have been in existence for much of this century. Most pharmacists can expand and enhance their traditional roles as self-care advisors and patient educators simply by incremental improvements in interpersonal and clinical skills. Rather than a Star Trek approach to "go where no man has gone before," the profession needs only a pharmaceutical sequel to Back to the Future.

  19. 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

  20. Difficult physician-patient relationships.

    PubMed

    Reifsteck, S W

    1998-01-01

    Changes in the delivery of health care services in the United States are proceeding so rapidly that many providers are asking how the working relationships between doctors and patients will be effected. Accelerated by cost containment, quality improvement and the growth of managed care, these changes have caused some critics to feel that shorter visits and gatekeeper systems will promote an adversarial relationship between physicians and patients. However, proponents of the changing system feel that better prevention, follow-up care and the attention to customer service these plans can offer will lead to increased patient satisfaction and improved doctor-patient communication. Dedicated to addressing these concerns, the Bayer Institute for Health Care Communication was established in 1987 as a continuing medical education program (CME) focusing on this topic. A half-day workshop on clinician-patient communication to enhance health outcomes was introduced in 1992 and a second workshop, "Difficult' Clinician-Patient Relationships," was developed two years later. The two courses discussed in this article are offered to all physicians, residents, medical students, mid-level providers and other interested staff within the Carle system. PMID:10186308

  1. [Pain Management in geriatric patients].

    PubMed

    Eiche, Jürgen; Schache, Florian

    2016-04-01

    Pains belong to the most frequent reasons for a doctor's visit. In elderly people, it is the result of progressive degenerative processes (e. g. , arthrosis, Osteoarthritis, degenerative spinal changes) and a higher prevalence of cancer disease to a further increase of the patients who suffer unnecessarily from pains. By the increasing polymorbidity (e.g. diabetes mellitus, vascular disease) and a declining immune competence, the prevalence of polyneuropathy and post-herpetic neuralgia rises. Insufficiently treated chronic or periodically returning pain can lead to serious interferences of the physical, cognitive and social everyday competence and therefore to a limited quality of life. These facts shows the relevance of a sufficient pain therapy in geriatric patients. Nevertheless, on account of existing comorbidity, polypharmacy as well as of impaired organ function, the pharmacological pain therapy in old patients also poses a potential hazard. Although pain prevalence is higher with geriatric than with younger patients, significantly less analgesics are prescribed in the elderly population. This results from existing uncertainties at the treating doctors as well as the complicated pain capture, in particular with cognitive affected patients. The present article should indicate options of treatment for geriatric pain patients. PMID:27123730

  2. 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

  3. 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.

  4. Clinical management of patients with hyperthyroidism

    SciTech Connect

    Cooper, D.S.; Ridgway, E.C.

    1985-09-01

    The clinical management of the hyperthyroid patient is controversial, because there is no perfect treatment. Factors that influence the choice of therapy include the patient's age, sex, and type of hyperthyroidism, as well as patient and physician preference.

  5. 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 ...

  6. Pulling a patient up in bed

    MedlinePlus

    Moving a patient in bed ... You must move or pull someone up in bed the right way to avoid injuring the patient's ... people to safely move a patient up in bed. Friction from rubbing can scrape or tear the ...

  7. How patient and staff experiences affect outcomes.

    PubMed

    Churchill, Neil; Warden, Ruth

    Exploring patient and staff experiences is a new discipline but is providing key insights into the quality of care patients receive. This article explores how patient and staff experiences are measured and how this information is used to change practice.

  8. 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

  9. Supporting patient autonomy: the importance of clinician-patient relationships.

    PubMed

    Entwistle, Vikki A; Carter, Stacy M; Cribb, Alan; McCaffery, Kirsten

    2010-07-01

    Personal autonomy is widely valued. Recognition of its vulnerability in health care contexts led to the inclusion of respect for autonomy as a key concern in biomedical ethics. The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. In this paper, we suggest that a strong focus on decision situations is problematic, especially when combined with a tendency to stress the importance of patients' independence in choosing. It distracts attention from other important aspects of and challenges to autonomy in health care. Relational understandings of autonomy attempt to explain both the positive and negative implications of social relationships for individuals' autonomy. They suggest that many health care practices can affect autonomy by virtue of their effects not only on patients' treatment preferences and choices, but also on their self-identities, self-evaluations and capabilities for autonomy. Relational understandings de-emphasise independence and facilitate well-nuanced distinctions between forms of clinical communication that support and that undermine patients' autonomy. These understandings support recognition of the value of good patient-professional relationships and can enrich the specification of the principle of respect for autonomy. PMID:20213206

  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. 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

  12. 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

  13. Mycoses in the transplanted patient.

    PubMed

    Dictar, M O; Maiolo, E; Alexander, B; Jacob, N; Verón, M T

    2000-01-01

    The incidence of invasive fungal infection (IFI) has increased considerably over the past 20 years, and transplant recipients are at especially high risk for fungal infections owing to their overall immunosuppressed condition. Organ transplantation procedures were incorporated as a therapeutic option for many patients who lacked the normal functions of organs such as the heart, liver, kidney, lung, pancreas and small bowel. The prevalence of IFI in solid organ transplant (SOTR) patients ranges from 5 to 50% in kidney and liver transplants, respectively. In bone marrow transplant (BMT) patients, IFI are major causes of morbidity and mortality due to the protracted neutropenic period and graft-versus-host disease. Candida spp. and Aspergillus spp. account for >80% of fungal episodes in both SOTR and BMT. The development of new immunosuppressive agents, new prophylaxis strategies (as pre-emptive therapy) and the improvement in surgical techniques led to increase survival of transplant recipients. In this session, a clear and concise update of the recent advances in the laboratory diagnosis of candidiasis and aspergillosis in this kind of patients was presented. However, we still need to establish more rapid, sensitive and specific methods for IFI diagnosis. Representatives of the 'Subcomision de Infecciones en el Paciente Neutropenico y Transplantado (SIPNYT)' de la Sociedad Argentina de Infectologia (SADI), presented the results of an unusual multicenter study both retrospective and descriptive studies of IFI in SOTR and BMT patients in Argentina. In addition, a study of IFI in 1,861 SOTR patients from four centers and the analysis of IFI in 2,066 BMT patients from all 12 BMT centers from Argentina was presented. From these studies it can be concluded that 'all transplant recipients are not the same' and that they should be stratified according to their different risk degrees in order to determine the best prophylaxis and treatment strategies.

  14. 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

  15. Visuomotor learning in cerebellar patients.

    PubMed

    Timmann, D; Shimansky, Y; Larson, P S; Wunderlich, D A; Stelmach, G E; Bloedel, J R

    1996-11-01

    The aim of the present study was to demonstrate that patients with pathology affecting substantial regions of the cerebellum can improve their performance in a series of two-dimensional tracing tasks, thus supporting the view that this type of motor behavior can be acquired even when the integrity of this structure is compromised. Eight patients with chronic, isolated cerebellar lesions and eight age- and sex-matched healthy controls were tested. Three patients had mild, five had moderate upper limb ataxia. The experiment was divided into two parts. In the first, subjects traced an irregularly shaped outline over 20 consecutive trials ('Trace 1' task). Next, subjects were asked to redraw the object without any underlying template as a guide ('Memory 1' task). In the second part of the study, subjects were asked to trace a different, irregularly shaped outline over 20 consecutive trials ('Trace 2' task). Next, they were required to redraw it by memory with its axis rotated 90 degrees ('Memory 2' task). In each of the memory tasks the template was placed over the drawn image after each trial and shown to the subjects. The error of performance was determined by calculating three different measurements, each focused on different aspects of the task. Based on these measurements, the cerebellar patients showed improvement in both memory tasks. In the 'Memory 1' task the calculated error decreased significantly for the patients with mild ataxia. In the 'Memory 2' task all cerebellar patients improved their performance substantially enough to reduce significantly the magnitude of all three error measurements. The experiments demonstrate that patients with cerebellar lesions are capable of improving substantially their performance of a complex motor task involving the recall of memorized shapes and the visuomotor control of a tracing movement.

  16. 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

  17. Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert(®) MTB/RIF in Zimbabwe.

    PubMed

    Charambira, K; Ade, S; Harries, A D; Ncube, R T; Zishiri, C; Sandy, C; Mutunzi, H; Takarinda, K; Owiti, P; Mafaune, P; Chonzi, P

    2016-06-21

    Contexte : Au Zimbabwe, la prise en charge des patients tuberculeux ayant une résistance à la rifampicine (RMP) diagnostiqués par Xpert(®) MTB/RIF est préoccupante.Objectif : Evaluer les liens entre le diagnostic et le traitement de ces patients dans les provinces de Harare et de Manicaland en 2014.Schéma : Etude rétrospective de cohorte.Résultats : Sur 20 329 tests Xpert, 90% ont été réussis, 11% ont détecté Mycobacterium tuberculosis et 4,5% ont mis en évidence une résistance à la RMP. Il y a eu 77 patients atteints d'une tuberculose (TB) résistante à la RMP diagnostiqués par Xpert. Parmi eux, 70% ont bénéficié d'un envoi d'échantillon au laboratoire de référence pour une culture et un test de pharmacosensibilité (CDST) ; pour 53% d'entre eux, les échantillons sont arrivés à bon port ; pour 21%, les échantillons ont mis en évidence une croissance de M. tuberculosis ; et chez 17%, les résultats du CDST ont été enregistrés et tous ont confirmé la résistance à la RMP. Sur 77 patients, 34 (44%) n'ont jamais mis en route un traitement pour le TB multirésistante (TB-MDR) ; les motifs documentés étaient le décès, la perte de vue ou un traitement incorrect. Des 43 patients qui ont débuté le traitement de TB-MDR, 12 (71%) à Harare et 17 (65%) au Manicaland ont commencé dans les 2 semaines suivant le diagnostic.Conclusion : L'Xpert a été lancé avec succès dans deux provinces du Zimbabwe. Cependant, le processus de confirmation du CDST pour une TB résistante à la RMP diagnostiquée par Xpert ne fonctionne pas bien, et de nombreux patients sont soit traités avec retard, soit ne démarrent jamais le traitement de TB-MDR. Ces problèmes doivent être examinés par le programme.

  18. 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 ...

  19. 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

  20. 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

  1. Nutritional Status in Cirrhotic Patients

    PubMed Central

    TEIUSANU, Adriana; ANDREI, Mihai; ARBANAS, Tudor; NICOLAIE, Tudor; DICULESCU, Mircea

    2012-01-01

    ABSTRACT Background: Malnutrition is prevalent in all forms of liver disease: from 20% in compensated liver disease to more than 80% in those patients with decompensated liver disease. Protein-calorie malnutrition (PCM) can be identified in all clinical stages but is easier observed in advanced stages of liver disease. The presence of malnutrition is associated with increased number of complications and increased short and long term mortality. Aim: to evaluate the nutritional status using of combination of BMI (Body Mass Index), TST (triceps skinfold thickness) and MAMC (mid-arm muscle circumference). Subjective Global Assessment (SGA) of nutritional status was determined for every patient. The features of subjective global assessment are history, physical evaluation and SGA rating. Based on this evaluation, patients were classified into three groups: well, moderately malnourished and severely malnourished. Material and methods: Our study was designed as a descriptive prospective analysis of patients with cirrhosis, admitted in Elias Emergency Hospital, Gastroenterology Department, during a year, January 2010-January 2011. The diagnosis of cirrhosis was based on the medical history, physical exa­mination, biochemical findings and imagistic methods (ultrasound and / or computed tomography). A series of 176 hospitalized patients with cirrhosis, 114 (65%) male and 62 (35%) female, median age 52 (range 18-68 years). Etiology of liver disease was alcoholic in 98 (56%), hepatitis B virus in 14 (8%), HCV in 43 (24%), HBV and HDV in 10 (7%), 11 patients have other etiology. The evaluation of nutritional status was made by different methods. A detailed history was recorded with appetite, caloric intake, change in body weight. Subjective Global Assessment (SGA) of nutritional status was determined for every patient. Conclusions: Malnutrition was correlated with clinical severity of liver disease. The mild-moderate malnourished patients are 88% Child B, over 58% with viral

  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. Psychoneuroimmunology in critically ill patients.

    PubMed

    DeKeyser, Freda

    2003-02-01

    Psychoneuroimmunology is the study of the interactions among behavior, neural, and endocrine functions and the immune system. The purpose of this review is to briefly summarize the evidence concerning interactions among behavior, the neuroendocrine system, and the immune system, and to show how this evidence relates to critical care patients. It has been shown that the immune function of many patients in the intensive care unit is suppressed as a result of trauma, sepsis, or profound physiologic and psychological stress. Three of the most common stressors among patients in the intensive care unit are pain, sleep deprivation, and fear or anxiety. Findings have shown each of these stressors to be associated with decreased immune functioning. Nurses have an important responsibility to protect their patients from infection and promote their ability to heal. Several actions are suggested that can help the nurse achieve these goals. It is hoped that nurses would keep these interactions in mind while caring for their patients in the intensive care unit.

  4. Falls in elderly hemodialysis patients.

    PubMed

    Abdel-Rahman, E M; Turgut, F; Turkmen, K; Balogun, R A

    2011-10-01

    The elderly, (age ≥ 65 years) hemodialysis (HD) patient population is growing rapidly across the world. The risk of accidental falls is very high in this patient population due to multiple factors which include aging, underlying renal disease and adverse events associated with HD treatments. Falls, the most common cause of fatal injury among elderly, not only increase morbidity and mortality, but also increase costs to the health system. Prediction of falls and interventions to prevent or minimize fall risk and associated complications will be a major step in helping these patients as well as decreasing financial and social burdens. Thus, it is vital to learn how to approach this important problem. In this review, we will summarize the epidemiology, risk factors, pathophysiology and complications of falls in elderly HD patients. We will also focus on available methods to assess and predict the patients at higher risk of falling and will provide recommendations for interventions to reduce the occurrence of falls in this population.

  5. 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

  6. Creating Simulated Microgravity Patient Models

    NASA Technical Reports Server (NTRS)

    Hurst, Victor; Doerr, Harold K.; Bacal, Kira

    2004-01-01

    The Medical Operational Support Team (MOST) has been tasked by the Space and Life Sciences Directorate (SLSD) at the NASA Johnson Space Center (JSC) to integrate medical simulation into 1) medical training for ground and flight crews and into 2) evaluations of medical procedures and equipment for the International Space Station (ISS). To do this, the MOST requires patient models that represent the physiological changes observed during spaceflight. Despite the presence of physiological data collected during spaceflight, there is no defined set of parameters that illustrate or mimic a 'space normal' patient. Methods: The MOST culled space-relevant medical literature and data from clinical studies performed in microgravity environments. The areas of focus for data collection were in the fields of cardiovascular, respiratory and renal physiology. Results: The MOST developed evidence-based patient models that mimic the physiology believed to be induced by human exposure to a microgravity environment. These models have been integrated into space-relevant scenarios using a human patient simulator and ISS medical resources. Discussion: Despite the lack of a set of physiological parameters representing 'space normal,' the MOST developed space-relevant patient models that mimic microgravity-induced changes in terrestrial physiology. These models are used in clinical scenarios that will medically train flight surgeons, biomedical flight controllers (biomedical engineers; BME) and, eventually, astronaut-crew medical officers (CMO).

  7. [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

  8. [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

  9. Bedside Evaluation of Dizzy Patients

    PubMed Central

    Huh, Young-Eun

    2013-01-01

    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

  10. Doppler ultrasonography in tinnitus patients.

    PubMed

    Bertora, Guillermo O; Bergman, Julia M

    2002-01-01

    Tinnitus can be functionally measured and localized through sensorimotor and neurosensory tests. According to our Neurofisiología Otooftalmológica data bank, 60% of patients requiring a consultation have a history of cardiocirculatory disorders. This figure has moved us to study cerebrovascular processes in those patients seeking consultation for a tinnitus symptom only. The sudden appearance of the tinnitus symptom alone independent of patient age, leads us to consider a pathology of vascular origin, which should be evaluated and treated immediately. A mistake or delay in the diagnosis could cause the symptom to become chronic, owing to the appearance of microlesions at any level of the auditory pathway, as has been demonstrated in former investigations.

  11. Thromboembolism in Patients with Cancer.

    PubMed

    Büyükçelik, Abdullah; Akbulut, Hakan

    2004-03-01

    One hundred and forty years ago, Armand Trousseau described phlegmasia alba dolens as a sign of internal malignancy. Nowadays, it is commonly believed that the presence malignant tumaor increases the risk of venous thromboembolism (i.e deep vein thrombosis and pulmonary embolism) However, cancer is usually associated with other factors such as old age, extensive surgery,immobility, etc., which may predispose to thromboembolism. The majority of thrombotic events occur in the venous system; the incidence of arterial thrombosis is much lower.Recurrent thromboembolism in cancer patients frequently and diminishes the quality of life of the patients.Furthermore, if the thromboembolism is massive, destipte of early and aggressive treatment, it may result in death. In this article, we review thromboembolic complications in cancer patients.

  12. 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

  13. The patient and the NHS.

    PubMed

    Toynbee, P

    1984-06-23

    A story of a hypothetical patient demonstrates the inadequacies of the National Health Service in delivering satisfactory patient care. Problems mentioned include lack of choice and ready access to physicians, long waits for care, loss of dignity in hospitals, lack of communication by health professsionals, disregard for pain, and reductions in facilities for geriatric care. The author sees a resurgence of private practice and the establishment of a two-tier system of care if the National Health Service does not change the nature of its relationship with the patient. She also advocates a sharing of expertise between doctors and nurses, an increase in the number of community hospitals, private hospital rooms, hospice care, and a reduction in working hours for junior doctors.

  14. Antifungal Prophylaxis in Immunocompromised Patients.

    PubMed

    Vazquez, Lourdes

    2016-01-01

    Invasive fungal infections (IFIs) represent significant complications in patients with hematological malignancies. Chemoprevention of IFIs may be important in this setting, but most antifungal drugs have demonstrated poor efficacy, particularly in the prevention of invasive aspergillosis. Antifungal prophylaxis in hematological patients is currently regarded as the gold standard in situations with a high risk of infection, such as acute leukemia, myelodysplastic syndromes, and autologous or allogeneic hematopoietic stem cell transplantation. Over the years, various scientific societies have established a series of recommendations for antifungal prophylaxis based on prospective studies performed with different drugs. However, the prescription of each agent must be personalized, adapting its administration to the characteristics of individual patients and taking into account possible interactions with concomitant medication. PMID:27648203

  15. Antifungal Prophylaxis in Immunocompromised Patients

    PubMed Central

    Vazquez, Lourdes

    2016-01-01

    Invasive fungal infections (IFIs) represent significant complications in patients with hematological malignancies. Chemoprevention of IFIs may be important in this setting, but most antifungal drugs have demonstrated poor efficacy, particularly in the prevention of invasive aspergillosis. Antifungal prophylaxis in hematological patients is currently regarded as the gold standard in situations with a high risk of infection, such as acute leukemia, myelodysplastic syndromes, and autologous or allogeneic hematopoietic stem cell transplantation. Over the years, various scientific societies have established a series of recommendations for antifungal prophylaxis based on prospective studies performed with different drugs. However, the prescription of each agent must be personalized, adapting its administration to the characteristics of individual patients and taking into account possible interactions with concomitant medication.

  16. 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.

  17. Antifungal Prophylaxis in Immunocompromised Patients

    PubMed Central

    Vazquez, Lourdes

    2016-01-01

    Invasive fungal infections (IFIs) represent significant complications in patients with hematological malignancies. Chemoprevention of IFIs may be important in this setting, but most antifungal drugs have demonstrated poor efficacy, particularly in the prevention of invasive aspergillosis. Antifungal prophylaxis in hematological patients is currently regarded as the gold standard in situations with a high risk of infection, such as acute leukemia, myelodysplastic syndromes, and autologous or allogeneic hematopoietic stem cell transplantation. Over the years, various scientific societies have established a series of recommendations for antifungal prophylaxis based on prospective studies performed with different drugs. However, the prescription of each agent must be personalized, adapting its administration to the characteristics of individual patients and taking into account possible interactions with concomitant medication. PMID:27648203

  18. Dermatoglyphics in patients with schizophrenia*

    PubMed Central

    Shakibaei, Fereshteh; Asadollahi, Ghorban Ali; Tabibi, Amirpooyan

    2011-01-01

    BACKGROUND: There are controversial evidences on the association between fingerprint traits and schizophrenia. We compared fingerprint traits of patients with schizophrenia and normal individuals in Iranian population. METHODS: Finger tip dermal ridge of 290 patients with schizophrenia and 290 normal subjects were studied for four dermal traits. Data was analyzed with Pearson correlation and student's tests. RESULTS: Finger print patterns and secondary creases were not significantly different between the two groups (p > 0.05). Although mean ridge counts of left and right index fingers of the case group were greater than the control group (p < 0.05), these differences were not significant in females. CONCLUSIONS: Probably the left index ridge counts and fluctuating asymmetry in schizophrenic patients are different from those of the normal population. This difference may serve as a diagnostic biological marker for screening people susceptible to schizophrenia. Further studies are needed to determine predictive value of fingerprint trait as a biomarker for the schizophrenia. PMID:22279482

  19. 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

  20. 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

  1. 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

  2. This chronic patient becomes a humanistic patient who helps clinicians.

    PubMed

    Achenbaum, W Andrew

    2012-11-01

    A historian of aging, privileged to work with an interdisciplinary team of caregivers and researchers in a division of geriatric and palliative care of a major medical school and teaching hospital, discovers that his history of chronic illnesses secures him a useful role as a humanistic patient who helps clinicians to respond to the concerns, fears, and needs of aging Boomers.

  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. [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.

  5. [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.

  6. [Palmar dermatoglyphics of schizophrenic patients].

    PubMed

    Dvirskiĭ, A E

    1975-01-01

    The paper deals with a study of palmar dermatoglyphics in 1120 schizophrenic patients with different forms of its development. As a control group 1240 normals were studied as well. The females displayed an increased frequency of patterns Au/Ac on the hypothenar and defective patterns on the thenar. Among the males there was an increased amount of displasia, genuine and defective patterns on the thenar, of the loops in III interfinger spaces. These differences are encountered more frequently in patients with progressive forms of schizophrenia.

  7. Patients with chronic pulmonary disease.

    PubMed

    Hong, Caron M; Galvagno, Samuel M

    2013-11-01

    Chronic pulmonary disease is common among the surgical population and the importance of a thorough and detailed preoperative assessment is monumental for minimizing morbidity and mortality and reducing the risk of perioperative pulmonary complications. These comorbidities contribute to pulmonary postoperative complications, including atelectasis, pneumonia, and respiratory failure, and can predict long-term mortality. The important aspects of the preoperative assessment for patients with chronic pulmonary disease, and the value of preoperative testing and smoking cessation, are discussed. Specifically discussed are preoperative pulmonary assessment and management of patients with chronic obstructive pulmonary disease, asthma, restrictive lung disease, obstructive sleep apnea, and obesity. PMID:24182721

  8. [Serodiagnosis of patients with glomerulonephritis].

    PubMed

    Sosunov, A V; Romanova, V I; Shishkin, A N; Lisin, V V

    1990-01-01

    A comprehensive clinical and morphologic examination of 160 nephrologic inpatients included titration of antibodies to respiratory viruses and to HBsAg and of streptolysin O. A correlation was detected between immunity status parameters and the presence and severity of proteinuria in the patients with chronic glomerulonephritis. Besides routine clinical and laboratory examinations, thorough serologic and virologic studies are necessary for this patient population, for such studies will help determine the trigger mechanism of the disease and thus predict the possible development of the condition.

  9. 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

  10. What the patient should order.

    PubMed

    Kush, Rebecca Daniels

    2009-10-21

    Open global standards, workflow integration profiles, and related processes have been developed through consensus-based procedures. Although these standards and profiles should be augmented with additional therapeutic area-based content standards, they are available now to enable the use of electronic health records to directly support clinical research concurrent with patient care. Improving the exchange of information and integrating workflow between research and health care are inherently necessary to accelerate the pace of informing clinical decisions based on current research findings and for an efficient, cost-effective health care system to improve the quality of patient care. PMID:20368165

  11. Nutritional support of reptile patients.

    PubMed

    De Voe, Ryan S

    2014-05-01

    Providing nutritional support to reptile patients is a challenging and often misunderstood task. Ill reptiles are frequently anorexic and can benefit greatly from appropriate nutrition delivered via a variety of assist-feeding techniques. Neonatal reptiles can also be very challenging patients because many fail to thrive without significant efforts to establish normal feeding behaviors. This article presents ideas supporting the benefit of timely nutritional support as well as specific recommendations for implementation of assist feeding. Also discussed are a few nutritional issues that affect captive reptile species.

  12. 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.

  13. 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

  14. Mucosal barrier injury, fever and infection in neutropenic patients with cancer: introducing the paradigm febrile mucositis.

    PubMed

    van der Velden, Walter J F M; Herbers, Alexandra H E; Netea, Mihai G; Blijlevens, Nicole M A

    2014-11-01

    Infection remains one of the most prominent complications after cytotoxic treatment for cancer. The connection between neutropenia and both infections and fever has long been designated as 'febrile neutropenia', but treatment with antimicrobial agents and haematopoietic growth factors has failed to significantly reduce its incidence. Moreover, emerging antimicrobial resistance is becoming a concern that necessitates the judicious use of available antimicrobial agents. In addition to neutropenia, patients who receive cytotoxic therapy experience mucosal barrier injury (MBI) or 'mucositis'. MBI creates a port-de-entrée for resident micro-organisms to cause blood stream infections and contributes directly to the occurrence of fever by disrupting the highly regulated host-microbe interactions, which, even in the absence of an infection, can result in strong inflammatory reactions. Indeed, MBI has been shown to be a pivotal factor in the occurrence of inflammatory complications after cytotoxic therapy. Hence, the concept 'febrile neutropenia' alone may no longer suffice and a new concept 'febrile mucositis' should be recognized as the two are at least complementary. This review we summarizes the existing evidence for both paradigms and proposes new therapeutic approaches to tackle the perturbed host-microbe interactions arising from cytotoxic therapy-induced tissue damage in order to reduce fever in neutropenic patients with cancer.

  15. [Electronic patient record as the tool for better patient safety].

    PubMed

    Schneider, Henning

    2015-01-01

    Recent studies indicate again that there is a deficit in the use of electronic health records (EHR) in German hospitals. Despite good arguments in favour of their use, such as the rapid availability of data, German hospitals shy away from a wider implementation. The reason is the high cost of installing and maintaining the EHRs, for the benefit is difficult to evaluate in monetary terms for the hospital. Even if a benefit can be shown it is not necessarily evident within the hospital, but manifests itself only in the health system outside. Many hospitals only manage to partly implement EHR resulting in increased documentation requirements which reverse their positive effect.In the United States, electronic medical records are also viewed in light of their positive impact on patient safety. In particular, electronic medication systems prove the benefits they can provide in the context of patient safety. As a result, financing systems have been created to promote the digitalisation of hospitals in the United States. This has led to a large increase in the use of IT systems in the United States in recent years. The Universitätsklinikum Eppendorf (UKE) introduced electronic patient records in 2009. The benefits, in particular as regards patient safety, are numerous and there are many examples to illustrate this position. These positive results are intended to demonstrate the important role EHR play in hospitals. A financing system of the ailing IT landscape based on the American model is urgently needed to benefit-especially in terms of patient safety-from electronic medical records in the hospital. PMID:25475524

  16. Serum Potassium Levels Inversely Correlate with D-Dimer In Patients with Acute-Onset Atrial Fibrillation.

    PubMed

    Cervellin, Gianfranco; Bonfanti, Laura; Picanza, Alessandra; Lippi, Giuseppe

    2014-12-09

    Background: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. Objective: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). Methods: To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Results: Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = -0.21; p < 0.001), even after adjustments for age and sex (beta coefficient -94.8; p = 0.001). The relative risk for a positive D-dimer value attributed to hypokalemia was 1.64 (95% CI, 1.02 to 2.63; p = 0.040). The correlation remained statistically significant in patients free from antihypertensive drugs (r = -0.25; p = 0.018), but not in those taking angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, or diuretics. Conclusions: The inverse correlation between values of potassium and D-dimer in patients with AAF provides important and complementary information about the thromboembolic risk of these patients.Fundamento: Valores de

  17. Serum Potassium Levels Inversely Correlate with D-Dimer In Patients with Acute-Onset Atrial Fibrillation.

    PubMed

    Cervellin, Gianfranco; Bonfanti, Laura; Picanza, Alessandra; Lippi, Giuseppe

    2014-12-01

    Background: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. Objective: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). Methods: To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Results: Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = -0.21; p < 0.001), even after adjustments for age and sex (beta coefficient -94.8; p = 0.001). The relative risk for a positive D-dimer value attributed to hypokalemia was 1.64 (95% CI, 1.02 to 2.63; p = 0.040). The correlation remained statistically significant in patients free from antihypertensive drugs (r = -0.25; p = 0.018), but not in those taking angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, or diuretics. Conclusions: The inverse correlation between values of potassium and D-dimer in patients with AAF provides important and complementary information about the thromboembolic risk of these patients.Fundamento: Valores de

  18. 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

  19. Why patients should keep their own records.

    PubMed

    Coleman, V

    1984-03-01

    Too many people now have access to confidential medical information. Patients are becoming justifiably wary and the doctor-patient relationship is deteriorating. We can avert the developing crisis by allowing patients to keep their own medical records at home. This will ensure that confidentiality is respected and that patients continue to trust their doctors.

  20. Thallium-201 stress imaging in hypertensive patients

    SciTech Connect

    Schulman, D.S.; Francis, C.K.; Black, H.R.; Wackers, F.J.

    1987-07-01

    To assess the potential effect of hypertension on the results of thallium-201 stress imaging in patients with chest pain, 272 thallium-201 stress tests performed in 133 hypertensive patients and 139 normotensive patients over a 1-year period were reviewed. Normotensive and hypertensive patients were similar in age, gender distribution, prevalence of cardiac risk factors (tobacco smoking, hyperlipidemia, and diabetes mellitus), medications, and clinical symptoms of coronary disease. Electrocardiographic criteria for left ventricular hypertrophy were present in 16 hypertensive patients. Stepwise probability analysis was used to determine the likelihood of coronary artery disease for each patient. In patients with mid to high likelihood of coronary disease (greater than 25% probability), abnormal thallium-201 stress images were present in 54 of 60 (90%) hypertensive patients compared with 51 of 64 (80%) normotensive patients. However, in 73 patients with a low likelihood of coronary disease (less than or equal to 25% probability), abnormal thallium-201 stress images were present in 21 patients (29%) of the hypertensive group compared with only 5 of 75 (7%) of the normotensive patients (p less than 0.001). These findings suggest that in patients with a mid to high likelihood of coronary artery disease, coexistent hypertension does not affect the results of thallium-201 exercise stress testing. However, in patients with a low likelihood of coronary artery disease, abnormal thallium-201 stress images are obtained more frequently in hypertensive patients than in normotensive patients.

  1. 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…

  2. Determinants of Compliance among Pediatric Amblyopia Patients.

    ERIC Educational Resources Information Center

    Wolff, Hans; Juhasz, Anne McCreary

    Given the recent focus on patient responsibility for health status and improvement, it is important to understand the dynamics involved in patient compliance to treatment regimens. The determinants of patching compliance among 30 pediatric amblyopia patients and their parents were investigated by means of parent, patient, and physician…

  3. The Use of Patients as Student Evaluators.

    ERIC Educational Resources Information Center

    Henkin, Yaakov; And Others

    1991-01-01

    A comparison of patient (n=181) and tutor (n=31) evaluations of medical student (n=41) behavior in an internal medicine clerkship revealed difficulties with patient evaluation of students. The process is time consuming and introduces tension between students and patients, and patients are poor discriminators. (Author/MSE)

  4. 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.

  5. Voluntary and involuntary treatment of aggressive patients.

    PubMed

    Madden, D J

    1977-05-01

    The author describes his experiences in treating violent patients in group therapy. Problems include the divergent goals of therapist, patient, and society; the environmental limitations on incarcerated patients; countertransference issues; and magical expectations on the part of patients. Therapeutic goals must be somewhat limited with patients who are forced into therapy. It may be dangerous to "open up" such patients, especially when they face lengthy prison terms. The author suggests that distancing tactics be avoided with violent patients, who need to encounter another person who has dealt successfully with hatred, fear, and limitations.

  6. 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

  7. 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

  8. [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).

  9. 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.

  10. A Patient Representative Inservice Journal.

    ERIC Educational Resources Information Center

    Garrison, Shirley; And Others

    This inservice journal is a diary of the inservice programs that were held in 1982-1983 for volunteers and paid staff working in the patient relations department at Highland Park Hospital in Highland Park, Illinois. The first section of the journal contains a list of the purposes of inservice education. Summarized next are individual inservice…

  11. Pain in the cancer patient.

    PubMed

    Ho, R C

    1994-01-01

    In summary, the ACS has acknowledged the magnitude and severity of the cancer pain problem nationally and recognized that cancer pain can be relieved. It has identified cancer pain control as a priority and has devised programs that emphasize the importance of pain assessment, recognize the availability of pain relief programs, and encourage treatment to achieve optimum pain relief for the cancer patient.

  12. [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.

  13. [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

  14. 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)

  15. [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

  16. Transferrin changes in haemodialysed patients.

    PubMed

    Formanowicz, Dorota; Formanowicz, Piotr

    2012-06-01

    Transferrin (Tf) is a glycoprotein responsible for iron transport in the human body. Physiologically in reaction with Concanavalin A, Tf occurs in four distinct variants Tf1, Tf2, Tf3 (apo-Tf) and Tf4. It was reported recently that Tf is changing, particularly during acute phase response, taking place among others in end-stage renal disease. In this study, we wanted to find the answer to three main questions: firstly, how Tf is changing in patients treated with maintenance haemodialysis (mHD), secondly, whether there are any Tf changes in the course of mHD treatment, and thirdly, what factors can affect Tf microheterogeneity in these patients. Studies were performed on 80 haemodialysed patients and 21 healthy volunteers. The Tf concentration was determined by the rocket immunoelectrophoresis, and its microheterogeneity was assessed by the ConA crossed immunoaffinity electrophoresis. During the annual observation of the distribution of the Tf variants, we have found both changes of the percentage contents of all Tf variants in the whole Tf concentration and a significant decrease in Tf2, Tf3 and Tf4 serum concentrations. Moreover, we found that decrease in the renal function, duration of mHD, and inflammation may contribute to these above-mentioned changes, which are probably the factors that should be taken into account when explaining the mechanisms of persistence of anaemia in haemodialysed patients.

  17. Imaging Pregnant and Lactating Patients.

    PubMed

    Tirada, Nikki; Dreizin, David; Khati, Nadia J; Akin, Esma A; Zeman, Robert K

    2015-10-01

    As use of imaging in the evaluation of pregnant and lactating patients continues to increase, misperceptions of radiation and safety risks have proliferated, which has led to often unwarranted concerns among patients and clinicians. When radiologic examinations are appropriately used, the benefits derived from the information gained usually outweigh the risks. This review describes appropriateness and safety issues, estimated doses for imaging examinations that use iodizing radiation (ie, radiography, computed tomography, nuclear scintigraphy, and fluoroscopically guided interventional radiology), radiation risks to the mother and conceptus during various stages of pregnancy, and use of iodinated or gadolinium-based contrast agents and radiotracers in pregnant and lactating women. Maternal radiation risk must be weighed with the potential consequences of missing a life-threatening diagnosis such as pulmonary embolus. Fetal risks (ie, spontaneous abortion, teratogenesis, or carcinogenesis) vary with gestational age and imaging modality and should be considered in the context of the potential benefit of medically necessary diagnostic imaging. When feasible and medically indicated, modalities that do not use ionizing radiation (eg, magnetic resonance imaging) are preferred in pregnant and lactating patients. Radiologists should strive to minimize risks of radiation to the mother and fetus, counsel patients effectively, and promote a realistic understanding of risks related to imaging during pregnancy and lactation. PMID:26466183

  18. 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)

  19. Atypical SARS in Geriatric Patient

    PubMed Central

    Oh, Helen M.L.; Hui, K.P.; Lien, Christopher T.C.; Narendran, K.; Heng, B.H.; Ling, A.E.

    2004-01-01

    We describe an atypical presentation of severe acute respiratory syndrome (SARS) in a geriatric patient with multiple coexisting conditions. Interpretation of radiographic changes was confounded by cardiac failure, with resolution of fever causing delayed diagnosis and a cluster of cases. SARS should be considered even if a contact history is unavailable, during an ongoing outbreak. PMID:15030694

  20. 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

  1. 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

  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. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. [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.

  9. 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

  10. [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

  11. Using tuberculosis patient characteristics to predict future cases with matching genotype results.

    PubMed

    Oeltmann, J E; Click, E S; Moonan, P K

    2014-03-21

    Contexte : Etats-Unis.Cadre : On ne sait pas si les caractéristiques d'un cas de tuberculose (TB) ou du patient permettent de prévoir la probabilité de contamination dans l'avenir.Objectif : Estimer la probabilité de cas présentant un génotype similaire dans le même conté et dans une période de 2 ans suivant le cas index.Schéma : Nous avons étudié tous les cas de TB avec génotypage déclarés aux Etats-Unis entre 2004 et 2010. Les scores prédictifs ont été calculés en fonction des caractéristiques du patient en divisant le nombre de patients qui n'étaient pas le dernier cas d'un groupement de génotypes au niveau d'un conté par le nombre total de patients.Résultats : Le risque global de nouveau cas lié à un autre cas était de 30,8% pendant les 2 années suivant l'année de déclaration de tout nouveau cas. Ces contaminations ont été détectées dans 34,7% des circonstances après diagnostic d'un cas à frottis positif, 51,9%, après diagnostic d'un patient sans domicile fixe et 45,2%, après diagnostic d'un patient toxicomane. Les scores prédictifs variaient en fonction de l'ethnie (Blancs 13,9% ; Amérindiens/Hawaïens 43,8%), l'âge (>65 ans 13,1% ; 0–4 ans 43%) et étaient plus élevé chez les patients nés aux Etats-Unis.Conclusion: Les facteurs comportementaux et socio-démographiques peuvent contribuer à prévoir la probabilité d'infection de cas dans le futur et peuvent servir à prioriser les recherches de sujets contacts.

  12. Le transfert de connaissances entre les mathematiques et les sciences. Une etude exploratoire aupres d'eleves de 4e secondaire

    NASA Astrophysics Data System (ADS)

    Samson, Ghislain

    2003-06-01

    Au moment ou dans plusieurs pays on travaille a refondre les programmes d'etudes, tant au primaire qu'au secondaire, l'interet pour le transfert renait. Un des concepts fondamentaux en apprentissage consiste en l'habilete a reutiliser de facon consciente et efficace un acquis d'une situation a une autre situation. Cette recherche emane de preoccupations professionnelles au moment ou le chercheur etait enseignant au secondaire. Au cours de ces annees, il lui a ete possible de constater que plusieurs eleves percevaient difficilement les liens presents entre les disciplines mathematiques et scientifiques. Des travaux en psychologie cognitive et plus particulierement selon une perspective du traitement de l'information ont servi de cadre de reference pour evaluer et analyser les capacites de transfert aupres d'eleves de 4e secondaire. Ce cadre de reference permet de formuler le principal objectif qui est de mieux comprendre le processus de transfert chez des eleves en situation de resolution de problemes scientifiques. Cette these s'interesse donc au transfert en tant que phenomene important du processus d'apprentissage au sens de l'integration. La methode de recherche choisie, de nature qualitative, est principalement axee sur l'evaluation de la capacite a transferer des connaissances lors d'une epreuve et d'un entretien. Pour evaluer ce potentiel de transfert, nous avons elabore deux outils: une epreuve en mathematiques et en sciences et un guide d'entretien. Pour la passation de l'epreuve, le chercheur a pu compter sur la collaboration de 130 sujets provenant de deux ecoles. L'entretien complete la prise de donnees avec 13 sujets ayant accepte de poursuivre l'etude. Les donnees recueillies par ces instruments font ensuite l'objet d'une analyse de contenu. En premier lieu, les verbatims de l'epreuve et de l'entretien ont ete transcrits, puis codifies. La correction des reponses fournies pour les problemes resolus s'est faite a partir d'une grille d

  13. Ergonomics: safe patient handling and mobility.

    PubMed

    Hallmark, Beth; Mechan, Patricia; Shores, Lynne

    2015-03-01

    This article reviews and investigates the issues surrounding ergonomics, with a specific focus on safe patient handling and mobility. The health care worker of today faces many challenges, one of which is related to the safety of patients. Safe patient handling and mobility is on the forefront of the movement to improve patient safety. This article reviews the risks associated with patient handling and mobility, and informs the reader of current evidence-based practice relevant to this area of care. PMID:25680494

  14. Perfume dermatitis. a study of 20 patients.

    PubMed

    Larsen, W G

    1977-05-01

    Patch tests to several screening sets of fragrance materials were performed on 20 perfume-sensitive patients. The most common allergens were found to be a jasmin synthetic (18 of 20 patients), cinnamic alcohol (15 of 20 patients), and hydroxycitronella (9 of 20 patients). More than half of the patients were also contact sensitive to other ingredients of cosmetics and over-the-counter and prescription preparations.

  15. Countering the stereotype of the unpopular patient.

    PubMed

    Price, Bob

    2013-07-01

    Labelling theory and Stockwell's seminal work on the unpopular patient can help inform nurses' interactions with patients in the modern healthcare system. Today, older patients might be deemed unpopular because of their perceived personality, attitudes or communication, and because their needs fit poorly with the service available to them. These, and other factors, such as staffing levels, length of hospital stays, and patients' expectations as consumers, help to influence what defines an unpopular patient. PMID:23901458

  16. 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

  17. ECLS in Pediatric Cardiac Patients

    PubMed Central

    Di Nardo, Matteo; MacLaren, Graeme; Marano, Marco; Cecchetti, Corrado; Bernaschi, Paola; Amodeo, Antonio

    2016-01-01

    Extracorporeal life support (ECLS) is an important device in the management of children with severe refractory cardiac and or pulmonary failure. Actually, two forms of ECLS are available for neonates and children: extracorporeal membrane oxygenation (ECMO) and use of a ventricular assist device (VAD). Both these techniques have their own advantages and disadvantages. The intra-aortic balloon pump is another ECLS device that has been successfully used in larger children, adolescents, and adults, but has found limited applicability in smaller children. In this review, we will present the “state of art” of ECMO in neonate and children with heart failure. ECMO is commonly used in a variety of settings to provide support to critically ill patients with cardiac disease. However, a strict selection of patients and timing of intervention should be performed to avoid the increase in mortality and morbidity of these patients. Therefore, every attempt should be done to start ECLS “urgently” rather than “emergently,” before the presence of dysfunction of end organs or circulatory collapse. Even though exciting progress is being made in the development of VADs for long-term mechanical support in children, ECMO remains the mainstay of mechanical circulatory support in children with complex anatomy, particularly those needing rapid resuscitation and those with a functionally univentricular circulation. With the increase in familiarity with ECMO, new indications have been added, such as extracorporeal cardiopulmonary resuscitation (ECPR). The literature supporting ECPR is increasing in children. Reasonable survival rates have been achieved after initiation of support during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS have reduced in the last 5 years and many centers support patients with functionally univentricular circulations. Improved results have been recently achieved in this complex subset of patients. PMID

  18. 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

  19. 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

  20. Autistic phenomena in neurotic patients.

    PubMed

    Klien, S

    1980-01-01

    I have described a group of patients who are seemingly successful in their professional and social lives, and who seek analysis ostensibly for professional reasons or for minor difficulties in their relationship. However, sooner or later they reveal phenomena which are strikingly similar to those observed in so-called autistic children. These autistic phenomena are characterized by an almost impenetrable encapsulation of part of the personality, mute and implacable resistance to change, and a lack of real emotional contact either with themselves or the analyst. Progress of the analysis reveals an underlying intense fear of pain, and of death, disintegration or breakdown. These anxieties occur as a reaction to real or feared separation, especially when commitment to analysis deepens. In the case I have described in detail the patient used various projective processes to deflect painful emotions either into other people, including the analyst, or into their own bodies. As a consequence the various objects or organs of the body swell up and became suffused with rage as a result of having to contain the unwanted feelings. This process leads in turn to intense persecutory fears and a heightened sensitivity to the analyst's tone of voice and facial expression. It would seem that the initial hypersensitivity of part of the personality is such as to lead it to anticipate danger to such an extent that it expels feelings even before they reach awareness. The sooner the analyst realizes the existence of this hidden part of the patient the less the danger of the analysis becoming an endless and meaningless intellectual dialogue and the greater the possibilities of the patient achieving a relatively stable equilibrium. Although the analyst has to live through a great deal of anxiety with the patient I feel that ultimately the results make it worth while.

  1. 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

  2. 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

  3. Patients' rights or patients' neglect: the impact of the patients' rights movement on delivery systems.

    PubMed

    Sehdev, H S

    1976-10-01

    This paper offers a clinician's perspective on the complex and controversial issues related to "patients' rights." It is suggested that such "rights" interpreted and applied literally may contravene the basic right of the individual to receive needed treatment. Related issues are discussed, and a mechanism for exploring resolutions to the conflict between psychiatry and the law is suggested.

  4. 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:......

  5. Renal failure in patients with multiple myeloma.

    PubMed

    Almueilo, Samir H

    2015-01-01

    Renal dysfunction is encountered in 20-25% of patients with multiple myeloma (MM) at the time of diagnosis. There is often a precipitating event. Several biochemical and clinical correlations with renal failure in MM have been reported. Renal failure in MM is associated with worse outcome of the disease. We retrospectively analyzed the medical records of 64 patients with MM admitted to our institution during the period January 1992 to December 2012. Abnormal renal function was observed in 24 (37.5%) patients and 17 (26.6%) of them had renal failure; 14 of the 17 (82.4%) of patients with renal failure had Stage III MM. Urine Bence- Jones protein was positive in ten (58.8%) patients with renal failure versus ten (21.3%) patients without renal failure (P = 0.004). Potential precipitating factors of renal failure were determined in nine patients. Renal function normalized in 11 patients with simple measures, while six patients required hemodialysis; one remained dialysis dependent till time of death. Early mortality occurred in five (29.4%) patients with renal failure as compared with two (4.3%) patients in the group without renal failure (P = 0.005). In conclusion, renal failure is associated with a higher tumor burden and Bence-Jones proteinuria in patients with MM. It is reversible in the majority of patients; however, early mortality tends to be higher in patients with persistent renal failure.

  6. 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

  7. Periorbital Hyperpigmentation in Patients with Xanthelasma Palpebrarum

    PubMed Central

    Kouris, Anargyros; Agiasofitou, Efthymia; Antoniou, Christina; Kontochristopoulos, Georgios

    2016-01-01

    Background: Xanthelasma palpebrarum refers to xanthomas that occur more often near the inner canthus of the eyelid. Periorbital hyperpigmentation presents as a dark area surrounding the eyelids. Objective: In the present study, the authors examined the prevalence and the associated factors of periorbital hyperpigmentation among patients with xanthelasma. Methods: One hundred and fourteen patients with xanthelasma palpebrarum were examined for the presence of dark circles. Detailed questionnaires regarding the history of diabetes, hypothyroidism, smoking status, and weight were completed by all patients. They were also tested for serum lipids (cholesterol, low-density lipoprotein, triglycerides, apolipoprotein A and apolipoprotein B). Results: From the 114 patients with xanthelasma, 94 (82.4%) were diagnosed with periorbital hyperpigmentation. At the time of the survey, 46 patients were smokers (48.9%), 23 of them had hypothyroidism (24.4%), and 16 patients were obese (17%). Only four patients had a history of diabetes. Cholesterol levels were elevated in 65 patients (69.1%). In 52 patients (55.3%), low-density lipoprotein was increased and in 51 patients (54.2%), both cholesterol and low-density lipoprotein were elevated. Apolipoprotein A was increased in 35 patients (37.2%), whereas apolipoprotein B was increased in 23 patients (24.4%). Conclusions: This study showed that a significant number of patients with xanthelasma exhibited periorbital hyperpigmentation. Smoking, obesity, and hyperlipidemia were observed in these patients. PMID:27721911

  8. Malignant hyperthermia in dental patients.

    PubMed

    Adriani, J; Sundin, R

    1984-02-01

    Malignant hyperthermia is a hypermetabolic, frequently fatal syndrome triggered by anesthetic drugs that occurs in genetically susceptible persons. Fatalities have been reported in patients receiving dental treatment with general anesthesia. The syndrome may also be triggered by stress, exercise, muscle injury, mild infections, and other nonpharmacologic agents or stimuli in conscious patients. Treatment is symptomatic and empiric, and potential reactors are not easily identified. However, criteria for identifying most susceptible persons have been established, and therapeutic agents for prophylaxis and treatment, which appear to be effective, are available. In this paper we report experiences with the syndrome and discuss an overview of its features, criteria used for identifying susceptible persons, prophylaxis, diagnostic features, and procedures to be followed should the syndrome develop. PMID:6584489

  9. 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.

  10. [Patient safety in management contracts].

    PubMed

    Campillo-Artero, C

    2012-01-01

    Patient safety is becoming commonplace in management contracts. Since our experience in patient safety still falls short of other clinical areas, it is advisable to review some of its characteristics in order to improve its inclusion in these contracts. In this paper opinions and recommendations concerning the design and review of contractual clauses on safety are given, as well as reflections drawn from methodological papers and informal opinions of clinicians, who are most familiar with the nuances of safe and unsafe practices. After reviewing some features of these contracts, criteria for prioritizing and including safety objectives and activities in them, and key points for their evaluation are described. The need to replace isolated activities by systemic and multifaceted ones is emphasized. Errors, limitations and improvement opportunities observed when contracts are linked to indicators, information and adverse event reporting systems are analysed. Finally, the influence of the rules of the game, and clinicians behaviour are emphasised.

  11. 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.

  12. Ventilatory strategies in trauma patients

    PubMed Central

    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

  13. 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

  14. 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

  15. [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).

  16. Informal caregiving for cancer patients.

    PubMed

    Romito, Francesca; Goldzweig, Gil; Cormio, Claudia; Hagedoorn, Mariët; Andersen, Barbara L

    2013-06-01

    According to the recent worldwide estimation by the GLOBOCAN project, in total, 12.7 million new cancer cases and 7.6 million cancer deaths occurred in 2008. The worldwide number of cancer survivors within 5 years of diagnosis has been estimated at be almost 28.8 million. Informal caregivers, such as family members and close friends, provide essential support to cancer patients. The authors of this report provide an overview of issues in the study of informal caregivers for cancer patients and long-term survivors in the United States and Europe, characterizing the caregivers commonly studied; the resources currently available to them; and their unmet needs, their psychosocial outcomes, and the psychosocial interventions tailored to their special circumstances. A broad overview of the state of research and knowledge, both in Europe and the United States, and observations on the directions for future research are provided.

  17. Informal Caregiving for Cancer Patients

    PubMed Central

    Romito, Francesca; Goldzweig, Gil; Cormio, Claudia; Hagedoorn, Mariët; Andersen, Barbara L.

    2013-01-01

    According to the recent worldwide estimation by the GLOBOCAN project, in total, 12.7 million new cancer cases and 7.6 million cancer deaths occurred in 2008. The worldwide number of cancer survivors within 5 years of diagnosis has been estimated at be almost 28.8 million. Informal caregivers, such as family members and close friends, provide essential support to cancer patients. The authors of this report provide an overview of issues in the study of informal caregivers for cancer patients and long-term survivors in the United States and Europe, characterizing the caregivers commonly studied; the resources currently available to them; and their unmet needs, their psychosocial outcomes, and the psychosocial interventions tailored to their special circumstances. A broad overview of the state of research and knowledge, both in Europe and the United States, and observations on the directions for future research are provided. PMID:23695928

  18. 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

  19. Depression in medically ill patients.

    PubMed

    Rackley, Sandra; Bostwick, J Michael

    2012-03-01

    In medically ill patients, given the many entities the phenotype of depression may represent, clinicians must be prepared to cast their diagnostic nets widely, not settling for the obvious but frequently incorrect choice of major depressive episode and throwing antidepressants at it willy nilly. Having chosen the correct diagnosis from among a broad differential of depression “look-alikes,” clinicians can draw upon a broad swath of treatment modalities including medications, psychotherapy, social supports, and spiritual interventions. Working as a psychiatrist in the medical arena requires the curiosity and analytic skills of a detective and the breadth of knowledge of a polymath adapting therapeutic tools from across the biopsychosociospiritual spectrum to the specific needs of the patient. PMID:22370500

  20. Penile perception of Koro patients.

    PubMed

    Chowdhury, A N

    1989-08-01

    Koro, a state where the perception of penis length decreases due to shrinkage from intra-abdominal traction, constitutes the central pathology. The present study was an attempt to explore the penis perception of the Koro patients by devising a graphomotor projective test, the Draw-a-penis Test (DAPT). DAPT elicited the penis image of the drawer, both of a normal penis and own penis perception. It also elicited the nature of perceptual process concerning the penile state changes, i.e. from flaccid to extended state. This controlled DAPT investigation showed a perceptual abnormality of penis image of Koro patients. They perceived less penis length, both for the penis of a normal person and their own penis and failed to perceive effectively the morphological change of penile states in terms of length increase. This perceptual abnormality in organ image is discussed in relation to the Koro vulnerability and psychopathology.

  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. 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

  3. 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.

  4. Ophthalmic Disparities in Transgender Patients.

    PubMed

    Hollar, Matthew W; Zhang, Matthew M; Mawn, Louise A

    2016-01-01

    Transgender individuals experience unique challenges with regards to discrimination and access to health care. Further, their unique health-care needs and challenges lead to greater rates of morbidity. This article seeks to review the unique biology of transgender patients and the effects of cross-sex hormone therapy on ophthalmic and non-ophthalmic pathology. Attention is given to topics in neuro-ophthalmology, oculoplastics, and retinal disease. PMID:27128494

  5. [Deglutition disorders in elderly patients].

    PubMed

    Menasria, Feriel; Lakroun, Samia; David, Jean-Philippe

    2013-01-01

    Deglutition disorders are frequent in elderly patients and can lead to serious consequences in terms of morbidity and mortality. Despite an easy screening test with the water, they are ignored or underestimated. Moreover, early detection and treatment focused essentially on the adaptation of textures, postures as well as the provision of information and training to all the people involved in feeding the elderly person require few resources and provide a real benefit.

  6. 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

  7. Kimura's disease in Malay patients.

    PubMed

    Shahrul, H; Baharudin, A; Effat, O

    2007-08-01

    Kimura's Disease (KD) is an uncommon, chronic inflammatory disorder of unknown etiology which is endemic in Orientals. It is characterized by painless, large solitary or multiple nodules in subcutis of head and neck region or the major salivary glands, associated with regional lymphadenopathy, blood eosinophilia and elevated IgE levels. Its treatment ranging from conservative observation in asymptomatic patient to surgical resection of the mass, corticotherapy and irradiation therapy for the symptomatic ones.

  8. 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

  9. Patient satisfaction surveys and multicollinearity.

    PubMed

    Stratmann, W C; Zastowny, T R; Bayer, L R; Adams, E H; Black, G S; Fry, P A

    1994-01-01

    The measurement of patient satisfaction is now an integral part of hospital market research. Just as consumer satisfaction is a function of the extent to which providers do things right, the value of consumer-oriented market research is directly related to whether the research itself is done right. The use of poorly designed consumer research instruments, no matter how well executed, can cause multicollinearity among the independent variables, which, in turn, can result in misleading conclusions.

  10. CMS emphasizes quality patient care.

    PubMed

    2014-07-01

    The Inpatient Prospective Payment System proposed rule for fiscal 2015 continues the Centers for Medicare & Medicaid Services' move toward basing reimbursement on quality of care, not quantity. The rule also asks for public input on the two-midnight rule and a policy to address short-stay patients. CMS is implementing the Hospital-Acquired Condition Reduction Program, which penalizes hospitals that perform poorly. The agency proposes to add two safety measures to value-based purchasing in the future. PMID:24946382

  11. [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

  12. 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

  13. Patient dosimetry in nuclear medicine.

    PubMed

    Mattsson, Sören

    2015-07-01

    In diagnostic nuclear medicine, the biokinetics of the radiopharmaceutical (actually of the radionuclide) is determined for a number of representative patients. At therapy, it is essential to determine the patient's individual biokinetics of the radiopharmaceutical in order to calculate the absorbed doses to critical normal organs/tissues and to the target volume(s) with high accuracy. For the diagnostic situations, there is still a lack of quantitative determinations of the organ/tissue contents of radiopharmaceuticals and their variation with time. Planar gamma camera imaging using the conjugate view technique combined with a limited number of SPECT/CT images is the main method for such studies. In a similar way, PET/CT is used for 3D image-based internal dosimetry for PET substances. The transition from stylised reference phantoms to voxel phantoms will lead to improved dose estimates for diagnostic procedures. Examples of dose coefficients and effective doses for diagnostic substances are given. For the therapeutic situation, a pre-therapeutic low activity administration is used for quantitative measurements of organ/tissue distribution data by a gamma camera or a SPECT- or PET-unit. Together with CT and/or MR images this will be the base for individual dose calculations using Monte Carlo technique. Treatments based on administered activity should only be used if biological variations between patients are small or if a pre-therapeutic activity administration is impossible.

  14. Patient advocacy and DSM-5.

    PubMed

    Stein, Dan J; Phillips, Katharine A

    2013-05-17

    The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a useful opportunity to revisit debates about the nature of psychiatric classification. An important debate concerns the involvement of mental health consumers in revisions of the classification. One perspective argues that psychiatric classification is a scientific process undertaken by scientific experts and that including consumers in the revision process is merely pandering to political correctness. A contrasting perspective is that psychiatric classification is a process driven by a range of different values and that the involvement of patients and patient advocates would enhance this process. Here we draw on our experiences with input from the public during the deliberations of the Obsessive Compulsive-Spectrum Disorders subworkgroup of DSM-5, to help make the argument that psychiatric classification does require reasoned debate on a range of different facts and values, and that it is appropriate for scientist experts to review their nosological recommendations in the light of rigorous consideration of patient experience and feedback.

  15. 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

  16. Dimensional psychopharmacology in somatising patients.

    PubMed

    Biondi, Massimo; Pasquini, Massimo

    2015-01-01

    Despite the recent DSM-5 review of somatoform disorders, which are now called somatic symptom and related disorders, the categorical definitions of these syndromes have inherent limitations because their causal mechanism or presumed aetiologies are still unknown. These limitations may affect everyday clinical practice and decision-making abilities. As a result, physicians have limited information at their disposal to treat these patients. Furthermore, the clinical presentations of somatic disorders may vary a lot. The purpose of this chapter is to illustrate a psychopathological dimensional approach to the somatising patient. This approach is constantly unconsciously applied in clinical practice using continuous variables, such as rating scales. Moreover, treatment strategies might be improved by adding a dimensional approach, simply recognising the prominent components of the presenting psychopathology of a given patient and addressing them with drugs according to their different mechanisms, targeting circuits and neurotransmitters. Some authors have proposed a shift from the nosological to functional application of psychotropic drugs, in which functional psychopharmacology will be dysfunction oriented and therefore inevitably geared towards utilising drug combinations. Here, we present a summary of the advantages of functional/dimensional psychopharmacology for the treatment of somatic symptoms and related disorders.

  17. Patient advocacy and DSM-5

    PubMed Central

    2013-01-01

    The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a useful opportunity to revisit debates about the nature of psychiatric classification. An important debate concerns the involvement of mental health consumers in revisions of the classification. One perspective argues that psychiatric classification is a scientific process undertaken by scientific experts and that including consumers in the revision process is merely pandering to political correctness. A contrasting perspective is that psychiatric classification is a process driven by a range of different values and that the involvement of patients and patient advocates would enhance this process. Here we draw on our experiences with input from the public during the deliberations of the Obsessive Compulsive-Spectrum Disorders subworkgroup of DSM-5, to help make the argument that psychiatric classification does require reasoned debate on a range of different facts and values, and that it is appropriate for scientist experts to review their nosological recommendations in the light of rigorous consideration of patient experience and feedback. PMID:23683696

  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. 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.

  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. Cancer Screening in Older Patients.

    PubMed

    Salzman, Brooke; Beldowski, Kathryn; de la Paz, Amanda

    2016-04-15

    Although cancer is the second leading cause of death among persons 65 years and older, there is a paucity of clinical trial data about the effectiveness and harms of cancer screening in this population. Given the heterogeneous nature of the older population, cancer screening in these patients should not be based on age alone. Studies suggest that a life expectancy of at least 10 years is necessary to derive a survival benefit from screening for breast and colorectal cancers; therefore, screening for these cancers is not recommended in those with a life expectancy of less than 10 years. Prostate cancer screening, if performed at all, should not be performed after 69 years of age. Cervical cancer screening may be stopped after 65 years of age if the patient has an adequate history of negative screening results. An individualized approach to cancer screening decisions involves estimating life expectancy, determining the potential benefits and harms of screenings, and weighing those benefits and harms in relation to the patient's values and preferences.

  2. Quality Assurance: Patient Chart Reviews

    NASA Astrophysics Data System (ADS)

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

    2009-07-01

    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).

  3. 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

  4. 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)

  5. Pancreas transplantation in diabetic patients.

    PubMed

    Pozza, G; Di Carlo, V

    1989-01-01

    After a brief historical background on pancreas transplantation in the treatment of diabetes mellitus, this review deals with the major surgical, pharmacological and functional aspects of this approach. In the Authors' opinion pancreas transplantation should be proposed only when the end-stage renal failure (ESRF), due to diabetic nephropathy, needs kidney transplantation. By using injection of polymers (mainly neoprene) into the pancreatic ducts, or urinary diversion of pancreatic juice and appropriate immunosuppressive therapy (cyclosporin, corticosteroids and azathioprine), dramatic advantages have been achieved in the last years, so that a satisfactory segmental or total pancreas graft survival on one hand, and the early graft rejection recognition on the other have been presently obtained. A prompt and good functional activity of pancreas graft has also been demonstrated by the Authors in successfully transplanted patients. As far as chronic diabetic complications are concerned, no conclusive results have been reported up to now; it is noteworthy, however, that pancreas transplantation may preserve the transplanted kidney from a relapse of diabetic nephropathy. The combined pancreas-kidney transplantation may actually be considered as a correct solution to the problem of diabetic patients with ESRF. Moreover, careful selection of patients, appropriate surgical technique and experienced immunosuppressive treatment are the major prerequisites to achieve a satisfactory improvement of diabetic status in addition to that of renal failure.

  6. 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.

  7. Patient moderator interaction in online health communities.

    PubMed

    Huh, Jina; McDonald, David W; Hartzler, Andrea; Pratt, Wanda

    2013-01-01

    An increasing number of people visit online health communities to share experiences and seek health information. Although studies have enumerated reasons for patients' visits to online communities for health information from peers, we know little about how patients gain health information from the moderators in these communities. We qualitatively analyze 480 patient and moderator posts from six communities to understand how moderators fulfill patients' information needs. Our findings show that patients use the community as an integral part of their health management practices. Based on our results, we suggest enhancements to moderated online health communities for their unique role to support patient care.

  8. Serum bile acids in patients with hyperlipidaemia.

    PubMed Central

    Pennington, C R; Ross, P E; Bateson, M C; Bouchier, I A

    1978-01-01

    Individual serum bile acids were analysed by an improved gas liquid chromatography method in 12 patients with primary hyperlipidaemia. Total serum bile acid concentrations were raised in 10 subjects. Ursodeoxycholic acid was found in all 12 patients. It was present in significantly greater concentrations, accounted for a greater proportion of the total serum bile acids, and occurred more frequently than in patients with various forms of hepatobiliary disease. Patients with hyperlipidaemia had proportionately less deoxycholic acid than controls but more than patients with liver disease. There was proportionately less chenodeoxycholic acid in patients with hypercholesterolaemia, in whom the primary bile acid ratio was raised. PMID:627619

  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. Numerical distance effect in patients with schizophrenia.

    PubMed

    Pourrahimi, Ali Mohammad; Mazhari, Shahrzad; Shabani, Mohammad; Tabrizi, Yousef Moghadas; Sheibani, Vahid

    2016-03-23

    There is growing evidence showing that mental representation of numbers is impaired in patients with schizophrenia. Yet, no study has examined the distance effect in the patients. We assessed the distance effect using two number size comparison tasks, with different number references (5 and 7) in 23 patients and 28 healthy individuals. Response times and error rates significantly increased when the distances between the centered references and the targets decreased in both groups. However, patients responded significantly slower and had more error rates compared to controls. Our finding indicates distance effect in patients is similar to the controls, indicating an automatic numerical processing is preserved in patients with schizophrenia.

  11. 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,...

  12. 78 FR 59036 - Patient Safety Organizations: Voluntary Relinquishment From Cogent Patient Safety Organization, Inc.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Cogent Patient Safety Organization, Inc. AGENCY: Agency for Healthcare Research and Quality... Patient Safety Organizations (PSOs), which collect, aggregate, and analyze confidential...

  13. Toxicité sérotoninergique résultant d’une interaction médicamenteuse entre le bleu de méthylène et les inhibiteurs de la recapture de la sérotonine

    PubMed Central

    Charbonneau, Annie

    2013-01-01

    RÉSUMÉ Contexte : Le bleu de méthylène est employé en pratique pour diverses raisons médicales. Des données récentes ont évoqué une interaction potentielle avec les inhibiteurs de la recapture de la sérotonine, pouvant conduire à une toxicité sérotoninergique. Objectif : Décrire le risque de toxicité sérotoninergique associé à l’interaction entre le bleu de méthylène et les inhibiteurs de la recapture de la sérotonine. Sources de l’information : Les publications pertinentes ont été ciblées systématiquement au moyen des moteurs de recherche MEDLINE (1946 au 21 mars 2013) et Embase (1974 à 2013, semaine 11) en utilisant les mots clés suivants : methylene blue, methylthioninium, monoamine oxidase inhibitors, serotonin reuptake inhibitors et serotonin syndrome. Aucune restriction touchant l’indication du bleu de méthylène ou la langue n’a été appliquée. Les références des publications ont également été analysées. Sélection des études et extraction des données : Dix-huit études de cas et deux séries de cas systématiques ont été sélectionnées. Aucune étude clinique aléatoire n’a encore été publiée. Synthèse des résultats : La première étude de cas à avoir soupçonné une interaction entre le bleu de méthylène et les inhibiteurs de la recapture de la sérotonine est parue en 2003. Dix-sept autres études de cas décrivant le même type d’interaction ont par la suite été rapportées. Les deux séries de cas ont regroupé les données de quelques 325 parathyroïdectomies où le bleu de méthylène avait été employé comme agent colorant. Les 17 patients qui ont présenté une toxicité du système nerveux central prenaient tous en période préopératoire des inhibiteurs de recapture de la sérotonine. Conclusion : Lorsqu’il est administré en concomitance avec des inhibiteurs de recapture de la sérotonine, le bleu de méthylène peut conduire à une toxicité sérotoninergique à une dose aussi

  14. 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

  15. Emergency laparotomy in patients with AIDS.

    PubMed

    Davidson, T; Allen-Mersh, T G; Miles, A J; Gazzard, B; Wastell, C; Vipond, M; Stotter, A; Miller, R F; Fieldman, N R; Slack, W W

    1991-08-01

    The presentation, operative management and final diagnosis were reviewed in 28 patients with AIDS (27 men and one woman) who underwent emergency laparotomy. On clinical and radiological examination, six patients showed features of toxic megacolon, five patients had small bowel obstruction, six patients had localized peritonitis and three had perforated viscus with generalized peritonitis. The most common disease processes were acute colitis in seven patients (associated with cytomegalovirus (CMV) infection in six), intra-abdominal lymphoma in five patients, acute appendicitis in five patients (associated with CMV infection in two), and atypical mycobacterial (MAI) infection in four patients. Two perioperative deaths occurred; one in a patient with acute pancreatitis and a second with generalized peritonitis. Later deaths were due to progression of AIDS, and patient survival at 1 month, 3 months and 6 months was 89 per cent, 64 per cent and 48 per cent, respectively. Lower operative mortality than in previously reported series may be due to earlier intervention in CMV toxic megacolon. Surgery, however, conferred less benefit in patients with acute abdominal pain from MAI infection or lymphoma. With careful patient selection, emergency laparotomy may achieve worthwhile palliation in patients with AIDS. PMID:1655153

  16. Dental students' perception of patient anxiety.

    PubMed

    Lodge, J; Tripp, G

    1993-04-01

    This study examined the ability of dental students to assess patients' anxiety during dental treatment, and the relationship between patients' general, waiting room and clinic levels of anxiety. Sixty-six restorative dental patients and 35 Final-year dental students participated in the study. Prior to a routine dental appointment, patients completed visual analogue scales indicating their general and waiting room levels of anxiety. During treatment, patients and dental students completed similar scales to indicate patients' levels of anxiety up to and at that time. Patients' general and waiting room levels of anxiety were found to correlate significantly with their reports of anxiety during treatment. Female patients reported higher levels of anxiety than male patients. The correlations between patient and student ratings of patients' anxiety were small and non-significant, suggesting the students were not accurate in their estimates of patients' anxiety during treatment. It is suggested, therefore, that dental students be encouraged to ask patients directly how they are feeling about the dental situation. Such discussion could take place prior to, or at the beginning of, the dental appointment.

  17. Association entre les hormones sexuelles, les marqueurs de remodelage osseux et la densité minérale osseuse chez des femmes ménopausées d'origine marocaine (étude transversale)

    PubMed Central

    El Maataoui, Aissam; Biaz, Asmae; El Boukhrissi, Fatima; El Machtani, Si; Dami, Abdellah; Bouhsain, Sanae; Bamou, Youssef; El Maghraoui, Abdellah; Ouzzif, Zhor

    2015-01-01

    Introduction Le présent travail se propose d’étudier la relation entre les hormones sexuelles, notamment l’œstradiol et l'indice de l’œstradiol libre, le sulfate de déhydroépiandrosterone et la sex hormone binding globulin, les marqueurs de remodelage osseux et la densité minérale osseuse chez une population de femmes marocaine ménopausées. Méthodes Il s'agit d'une étude transversale, menée sur une période de 6 mois d'octobre 2012 à fin avril 2013 et ayant fait participer deux cent deux (202). Résultats L’œstradiol et l'indice d’œstradiol libre (IEL) ont montré une corrélation négative respectivement à l'ostéocalcine (OC), à la crosslaps (β-CTX) et l'OC (p<0.001). La sulfate de déhydroepiandrosterone S-DHEA a été corrélée positivement à l'OC (p<0.001), alors que e taux sérique de la sex hormone binding globulin (SHBG) l'a été corrélé à la β-CTX et l'OC (p<0.001). Par ailleurs, une corrélation positive a été établie entre la densité minérale osseuse (DMO) au col de fémur et le poids, l'indice de masse corporelle (IMC), l'IEL et la S-DHEA. Une corrélation négative a été retrouvée entre la DMO au col de fémur d'une part et l’âge, la DDR, la SHBG, la β-CTX et l'OC d'une autre part. Conclusion Le présent travail montre que l'augmentation de l’âge et la diminution de l’œstradiol libre expliquent la diminution de la DMO au niveau du col du fémur, alors que l'augmentation du taux sérique de la SHBG et la diminution du poids expliquent la diminution de la DMO au rachis lombaire. PMID:26848353

  18. [Neurological disorders and immunosuppression in kidney transplant patients. Preliminary study].

    PubMed

    Romero-Vázquez, Chasity; Rodríguez-Orozco, Alain R; Leal-Cantú, Raúl; Cortés-Rojo, Christian

    2016-01-01

    Antecedentes: Las alteraciones neurológicas en pacientes trasplantados de riñón pueden relacionarse con diversos factores, entre ellos la toxicidad secundaria al uso de medicamentos inmunosupresores. Objetivo: Conocer si existió asociación entre complicaciones neurológicas e inmunosupresión en una muestra de pacientes que recibieron trasplante renal. Métodos: Estudio transversal en el que participaron 121 pacientes con trasplante renal, de los cuales 22 (18 %) presentaron alteraciones neurológicas, Se usó χ2 para analizar la relación entre alteraciones neurológicas y comorbilidad como diabetes mellitus e hipertensión arterial y tiempo del uso de inmunosupresor. Se aceptó un nivel de significación p<0.05 para todas las determinaciones Resultados: De los sujetos estudiados, 13 eran hombres (59%) y nueve mujeres (41%). La edad media de los pacientes incluidos en el estudio fue 33 ± 12 años. El 59 % de las alteraciones neurológicas ocurrieron entre seis meses y cinco años de que los pacientes habían recibido el trasplante. Las alteraciones neurológicas encontradas fueron: temblor (7.4%), vértigo (4.1%), neuropatía periférica (3.3%), cefalea (2.4%) y disminución de la fuerza (0.8 %). Conclusión: No se encontró relación estadísticamente significativa entre las alteraciones neurológicas y el inmunosupresor usado ni entre éstas y el tiempo que duró la inmunosupresión.

  19. 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).

  20. CEU your jewish patient is dying....

    PubMed

    Schwartz, E A

    1989-01-01

    This article offers the nurse information needed for planning the care of Jewish patients and their families during the dying and mourning process - whether that patient is Orthodox, Conservative, or Reform.

  1. Infectious arthritis in patients with rheumatoid arthritis.

    PubMed Central

    Mateo Soria, L; Miquel Nolla Solé, J; Rozadilla Sacanell, A; Valverde García, J; Roig Escofet, D

    1992-01-01

    Eleven cases of infectious arthritis occurring in patients with rheumatoid arthritis are reported. Staphylococcus aureus was the causative organism in eight patients. Streptococcus anginosus and Streptococcus agalactiae in one patient each, and Mycobacterium tuberculosis in two patients. The mean duration of symptoms before diagnosis was 16 days in patients with pyogenic arthritis. The diagnosis of joint infection caused by Mycobacterium tuberculosis was especially delayed (57 days). Four patients died; they were found to have a longer time to diagnosis and two of them had multiple joint infection. Although Staphylococcus aureus is the microorganism most often affecting patients with rheumatoid arthritis, infection caused by Mycobacterium tuberculosis must also be considered in such patients. PMID:1575593

  2. Preoperative nuclear scans in patients with melanoma

    SciTech Connect

    Au, F.C.; Maier, W.P.; Malmud, L.S.; Goldman, L.I.; Clark, W.H. Jr.

    1984-05-15

    One hundred forty-one liver scans, 137 brain scans, and 112 bone scans were performed in 192 patients with clinical Stage 1 melanoma. One liver scan was interpreted as abnormal; liver biopsy of that patient showed no metastasis. There were 11 suggestive liver scans; three of the patients with suggestive liver scans had negative liver biopsies. The remaining eight patients were followed from 4 to 6 years and none of those patients developed clinical evidence of hepatic metastases. All of the brain scans were normal. Five patients had suggestive bone scans and none of those patients had manifested symptoms of osseous metastases with a follow-up of 2 to 4.5 years. This study demonstrates that the use of preoperative liver, brain and bone scan in the evaluation of patients with clinical Stage 1 melanoma is virtually unproductive.

  3. 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 » ...

  4. Percutaneous cholecystolithotomy: the first 60 patients.

    PubMed Central

    Chiverton, S G; Inglis, J A; Hudd, C; Kellett, M J; Russell, R C; Wickham, J E

    1990-01-01

    OBJECTIVE--To assess the feasibility and possible complications of percutaneous removal of gall stones. DESIGN--Prospective study of the first 60 patients treated. SETTING--The London Clinic. PATIENTS--60 Consecutive patients with symptomatic gall stones who agreed to have them removed percutaneously. RESULTS--56 Patients had stones successfully removed percutaneously. In four patients failure of access necessitated a cholecystectomy under the same anaesthetic. Two patients had an empyema of the gall bladder drained initially, followed by a second operation to remove the stones one week later. Seven patients had postoperative complications, and two had recurrences of biliary calculi. CONCLUSIONS--The techniques and instruments used in percutaneous nephrolithotomy can successfully be adapted for percutaneous removal of gall stones. The procedure is suitable for a wider range of patients than other techniques that leave the gall bladder intact. PMID:2369662

  5. 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 ...

  6. 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

  7. Uninsured patients require creative discharge plans.

    PubMed

    2012-04-01

    Case managers are being challenged to find a discharge destination for patients who are uninsured or underinsured and who need services after hospitalization.These patients often stay in the hospital longer than necessary, at the hospital's expense. Case managers should develop a network of community resources that can assist with care for unfunded patients after discharge. In some cases, it makes sense for the hospital to pay for a lower level of care rather than keeping patients in acute care beds that could be occupied by paying patients. Case managers often are under pressure to move patients through the continuum of care, making it a challenge to create an effective discharge plan for patients with limited financial resources. Many unfunded patients are eligible for financial assistance with their healthcare needs, but they aren't aware of it and don't know how to apply.

  8. 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 ...

  9. 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)

  10. 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 ...

  11. 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)

  12. 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 ...

  13. 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.

  14. Perfecting patient flow in the surgical setting.

    PubMed

    Amato-Vealey, Elaine J; Fountain, Patricia; Coppola, Deborah

    2012-07-01

    Reduced surgical efficiency and productivity, delayed patient discharges, and prolonged use of hospital resources are the results of an OR that is unable to move patients to the postanesthesia care unit or other patient units. A primary reason for perioperative patient flow delay is the lack of hospital beds to accommodate surgical patients, which consequently causes backups of patients currently in the surgical suite. In one facility, implementing Six Sigma methodology helped to improve OR patient flow by identifying ways that frontline staff members could work more intelligently and more efficiently, and with less stress to streamline workflow and eliminate redundancy and waste in ways that did not necessitate reducing the number of employees. The results were improved employee morale, job satisfaction and safety, and an enhanced patient experience.

  15. Reconstruction of mandibular defects in irradiated patients

    SciTech Connect

    Klotch, D.W.; Gump, J.; Kuhn, L. )

    1990-10-01

    In this prospective study, mandibular reconstruction using titanium plates was evaluated in 31 patients treated between July 1988 and January 1990. Sixteen patients had prior surgery; 13 had prior radiotherapy. In 11 patients, prior radiation and surgery had failed. Sixteen patients received postoperative radiotherapy either in standard or accelerated fractions. Twelve patients had complications of either intraoral (8), extraoral (5), or combined (1) plate exposure or fistula formation (2). Factors significantly related to complications were poor nutrition, accelerated radiation, and recurrence. Sixty-one percent of all patients healed uneventfully. When patients with complications secondary to recurrence who subsequently died were excluded, the success rate was 73%. Only one patient had an unacceptable result that produced a cosmetic and functional deformity despite secondary repair.

  16. Patient Centeredness, Cultural Competence and Healthcare Quality

    PubMed Central

    Saha, Somnath; Beach, Mary Catherine; Cooper, Lisa A.

    2010-01-01

    Cultural competence and patient centeredness are approaches to improving healthcare quality that have been promoted extensively in recent years. In this paper, we explore the historical evolution of both cultural competence and patient centeredness. In doing so, we demonstrate that early conceptual models of cultural competence and patient centeredness focused on how healthcare providers and patients might interact at the interpersonal level and that later conceptual models were expanded to consider how patients might be treated by the healthcare system as a whole. We then compare conceptual models for both cultural competence and patient centeredness at both the interpersonal and healthcare system levels to demonstrate similarities and differences. We conclude that, although the concepts have had different histories and foci, many of the core features of cultural competence and patient centeredness are the same. Each approach holds promise for improving the quality of healthcare for individual patients, communities and populations. PMID:19024223

  17. 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

  18. Évolution des conditions d’initiation du traitement antirétroviral des patients infectés par le VIH en Afrique de l’Ouest

    PubMed Central

    Bashi, J.; Balestre, E.; Messou, E.; Maiga, M.; Coffie, P.A.; Zannou, D.M.; Ba-Gomis, O.; Traore, H.A.; Eholie, S.; Minga, A.; Sow, P.S.; Bissagnene, E.; Dabis, F.; Ekouevi, D.K.

    2013-01-01

    Résumé Objectif Étudier entre 1996 et 2006, l’évolution des schémas thérapeutiques et du profil clinique et immunologique des patients infectés par le VIH au début du traitement antirétroviral (TARV) en Afrique de l’Ouest. Cadre et méthode Les données issues de 12 centres cliniques adultes (IeDEA West Africa réseau collaboratif de prise en charge de l’infection à VIH) de cinq pays (Bénin, Cote d’Ivoire, Sénégal, Gambie, Mali) ont été mises en commun et analysées. Les patients âgés de 16 ans et plus dont le sexe, la date de naissance et la date d’initiation du TARV étaient connus ont été inclus dans cette étude. Résultats Quatorze mille quatre-cent-quatre-vingt-seize patients avaient débuté un TARV entre 1996–2006 avec 55 % des patients l’ayant débuté entre 2005–2006. La proportion de femmes était de 46 % en 1996–2000 et de 63 % en 2005–2006. L’âge médian à la mise sous traitement était constant: 35 ans chez les femmes et 40 ans chez les hommes. La proportion de patients qui ont débuté le TARV avec un taux de CD4 inférieur à 200 cellules/µl était de 54 % en 1996–2000 et de 64 % en 2005–2006. Les combinaisons thérapeutiques les plus prescrites étaient: AZT/3TC (ou d4T/DDI)/IDV (27 %) en 1996–2000; d4T (ou AZT)/3TC/EFV (59 %) en 2003–2004; et d4T/3TC/NVP (49 %) en 2005–2006. Les traitements de première ligne recommandés par l’OMS étaient débutés dans 83 % de cas en 2005–2006. Conclusion De nouvelles approches pour débuter un TARV plus précocement doivent être développées pour améliorer la survie des patients sous TARV. PMID:20045273

  19. 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

  20. [Prescribing drugs to patients receiving out-patient care].

    PubMed

    Garjón Parra, F J

    2009-01-01

    Drug prescription has evolved to deal mainly with chronic diseases. Nowadays, repeating prescriptions using computers results in problems if this is not done with adequate control. Steps proposed for appropriate prescription are: defining the problem; specifying the objective; selecting the drug; initiating therapy with appropriate details; giving information; regular evaluation; considering cost; and using tools to reduce errors. Published recommendations for prescription, which have focused on elderly patients, include: avoiding polypharmacy; carrying out a regular medication review; stopping any current drugs that are not indicated and prescribing new drugs that have a clear indication; avoiding drugs that have deleterious effects; using dosages that are suitable for the age and renal function; using simple drug regimes and appropriate administration systems; considering non-pharmacological treatments; limiting the number of practitioners prescribing for each patient; and avoiding treating adverse drug reactions with further drugs. Examples of compliance with those recommendations in the Navarre Health Service, extracted from the prescription information system, are provided. The measures for improving prescription are: education, auditing, collaboration between health professionals and use of electronic tools.

  1. Preferences for patient medication information: what do patients want?

    PubMed

    Kish-Doto, Julia; Scales, Monica; Eguino-Medina, Paula; Fitzgerald, Tania; Tzeng, Janice P; McCormack, Lauren A; O'Donoghue, Amie; Oguntimein, Oluwamurewa; West, Suzanne L

    2014-01-01

    This study investigated respondent preferences on how best to display patient medication information (PMI) that accompanies prescription medications to promote comprehension and appropriate usage. The authors identified 30 individuals diagnosed with select immune disorders, 30 with other chronic diseases, and 30 from the general public and had them review one of two PMI handouts that varied by format, organization, and content. The authors explored preferences for the PMI handout using one-on-one interviews. The authors analyzed the qualitative data to identify relevant themes and patterns using NVivo9 qualitative software. The majority of respondents noted that the formats of the two PMI handouts were more informative than those they currently receive from the pharmacist, with a preference for the 2-column, segmented design. However, respondent PMI preferences varied by age, education, and health status. Patients need simpler and more concise drug information to make better decisions about their health. Current PMI handouts are dense and complex, which can be confusing and not reader friendly. To improve PMI understandability and usefulness, the U.S. Food and Drug Administration is working with stakeholders, consumer advocates, and academics. Findings from this study may help inform future development of more user-friendly PMI.

  2. 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.

  3. Anesthesia and analgesia for geriatric veterinary patients.

    PubMed

    Baetge, Courtney L; Matthews, Nora S

    2012-07-01

    The number of geriatric veterinary patients presented for anesthesia appears to be increasing. This article summarizes physiologic changes that occur in geriatric patients that are relevant to anesthesia. Proper patient preparation and vigilant monitoring are the best defense against anesthetic problems in the geriatric animal. The authors also discuss particular anesthetic problems as they relate to geriatric patients and seek to present solutions to these problems.

  4. [Prevention of severe infections in asplenic patients].

    PubMed

    Verheij, Th J M

    2016-01-01

    The lifetime risk of dying from sepsis is approximately 2-3% in persons with (functional) asplenia. Both patients and their physicians are not always fully aware of these risks and the implementation of preventive measures is insufficient. Physicians should inform both patients and colleagues on the consequences of lost splenic function. Primary care physicians should screen their lists for patients with (functional) asplenia and offer these patient adequate preventive measures when needed. PMID:27650028

  5. [Personality in patients with panic disorder].

    PubMed

    Sanz-Carrillo, C; García-Campayo, J J; Sánchez Blanque, A

    1993-01-01

    Fourty-five patients diagnosed ad Panic Disorder and forty-five control patients are studied. Personality traits are assessed by Cattel's 16 PF. Test and several subscales derived from MMPI (dependence, repression, hypersensibility, etc.). Anxiety is measured by Zung's Anxiety Scale. Panic disorder patients show higher "dependence", "inferiority", "hypersensibility", low "ego strength", "parmia", "shrewdness", "self-sentiment integration" and high "ergic tension". In addition, male patients show significative differences in "affectothymia", "self-sufficiency", "self-sentiment integration" and "invia". PMID:8172011

  6. Patient Appreciation Day in radiation oncology.

    PubMed

    Cirillo, Dianne

    2014-08-01

    Patients undergoing radiation therapy struggle with many physical and emotional stressors. Many ways to help patients cope with stressors and improve the treatment experience are found in the literature, including humor, art, entertainment, and hospitality. At H. Lee Moffitt Cancer Center, the radiation therapy nurses and staff members use entertainment in an annual patient appreciation day event as one way to give back to the patients.

  7. Good's Syndrome Patients Hospitalized for Infections

    PubMed Central

    Sun, Xuefeng; Shi, Juhong; Wang, Mengzhao; Xu, Kaifeng; Xiao, Yi

    2015-01-01

    Abstract Good's syndrome (GS) is a rare combination of thymoma and hypogammaglobulinemia, resulting in immunodeficiency. Patients with GS are highly susceptible to bacterial infection, particularly encapsulated bacterial infection in upper and lower respiratory tracts. Good's syndrome patients with moderate-to- severe infection are often hospitalized. Clinical features of GS patients remain to be characterized. Patients with the discharge diagnosis of GS and simultaneous infection from Peking Union Medical College Hospital between January 2001 and July 2015 were retrospectively analyzed. Among 14 hospitalized GS patients, 12 of them were admitted for severe infections. Mean patient age was 56.7 + 10.1 years. Average concentrations of serum IgG, IgA, and IgM were 2.3 + 1.9 g/L, 0.28 + 0.28 g/L, and 0.06 + 0.07 g/L, respectively. Respiratory and intestinal tracts were the most common sites for infection, which occurred in 7 and 4 patients, respectively. Pathogens identified in 10 patients included cytomegalovirus in 5 patients, Pneumocystis jirovecii, Clostridium difficile in 2 patients, Klebsiella pneumonia in 2 patients, and Streptococcus pneumonia and Hemophilus influenza in 1 patient. Ten patients were treated with antibiotics and immunoglobulin replacement. Only 1 patient who was on immunosuppressant therapy died from P. jirovecii pneumonia. Infection was the most frequent cause for hospitalization of GS patients. Both respiratory and intestinal tracts were the most common sites of infection. Cytomegalovirus and P. jirovecii represented 2 common opportunistic pathogens isolated from hospitalized GS patients with infections. PMID:26632723

  8. 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

  9. 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

  10. Can we improve patient safety?

    PubMed

    Corbally, Martin Thomas

    2014-01-01

    Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out World Health Organization (WHO), errors, especially wrong site surgery, continue. Most such errors are due to lapses in communication where decision makers fail to consult or confirm operative findings but worryingly where parental concerns over the planned procedure are ignored or not followed through. The WHO Surgical Pause/Time Out aims to capture these errors and prevent them, but the combination of human error and complex hospital environments can overwhelm even robust safety structures and simple common sense. Parents are the ultimate repository of information on their child's condition and planned surgery but are traditionally excluded from the process of Surgical Pause and Time Out, perhaps to avoid additional stress. In addition, surgeons, like pilots, are subject to the phenomenon of "plan-continue-fail" with potentially disastrous outcomes. If we wish to improve patient safety during surgery and avoid wrong site errors then we must include parents in the Surgical Pause/Time Out. A recent pilot study has shown that neither staff nor parents found it added to their stress, but, moreover, 100% of parents considered that it should be a mandatory component of the Surgical Pause nor does it add to the stress of surgery. Surgeons should be required to confirm that the planned procedure is in keeping with the operative findings especially in extirpative surgery and this "step back" should be incorporated into the standard Surgical Pause. It is clear that we must improve patient safety further and these simple measures should add to that potential. PMID:25279366

  11. 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

  12. 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.

  13. 42 CFR 2.14 - Minor patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.14 Minor patients. (a) Definition of minor... patient acting alone has the legal capacity under the applicable State law to apply for and obtain alcohol or drug abuse treatment, any written consent for disclosure authorized under subpart C of...

  14. 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

  15. 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…

  16. Depression and Suicide in Schizophrenic Patients.

    ERIC Educational Resources Information Center

    Salama, Aziz A.

    1988-01-01

    Identified schizophrenic patients as distinctive subgroup of patients who can suffer from major depressive illness and can commit suicide. Found 22.4 percent of 620 schizophrenics in psychiatric facility showed symptoms of major depressive episode. Seven patients committed suicide during acute phase of illness, 9 attempted suicide while…

  17. 21 CFR 880.2720 - Patient scale.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... transducers, electronic signal amplification, conditioning and display equipment. (b) Classification. Class I... 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...

  18. 21 CFR 880.2720 - Patient scale.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... transducers, electronic signal amplification, conditioning and display equipment. (b) Classification. Class I... 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...

  19. 21 CFR 880.2720 - Patient scale.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... transducers, electronic signal amplification, conditioning and display equipment. (b) Classification. Class I... 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...

  20. Cardiac valve replacement: Experience in 2400 patients

    PubMed Central

    Papo, Isidor; Albreht, Mis̆a; Martinović, Nebojs̆a; Sokolić, Josip; Marenović, Tomislav

    1981-01-01

    In the series described here, 2400 patients over a 15-year period underwent surgery for correction of acquired valvular heart disease. Of these, 1586 patients had single valve replacement, 714 had double valve replacement, and 100 had triple valve replacement. Concomitant surgery for associated congenital and acquired lesions was done in 114 patients. The hospital mortality was 9.16%. PMID:15216220