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Sample records for patients hypertendus vus

  1. Hémogramme chez les hypertendus vus au laboratoire du CHU-HJRB d'Antananarivo en 2013

    PubMed Central

    Rakotovao-Ravahatra, Zafindrasoa Domoina; Randriatsarafara, Fidiniaina Mamy; Razafimanantsoa, Fetralinjiva; Rabetokotany, Felana Ranaivo; Rakotovao, Andriamiadana Luc

    2016-01-01

    Introduction L'hémogramme est un bilan biologique de routine demandé chez tout patient souffrant d'Hypertension Artérielle (HTA). Cette étude se propose de décrire les résultats d'hémogramme chez les hypertendus et d'identifier les pathologies associées. Méthodes Il s'agit d'une étude rétrospective type descriptif s’étalant du 01 Décembre 2012 au 31 Décembre 2013 au laboratoire du Centre Hospitalo-Universitaire Hôpital Joseph Raseta Befelatanana (CHU-HJRB) d'Antananarivo. Tous les registres des résultats des hypertendus demandant un hémogramme ont été exploités. Résultats Parmi les 151 hypertendus, 91 (60,3%) ont présenté des hémogrammes pathologiques. Parmi ces derniers, 64 (70,4%) ont montré un seul type d'anomalie et 27 (29,6%) des anomalies multiples. Les anémies (33,91%), les hyperleucocytoses (33,04%), les polyglobulies (10,43%) et les leucopénies (9,57%) sont les plus fréquentes. Pour les anomalies multiples, les anémies associées aux hyperleucocytoses sont les plus observées (29,6%). Les anémies microcytaires (41%) et les hyperleucocytoses à polynucléaires neutrophiles sont les plus dominantes (47,4%). Les patients hospitalisés en néphrologie (90%) et en endocrinologie (81,3%) sont les plus concernés (p = 0,008). Les hypertendus moins de 20 ans (100%) et les femmes (61,5%) sont les plus affectés (p > 0,05). Les crises convulsives (100%), les œdèmes des membres inférieurs (100%) et le diabète (70%) sont les signes et pathologies associés les plus rencontrés (p > 0,05). Conclusion L'hémogramme doit être prescrit chez tout patient hypertendu pour connaître les affections sous-jacentes qui seront traitées simultanément avec l'HTA. Ainsi, le patient hypertendu sera pris en charge convenablement et son espérance de vie sera améliorée. PMID:27217875

  2. Patients diabétiques de type 2 hypertendus: préfèrent-ils traiter le diabète ou l'hypertension artérielle?

    PubMed Central

    Aassri, Hind El; El Mghari, Ghizlane; El Ansari, Nawal

    2014-01-01

    Les diabétologues sont confrontés à des diabétiques le plus souvent hypertendus et polypathologiques, les rendant peu observants des différentes thérapeutiques prescrites. Le but de notre étude est d’évaluer l'observance au traitement chez les patients diabétiques hypertendus. Il s'agit d'une étude descriptive prospective transversale. La population est faite de patients diabétiques de type 2 hypertendus vus aux urgences, à la consultation ou hospitalisés au service d'Endocrinologie. L’échantillon est non probabiliste. La population est faite de 61 patients, d'un âge moyen de 48,9 ans avec une hypertension (HTA) de type systolique dans 59%, diastolique dans 16% et systolo-diastolique dans 25% des cas. Les patients sont équilibrés sur le plan glycémique dans 65% des cas, alors que l’équilibre tensionnel n'est atteint que dans 41% des cas. En ce qui concerne l'observance thérapeutique, 24% des patients sont observant totalement au traitement prescrit, 33% ne sont pas observant au traitement et 43% ont une observance partielle au traitement dont 73.68% préfèrent le traitement destiné au diabète et 26,32% prennent le traitement anti hypertenseur. Les facteurs altérant l'observance au traitement médicamenteux sont un surcoût du traitement un nombre élevé de médicaments prescrits, un nombre important de prises quotidiennes de médicaments, une intolérance au traitement et une mauvaise information du patient sur la justification du traitement. Enfin, les patients diabétiques hypertendus sont classés comme patients à haut risque cardiovasculaire ce qui impose l'application de stratégies thérapeutiques parfois lourdes. Cette polymédication entrave la qualité de l'observance thérapeutique des patients ayant une pathologie chronique dont la compliance au traitement constitue la pierre angulaire de la prise en charge, et ce pour plusieurs raisons en particulier d'ordre économique. PMID:25396019

  3. Syndrome métabolique chez les patients hypertendus dans le service cardiologie du CHU Yalgado Ouedraogo de Ouagadougou, Burkina Faso

    PubMed Central

    Millogo, Georges Rosario Christian; Samandoulougou, André; Yaméogo, Nobila Valentin; Yaméogo, Aristide Relwendé; Kologo, Koudougou Jonas; Toguyeni, Jean Yves; Zabsonré, Patrice

    2014-01-01

    Introduction Le syndrome métabolique constitue de nos jours un véritable problème de santé publique. Le syndrome métabolique est le moteur d'une double épidémie mondiale de diabète type II et de maladies cardiovasculaires. L'objectif de notre étude est de décrire les aspects épidémiologiques, cliniques, para cliniques et évolutifs chez les hypertendus dans le service de Cardiologie du CHU Yalgado Ouédraogo. Méthodes Il s'agissait d'une étude rétrospective sur une période de deux ans dans le service de cardiologie chez les patients hypertendus ayant un syndrome métabolique. Résultats La fréquence du syndrome métabolique était de 17,5% des patients hypertendus. Le sex ratio était de 1,2. L’âge moyen des patients étaient de 56,1 ±10,7 ans. Les patients connus hypertendus étaient de 92,1% avec une durée moyenne d’évolution de l'HTA qui était de 8,7 ± 5,9 ans. Le suivi était irrégulier dans 60% cas et une rupture du traitement dans 37,1% des cas. La dyslipidémie était notée dans 84,2% des cas et le diabète dans 60,5% des cas. La PAS moyenne était de 184,3 ± 47,3 mmHg et la PAD moyenne était de 110,7 ± 27,7 mmHg. L'HTA était sévère dans 63,2% des cas. La glycémie moyenne était de 8,3 ± 4,3 mmol/L, le LDL cholestérol moyen était de 3,5 ± 1,0 mmol/L et le taux des triglycérides moyen était de 1,6 ± 1,1 mmol/L. L'HVG électrique était notée chez 76,3% des patients et échographique dans 58,8% des cas. Les atteintes viscérales étaient neurologique dans 44,5%, rénale dans 55,3% et cardiaque dans 31,2% des cas. Le nombre moyen d'antihypertenseurs était de 3,0 ± 1,0 et 76,3% ont reçu au moins une trithérapie antihypertensive. Le taux de mortalité était de 5,3%. Conclusion Le syndrome métabolique est une pathologie qui pose la problématique de la définition qui n'est pas consensuelle d'une part et d'autre part du contrôle de ses éléments constitutifs surtout l'HTA. PMID:25883718

  4. Prévalence de l’hypotension orthostatique et ses facteurs favorisants chez les hypertendus noirs africains traités

    PubMed Central

    Baragou, Soodougoua; Pio, Machiude; Pessinaba, Soulemane; Redah, Datouda

    2012-01-01

    Introduction Le but de cette étude était de déterminer la prévalence de l’hypotension orthostatique (HO) chez les hypertendus noirs africains traités, et rechercher ses facteurs favorisants. Méthodes Il s’est agi d’une étude prospective transversale menée du 1er février 2007 au 31 janvier 2009 à la clinique cardiologique du CHU Campus de Lomé, incluant des patients régulièrement traités pour hypertension artérielle. La pression artérielle et la fréquence cardiaque étaient mesurées en décubitus dorsal puis immédiatement en orthostatisme (1ère et 3ème minutes). Résultats Sur une population de 394 patients hypertendus traités, 81 cas d’HO (20,5%) ont été observés dont 53 (65,4 %) étaient symptomatiques. Il s’agissait de 188 femmes (49,2%) et de 206 hommes (50,8%). L’âge moyen des hypertendus était de 53,4 ans ± 11,2 avec des extrêmes de 26 ans et de 81ans. Les patients ayant présenté une HO avaient un âge moyen significativement plus élevé : 60 ans contre 51 ans chez les autres (p= 0,01). L’HO était plus fréquente chez les patients traités par antihypertenseurs centraux, les patients ayant présenté un accident vasculaire cérébral, les diabétiques, les obèses. Conclusion L’hypotension orthostatique est fréquente chez les hypertendus noirs africains traités. Il faut la rechercher systématiquement chez tous les hypertendus surtout mal contrôlés car elle peut être non seulement un facteur de mauvaise observance thérapeutique, mais aussi un facteur de risque cardiovasculaire indépendant. PMID:22368755

  5. Determinations of Vus using inclusive hadronic τ decay data

    NASA Astrophysics Data System (ADS)

    Maltman, Kim; Hudspith, Renwick James; Lewis, Randy; Izubuchi, Taku; Ohki, Hiroshi; Zanotti, James M.

    2016-08-01

    Two methods for determining |Vus| employing inclusive hadronic τ decay data are discussed. The first is the conventional flavor-breaking sum rule determination whose usual implementation produces results ˜ 3σ low compared to three-family unitary expectations. The second is a novel approach combining experimental strange hadronic τ distributions with lattice light-strange current-current two-point function data. Preliminary explorations of the latter show the method promises |Vus| determinations competitive with those from Kℓ3 and Γ[Kμ2]/Γ[πμ2]. For the former, systematic issues in the conventional implementation are investigated. Unphysical dependences of |Vus| on the choice of sum rule weight, w, and upper limit, s0, of the weighted experimental spectral integrals are observed, the source of these problems identified and a new implementation which overcomes these problems developed. Lattice results are shown to provide a tool for quantitatively assessing truncation uncertainties for the slowly converging D = 2 OPE series. The results for |Vus| from this new implementation are shown to be free of unphysical w- and s0-dependences, and ˜ 0.0020 higher than those produced by the conventional implementation. With preliminary new Kπ branching fraction results as input, we find |Vus| in excellent agreement with that obtained from Kℓ3, and compatible within errors with expectations from three-family unitarity.

  6. Determinations of Vus using inclusive hadronic τ decay data

    DOE PAGES

    Maltman, Kim; Hudspith, Renwick James; Lewis, Randy; ...

    2016-08-30

    Two methods for determining |Vus| employing inclusive hadronic ττ decay data are discussed. The first is the conventional flavor-breaking sum rule determination whose usual implementation produces results ~3σ low compared to three-family unitary expectations. The second is a novel approach combining experimental strange hadronic ττ distributions with lattice light-strange current–current two-point function data. In preliminary explorations of the latter show the method promises |Vus| determinations are competitive with those from Kℓ3 and Γ[πμ2]/Γ[πμ2]. For the former, systematic issues in the conventional implementation are investigated. Unphysical dependences of |Vus| on the choice of sum rule weight, w, and upper limit, s0,more » of the weighted experimental spectral integrals are observed, the source of these problems identified and a new implementation which overcomes these problems developed. The lattice results are shown to provide a tool for quantitatively assessing truncation uncertainties for the slowly converging D=2 OPE series. Our results for |Vus| from this new implementation are shown to be free of unphysical w- and s0-dependences, and ~0.0020 higher than those produced by the conventional implementation. With preliminary new Kπ branching fraction results as input, we find |Vus| in excellent agreement with that obtained from Kℓ3, and compatible within errors with expectations from three-family unitarity.« less

  7. Contrast enhanced Voiding Urosonography (ce-VUS) as a radiation-free technique in the diagnosis of vesicoureteric reflux: Our early experience.

    PubMed

    Faizah, M Z; Hamzaini, A H; Kanaheswari, Y; Dayang A, A A; Zulfiqar, M A

    2015-10-01

    Contrast-enhanced ultrasound has become increasingly utilised as an alternative imaging modality for the diagnosis of vesicoureteric reflux (VUR) in paediatric patients. The study objective is to evaluate the efficacy of contrast enhanced Voiding Urosonography (ce-VUS) compared with fluoroscopic micturating cystourethrography (MCU) in the detection of VUR. This prospective study was carried out between July 2011 and January 2013 on paediatric patients who underwent MCU. All consented patients would undergo ce- VUS prior to MCU. We documented the epidemiology details, the number of Kidney-Ureter (K-U) unit studied, baseline renal and bladder sonogram, as well as presence of VUR on ce-VUR. The technique for ce-VUS was standardized using normal saline to fill the bladder prior to administration of SonoVue® (2.5 ml) to assess the kidney-ureter (K-U) unit. Dedicated contrast detection software was used to discern the presence of microbubbles in the pelvicaliceal system (PCS). The findings were then compared with MCU. 27 paediatric patients were involved in the study [17 males (63%) and 10 females (37%)] involving 55 K-U units (one patient had a complete duplex system). MCU detected VUR in 10 K-U units while ce-VUS detected VUR in 8 out of the 10 K-U units. There were 2 false negative cases (both Grade 1) with ce-VUS. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ce-VUS were 80%, 98%, 95%, 89% and 96%, respectively. ce-VUS is a sensitive and specific radiation-free alternative for the detection of VUR in the paediatric population.

  8. Troubles du sommeil, symptômes anxio-dépressifs et risque cardio-vasculaire chez les hypertendus noirs africains: étude transversale de 414 hypertendus suivis en ambulatoire au CHU de Ouagadougou (Burkina Faso)

    PubMed Central

    Yaméogo, Nobila Valentin; Samadoulougou, André; Kagambèga, Larissa Justine; Yaméogo, Aimé Arsène; Ilboudo, Eric; Millogo, Georges; Kologo, Jonas; Toguyeni, Jean Yves; Simporé, Jacques; Zabsonré, Patrice

    2015-01-01

    Introduction Dans le but de déterminer la fréquence des troubles du sommeil, de l'anxiété et de la dépression, et de rechercher l'existence d'une relation entre ces troubles et le risque cardio-vasculaire global chez les hypertendus noirs africains, nous avons réalisé une étude transversale de mai 2010 à mars 2011 à l'unité de consultation externe du service de cardiologie du CHU-Yalgado Ouédraogo de Ouagadougou qui a inclut 414 hypertendus adultes suivis en ambulatoire. Après un examen clinique à la recherche des facteurs de risque cardio-vasculaire, deux auto-questionnaires ont été administrés. Méthodes Le questionnaire de l’«European Sleep Center » pour la recherche des troubles du sommeil et, l’échelle «Hospital Anxiety and Depression Scale » de Zigmond et Snaith pour la recherche de l'anxiété et la dépression. Le diagnostic du syndrome d'apnée du sommeil était clinique et basé sur la présence des 4 symptômes principaux: hypersomnolence diurne, éveils nocturnes fréquents avec nycturie, asthénie matinale avec ou sans céphalées et ronflements importants. Le risque cardio-vasculaire global était calculé grâce à l’équation d'Anderson tirée de l’étude de Framingham. L'analyse des données a été réalisée par le logiciel SPSS version 17. La comparaison des variables a été effectuée grâce au test de Khi 2 pour les variables qualitatives et au test «t» de Student pour les variables quantitatives. Le seuil de signification a été fixé à 5%. Résultats L’échantillon était composé de 414 patients dont 248 femmes (59,9%). L’âge moyen était de 54,6 ± 9,3 ans. Les troubles du sommeil étaient retrouvés dans 72,2% des cas. Ils étaient dominés par l'insomnie (49,2%), le syndrome d'apnée du sommeil (33,5%) et le syndrome des jambes sans repos (25,8%). L'anxiété était retrouvée dans 37,1% des cas et la dépression dans 16,6% des cas. Le risque cardio-vasculaire global était faible dans 21,0%, mod

  9. L'observance médicamenteuse et ses facteurs dans un groupe d'hypertendus congolais

    PubMed Central

    Ikama, Méo Stéphane; Nsitou, Bernice Mesmer; Loumouamou, Mpouoni; Kimbally-Kaky, Gisèle; Nkoua, Jean Louis

    2013-01-01

    L'objectif de ce travail était d’évaluer le niveau d'observance des patients hypertendus et identifier les facteurs prédictifs de mauvaise observance. Il s'est agi d'une étude transversale à recueil de données prospectif sur une période de six mois. Elle s'est déroulée dans les services de consultations externes de cardiologie dans trois hôpitaux: le CHU de Brazzaville, l'hôpital central des armées de Brazzaville, et l'hôpital général de Loandjili (Pointe-Noire). Cette étude a concerné 212 patients dont 122 femmes (57.5%) et 90 hommes (42.5%), âgés de plus de 18ans, hypertendus traités depuis au moins six mois. Le questionnaire à six questions conçu par Girerd a été utilisé pour évaluer l'observance médicamenteuse. Une régression logistique a été utilisée pour rechercher les facteurs de mauvaise observance. L'observance était considérée comme bonne chez 45 patients soit 21.2%, et mauvaise chez 69 patients soit 32.5%. Dans 98 cas soit 46.2% il y avait un minime problème d'observance. Une HTA ancienne de plus de 5 ans, la présence des complications évolutives de l'HTA ainsi que les niveaux élevés de la PAS et de la PAD étaient liés à la mauvaise observance. Par contre aucune relation statistique n'a été retrouvée entre la mauvaise observance et l'existence d'une co-morbidité, la fréquence des prises médicamenteuses, le nombre de comprimés par jour et une pression artérielle non contrôlée. Les patients non observant étaient en moyenne plus âgés que les autres. Une mauvaise connaissance du traitement et des complications de l'HTA, le fait de ne pas acheter soi-même ses médicaments, l'ignorance de la gravité de l'HTA, et le coût élevé du traitement étaient prédictifs d'une mauvaise observance. La possession d'un tensiomètre électronique d'auto mesure tensionnelle ainsi que le rappel des prises médicamenteuses par les parents étaient liés à une bonne observance. Après ajustement par une r

  10. Relationship between ultrasound criteria and voiding ultrasonography (VUS) in the evaluation of vesicoureteral reflux (VUR).

    PubMed

    Vegar-Zubović, Sandra; Kristić, Spomenka; Čarovac, Aladin; Sefić-Pašić, Irmina; Džananović, Amra; Miličić-Pokrajac, Danka; Lidija, Lincender

    2014-08-01

    To analyze the usefulness of five ultrasound parameters (ureteral dilatation, renal pelvis dilatation, renal parenchyma width reduction, calyceal dilatation, and urothelial reaction) in detecting vesicoureteral reflux (VUR). The study included 101 patients with diagnosed and therapeutically treated urinary infection. The ultrasound examination and voiding urosonography (VUS) were carried out according to a standard protocol. In the group of patients with proven VUR the presence of the indirect ecomorphological signs of VUR was evaluated. The referral diagnosis urinary tract infection was present at the admission in 53 patients, while the remaining 48 patients were admitted with the diagnosis of infectio tractus urinarii recidivans. Pathological VUS was found in 53 patients. The ultrasound parameter with the highest sensitivity, specificity, and negative predictive value (77.4%, 79.2%, and 76.0%, respectively) in detection of VUR was urethral dilatation, while the parameter with the highest positive predictive value (62.5%) in detection of VUR was urothelial reaction. In case of ultrasound verification of ureteral dilatation or urothelial reaction, especially in if the urinary infection has proved, it is necessary to exclude the existence of VUR.

  11. Missense Variants of Uncertain Significance (VUS) Altering the Phosphorylation Patterns of BRCA1 and BRCA2

    PubMed Central

    Tram, Eric; Savas, Sevtap; Ozcelik, Hilmi

    2013-01-01

    Mutations in BRCA1 and BRCA2 are responsible for a large proportion of breast-ovarian cancer families. Protein-truncating mutations have been effectively used in the clinical management of familial breast cancer due to their deleterious impact on protein function. However, the majority of missense variants identified throughout the genes continue to pose an obstacle for predictive informative testing due to low frequency and lack of information on how they affect BRCA1/2 function. Phosphorylation of BRCA1 and BRCA2 play an important role in their function as regulators of DNA repair, transcription and cell cycle in response to DNA damage but whether missense variants of uncertain significance (VUS) are able to disrupt this important process is not known. Here we employed a novel approach using NetworKIN which predicts in vivo kinase-substrate relationship, and evolutionary conservation algorithms SIFT, PolyPhen and Align-GVGD. We evaluated whether 191 BRCA1 and 43 BRCA2 VUS from the Breast Cancer Information Core (BIC) database can functionally alter the consensus phosphorylation motifs and abolish kinase recognition and binding to sites known to be phosphorylated in vivo. Our results show that 13.09% (25/191) BRCA1 and 13.95% (6/43) BRCA2 VUS altered the phosphorylation of BRCA1 and BRCA2. We highlight six BRCA1 (K309T, S632N, S1143F, Q1144H, Q1281P, S1542C) and three BRCA2 (S196I, T207A, P3292L) VUS as potentially clinically significant. These occurred rarely (n<2 in BIC), mutated evolutionarily conserved residues and abolished kinase binding to motifs established in the literature involved in DNA repair, cell cycle regulation, transcription or response to DNA damage. Additionally in vivo phosphorylation sites identified via through-put methods are also affected by VUS and are attractive targets for studying their biological and functional significance. We propose that rare VUS affecting phosphorylation may be a novel and important mechanism for which BRCA1 and

  12. The inclusive flavor-breaking τ-based sum rule determination of Vus

    NASA Astrophysics Data System (ADS)

    Maltman, K.; Hudspith, R. J.; Izubuchi, T.; Lewis, R.; Ohki, H.; Zanotti, J. M.

    2017-06-01

    We revisit the puzzle of the > 3 σ low (c.f. three-family-unitarity expections) determination of Vus from the conventional implementation of flavor-breaking (FB) finite-energy sum rules (FESRs) employing inclusive hadronic τ decay data. Problems with this implementation are identified and an alternative implementation which cures them described. Using this new implementation and preliminary BaBar results for the exclusive τ →K-π0ντ find Vus = 0.2228(23)exp(6)th, in excellent agreement with results from other sources. Limitations on the near-term possibilities for reducing experimental errors in this approach are highlighted, and a new proposal for improving this situation via dispersive analyses of strange hadronic τ data using lattice data as input described.

  13. A Guide for Functional Analysis of BRCA1 Variants of Uncertain Significance (VUS)

    PubMed Central

    Millot, Gaël; Carvalho, Marcelo A.; Caputo, Sandrine M; Vreeswijk, Maaike P.G.; Brown, Melissa A; Webb, Michelle; Rouleau, Etienne; Neuhausen, Susan L.; Hansen, Thomas v. O.; Galli, Alvaro; Brandão, Rita D; Blok, Marinus J.; Velkova, Aneliya; Couch, Fergus J.; Monteiro, Alvaro N.A.

    2012-01-01

    Germline mutations in the tumor suppressor gene BRCA1 confer an estimated lifetime risk of 56–80% for breast cancer and 15–60% for ovarian cancer. Since the mid 1990’s when BRCA1 was identified, genetic testing has revealed over 3,000 unique germline variants. However, for a significant number of these variants, the effect on protein function is unknown making it difficult to infer the consequences on risks of breast and ovarian cancers. Thus, many individuals undergoing genetic testing for BRCA1 mutations receive test results reporting a variant of uncertain clinical significance (VUS), leading to issues in risk assessment, counseling, and preventive care. Here we describe functional assays for BRCA1 to directly or indirectly assess the impact of a variant on protein conformation or function and how these results can be used to complement genetic data to classify a VUS as to its clinical significance. Importantly, these methods may provide a framework for genome-wide pathogenicity assignment. PMID:22753008

  14. Lynch Syndrome Limbo: Patient Understanding of Variants of Uncertain Significance.

    PubMed

    Solomon, Ilana; Harrington, Elizabeth; Hooker, Gillian; Erby, Lori; Axilbund, Jennifer; Hampel, Heather; Semotiuk, Kara; Blanco, Amie; Klein, William M P; Giardiello, Francis; Leonard, Lori

    2017-01-26

    Providers and patients encounter challenges related to the management of Variants of Unknown Significance (VUS). A VUS introduces new counseling dilemmas for the understanding and psychosocial impact of uncertain genetic test results. This descriptive study uses Mishel's theory of uncertainty in illness to explore the experience of individuals who have received a VUS as part of the genetic testing process. Semi-structured interviews were conducted with 27 adult individuals who received a VUS for Lynch syndrome mismatch repair genes between 2002 and 2013. The interviews were transcribed and analyzed. Most individuals recalled their result and perceived various types of uncertainty associated with their VUS. Half of the participants appraised their variant as a danger and implemented coping strategies to reduce the threat of developing cancer. Mobilizing strategies to reduce their risk included vigilant cancer surveillance, information seeking and notifying relatives. The majority of participants were unaware of the possibility of a VUS before receiving their result and expected reclassification over time. These results provide insight into the ways healthcare providers can support patients who receive VUS for Lynch syndrome. Findings also provide direction for future work that can further explicate the impact of receiving a VUS.

  15. a Measurement of Ξ0 Beta Decay by NA48/1 and the Extraction of VUS

    NASA Astrophysics Data System (ADS)

    Jeitler, M.

    2005-04-01

    A large sample of Ξ0 decays was collected by the NA48/1 collaboration at the CERN SPS accelerator during a high-intensity KS and hyperon run in 2002. Clean signals for the semileptonic decays Ξ 0 -> Σ + e- bar {ν }e and Ξ 0 -> Σ + μ - bar {ν }μ have been obtained. The measurement of the Ξ 0 -> Σ + e- bar {ν }e branching ratio has been used to extract Vus. This measurement is of special interest because recent results on Vus obtained mostly from "Ke3" decays of neutral and charged kaons (K → πeν), in combination with measured values for Vud seemed to be in conflict with the unitarity condition of the CKM matrix.

  16. Determination of |V(us)|| from a lattice QCD calculation of the K → πℓν semileptonic form factor with physical quark masses.

    PubMed

    Bazavov, A; Bernard, C; Bouchard, C M; Detar, C; Du, Daping; El-Khadra, A X; Foley, J; Freeland, E D; Gámiz, E; Gottlieb, Steven; Heller, U M; Kim, Jongjeong; Kronfeld, A S; Laiho, J; Levkova, L; Mackenzie, P B; Neil, E T; Oktay, M B; Qiu, Si-Wei; Simone, J N; Sugar, R; Toussaint, D; Van de Water, R S; Zhou, Ran

    2014-03-21

    We calculate the kaon semileptonic form factor f+(0) from lattice QCD, working, for the first time, at the physical light-quark masses. We use gauge configurations generated by the MILC Collaboration with Nf = 2 + 1 + 1 flavors of sea quarks, which incorporate the effects of dynamical charm quarks as well as those of up, down, and strange. We employ data at three lattice spacings to extrapolate to the continuum limit. Our result, f+(0) = 0.9704(32), where the error is the total statistical plus systematic uncertainty added in quadrature, is the most precise determination to date. Combining our result with the latest experimental measurements of K semileptonic decays, one obtains the Cabibbo-Kobayashi-Maskawa matrix element |V(us)| = 0.22290(74)(52), where the first error is from f+(0) and the second one is from experiment. In the first-row test of Cabibbo-Kobayashi-Maskawa unitarity, the error stemming from |V(us)| is now comparable to that from |V(ud)|.

  17. Prise en charge des hypertendus dans la ville de Cotonou (Bénin) en 2011: connaissances attitudes et pratiques des médecins généralistes

    PubMed Central

    Houenassi, Martin Dèdonougbo; David, Dokoui; Codjo, Léopold Houétondji; Attinsounon, Angelo Cossi; Alassani, Adebayo; Ahoui, Séraphin; Dovonou, Albert Comlan; Adoukonou, Thierry Armel; Dohou, Serge Hugues Mahougnon; Wanvoegbe, Armand; Agbodande, Anthelme

    2016-01-01

    Summary But: Ce travail vise à évaluer les connaissances, attitudes et pratiques des médecins généralistes sur la prise en charge de l’hypertension artérielle à Cotonou. Méthodes: L’étude était transversale et descriptive basée sur une enquête multicentrique du 1er Mai 2011 au 31 Juillet 2011. Un recrutement de tous les médecins généralistes, volontaires exerçant dans les centres de santé privés, publics et confessionnels de la ville de Cotonou, ayant autorisé l’étude, a été fait. Le 7ème rapport de Joint National Committee (JNC7) a été utilisé comme référentiel pour l’évaluation de la prise en charge des hypertendus. Un auto-questionnaire adressé aux généralistes, testé et validé, a été utilisé pour recueillir ces données. Résultats: Au total, 41 médecins généralistes dans huit établissements sanitaires ont été inclus. Près de la moitié des généralistes (48.8%) ne connaissaient pas la définition de l’HTA. Seulement 25 généralistes (61.0%) pouvaient décrire les conditions de mesure de la pression artérielle. Dix généralistes (24.4%) étaient incapables de lister la moitié des examens du bilan minimum de l’hypertension artérielle (HTA). La majorité (92.7%) ne connaissait pas la notion de risque cardiovasculaire global. L’objectif tensionnel (TA ≤ 140/90 mmHg) n’était connu que par 18 (43.9%) médecins. Les mesures hygiéno-diététiques seules (82.9%) et la monothérapie seule (70.7%) étaient les modalités thérapeutiques les plus prescrites. Les classes pharmacologiques antihypertensives prescrites étaient surtout les inhibiteurs calciques (82.9%), les inhibiteurs de l’enzyme de conversion (53.7%) et les diurétiques (36.6%). Les généralistes référaient les hypertendus aux cardiologues principalement pour non-maitrise du chiffres tensionnels (63,4%) et l’apparition de complications aigues (56.1%). Conclusion: Les connaissances des généralistes sur la prise en charge de l

  18. Falls, Balance Confidence, and Lower-Body Strength in Patients Seeking Outpatient Venous Ulcer Wound Care.

    PubMed

    Pieper, Barbara; Templin, Thomas N

    2016-02-01

    To provide information about a quality improvement project examining falls in persons seeking outpatient wound care. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Describe the scope of the problem and the related quality improvement project. 2. Delineate the results of the project and their implications for treatment of patients with venous ulcers. The authors aim to examine fall occurrence and fall injuries in persons seeking outpatient wound care and to compare falls, balance confidence, and lower-body strength in persons with injection-related venous ulcers (IRVUs) versus persons with venous ulcers (VUs) related to other risk factors besides injection drugs (VUs-other). This quality improvement project used a cross-sectional, comparative design. Participants responded to demographic questions, the Activities-specific Balance Confidence (ABC) Scale, fear of falling, fall numbers, and injuries and performed the 30-second chair-rise test. Outpatient wound service. Patients (N = 106; mean age, 59.94 years) included men (66%) and women. Sixty patients reported falling; 47 were recurrent fallers. Twenty patients stated they were injured, but did not go to an emergency department. A higher number of total falls was significantly related to more comorbidities. Total falls were significantly related to fear of falling and ABC Scale scores. Those with VUs-other had significantly more comorbidities and higher body mass index values than those with IRVUs. Those with IRVUs were comparable to those VUs-other on number of falls and fear of falling, respectively. Those with IRVUs (7.30) performed significantly more chair rises than those with VUs-other (4.72). Persons with IRVUs had significantly higher ABC Scale scores (63.24%) than those with VUs-other (49.38%). Falls are a common occurrence in persons seeking

  19. Genetic basis of familial dilated cardiomyopathy patients undergoing heart transplantation.

    PubMed

    Cuenca, Sofia; Ruiz-Cano, Maria J; Gimeno-Blanes, Juan Ramón; Jurado, Alfonso; Salas, Clara; Gomez-Diaz, Iria; Padron-Barthe, Laura; Grillo, Jose Javier; Vilches, Carlos; Segovia, Javier; Pascual-Figal, Domingo; Lara-Pezzi, Enrique; Monserrat, Lorenzo; Alonso-Pulpon, Luis; Garcia-Pavia, Pablo

    2016-05-01

    Dilated cardiomyopathy (DCM) is the most frequent cause of heart transplantation (HTx). The genetic basis of DCM among patients undergoing HTx has been poorly characterized. We sought to determine the genetic basis of familial DCM HTx and to establish the yield of modern next generation sequencing (NGS) technologies in this setting. Fifty-two heart-transplanted patients due to familial DCM underwent NGS genetic evaluation with a panel of 126 genes related to cardiac conditions (59 associated with DCM). Genetic variants were initially classified as pathogenic mutations or as variants of uncertain significance (VUS). Final pathogenicity status was determined by familial cosegregation studies. Initially, 24 pathogenic mutations were found in 21 patients (40%); 25 patients (48%) carried 19 VUS and 6 (12%) did not show any genetic variant. Familial evaluation of 220 relatives from 36 of the 46 families with genetic variants confirmed pathogenicity in 14 patients and allowed reclassification of VUS as pathogenic in 17 patients, and as non-pathogenic in 3 cases. At the end of the study, the DCM-causing mutation was identified in 38 patients (73%) and 5 patients (10%) harbored only VUS. No genetic variants were identified in 9 cases (17%). The genetic spectrum of familial DCM patients undergoing HTx is heterogeneous and involves multiple genes. NGS technology plus detailed familial studies allow identification of causative mutations in the vast majority of familial DCM cases. Detailed familial studies remain critical to determine the pathogenicity of underlying genetic defects in a substantial number of cases. Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  20. Thyroglobulin gene mutations in Chinese patients with congenital hypothyroidism.

    PubMed

    Hu, Xuyun; Chen, Rongyu; Fu, Chunyun; Fan, Xin; Wang, Jin; Qian, Jiale; Yi, Shang; Li, Chuan; Luo, Jingsi; Su, Jiasun; Zhang, Shujie; Xie, Bobo; Zheng, Haiyang; Lai, Yunli; Chen, Yun; Li, Hongdou; Gu, Xuefan; Chen, Shaoke; Shen, Yiping

    2016-03-05

    Mutations in Thyroglobulin (TG) are common genetic causes of congenital hypothyroidism (CH). But the TG mutation spectrum and its frequency in Chinese CH patients have not been investigated. Here we conducted a genetic screening of TG gene in a cohort of 382 Chinese CH patients. We identified 22 rare non-polymorphic variants including six truncating variants and 16 missense variants of unknown significance (VUS). Seven patients carried homozygous pathogenic variants, and three patients carried homozygous or compound heterozygous VUS. 48 out of 382 patients carried one of 18 heterozygous VUS which is significantly more often than their occurrences in control cohort (P < 0.0001). Unique to Asian population, the c.274+2T>G variant is the most common pathogenic variant with an allele frequency of 0.021. The prevalence of CH due to TG gene defect in Chinese population was estimated to be approximately 1/101,000. Our study uncovered ethnicity specific TG mutation spectrum and frequency.

  1. Patient Recall, Interpretation, and Perspective of an Inconclusive Long QT Syndrome Genetic Test Result.

    PubMed

    Predham, Sarah; Hathaway, Julie; Hulait, Gurdip; Arbour, Laura; Lehman, Anna

    2017-02-01

    Patients' perceptions of inconclusive results have been previously investigated in cancer genetics. The differences in how patients recall and interpret an uninformative test result compared to a known pathogenic result can affect medical decisions post disclosure. However, there is little to no data available on patients' interpretation and perception of uninformative genetic results in inherited heart disease. We report the results of a qualitative analysis of 16 telephone interviews with participants who received a negative or a variant of unknown significance (VUS) result from Long QT syndrome (LQTS) genetic testing. Our results suggest that the type of result (negative versus VUS) does not affect recall, regardless of the reason for testing. When receiving a negative result, a majority of participants appropriately perceived no change in their diagnosis, while the perception of risk for family members varied. The majority of participants felt they maintained an awareness of their condition after the result disclosure, and that clinical follow-up was similar to that planned prior to the genetic test result. Further work is needed to determine if there are any differences between obtaining a VUS result versus a negative result in this population.

  2. Épidémiologie des brûlures de la main chez les enfants vus dans le Centre National des Brûlés et de Chirurgie Plastique de Casablanca, Maroc

    PubMed Central

    Rafik, A.; Lahlou, M.; Diouri, M.; Bahechar, N.; Chlihi, A.

    2015-01-01

    Summary Les brûlures de la main chez l’enfant constituent une source de séquelles invalidantes. A cet régard, la conservation et la restauration complète de la fonction de la main demeurent le but primordial de la prise en charge. Afin de répertorier les caractéristiques épidémiologiques, cliniques et évolutives des mains brûlées, nous avons réalisé une étude rétrospective étalée sur 4 ans, de janvier 2011 à janvier 2015. Cette étude a permis de colliger les cas de 313 enfants atteints de brûlure de la main vus dans le Centre National des Brulés et de Chirurgie Plastique du CHU Ibn Rochd de Casablanca. La majorité des brûlures touche les enfants de 3 à 6 ans (70% des cas), avec une légère prédominance masculine. La principale cause des brûlures survenant à cet âge est l’ébouillantement. Les brûlures par flamme représentent 33% des cas, celles par électricité 4,5%. Les brûlures chimiques et par contact sont anecdotiques (1 cas chacune). L’accident survient le plus souvent à domicile. Soixante douze pour cent des brûlures ont guéri spontanément. Afin de diminuer l’incidence de ces accidents, une approche préventive faite de sensibilisation et d’éducation devrait faire partie du cursus scolaire. PMID:27777543

  3. Computer-aided evaluation of inflammatory changes over time on MRI of the spine in patients with suspected axial spondyloarthritis: a feasibility study.

    PubMed

    Aizenberg, Evgeni; van den Berg, Rosaline; Ez-Zaitouni, Zineb; van der Heijde, Désirée; Reijnierse, Monique; Dzyubachyk, Oleh; Lelieveldt, Boudewijn P F

    2017-09-19

    Evaluating inflammatory changes over time on MR images of the spine in patients with suspected axial Spondyloarthritis (axSpA) can be a labor-intensive task, requiring readers to manually search for and perceptually align a set of vertebrae between two scans. The purpose of this study was to assess the feasibility of computer-aided (CA) evaluation of such inflammatory changes in a framework where scans from two time points are fused into a single color-encoded image integrated into an interactive scoring tool. For 30 patients from the SPondyloArthritis Caught Early (SPACE) cohort (back pain ≥ 3 months, ≤ 2 years, onset < 45 years), baseline and follow-up MR scans acquired 9-12 months apart were fused into a single color-encoded image through locally-rigid image registration to evaluate inflammatory changes in 23 vertebral units (VUs). Scoring was performed by two expert readers on a (-2, 2) scale using an interactive scoring tool. For comparison of direction of change (increase/decrease) indicated by an existing reference, Berlin method scores ((-3, 3) scale) of the same MR scans from a different ongoing study were used. The distributions of VU-level differences between CA readers and between the CA and Berlin methods (sign of change scores) across patients were analyzed descriptively. Patient-level agreement between CA readers was assessed by intraclass correlation coefficient (ICC). Five patients were excluded from evaluation due to failed vertebrae segmentation. Patient-level inter-reader agreement ICC was 0.56 (95% CI: 0.22 to 0.78). Mean VU-level inter-reader differences across 25 patients ranged (-0.04, 0.12) with SD range (0, 0.45). Across all VUs, inter-reader differences ranged (-1, 1) in 573/575 VUs (99.7%). Mean VU-level inter-method differences across patients ranged (-0.04, 0.08) with SD range (0, 0.61). Across all VUs, inter-method differences ranged (-1, 1) in 572/575 VUs (99.5%). Fusion of MR scans of the spine from two time points into a

  4. Presurgical brain mapping of the language network in patients with brain tumors using resting-state fMRI: Comparison with task fMRI.

    PubMed

    Sair, Haris I; Yahyavi-Firouz-Abadi, Noushin; Calhoun, Vince D; Airan, Raag D; Agarwal, Shruti; Intrapiromkul, Jarunee; Choe, Ann S; Gujar, Sachin K; Caffo, Brian; Lindquist, Martin A; Pillai, Jay J

    2016-03-01

    To compare language networks derived from resting-state fMRI (rs-fMRI) with task-fMRI in patients with brain tumors and investigate variables that affect rs-fMRI vs task-fMRI concordance. Independent component analysis (ICA) of rs-fMRI was performed with 20, 30, 40, and 50 target components (ICA20 to ICA50) and language networks identified for patients presenting for presurgical fMRI mapping between 1/1/2009 and 7/1/2015. 49 patients were analyzed fulfilling criteria for presence of brain tumors, no prior brain surgery, and adequate task-fMRI performance. Rs-vs-task-fMRI concordance was measured using Dice coefficients across varying fMRI thresholds before and after noise removal. Multi-thresholded Dice coefficient volume under the surface (DiceVUS) and maximum Dice coefficient (MaxDice) were calculated. One-way Analysis of Variance (ANOVA) was performed to determine significance of DiceVUS and MaxDice between the four ICA order groups. Age, Sex, Handedness, Tumor Side, Tumor Size, WHO Grade, number of scrubbed volumes, image intensity root mean square (iRMS), and mean framewise displacement (FD) were used as predictors for VUS in a linear regression. Artificial elevation of rs-fMRI vs task-fMRI concordance is seen at low thresholds due to noise. Noise-removed group-mean DiceVUS and MaxDice improved as ICA order increased, however ANOVA demonstrated no statistically significant difference between the four groups. Linear regression demonstrated an association between iRMS and DiceVUS for ICA30-50, and iRMS and MaxDice for ICA50. Overall there is moderate group level rs-vs-task fMRI language network concordance, however substantial subject-level variability exists; iRMS may be used to determine reliability of rs-fMRI derived language networks. © 2015 Wiley Periodicals, Inc.

  5. Molecular Diagnostic Testing by eyeGENE: Analysis of Patients With Hereditary Retinal Dystrophy Phenotypes Involving Central Vision Loss

    PubMed Central

    Alapati, Akhila; Goetz, Kerry; Suk, John; Navani, Mili; Al-Tarouti, Amani; Jayasundera, Thiran; Tumminia, Santa J.; Lee, Pauline; Ayyagari, Radha

    2014-01-01

    Purpose. To analyze the genetic test results of probands referred to eyeGENE with a diagnosis of hereditary maculopathy. Methods. Patients with Best macular dystrophy (BMD), Doyne honeycomb retinal dystrophy (DHRD), Sorsby fundus dystrophy (SFD), or late-onset retinal degeneration (LORD) were screened for mutations in BEST1, EFEMP1, TIMP3, and CTRP5, respectively. Patients with pattern dystrophy (PD) were screened for mutations in PRPH2, BEST1, ELOVL4, CTRP5, and ABCA4; patients with cone-rod dystrophy (CRD) were screened for mutations in CRX, ABCA4, PRPH2, ELOVL4, and the c.2513G>A p.Arg838His variant in GUCY2D. Mutation analysis was performed by dideoxy sequencing. Impact of novel variants was evaluated using the computational tool PolyPhen. Results. Among the 213 unrelated patients, 38 had BMD, 26 DHRD, 74 PD, 8 SFD, 6 LORD, and 54 CRD; six had both PD and BMD, and one had no specific clinical diagnosis. BEST1 variants were identified in 25 BMD patients, five with novel variants of unknown significance (VUS). Among the five patients with VUS, one was diagnosed with both BMD and PD. A novel EFEMP1 variant was identified in one DHRD patient. TIMP3 novel variants were found in two SFD patients, PRPH2 variants in 14 PD patients, ABCA4 variants in four PD patients, and p.Arg838His GUCY2D mutation in six patients diagnosed with dominant CRD; one patient additionally had a CRX VUS. ABCA4 mutations were identified in 15 patients with recessive CRD. Conclusions. Of the 213 samples, 55 patients (26%) had known causative mutations, and 13 (6%) patients had a VUS that was possibly pathogenic. Overall, selective screening for mutations in BEST1, PRPH2, and ABCA4 would likely yield the highest success rate in identifying the genetic basis for macular dystrophy phenotypes. Because of the overlap in phenotypes between BMD and PD, it would be beneficial to screen genes associated with both diseases. PMID:25082885

  6. Impact of Panel Gene Testing for Hereditary Breast and Ovarian Cancer on Patients.

    PubMed

    Lumish, Heidi S; Steinfeld, Hallie; Koval, Carrie; Russo, Donna; Levinson, Elana; Wynn, Julia; Duong, James; Chung, Wendy K

    2017-03-29

    Recent advances in next generation sequencing have enabled panel gene testing, or simultaneous testing for mutations in multiple genes for a clinical condition. With more extensive and widespread genetic testing, there will be increased detection of genes with moderate penetrance without established clinical guidelines and of variants of uncertain significance (VUS), or genetic variants unknown to either be disease-causing or benign. This study surveyed 232 patients who underwent genetic counseling for hereditary breast and ovarian cancer to examine the impact of panel gene testing on psychological outcomes, patient understanding, and utilization of genetic information. The survey used standardized instruments including the Impact of Event Scale (IES), Multidimensional Impact of Cancer Risk Assessment (MICRA), Satisfaction with Decision Instrument (SWD), Ambiguity Tolerance Scale (AT-20), genetics knowledge, and utilization of genetic test results. Study results suggested that unaffected individuals with a family history of breast or ovarian cancer who received positive results were most significantly impacted by intrusive thoughts, avoidance, and distress. However, scores were also modestly elevated among unaffected patients with a family history of breast and ovarian cancer who received VUS, highlighting the impact of ambiguous results that are frequent among patients undergoing genetic testing with large panels of genes. Potential risk factors for increased genetic testing-specific distress in this study included younger age, black or African American race, Hispanic origin, lower education level, and lower genetic knowledge and highlight the need for developing strategies to provide effective counseling and education to these communities, particularly when genetic testing utilizes gene panels that more commonly return VUS. More detailed pre-test education and counseling may help patients appreciate the probability of various types of test results and how results

  7. La dysfonction érectile chez l'hypertendu togolais: étude transversale chez 100 patients dans le Service de Cardiologie du CHU Campus de Lomé

    PubMed Central

    Pessinaba, Soulemane; Baragou, Soodougoua; Pio, Machihude; Tengué, Kevin; Afassinou, Yaovi; Kpatcha, Matchona; Awisoba, Madikizi; Kpélafia, Mouhamed; Nda, NKenon Watani; Damorou, Findibé

    2015-01-01

    Introduction L'association HTA et dysfonction érectile (DE) est connue. Les objectifs de ce travail étaient de déterminer la prévalence de la DE et d'en évaluer la sévérité chez l'hypertendu togolais. Méthodes Il s'agit d'une étude transversale menée chez 100 hypertendus reçus en consultations externes dans le service cardiologie du CHU Campus d'octobre à décembre 2012. Le statut érectile a été évalué avec l'international index of erectile function (IIEF-5). Résultats L’âge moyen des hypertendus était de 53,3 ± 10,3 ans. La durée moyenne de l'HTA était de 6,7 ± 6,9 ans. Les facteurs de risque cardio-vasculaire retrouvés chez ces hypertendus étaient: diabète (7%), obésité (17,5%), obésité abdominale (40%), dyslipidémie (36%) et tabac (1%). La prévalence de la DE était de 53% dont 32% de DE légère, 18% de DE modérée et 3% de DE sévère. Parmi les patients ayant une DE, 60% avaient une DE légère, 34% une DE modérée et 6% une DE sévère. Le score IIFE moyen était de 19,1 ± 5,2. La prévalence de la DE augmentait avec l’âge (p=0,05), le grade (p=0,004) et la durée de l'HTA (p=0,20). La DE était significativement plus fréquente en présence du diabète (p=0,02) et de l'obésité abdominale (p=0,007). Conclusion La prévalence de la DE est élevée chez l'hypertendu togolais. Cette prévalence augmente avec l’âge, la durée de l'HTA, la présence de diabète et l'obésité abdominale. La DE doit être systématiquement recherchée chez l'hypertendu surtout en présence des autres FDR. PMID:26405483

  8. Type and frequency of MUTYH variants in Italian patients with suspected MAP: a retrospective multicenter study.

    PubMed

    Ricci, Maria Teresa; Miccoli, Sara; Turchetti, Daniela; Bondavalli, Davide; Viel, Alessandra; Quaia, Michele; Giacomini, Elisa; Gismondi, Viviana; Sanchez-Mete, Lupe; Stigliano, Vittoria; Martayan, Aline; Mazzei, Filomena; Bignami, Margherita; Bonelli, Luigina; Varesco, Liliana

    2017-02-01

    To determine prevalence, spectrum and genotype-phenotype correlations of MUTYH variants in Italian patients with suspected MAP (MUTYH-associated polyposis), a retrospective analysis was conducted to identify patients who had undergone MUTYH genetic testing from September 2002 to February 2014. Results of genetic testing and patient clinical characteristics were collected (gender, number of polyps, age at polyp diagnosis, presence of colorectal cancer (CRC) and/or other cancers, family data). The presence of large rearrangements of the MUTYH gene was evaluated by Multiplex Ligation-dependent Probe Amplification analysis. In all, 299 patients with colorectal neoplasia were evaluated: 61.2% were males, the median age at polyps or cancer diagnosis was 50 years (16-80 years), 65.2% had <100 polyps and 51.8% had CRC. A total of 36 different MUTYH variants were identified: 13 (36.1%) were classified as pathogenetic, whereas 23 (63.9%) were variants of unknown significance (VUS). Two pathogenetic variants were observed in 78 patients (26.1%). A large homozygous deletion of exon 15 was found in one patient (<1.0%). MAP patients were younger than those with negative MUTYH testing at polyps diagnosis (P<0.0001) and at first cancer diagnosis (P=0.007). MAP patients carrying the p.Glu480del variant presented with a younger age at polyp diagnosis as compared to patients carrying p.Gly396Asp and p.Tyr179Cys variants. A high heterogeneity of MUTYH variants and a high rate of VUS were identified in a cohort of Italian patients with suspected MAP. Genotype-phenotype analysis suggests that the p.Glu480del variant is associated with a severe phenotype.

  9. 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.

  10. Profil épidémio-clinique des dermatoses chez les enfants vus en consultation dermatologique dans le service de dermatologie du centre national d’appui à la lutte contre la maladie à Bamako (Mali)

    PubMed Central

    Fofana, Youssouf; Traore, Bekaye; Dicko, Adama; Faye, Ousmane; Berthe, Siritio; Cisse, Lamissa; Keita, Alimata; Tall, Koureissi; Kone, Mamadou Bakary; Keita, Somita

    2016-01-01

    Introduction Les maladies de peau constituent un problème majeur de santé publique dans les pays en voie développement. En pratique courante les enfants représentent la couche sociale la plus touchée. Le but de notre travail était de décrire les aspects épidémio- cliniques des dermatoses chez les enfants de 0-15 ans dans le service de dermatologie du centre national d’appui à la lutte contre la maladie à Bamako, Mali. Méthodes Il s’agissait d’une étude transversale effectuée au cours de la période allant du premier janvier 2009 au 31 Décembre 2009 dans le service de Dermato-vénérologie du centre national d’appui à la lutte contre la maladie. Sur un total de 16339 patients ayant fait une consultation dermatologique 5149 enfants ont été inclus. Résultats La fréquence hospitalière des dermatoses infantiles était de 31,51%. Les malades se répartissaient en 2838 garçons (55,10%) et 2311 filles (44,90%) soit un sex-ratio de 1,22. L’âge des malades variait de 03 jours à 15 ans avec une moyenne d’âge de 8±5,7 ans. Parmi les affections retrouvées les dermatoses infectieuses représentaient 55,10% de l’ensemble des dermatoses, les dermatoses immuno-allergiques (32,5%), les dermatoses inflammatoires (11,85%). Conclusion Notre étude a révélé l’importance des pathologies infectieuses et immuno-allergiques et la nécessité de mener des actions de prévention simple comme l’hygiène, l’achat d’une tondeuse pour chaque enfant. PMID:28293354

  11. Whole Gene Capture Analysis of 15 CRC Susceptibility Genes in Suspected Lynch Syndrome Patients

    PubMed Central

    van Wezel, Tom; Jagmohan-Changur, Shantie C.; Ruano, Dina; van der Klift, Heleen M.; van den Akker, Brendy E. W. M.; Laros, Jeroen F. J.; van Galen, Michiel; Wagner, Anja; Letteboer, Tom G. W.; Gómez-García, Encarna B.; Tops, Carli M. J.; Vasen, Hans F.; Devilee, Peter; Hes, Frederik J.; Morreau, Hans; Wijnen, Juul T.

    2016-01-01

    Background and Aims Lynch Syndrome (LS) is caused by pathogenic germline variants in one of the mismatch repair (MMR) genes. However, up to 60% of MMR-deficient colorectal cancer cases are categorized as suspected Lynch Syndrome (sLS) because no pathogenic MMR germline variant can be identified, which leads to difficulties in clinical management. We therefore analyzed the genomic regions of 15 CRC susceptibility genes in leukocyte DNA of 34 unrelated sLS patients and 11 patients with MLH1 hypermethylated tumors with a clear family history. Methods Using targeted next-generation sequencing, we analyzed the entire non-repetitive genomic sequence, including intronic and regulatory sequences, of 15 CRC susceptibility genes. In addition, tumor DNA from 28 sLS patients was analyzed for somatic MMR variants. Results Of 1979 germline variants found in the leukocyte DNA of 34 sLS patients, one was a pathogenic variant (MLH1 c.1667+1delG). Leukocyte DNA of 11 patients with MLH1 hypermethylated tumors was negative for pathogenic germline variants in the tested CRC susceptibility genes and for germline MLH1 hypermethylation. Somatic DNA analysis of 28 sLS tumors identified eight (29%) cases with two pathogenic somatic variants, one with a VUS predicted to pathogenic and LOH, and nine cases (32%) with one pathogenic somatic variant (n = 8) or one VUS predicted to be pathogenic (n = 1). Conclusions This is the first study in sLS patients to include the entire genomic sequence of CRC susceptibility genes. An underlying somatic or germline MMR gene defect was identified in ten of 34 sLS patients (29%). In the remaining sLS patients, the underlying genetic defect explaining the MMRdeficiency in their tumors might be found outside the genomic regions harboring the MMR and other known CRC susceptibility genes. PMID:27300758

  12. Determinations of Vus using inclusive hadronic τ decay data

    SciTech Connect

    Maltman, Kim; Hudspith, Renwick James; Lewis, Randy; Izubuchi, Taku; Ohki, Hiroshi; Zanotti, James M.

    2016-08-30

    Two methods for determining |Vus| employing inclusive hadronic ττ decay data are discussed. The first is the conventional flavor-breaking sum rule determination whose usual implementation produces results ~3σ low compared to three-family unitary expectations. The second is a novel approach combining experimental strange hadronic ττ distributions with lattice light-strange current–current two-point function data. In preliminary explorations of the latter show the method promises |Vus| determinations are competitive with those from Kℓ3 and Γ[πμ2]/Γ[πμ2]. For the former, systematic issues in the conventional implementation are investigated. Unphysical dependences of |Vus| on the choice of sum rule weight, w, and upper limit, s0, of the weighted experimental spectral integrals are observed, the source of these problems identified and a new implementation which overcomes these problems developed. The lattice results are shown to provide a tool for quantitatively assessing truncation uncertainties for the slowly converging D=2 OPE series. Our results for |Vus| from this new implementation are shown to be free of unphysical w- and s0-dependences, and ~0.0020 higher than those produced by the conventional implementation. With preliminary new Kπ branching fraction results as input, we find |Vus| in excellent agreement with that obtained from Kℓ3, and compatible within errors with expectations from three-family unitarity.

  13. Determinations of Vus using inclusive hadronic τ decay data

    SciTech Connect

    Maltman, Kim; Hudspith, Renwick James; Lewis, Randy; Izubuchi, Taku; Ohki, Hiroshi; Zanotti, James M.

    2016-08-30

    Two methods for determining |Vus| employing inclusive hadronic ττ decay data are discussed. The first is the conventional flavor-breaking sum rule determination whose usual implementation produces results ~3σ low compared to three-family unitary expectations. The second is a novel approach combining experimental strange hadronic ττ distributions with lattice light-strange current–current two-point function data. In preliminary explorations of the latter show the method promises |Vus| determinations are competitive with those from Kℓ3 and Γ[πμ2]/Γ[πμ2]. For the former, systematic issues in the conventional implementation are investigated. Unphysical dependences of |Vus| on the choice of sum rule weight, w, and upper limit, s0, of the weighted experimental spectral integrals are observed, the source of these problems identified and a new implementation which overcomes these problems developed. The lattice results are shown to provide a tool for quantitatively assessing truncation uncertainties for the slowly converging D=2 OPE series. Our results for |Vus| from this new implementation are shown to be free of unphysical w- and s0-dependences, and ~0.0020 higher than those produced by the conventional implementation. With preliminary new Kπ branching fraction results as input, we find |Vus| in excellent agreement with that obtained from Kℓ3, and compatible within errors with expectations from three-family unitarity.

  14. Installation of a network for patients with congenital melanocytic nevi in German-speaking countries.

    PubMed

    Krengel, Sven; Breuninger, Helmut; Hauschild, Axel; Höger, Peter; Merl, Volker; Hamm, Henning

    2008-03-01

    In 2005, an Internet-based network for the support of patients with congenital melanocytic nevi in German-speaking countries was started (http://www.naevus-netzwerk.de). Along with detailed information for patients and parents, the home-page includes a nevus registry which is based on an electronic questionnaire and which aims at providing data on the long-term course of nevi estimated to reach > 10 cm in largest diameter. In the past, congenital melanocytic nevi have been subject to various mythological interpretations ("Tierfellnävus", lit."animal coat nevus";"Muttermal"). Today an increasing body of reliable scientific data allows a differentiated reflection of the risk of malignant transformation and has led to progress in the diagnostic and therapeutic management. Recent findings from the literature and considerations from scientific meetings are reviewed.

  15. Attenuation of the Transforming Growth Factor β –Signaling Pathway in Chronic Venous Ulcers

    PubMed Central

    Pastar, Irena; Stojadinovic, Olivera; Krzyzanowska, Agata; Barrientos, Stephan; Stuelten, Christina; Zimmerman, Karen; Blumenberg, Miroslav; Brem, Harold; Tomic-Canic, Marjana

    2010-01-01

    Transforming growth factor β (TGFβ) is important in inflammation, angiogenesis, reepithelialization and connective tissue regeneration during wound healing. We analyzed components of TGFβ signaling pathway in biopsies from 10 patients with nonhealing venous ulcers (VUs). Using comparative genomics of transcriptional profiles of VUs and TGFβ-treated keratinocytes, we found deregulation of TGFβ target genes in VUs. Using quantitative polymerase chain reaction (qPCR) and immunohistochemical analysis, we found suppression of TGFβ RI, TGFβ RII and TGFβ RIII, and complete absence of phosphorylated Smad2 (pSmad2) in VU epidermis. In contrast, pSmad2 was induced in the cells of the migrating epithelial tongue of acute wounds. TGFβ-inducible transcription factors (GADD45β , ATF3 and ZFP36L1) were suppressed in VUs. Likewise, genes suppressed by TGFβ (FABP5, CSTA and S100A8) were induced in nonhealing VUs. An inhibitor of Smad signaling, Smad7 was also downregulated in VUs. We conclude that TGFβ signaling is functionally blocked in VUs by downregulation of TGFβ receptors and attenuation of Smad signaling resulting in deregulation of TGFβ target genes and consequent hyperproliferation. These data suggest that application of exogenous TGFβ may not be a beneficial treatment for VUs. PMID:20069132

  16. Germline mutations in DNA repair genes may predict neoadjuvant therapy response in triple negative breast patients.

    PubMed

    Spugnesi, Laura; Gabriele, Michele; Scarpitta, Rosa; Tancredi, Mariella; Maresca, Luisa; Gambino, Gaetana; Collavoli, Anita; Aretini, Paolo; Bertolini, Ilaria; Salvadori, Barbara; Landucci, Elisabetta; Fontana, Andrea; Rossetti, Elena; Roncella, Manuela; Naccarato, Giuseppe Antonio; Caligo, Maria Adelaide

    2016-12-01

    Triple negative breast cancers (TNBCs) represent about 15-20% of all breast cancer cases and are characterized by a complex molecular heterogeneity. Some TNBCs exhibit clinical and pathological properties similar to BRCA-mutated tumors, without actually bearing a mutation in BRCA genes. This "BRCAness" phenotype may be explained by germline mutations in other genes involved in DNA repair. Although respond to chemotherapy with alkylating agents, they have a high risk of recurrence and progression. Some studies have shown the efficacy of neoadjuvant therapy in TNBC patients with DNA repair defects, but proper biomarkers of DNA repair deficiency are still needed. Here, we investigated if mutations in DNA repair genes may be correlated with anthracyclines/taxanes neoadjuvant therapy response. DNA from 19 TNBC patients undergoing neoadjuvant therapy were subjected to next generation sequencing of a panel of 24 genes in DNA repair and breast cancer predisposition. In this study, 5 of 19 patients (26%) carried a pathogenic mutation in BRCA1, PALB2, RAD51C and two patients carried a probable pathogenic missense variant. Moreover, VUS (Variants of Unknown Significance) in other genes, predicted to be deleterious by in silico tools, were detected in five patients. Germline mutations in DNA repair genes were found to be associated with the group of TNBC patients who responded to therapy. We conclude that a subgroup of TNBC patients have defects in DNA repair genes, other than BRCA1, and such patients respond favourably to neoadjuvant anthracyclines/taxanes therapy. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. Measurement of Cabibbo-Suppressed Tau Lepton Decays and the Determination of |Vus|

    SciTech Connect

    Schenk, Stefan

    2008-07-07

    This work presents simultaneous branching fraction measurements of the decay modes τ- → K-0ντ with n = 0,1,2,3 and τ- → π-0ντ with n = 3,4. The analysis is based on a data sample of 427 x 106 τ+τ- pairs recorded with the BABAR detector, which corresponds to an integrated luminosity of 464.4 fb-1. The measured values are β(τ- → K-ντ ) = (6.57 ± 0.03 ± 0.11) x 10-3, β(τ- → K-π0ντ ) = (4.61 ± 0.03 ± 0.11) x 10-3, β(τ- {yields} K- π0π0ντ) = (5.05 ± 0.17 ± 0.44) x 10-4, β(τ- {yields} K-π0π0π0ντ ) = (1.31 ± 0.43 ± 0.40) x 10-4, β(τ0 → π0π0π0π0ντ) = (1.263 ± 0.008 ± 0.078) x 10-2 and β(τ0 → π0π0π0π0π0ντ) = (9.6 ± 0.5 ± 1.2) x 10-4, where the uncertainties are statistical and systematic, respectively. All measurements are compatible with the current world averages whereas the uncertainties are significantly smaller by a factor of up to five. The determination of β(τ0 → π-π0π0π0π0vτ) is the first measurement of this branching fraction. The measured branching fractions are combined with the current world averages. Using the new averages, an updated determination of |Vus| from hadronic τ decays yields |Vus| = 0.2146 ± 0.0025, which improves previous measurements by 19%. Its uncertainty is comparable to the one of the current world average from semileptonic kaon decays.

  18. Lepton Universality, |V(Us)| and Search for Second Class Current in Tau Decays

    SciTech Connect

    Banerjee, Swagato; /Victoria U.

    2011-11-10

    Several hundred million {tau} decays have been studied with the BABAR detector at the PEP-II e{sup +}e{sup -} collider at the SLAC National Accelerator Laboratory. Recent results on Charged Current Lepton Universality and two independent measurements of |V{sub us}| using {tau}{sup -} {yields} e{sup -}{bar {nu}}{sub e}{nu}{sub {tau}}, {mu}{sup -}{bar {nu}}{sub {mu}}{nu}{sub {tau}}, {pi}{sup -}{nu}{sub {tau}}, K{sup -} {nu}{sub {tau}} and K{sub S}{sup 0}{pi}{sup -} {nu}{sub {tau}} decays, and a search for Second Class Current in {tau}{sup -} {yields} {pi}{sup -} {omega}{nu}{sub {tau}} decays are presented, where the charge conjugate decay modes are also implied.

  19. Variants of Uncertain Significance in BRCA Testing: Evaluation of Surgical Decisions, Risk Perception, and Cancer Distress

    PubMed Central

    Culver, J.O.; Brinkerhoff, C.D.; Clague, J.; Yang, K.; Singh, K.E.; Sand, S.R.; Weitzel, J.N.

    2013-01-01

    Studies suggest that patients carrying a BRCA variant of uncertain significance (VUS) may have lingering confusion concerning results interpretation. Counseling for uninformative BRCA-negative (UN) results is thought to be more straightforward, despite the fact that both results lead to similar methods of empiric cancer risk counseling. This study compared surgical choices and perceptions between 71 patients with VUS results and 714 patients with UN results. All patients underwent genetic counseling because of a personal or family history of breast or ovarian cancer between 1997 and 2010, and completed a two-year follow-up survey. Risk-reducing mastectomy rates in both groups were 7% (p=1.00) and risk-reducing oophorectomy rates were 5% and 3%, respectively (p=0.42). The VUS group reported less cancer distress reduction than the UN group (23.0% versus 35.8%, respectively, p=.043). Over 90% of both groups found the counseling process helpful. Overall, the study suggests that VUS results disclosed in genetic counseling did not cause excessive surgery or exaggerated cancer distress, though patients with a VUS found counseling somewhat less informative or reassuring. Future research on communication of VUS results, including pre-and post-test counseling, is essential for full realization of the potential for genomic medicine. PMID:23323793

  20. Screening for germline mutations in mismatch repair genes in patients with Lynch syndrome by next generation sequencing.

    PubMed

    Soares, Barbara Luísa; Brant, Ayslan Castro; Gomes, Renan; Pastor, Tatiane; Schneider, Naye Balzan; Ribeiro-Dos-Santos, Ândrea; de Assumpção, Paulo Pimentel; Achatz, Maria Isabel W; Ashton-Prolla, Patrícia; Moreira, Miguel Angelo Martins

    2017-09-20

    Lynch syndrome (LS) is an autosomal dominant disorder, with high penetrance that affects approximately 3% of the cases of colorectal cancer. Affected individuals inherit germline mutations in genes responsible for DNA mismatch repair, mainly at MSH2, MLH1, MSH6 and PMS2. The molecular screening of these individuals is frequently costly and time consuming due to the large size of these genes. In addition, PMS2 mutation detection is often a challenge because there are 16 different pseudogenes identified until now. In the present work we evaluate a molecular screening strategy based in next generation sequencing (NGS) in order to optimize the mutation detection in LS patients. We established 16 multiplex PCRs for MSH2, MSH6 and MLH1 and 5 Long-Range PCRs for PMS2, coupled with NGS. The strategy was validated by screening 66 patients who filled Bethesda and Amsterdam criteria for LS from health institutions of Brazil. The mean depth of coverage for MSH2, MSH6, MLH1 and PMS2 genes was 7.988, 36.313, 11.899 and 4.772 times, respectively. Ninety-four variants were found in exons and flanking intron/exon regions for the four MMR genes. Twenty-five were pathogenic or VUS and found in 32 patients (7 in MSH2, 5 in MSH6, 12 in MLH1 e 1 in PMS2). All variants were confirmed by Sanger sequencing. The strategy was efficient to reduce time consuming and costs to identify genetic changes at these MMR genes, reducing in three times the number of PCR reactions performed per patient and was efficient in identifying variants at PMS2 gene.

  1. Germline mutations of BRCA1 gene exon 11 are not associated with platinum response neither with survival advantage in patients with primary ovarian cancer: understanding the clinical importance of one of the biggest human exons. A study of the Tumor Bank Ovarian Cancer (TOC) Consortium.

    PubMed

    Dimitrova, Desislava; Ruscito, Ilary; Olek, Sven; Richter, Rolf; Hellwag, Alexander; Türbachova, Ivana; Woopen, Hannah; Baron, Udo; Braicu, Elena Ioana; Sehouli, Jalid

    2016-09-01

    Germline mutations in BRCA1 gene have been reported in up to 20 % of epithelial ovarian cancer (EOC) patients. Distinct clinical characteristics have been attributed to this special EOC population. We hypothesized that mutations in different BRCA1 gene exons may differently affect the clinical course of the disease. The aim of this study was to analyze, in a large cohort of primary EOCs, the clinical impact of mutations in BRCA1 gene exon 11, the largest exon of the gene sequence encoding the 60 % of BRCA1 protein. Two hundred sixty-three primary EOC patients, treated between 2000 and 2008 at Charité University Hospital of Berlin, were included. Patients' blood samples were obtained from the Tumor Ovarian Cancer (TOC) Network ( www.toc-network.de ). Direct sequencing of BRCA1 gene exon 11 was performed for each patient to detect mutations. Based on their BRCA1 exon 11 mutational status, patients were compared regarding clinico-pathological variables and survival. Mutations in BRCA1 exon 11 were found in 18 out of 263 patients (6.8 %). Further 10/263 (3.8 %) cases showed variants of uncertain significance (VUS). All exon 11 BRCA1-positive tumors (100 %) were Type 2 ovarian carcinomas (p = 0.05). Age at diagnosis was significantly younger in Type 2 exon 11 mutated patients (p = 0.01). On multivariate analysis, BRCA1 exon 11 mutational status was not found to be an independent predictive factor for optimal cytoreduction, platinum response, or survival. Mutations in BRCA1 gene exon 11 seem to predispose women to exclusively develop a Type 2 ovarian cancer at younger age. Exon 11 BRCA1-mutated EOC patients showed distinct clinico-pathological features but similar clinical outcome with respect to sporadic EOC patients.

  2. [Alterations in blood circulation of vesicourethral segment in men with neurogenic and non-neurogenic lower urinary tract symptoms].

    PubMed

    Alayev, Yu G; Esilevskiy, Yu M; Shmidt, T E; Demidko, Yu L; Fiev, D N; Kazantsev, K Yu

    2016-12-01

    To specify the pathogenetic link between blood supply of the bladder neck and lower urinary tract symptoms (LUTS). The study involved 78 men aged 26 to 50 years, including 19 patients with multiple sclerosis (MS) and LUTS, 29 patients with chronic prostatitis category IIIB with LUTS and 30 patients with chronic prostatitis category IIIB without LUTS (control group). All the patients underwent Doppler ultrasonography of prostatic arteries and selective study of blood flow in the neck of the bladder. Pharmacological test using combinations of 1-blockers (1-AB) with m-anticholinergics (m-CB) and phosphodiesterase type 5 inhibitors (PDEI-5). The changes in the blood circulation of VUS were found to correlate with LUTS. The response of blood flow depended not only on the type of pharmacological agents, but also on the degree of vascular changes and neurological deficit in VUS. The findings of VUS vascular pharmacological tests with PDEI-5 and 1-AB + m-CB were comparable in chronic prostatitis with non-neurogenic LUTS and in MS with neurogenic LUTS. Vascular reaction in VUS depends on the presence of neurological deficit. The combination of (1-AB+ m-CB) increases the blood circulation of the bladder neck and prostate and reduces the LUTS. PDEI-5 reduces LUTS due to the positive effect on the blood circulation of the prostate and VUS. Circulatory abnormalities (=hypoxia) in VUS is an important pathogenetic mechanism of neurogenic and non-neurogenic LUTS and the way to compensate them using a combination of (1-AB+ m-CB) or PDEI-5. Therefore, one of the mechanisms of LUTS is associated with impaired blood flow in the bladder neck and VUS.

  3. Family Studies for Classification of Variants of Uncertain Classification: Current Laboratory Clinical Practice and a New Web-Based Educational Tool.

    PubMed

    Garrett, Lauren T; Hickman, Nathan; Jacobson, Angela; Bennett, Robin L; Amendola, Laura M; Rosenthal, Elisabeth A; Shirts, Brian H

    2016-12-01

    Multi-gene cancer panels often identify variants of uncertain clinical significance (VUS) that pose a challenge to health care providers in managing a patient's cancer risk. Family segregation analysis can yield powerful data to re-classify a VUS (as either benign or pathogenic). However, financial and personnel resources to coordinate these studies are limited. In an informal assessment we found that family studies for variant classification are done by most clinical genetics laboratories that offer hereditary cancer panel testing. The process for family studies differs substantially across laboratories. One near universal limitation is that families usually have too few individuals for an informative co-segregation analysis. A unique and potential resource-saving approach is to engage patients and their families in expanding their own pedigrees for segregation analysis of their VUS. We describe a novel public educational tool ( FindMyVariant.org ) designed to inform patients and genetic counselors about strategies to improve the probability of variant classification using familial segregation. While the web tool is designed to be useful for any gene, the project was primarily focused on VUS's returned in cancer risk genes. FindMyVariant.org is a resource for genetic providers to offer motivated families who are willing to gather information about their family relationships and history. Working alongside clinical or research genetic laboratories, the information they collect may help reclassify their VUS using segregation analysis.

  4. L'obésité en consultation cardiologique à Lomé: prévalence et facteurs de risque cardio-vasculaire associés - étude chez 1200 patients

    PubMed Central

    Pessinaba, Soulemane; Yayehd, Komlavi; Pio, Machiude; Baragou, Réné; Afassinou, Yaovi; Tchérou, Tchaa; Damorou, Findibé

    2012-01-01

    Introduction Introduction: Les objectifs de ce travail étaient de déterminer la fréquence de l'obésité et celle des autres facteurs de risque cardio-vasculaire chez ces patients obèses à Lomé (Togo). Méthodes Il s'est agi d'une étude multicentrique transversale de prévalence. Elle s'est déroulée du 05 septembre 2005 au 04 mars 2006 et a porté sur les malades vus en consultation externe dans 3 services de cardiologie de la commune de Lomé. Ont été inclus dans cette étude les malades ayant un surpoids selon les normes de l'OMS. Résultats Parmi 1200 patients vus en consultations, 779 (64,92%) avaient une surcharge pondérale. L’âge moyen était de 49,53 ± 17,24 ans. L'obésité était plus fréquente chez les femmes (79,49%) que chez les hommes (20,51%). Un antécédent d'obésité familiale (61,8%) était le principal facteur favorisant. Les autres facteurs de risque cardio-vasculaire retrouvés étaient: sédentarité (82% vs50% chez les non obèses), hypertension artérielle (54,8% vs 39,2%), alcool (50,9% vs 43,9%), dyslipidémie (34,5% vs 20%), diabète (30,9% vs 10,7%) et tabac (14,1% vs 20,3%). La différence était statistiquement significative entre les deux groupes. Les principales complications cardiovasculaires observées chez les obèses étaient: l'ischémie myocardique (26,7%), l'hypertrophie ventriculaire gauche (46,4%), la dilatation cavitaire cardiaque (30,1%) et les accidents vasculaires cérébraux (7,1%). Conclusion L'obésité est un problème de santé publique au Togo. Sa prévalence est très élevée et elle est le plus souvent associée aux autres facteurs de risque cardio-vasculaire. Des mesures préventives doivent être mises en jeu pour lutter contre ce facteur de risque. Mots clés: Obésité, prévalence, facteurs de risque. PMID:23133699

  5. Reporting practices for variants of uncertain significance from next generation sequencing technologies.

    PubMed

    Vears, Danya F; Sénécal, Karine; Borry, Pascal

    2017-10-01

    The nature of next generation sequencing technologies (NGS) results in the generation of large amounts of data and the identification of numerous variants, for some of which the clinical significance may be difficult to ascertain based on our current knowledge. These Variants of Uncertain Significance (VUS) may be identified in genes in which the function is known or unknown and which may or may not be related to the original rationale for sequencing the patient. Little is known about whether laboratories report VUS to clinicians and current guidelines issued by some of the most notable professional bodies do not provide specific recommendations on this point. To address this, 26 interviews were conducted with 27 laboratory personnel, representing 24 laboratories in Europe (12), Canada (5) and Australasia (7) in order to explore their reporting practices. Participants highlighted that the classification of variants is a real challenge despite the presence of classification guidelines. We identified variation in the reporting practices of VUS across the laboratories within the study. While some laboratories limit their reporting to variants that are pathogenic and thought to be causative of the phenotype, more commonly laboratories report VUS when they are identified in genes related to the clinical question. Some laboratories will also report VUS in candidate genes. VUS that are secondary findings are generally not reported. While it is unclear whether uniformity in reporting is desirable, exploring the perspectives of laboratory personnel undertaking these analyses are critical to ensure the feasibility of any future reporting recommendations. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  6. Measurements of Charged Current Lepton Universality and |Vus| using Tau Lepton Decays to e- v v, __- v v, pi- v and K- v

    SciTech Connect

    Aubert, Bernard; Karyotakis, Y.; Lees, J.P.; Poireau, V.; Prencipe, E.; Prudent, X.; Tisserand, V.; Garra Tico, J.; Grauges, E.; Martinelli, M.; Palano, A.; Pappagallo, M.; Eigen, G.; Stugu, B.; Sun, L.; Battaglia, M.; Brown, D.N.; Kerth, L.T.; Kolomensky, Yu.G.; Lynch, G.; Osipenkov, I.L.; /UC, Berkeley /Birmingham U. /Ruhr U., Bochum /British Columbia U. /Brunel U. /Novosibirsk, IYF /UC, Irvine /UC, Riverside /UC, San Diego /UC, Santa Barbara /UC, Santa Cruz /Caltech /Cincinnati U. /Colorado U. /Colorado State U. /Dortmund U. /Dresden, Tech. U. /Ecole Polytechnique /Edinburgh U. /INFN, Ferrara /Ferrara U. /INFN, Ferrara /INFN, Ferrara /Ferrara U. /INFN, Ferrara /INFN, Ferrara /Ferrara U. /Frascati /INFN, Genoa /Genoa U. /INFN, Genoa /INFN, Genoa /Genoa U. /INFN, Genoa /INFN, Genoa /Genoa U. /Harvard U. /Heidelberg U. /Humboldt U., Berlin /Imperial Coll., London /Iowa State U. /Iowa State U. /Johns Hopkins U. /Orsay, LAL /LLNL, Livermore /Liverpool U. /Queen Mary, U. of London /Royal Holloway, U. of London /Louisville U. /Mainz U., Inst. Kernphys. /Manchester U. /Maryland U. /Massachusetts U., Amherst /MIT /McGill U. /INFN, Milan /Milan U. /INFN, Milan /INFN, Milan /Milan U. /Mississippi U. /Montreal U. /Mt. Holyoke Coll. /INFN, Naples /Naples U. /INFN, Naples /INFN, Naples /Naples U. /NIKHEF, Amsterdam /NIKHEF, Amsterdam /Notre Dame U. /Ohio State U. /Oregon U. /INFN, Padua /Padua U. /INFN, Padua /INFN, Padua /Padua U. /Paris U., VI-VII /Pennsylvania U. /INFN, Perugia /Perugia U. /INFN, Pisa /Pisa U. /INFN, Pisa /Pisa, Scuola Normale Superiore /INFN, Pisa /Pisa U. /INFN, Pisa /Princeton U. /INFN, Rome /INFN, Rome /Rome U. /INFN, Rome /INFN, Rome /Rome U. /INFN, Rome /INFN, Rome /Rome U. /INFN, Rome /INFN, Rome /Rome U. /INFN, Rome /Rostock U. /Rutherford /DAPNIA, Saclay /SLAC /South Carolina U. /Stanford U., Phys. Dept. /SUNY, Albany /Tel Aviv U. /Tennessee U. /Texas U. /Texas U., Dallas /INFN, Turin /Turin U. /INFN, Trieste /Trieste U. /Valencia U. /Victoria U. /Warwick U. /Wisconsin U., Madison

    2011-06-30

    Using 467 fb{sup -1} of e{sup +}e{sup -} annihilation data collected with the BABAR detector, they measure {Beta}({tau}{sup -} {yields} {mu}{sup -}{bar {nu}}{sub {mu}}{nu}{sub {tau}})/{Beta}({tau}{sup -} {yields} e{sup -} {bar {nu}}{sub e}{nu}{sub {tau}}) = (0.9796 {+-} 0.0016 {+-} 0.0036), {Beta}({tau}{sup -} {yields} {pi}{sup -} {nu}{sub {tau}})/{Beta}({tau}{sup -} {yields} e{sup -}{bar {nu}}{sub e}{nu}{sub {tau}}) = (0.5945 {+-} 0.0014 {+-} 0.0061), and {Beta}({tau}{sup -} {yields} K{sup -}{nu}{sub {tau}})/{Beta}({tau}{sup -} {yields} e{sup -}{bar {nu}}{sub e}{nu}{sub {tau}}) = (0.03882 {+-} 0.00032 {+-} 0.00057), where the uncertainties are statistical and systematic, respectively. From these precision {tau} measurements, they test the Standard Model assumption of {mu}-e and {tau}-{mu} charge current lepton universality and provide determinations of |V{sub us}| experimentally independent of the decay of a kaon.

  7. Stratégie de prise en charge de l'hypertension artérielle en hémodialyse chronique: un modèle appliqué d’éducation thérapeutique des patients (ETP)

    PubMed Central

    El Harraqui, Ryme; Naima, Abda; Yassamine, Bentata; Haddiya, Intissar

    2014-01-01

    Même après l'entrée en dialyse, la prévalence de l'hypertension artérielle (HTA) reste élevée. Elle est souvent greffée d'une forte morbi-mortalité, et altère la qualité de vie des patients hémodialysés chroniques. La « méthode du poids sec (PS) », établie par Scribner, présente un intérêt indéniable dans la gestion de l'HTA chez le patient hémodialysé. Le but de notre travail était de déterminer la prévalence et les facteurs de risque (FDR) de l'HTA chez nos hémodialysés chroniques et d'en tenter une réduction en nous basant sur une stratégie d’éducation thérapeutique basée sur les recommandations de Scribner. Nous avons mené une étude prospective interventionnelle en trois mois et en trois phases, auprès des 93 hémodialysés chroniques de l'Hôpital Al Farabi d'Oujda. En phase 1, nous avons déterminé la prévalence de l'HTA par la surveillance horaire de la tension artérielle (TA) durant la séance de dialyse pendant deux semaines, soit sur un total de 442 séances. Les patients ont également mesuré leur pression artérielle (PA) hors-centre de façon biquotidienne les jours de non-dialyse, soit un total de 1720 mesures hors-centre. L'HTA a été définie par une Pression Artérielle Systolique (PAS) supérieure ou égale à 140mmHg et/ou une Pression Artérielle Diastolique (PAD) supérieure ou égale à 90mmHg sur au moins 2 mesures. En phase 2, les patients hypertendus ont bénéficié d'une prise en charge basée sur les recommandations de Scribner et une éducation thérapeutique (ETP). En phase 3, nous évalué les retombées de notre prise en charge. Une HTA a été notée sur 231 séances chez 57 patients, soit une prévalence de 61,3%. La PAS moyenne était de 172,75±17,69 (145-220) mmHg. Les FDR retenus sont: l’âge, la PPID importante, le non respect des règles hygiéno-diététiques (RHD) et le rythme de 2 séances de dialyse/semaine. Au départ, 13 patients (22,8%) étaient dialysés trois fois par

  8. Identification of pathogenic gene mutations in LMNA and MYBPC3 that alter RNA splicing.

    PubMed

    Ito, Kaoru; Patel, Parth N; Gorham, Joshua M; McDonough, Barbara; DePalma, Steven R; Adler, Emily E; Lam, Lien; MacRae, Calum A; Mohiuddin, Syed M; Fatkin, Diane; Seidman, Christine E; Seidman, J G

    2017-07-18

    Genetic variants that cause haploinsufficiency account for many autosomal dominant (AD) disorders. Gene-based diagnosis classifies variants that alter canonical splice signals as pathogenic, but due to imperfect understanding of RNA splice signals other variants that may create or eliminate splice sites are often clinically classified as variants of unknown significance (VUS). To improve recognition of pathogenic splice-altering variants in AD disorders, we used computational tools to prioritize VUS and developed a cell-based minigene splicing assay to confirm aberrant splicing. Using this two-step procedure we evaluated all rare variants in two AD cardiomyopathy genes, lamin A/C (LMNA) and myosin binding protein C (MYBPC3). We demonstrate that 13 LMNA and 35 MYBPC3 variants identified in cardiomyopathy patients alter RNA splicing, representing a 50% increase in the numbers of established damaging splice variants in these genes. Over half of these variants are annotated as VUS by clinical diagnostic laboratories. Familial analyses of one variant, a synonymous LMNA VUS, demonstrated segregation with cardiomyopathy affection status and altered cardiac LMNA splicing. Application of this strategy should improve diagnostic accuracy and variant classification in other haploinsufficient AD disorders.

  9. Patient Power!

    MedlinePlus

    ... turn JavaScript on. Feature: Crowdsourcing & Rare Diseases Patient Power! Past Issues / Winter 2016 Table of Contents Social ... Porzecanski couldn't be happier that such "patient power" efforts will help SCLS patients who otherwise would ...

  10. Genetic purgatory and the cardiac channelopathies: Exposing the variants of uncertain/unknown significance issue.

    PubMed

    Ackerman, Michael J

    2015-11-01

    Merriam-Webster's online dictionary defines purgatory as "an intermediate state after death for expiatory purification" or more specifically as "a place or state of punishment wherein according to Roman Catholic doctrine the souls of those who die in God׳s grace may make satisfaction for past sins and so become fit for heaven." Alternatively, it is defined as "a place or state of temporary suffering or misery." Either way, purgatory is a place where you are stuck, and you don't want to be stuck there. It is in this context that the term genetic purgatory is introduced. Genetic purgatory is a place where the genetic test-ordering physician and patients and their families are stuck when a variant of uncertain/unknown significance (VUS) has been elucidated. It is in this dark place where suffering and misery are occurring because of unenlightened handling of a VUS, which includes using the VUS for predictive genetic testing and making radical treatment recommendations based on the presence or absence of a so-called maybe mutation. Before one can escape from this miserable place, one must first recognize that one is stuck there. Hence, the purpose of this review article is to fully expose the VUS issue as it relates to the cardiac channelopathies and make the cardiologists/geneticists/genetic counselors who order such genetic tests believers in genetic purgatory. Only then can one meaningfully attempt to get out of that place and seek to promote a VUS to disease-causative mutation status or demote it to an utterly innocuous and irrelevant variant. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  11. Patient Rights

    MedlinePlus

    ... have a patient bill of rights. An important patient right is informed consent. This means that if you need a treatment, your health care provider must give you the information you need to make a decision. Many hospitals have patient advocates who can help you if you have ...

  12. PATIENT NAVIGATION

    PubMed Central

    Wells, Kristen J.; Battaglia, Tracy A.; Dudley, Donald J.; Garcia, Roland; Greene, Amanda; Calhoun, Elizabeth; Mandelblatt, Jeanne S.; Paskett, Electra D.; Raich, Peter C.

    2008-01-01

    Background First implemented in 1990, patient navigation interventions are emerging as an approach to reduce cancer disparities. However, there is lack of consensus about how patient navigation is defined, what patient navigators do, and what their qualifications should be. Little is known about the efficacy and cost effectiveness of patient navigation. Methods We conducted a qualitative synthesis of published literature on cancer patient navigation. Using the keywords “navigator” or “navigation” and “cancer,” we identified 45 articles from Pubmed and reference searches that were published or in press through October 2007. 16 provided data on efficacy of navigation in improving timeliness and receipt of cancer screening, diagnostic follow-up care, and treatment. Patient navigation services are defined and differentiated from other outreach services. Results Overall there is evidence for some degree of efficacy for patient navigation in increasing participation in cancer screening and adherence to diagnostic follow-up care following an abnormality, with increases in screening ranging from 10.8% to 17.1% and increases in adherence to diagnostic follow-up care ranging from 21% to 29.2%, when compared to control patients. There is less evidence regarding efficacy of patient navigation in reducing either late stage cancer diagnosis or delays in initiation of cancer treatment or improving outcomes during cancer survivorship. There were methodological limitations in most studies, such as lack of control groups, small sample sizes, and contamination with other interventions. Conclusions Although cancer-related patient navigation interventions are being increasingly adopted across the U.S. and Canada, further research is necessary to evaluate their efficacy and cost-effectiveness in improving cancer care. PMID:18780320

  13. Patient management.

    PubMed

    Guptill, Lynn

    2015-03-01

    Hospital-associated infections, including those caused by zoonotic agents, represent an increasing concern in veterinary practice. Veterinarians and hospital staff are obligated and expected to provide education about and protection from transmission of pathogens among animal patients and between animal patients and human beings (eg, veterinary staff, volunteers, owners) who come into contact with infected animals. Patient management involves assessing risks of pathogen transmission, identification of animals either suspected of or proved to be infected with a transmissible infectious disease agent, and the implementation of measures that minimize the likelihood of transmission of the infectious agent.

  14. Refining the role of PMS2 in Lynch syndrome: germline mutational analysis improved by comprehensive assessment of variants.

    PubMed

    Borràs, Ester; Pineda, Marta; Cadiñanos, Juan; Del Valle, Jesús; Brieger, Angela; Hinrichsen, Inga; Cabanillas, Ruben; Navarro, Matilde; Brunet, Joan; Sanjuan, Xavier; Musulen, Eva; van der Klift, Helen; Lázaro, Conxi; Plotz, Guido; Blanco, Ignacio; Capellá, Gabriel

    2013-08-01

    The majority of mismatch repair (MMR) gene mutations causing Lynch syndrome (LS) occur either in MLH1 or MSH2. However, the relative contribution of PMS2 is less well defined. The aim of this study was to evaluate the role of PMS2 in LS by assessing the pathogenicity of variants of unknown significance (VUS) detected in the mutational analysis of PMS2 in a series of Spanish patients. From a cohort of 202 LS suspected patients, 13 patients showing loss of PMS2 expression in tumours were screened for germline mutations in PMS2, using a long range PCR based strategy and multiplex ligation dependent probe amplification (MLPA). Pathogenicity assessment of PMS2 VUS was performed evaluating clinicopathological data, frequency in control population and in silico and in vitro analyses at the RNA and protein level. Overall 25 different PMS2 DNA variants were detected. Fourteen were classified as polymorphisms. Nine variants were classified as pathogenic: seven alterations based on their molecular nature and two after demonstrating a functional defect (c.538-3C>G affected mRNA processing and c.137G>T impaired MMR activity). The c.1569C>G variant was classified as likely neutral while the c.384G>A remained as a VUS. We have also shown that the polymorphic variant c.59G>A is MMR proficient. Pathogenic PMS2 mutations were detected in 69% of patients harbouring LS associated tumours with loss of PMS2 expression. In all, PMS2 mutations account for 6% of the LS cases identified. The comprehensive functional analysis shown here has been useful in the classification of PMS2 VUS and contributes to refining the role of PMS2 in LS.

  15. Patient Empowerment

    MedlinePlus

    ... Chat Social Home FAQ Start Here Learn About Kidney Cancer Guidelines for Patients Statistics and Survival Data (NIH) Cancer Term Dictionary (NCI) Surgery for Kidney Cancer Print Surgery Information Therapies for Advanced Kidney Cancer ...

  16. Patient passport.

    PubMed

    2014-11-01

    This article outlines the development, testing and evaluation of a patient passport designed specifically for people with severe asthma, who often prefer to self-manage rather than attend emergency services, and thereby put their lives at risk.

  17. Exact confidence interval estimation for the difference in diagnostic accuracy with three ordinal diagnostic groups.

    PubMed

    Tian, Lili; Xiong, Chengjie; Lai, Chin-Ying; Vexler, Albert

    2011-01-01

    In the cases with three ordinal diagnostic groups, the important measures of diagnostic accuracy are the volume under surface (VUS) and the partial volume under surface (PVUS) which are the extended forms of the area under curve (AUC) and the partial area under curve (PAUC). This article addresses confidence interval estimation of the difference in paired VUS s and the difference in paired PVUS s. To focus especially on studies with small to moderate sample sizes, we propose an approach based on the concepts of generalized inference. A Monte Carlo study demonstrates that the proposed approach generally can provide confidence intervals with reasonable coverage probabilities even at small sample sizes. The proposed approach is compared to a parametric bootstrap approach and a large sample approach through simulation. Finally, the proposed approach is illustrated via an application to a data set of blood test results of anemia patients.

  18. Utility of whole exome sequencing in evaluation of juvenile motor neuron disease.

    PubMed

    Agarwal, Sonika; Potocki, Lorraine; Collier, Talia R; Woodbury, Suzanne L; Adesina, Adekunle M; Jones, Jeremy; Lotze, Timothy E

    2016-04-01

    This case report focuses on identifying novel mutations in juvenile motor neuron disease and emphasizes the significance of whole exome sequencing (WES). We report a 13-year-old Hispanic boy with rapidly progressive weakness, muscle atrophy, tremor, and tongue fasciculation, along with upper motor neuron findings of hyperactive gag reflex, hyperreflexia, and cog-wheel rigidity. Electromyography was suggestive of motor neuron disease. After an extensive evaluation, WES was performed. WES identified a heterozygous de novo variant of unknown clinical significance (VUS) in the fused-in-sarcoma gene (FUS) [c.1554_1557del]. Although initially reported as a VUS, the clinical data from our patient and data from the medical literature support that the variant is indeed disease-causing. The genetic etiology of amyotrophic lateral sclerosis (ALS) is heterogeneous and, as clinical sequencing for FUS was not available, WES was the only method by which a diagnosis of juvenile ALS could be made. © 2016 Wiley Periodicals, Inc.

  19. 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.

  20. Patient lifts.

    PubMed

    1990-03-01

    In this issue, we evaluate conventional patient lifts that operate by hand cranking, hand pumping, or battery-powered motors and are intended for use in the home or in institutions. We did not evaluate lifts that are designed to be used solely in bathrooms or vehicles or those that permanently affix to walls, floors or ceilings. Some of the evaluated lifts are intended primarily for use in specific environments (e.g., one can be easily disassembled into small components for automobile transport). We evaluated 15 patient lifts from eight manufacturers, basing our ratings on performance, safety, and human factors design. Because different designs make lifts preferable for different environments, we rated the lifts for both home and institutional use based on their size, ruggedness, ease of storage, maneuverability, and cost. Seven units-the Arjo 218150; the Handi-Move 1200; the Hoyer C-CBL; the Invacare 9901, 9916 and 9917; and the Porto-Lift PL-1 are rated Acceptable for both home and institutional use. The Trans-Aid S1-600 and the Versa Lift are rated Acceptable for institutional use and Acceptable-Not Recommended for home use because of their size and cost. The Arjo B and the Hoyer Travel Lift are rated Acceptable for home use and Acceptable-Not Recommended for institutional use because they will not comfortably accommodate patients of all sizes; the Arjo B has additional limitations. The Hoyer C-HLA, the Invacare 9902, and the Trans-Aid LAT-2 are rated Conditionally Acceptable for home use on the condition that they are not used to transfer patients who weigh more than 200 lb; all three units are rated Conditionally Acceptable-Not Recommended for institutional use since there is no reliable way to ensure that they will not be used on heavier patients. The Century C-3 lift is rated Conditionally Acceptable for institutional use on the condition that it is used with the base fully extended; because the fully extended base makes the unit awkward to maneuver in

  1. Should the visceral peritoneum at the bladder flap closed at cesarean sections? A post-partum sonographic and clinical assessment.

    PubMed

    Malvasi, Antonio; Tinelli, Andrea; Guido, Marcello; Zizza, Antonella; Farine, Dan; Stark, Michael

    2010-07-01

    To compare cesarean section (CS) using open or closed visceral peritoneum of the bladder flap (BF) in relation to fluid collection in vesico-uterine space (VUS) by ultrasound (US) and clinical outcome. A prospective cohort of repeat CS in 474 in advanced first and second stage of labor was studied. All women underwent a Misgav Ladach CS, in local combined anesthesia. These were divided into two groups by surgical management of the BF at the time of CS: Group I (n = 262), with visceral peritoneum left open and Group II (n = 212), with visceral peritoneum closed. An US check for the fluid collections in the VUS was done in the third post-operative day. The two groups were also clinically compared for: intra-operative estimated blood loss, the need for post-CS pain killers, febrile morbidity and duration of hospital stay. Visceral peritoneum (VP) closure resulted in a significant increase blood collections in the VUS (p < 0.05). VP closure resulted in a significantly higher morbidity in all the following parameters. Rate of BFHs, post-operative fever, need for post-operative analgesia, require antibiotic administration and prolonged hospitalisation (p < 0.05). VP suturing of women requiring CS for dystocia is associated to increased rate of blood collection in the VUS, which could possibly explain the higher rate of puerperal complications in these patients. These data clearly indicate that suturing the VP of the BF in women undergoing CS for dystocia is contraindicated. This data could be probably extrapolated to all cesarean deliveries.

  2. Comprehensive functional assessment of MLH1 variants of unknown significance.

    PubMed

    Borràs, Ester; Pineda, Marta; Brieger, Angela; Hinrichsen, Inga; Gómez, Carolina; Navarro, Matilde; Balmaña, Judit; Ramón y Cajal, Teresa; Torres, Asunción; Brunet, Joan; Blanco, Ignacio; Plotz, Guido; Lázaro, Conxi; Capellá, Gabriel

    2012-11-01

    Lynch syndrome is associated with germline mutations in DNA mismatch repair (MMR) genes. Up to 30% of DNA changes found are variants of unknown significance (VUS). Our aim was to assess the pathogenicity of eight MLH1 VUS identified in patients suspected of Lynch syndrome. All of them are novel or not previously characterized. For their classification, we followed a strategy that integrates family history, tumor pathology, and control frequency data with a variety of in silico and in vitro analyses at RNA and protein level, such as MMR assay, MLH1 and PMS2 expression, and subcellular localization. Five MLH1 VUS were classified as pathogenic: c.[248G>T(;)306G>C], c.[780C>G;788A>C], and c.791-7T>A affected mRNA processing, whereas c.218T>C (p.L73P) and c.244A>G [corrected] (p.T82A) impaired MMR activity. Two other VUS were considered likely neutral: the silent c.702G>A variant did not affect mRNA processing or stability, and c.974G>A (p.R325Q) did not influence MMR function. In contrast, variant c.25C>T (p.R9W) could not be classified, as it associated with intermediate levels of MMR activity. Comprehensive functional assessment of MLH1 variants was useful in their classification and became relevant in the diagnosis and genetic counseling of carrier families. © 2012 Wiley Periodicals, Inc.

  3. UMD-MLH1/MSH2/MSH6 databases: description and analysis of genetic variations in French Lynch syndrome families

    PubMed Central

    Grandval, Philippe; Fabre, Aurélie J.; Gaildrat, Pascaline; Baert-Desurmont, Stéphanie; Buisine, Marie-Pierre; Ferrari, Anthony; Wang, Qing; Béroud, Christophe; Olschwang, Sylviane

    2013-01-01

    Lynch syndrome is an autosomal dominant disease caused by germ line heterozygous mutations mainly involving the MSH2, MLH1 and MSH6 genes that belong to the DNA MisMatch Repair (MMR) genes family. The French network counting the 16 licensed laboratories involved in Lynch syndrome genetic testing developed three locus-specific databases with the UMD® software (www.umd.be/MLH1/, www.umd.be/MSH2/ and www.umd.be/MSH6/) that presently contain a total of 7047 sequence variations including 707 distinct variations of a priori unknown functional significance (VUS) that were identified through complete mutation screening or targeted predictive testing. Mutation carriers are at high risk for developing early-onset colorectal and endometrial adenocarcinomas. Consensus clinical guidelines have been proposed, allowing the efficient detection of curable lesions. The major challenge of genetic testing is to reliably classify the genomic variations in those patients who seek genetic counseling. Combining the interactive tools of the software, the relevant published data and mainly original information produced by the French MisMatch Repair network, the UMD-MLH1/MSH2/MSH6 databases provide interpretation data for the 707 VUS that were classified according to the IARC 5-Class system. These public databases are regularly updated to improve the classification of all registered VUS, exploring their role in cancer pre-disposition based on structural and functional approaches. PMID:23729658

  4. Gaps in Incorporating Germline Genetic Testing Into Treatment Decision-Making for Early-Stage Breast Cancer.

    PubMed

    Kurian, Allison W; Li, Yun; Hamilton, Ann S; Ward, Kevin C; Hawley, Sarah T; Morrow, Monica; McLeod, M Chandler; Jagsi, Reshma; Katz, Steven J

    2017-04-12

    Purpose Genetic testing for breast cancer risk is evolving rapidly, with growing use of multiple-gene panels that can yield uncertain results. However, little is known about the context of such testing or its impact on treatment. Methods A population-based sample of patients with breast cancer diagnosed in 2014 to 2015 and identified by two SEER registries (Georgia and Los Angeles) were surveyed about genetic testing experiences (N = 3,672; response rate, 68%). Responses were merged with SEER data. A patient subgroup at higher pretest risk of pathogenic mutation carriage was defined according to genetic testing guidelines. Patients' attending surgeons were surveyed about genetic testing and results management. We examined patterns and correlates of genetic counseling and testing and the impact of results on bilateral mastectomy (BLM) use. Results Six hundred sixty-six patients reported genetic testing. Although two thirds of patients were tested before surgical treatment, patients without private insurance more often experienced delays. Approximately half of patients (57% at higher pretest risk, 42% at average risk) discussed results with a genetic counselor. Patients with pathogenic mutations in BRCA1/2 or another gene had the highest rates of BLM (higher risk, 80%; average risk, 85%); however, BLM was also common among patients with genetic variants of uncertain significance (VUS; higher risk, 43%; average risk, 51%). Surgeons' confidence in discussing testing increased with volume of patients with breast cancer, but many surgeons (higher volume, 24%; lower volume, 50%) managed patients with BRCA1/2 VUS the same as patients with BRCA1/2 pathogenic mutations. Conclusion Many patients with breast cancer are tested without ever seeing a genetic counselor. Half of average-risk patients with VUS undergo BLM, suggesting a limited understanding of results that some surgeons share. These findings emphasize the need to address challenges in personalized communication

  5. [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.

  6. Contrast-enhanced voiding urosonography with intravesical administration of a second-generation ultrasound contrast agent for diagnosis of vesicoureteral reflux: prospective evaluation of contrast safety in 1,010 children.

    PubMed

    Papadopoulou, Frederica; Ntoulia, Aikaterini; Siomou, Ekaterini; Darge, Kassa

    2014-06-01

    To evaluate the safety of intravesical administration of a second-generation ultrasound (US) contrast agent for the diagnosis of vesicoureteral reflux in children. One thousand and ten children (563 girls, 447 boys; mean age: 2.9 years, range: 15 days-17.6 years) with 2,043 pelvi-ureter-units underwent contrast-enhanced voiding urosonography (ce-VUS) to rule out vesicoureteral reflux. A second-generation US contrast agent (SonoVue®, Bracco, Milan) was administered intravesically through transurethral bladder catheterization at a dose of 0.5 ml/bladder filling. Possible adverse events were monitored during the examination and followed up for 7 days after ce-VUS by phone calls. Urine analysis and culture were performed 3-5 days before ce-VUS in all children and 24-48 h in any patient who reported with adverse events. No case of serious adverse event was recorded. Minor events were reported in 37 children (3.66% of the study population). These included dysuria (n = 26, 2.57%), urinary retention (n = 2, 0.2%), abdominal pain (n = 2, 0.2%), anxiety (n = 1, 0.1%) and crying (n = 1, 0.1%) during micturition, blood and mucous discharge (n = 1, 0.1%), increased frequency of micturition (n = 1, 0.1%), vomiting (n = 1, 0.1%), perineal irritation (n = 1, 0.1%), and an episode of urinary tract infection 10 days after ce-VUS (n = 1, 0.1%). Of these adverse events, 91.9% were subacute in onset and 8.1% were delayed. All events were self-limited and none required hospitalization. There were no serious adverse events. Only a few minor events were reported, most likely due to the catheterization process. Thus, ce-VUS with intravesical administration of the second-generation US contrast agent (SonoVue®) for vesicoureteral reflux detection or exclusion had a favorable safety profile in our study group.

  7. Achieving patient satisfaction: resolving patient complaints.

    PubMed

    Oxler, K F

    1997-07-01

    Patients demand to be active participants on and partners with the health care team to design their care regimen. Patients bring unique perceptions and expectations and use these to evaluate service quality and satisfaction. If customer satisfaction is not achieved and a patient complaint results, staff must have the skills to respond and launch a service recovery program. Service recovery, when done with style and panache, can retain loyal customers. Achieving patient satisfaction and resolving patient complaints require commitment from top leadership and commitment from providers to dedicate the time to understand their patients' needs.

  8. 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.

  9. Pharmacist-Patient Interaction and Patient Expectations

    ERIC Educational Resources Information Center

    DeSimone, Edward M.; And Others

    1977-01-01

    The nature of the professional interaction between the pharmacist and the patient was explored, with data collected from 3,743 questions asked of 16 pharmacists during an 8-week period. Factors that might affect the nature of the pharmacist-patient interaction are identified along with a cognitive-based profile of patient wants. (LBH)

  10. Observance thérapeutique de l’hypertension artérielle et ses facteurs dans le service de cardiologie du CHU Tokoin de Lomé

    PubMed Central

    Pio, Machihude; Baragou, Soodougoua; Afassinou, Yaovi; Pessinaba, Souleymane; Atta, Borgatia; Ehlan, Koffi; Goeh-Akue, Edem; Zoméni, Folly; Damorou, Jean-Marie

    2013-01-01

    Introduction Evaluer l’observance thérapeutique de l’HTA et de déterminer les facteurs de mauvaise observance chez les hypertendus au CHU Tokoin de Lomé. Méthodes Nous avons effectué une étude transversale descriptive sur une durée de 6 mois en consultation externe dans le service de Cardiologie du CHU-Tokoin de Lomé. L’étude a concerné 363 patients hypertendus. L’évaluation de l’observance a été effectuée avec le test d’évaluation de l’observance de Girerd. Résultats Le revenu mensuel était inférieur à 50.000 FCFA chez 49,86% patients; 85,05% des patients n’avaient aucune assurance maladie. Le coût mensuel du traitement par patient était de 10.560 FCFA soit 37,74% du SMIG au Togo. Quatre-vingt et trois virgule soixante-quinze pour cent (83,75%) de nos patients avaient eu des difficultés à observer correctement leur traitement antihypertenseur. Parmi eux 52,34% étaient mauvais observants et 31,41% avaient de minimes problèmes d’observance. Seuls 16,25% étaient de bons observants. Les facteurs de mauvaises observances étaient: le revenu mensuel faible, l’absence d’assurance maladie, le nombre de comprimés et de prises de comprimés supérieurs à 3, et la tradithérapie. Conclusion L’observance thérapeutique a été mauvaise dans notre série. Les facteurs de cette mauvaise observance sont multiples et variés mais dominés pour la plupart par la pauvreté et l’absence d’assurance maladie. PMID:23560131

  11. 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)

  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. Physician accountability, patient safety and patient compensation.

    PubMed

    Gray, John E

    2006-01-01

    In Canada, the response to adverse medical events follows one or more of three main paths: patient safety, physician accountability and patient compensation. While their goals differ, each of these responses serves a valuable function. There are however competing imperatives inherent in each response, particularly in terms of information disclosure: Effective patient safety depends on the full and protected disclosure of all information relevant to an adverse event and requires a "no blame" environment. While natural justice demands that a physician be held accountable for his actions, the doctor should be accorded the right of due process and be judged against an established standard of care. This is necessarily a fault-finding activity. Patient compensation meets both accountability demands and the social justice imperatives of supporting a patient injured through physician negligence. The most effective approach is one that achieves balance between competing imperatives. With clear information disclosure rules, patient safety, physician accountability and patient compensation can operate synergistically.

  14. [Patient education in France].

    PubMed

    Bertrand, Dominique

    2011-10-01

    Patient education is an increasingly important component of therapeutic strategies, especially for chronic illnesses, which currently affect about 12% of the French population and will undoubtedly increase in coming years. Patient education aims to enhance patients' personal responsibility and participation in their therapeutic management and quality of life. Article 84 of French health legislation passed in 2009 inscribes patient education in the Public Health Code for the first time. It distinguishes personalized therapeutic education, patient accompaniment, and learning programs. Direct links between patients and drug companies are prohibited. However, the notion of patient accompaniment remains to be defined, along with the evaluation of patient education, funding sources and practical modalities.

  15. 'Patient satisfaction' in hospitalized cancer patients.

    PubMed

    Skarstein, Jon; Dahl, Alv A; Laading, Jacob; Fosså, Sophie D

    2002-01-01

    Predictors of 'patient satisfaction' with hospitalization at a specialized cancer hospital in Norway are examined in this study. Two weeks after their last hospitalization, 2021 consecutive cancer patients were invited to rate their satisfaction with hospitalization, quality of life, anxiety and depression. Compliance rate was 72% (n = 1453). Cut-off levels separating dissatisfied from satisfied patients were defined. It was found that 92% of the patients were satisfied with their stay in hospital, independent of cancer type and number of previous admissions. Performance of nurses and physicians, level of information perceived, outcome of health status, reception at the hospital and anxiety independently predicted 'patient satisfaction'. The model explained 35% of the variance with an area under the curve of 0.76 of the Receiver Operator Curve. Cancer patients' satisfaction with their hospital stay was high, and predicted by four independently predictive variables related to the performance of caregivers. These suggest areas for further improvement in the healthcare service.

  16. Patient hand hygiene practices in surgical patients.

    PubMed

    Ardizzone, Laura L; Smolowitz, Janice; Kline, Nancy; Thom, Bridgette; Larson, Elaine L

    2013-06-01

    Little is known about the hand hygiene practices of surgical patients. Most of the research has been directed at the health care worker, and this may discount the role that hand hygiene of the surgical patient might play in surgical site infections. A quasiexperimental, pretest/post-test study was conducted in which patients (n = 72) and nurses (n = 42) were interviewed to examine perceptions and knowledge about patient hand hygiene. Concurrently, observations were conducted to determine whether surgical patients were offered assistance by the nursing staff. Following an initial observation period, nursing staff received an educational session regarding general hand hygiene information and observation results. One month after the education session, patient/nurse dyads were observed for an additional 6 weeks to determine the impact of the educational intervention. Eighty observations, 72 patient interviews, and 42 nurse interviews were completed preintervention, and 83 observations were completed postintervention. In response to the survey, more than half of patients (n = 41, 55%) reported that they were not offered the opportunity to clean their hands, but a majority of the nursing staff reported (n = 25, 60%) that they offered patients the opportunity to clean their hands. Prior to the educational intervention, nursing staff assisted patients in 14 of 81 hand hygiene opportunities. Following the intervention, nursing staff assisted patients 37 out of 83 opportunities (17.3% vs 44.6%, respectively, [χ(2)1 = 13.008, P = .0003]). This study suggests that efforts to increase hand hygiene should be directed toward patients as well as health care workers. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  17. Helping patients stop smoking.

    PubMed

    Ferentz, K S; Valente, C M

    1994-01-01

    As more patients seek treatment for nicotine addiction, physicians must become adept at counseling patients on how to quit. Several simple behavioral modification techniques are available to help patients stop smoking, and these techniques can be incorporated into any busy practice. Any patient encounter can be used to inform patients of the dangers of smoking and to tell them to quit. Patients can be offered nicotine replacement therapy, although the long-term benefit is still unknown. Helping patients to quit is a rewarding process.

  18. Multi-gene panel testing for hereditary cancer susceptibility in a rural Familial Cancer Program.

    PubMed

    Hermel, David J; McKinnon, Wendy C; Wood, Marie E; Greenblatt, Marc S

    2017-01-01

    This study explores our Familial Cancer Program's experience implementing multi-gene panel testing in a largely rural patient population. We conducted a retrospective review of patients undergoing panel testing between May 2011 and August 2015. Our goal was to evaluate factors that might be predictors of identifying variants (pathogenic or uncertain significance) and to assess clinical management changes due to testing. We utilized a structured family history tool to determine the significance of patient's family histories with respect to identification of genetic variants. A total of 227 patients underwent panel testing at our center and 67 patients (29.5 %) had variants identified, with 8 (3.5 %) having multiple variants. Overall, 44 patients (19.4 %) had a variant of uncertain significance (VUS) and 28 patients (12.3 %) had a pathogenic variant detected, with 10 (4.4 %) having pathogenic variants in highly penetrant genes. We found no statistical difference in patient familial and personal cancer history, age, rural status, Ashkenazi Jewish ancestry, insurance coverage and prior single-gene testing among those with pathogenic, VUS and negative panel testing results. There were no predictors of pathogenic variants on regression analysis. Panel testing changed cancer screening and management guidelines from that expected based on family history alone in 13.2 % of patients. Ultimately, cancer panel testing does yield critical information not identified by traditional single gene testing but maximal utility through a broad range of personal and family histories requires improved interpretation of variants.

  19. Mucormycosis in trauma patients.

    PubMed

    Cocanour, C S; Miller-Crotchett, P; Reed, R L; Johnson, P C; Fischer, R P

    1992-01-01

    Cutaneous mucormycosis is a rare but often fatal infection in trauma patients. We retrospectively reviewed a 9-year experience with mucormycosis among injured patients. Eleven patients had biopsy- or culture-proven mucormycosis. Nine patients were victims of blunt trauma, two patients had burns measuring greater than 50% TBSA. No patient was at increased risk because of underlying disease or immunosuppression prior to injury. All 11 patients had open wounds on admission. Four patients died of mucormycosis. All nonsurvivors had phycomycotic gangrenous cellulitis of the head, the trunk, or both. In contrast, survivors had involvement of only the extremities. Because of underlying disease, contaminating wounds, antibiotic use, or immunocompromise secondary to shock and sepsis, trauma patients are at risk of developing mucormycosis. To successfully treat mucormycosis, diagnosis must be prompt and accompanied by aggressive debridement and parenteral administration of amphotericin B.

  20. Patient Satisfaction by Design.

    PubMed

    Jacobs, Karen

    2016-11-01

    The concept of the patient experience as it relates to patient satisfaction is a complex dynamic. It is a dynamic that is becoming increasingly more important as patients are faced with multiple choices for their hearing and balance care. As reimbursement and performance policies have become more normative within health care, patient satisfaction has become a metric to measure quality. Patient satisfaction is no longer contained to just the interaction with the audiologist. It extends to the entire experience-the staff, the service, the product, and other factors. Many practices fail to capitalize on one of the primary components of the patient experience-office design. This article discusses the role of evidence-based design in facility planning as it relates to patient satisfaction. It will illustrate how design principles and ideal attributes may be used to send conscious and subconscious cues that will motivate staff, facilitate patient-centered care, and ultimately increase patient satisfaction.

  1. The Angry Dying Patient.

    PubMed

    Houston, Robert E.

    1999-02-01

    Over 25 years ago, Kubler-Ross identified anger as a predictable part of the dying process. When the dying patient becomes angry in the clinical setting, all types of communication become strained. Physicians can help the angry dying patient through this difficult time by using 10 rules of engagement. When physicians engage and empathize with these patients, they improve the patient's response to pain and they reduce patient suffering. When physicians educate patients on their normal responses to dying and enlist them in the process of family reconciliation, they can impact the end-of-life experience in a positive way.

  2. Managing patient expectations.

    PubMed

    Gladfelter, Joanne P

    2006-01-01

    Nurses and physicians are the leading advocates of patient education and patient safety. They believe that the more knowledge and understanding patients have about the procedures they are about to undertake, the better their expectations and recovery will be. Even though efforts are taken to ensure that patients have been adequately informed about risks, complications, and expectations, evaluation of patient comprehension and understanding remains difficult. Verbal information re-enforced by repetition, written text, and a signed consent do not ensure an accurate or adequate means of truly evaluating patient knowledge, understanding, or expectations.

  3. Cirrhosis: A Patient's Guide

    MedlinePlus

    ... ZIP code here Cirrhosis: A Patient's Guide for Health Care Providers Cirrhosis: A Patient's Guide March 2007 Contents ... how best to treat it. What will your health care provider do about cirrhosis? People with cirrhosis need ...

  4. 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

  5. Elucidating the molecular basis of MSH2-deficient tumors by combined germline and somatic analysis.

    PubMed

    Vargas-Parra, Gardenia M; González-Acosta, Maribel; Thompson, Bryony A; Gómez, Carolina; Fernández, Anna; Dámaso, Estela; Pons, Tirso; Morak, Monika; Del Valle, Jesús; Iglesias, Silvia; Velasco, Àngela; Solanes, Ares; Sanjuan, Xavier; Padilla, Natàlia; de la Cruz, Xavier; Valencia, Alfonso; Holinski-Feder, Elke; Brunet, Joan; Feliubadaló, Lídia; Lázaro, Conxi; Navarro, Matilde; Pineda, Marta; Capellá, Gabriel

    2017-10-01

    In a proportion of patients presenting mismatch repair (MMR)-deficient tumors, no germline MMR mutations are identified, the so-called Lynch-like syndrome (LLS). Recently, MMR-deficient tumors have been associated with germline mutations in POLE and MUTYH or double somatic MMR events. Our aim was to elucidate the molecular basis of MSH2-deficient LS-suspected cases using a comprehensive analysis of colorectal cancer (CRC)-associated genes at germline and somatic level. Fifty-eight probands harboring MSH2-deficient tumors were included. Germline mutational analysis of MSH2 (including EPCAM deletions) and MSH6 was performed. Pathogenicity of MSH2 variants was assessed by RNA analysis and multifactorial likelihood calculations. MSH2 cDNA and methylation of MSH2 and MSH6 promoters were studied. Matched blood and tumor DNA were analyzed using a customized next generation sequencing panel. Thirty-five individuals were carriers of pathogenic or probably pathogenic variants in MSH2 and EPCAM. Five patients harbored 4 different MSH2 variants of unknown significance (VUS) and one had 2 novel MSH6 promoter VUS. Pathogenicity assessment allowed the reclassification of the 4 MSH2 VUS and 6 probably pathogenic variants as pathogenic mutations, enabling a total of 40 LS diagnostics. Predicted pathogenic germline variants in BUB1, SETD2, FAN1 and MUTYH were identified in 5 cases. Three patients had double somatic hits in MSH2 or MSH6, and another 2 had somatic alterations in other MMR genes and/or proofreading polymerases. In conclusion, our comprehensive strategy combining germline and somatic mutational status of CRC-associated genes by means of a subexome panel allows the elucidation of up to 86% of MSH2-deficient suspected LS tumors. © 2017 UICC.

  6. Missense variants in the middle domain of DNM1L in cases of infantile encephalopathy alter peroxisomes and mitochondria when assayed in Drosophila.

    PubMed

    Chao, Yu-Hsin; Robak, Laurie A; Xia, Fan; Koenig, Mary K; Adesina, Adekunle; Bacino, Carlos A; Scaglia, Fernando; Bellen, Hugo J; Wangler, Michael F

    2016-05-01

    Defects in organelle dynamics underlie a number of human degenerative disorders, and whole exome sequencing (WES) is a powerful tool for studying genetic changes that affect the cellular machinery. WES may uncover variants of unknown significance (VUS) that require functional validation. Previously, a pathogenic de novo variant in the middle domain of DNM1L (p.A395D) was identified in a single patient with a lethal defect of mitochondrial and peroxisomal fission. We identified two additional patients with infantile encephalopathy and partially overlapping clinical features, each with a novel VUS in the middle domain of DNM1L (p.G350R and p.E379K). To evaluate pathogenicity, we generated transgenic Drosophila expressing wild-type or variant DNM1L. We find that human wild-type DNM1L rescues the lethality as well as specific phenotypes associated with the loss of Drp1 in Drosophila. Neither the p.A395D variant nor the novel variant p.G350R rescue lethality or other phenotypes. Moreover, overexpression of p.A395D and p.G350R in Drosophila neurons, salivary gland and muscle strikingly altered peroxisomal and mitochondrial morphology. In contrast, the other novel variant (p.E379K) rescued lethality and did not affect organelle morphology, although it was associated with a subtle mitochondrial trafficking defect in an in vivo assay. Interestingly, the patient with the p.E379K variant also has a de novo VUS in pyruvate dehydrogenase 1 (PDHA1) affecting the same amino acid (G150) as another case of PDHA1 deficiency suggesting the PDHA1 variant may be pathogenic. In summary, detailed clinical evaluation and WES with functional studies in Drosophila can distinguish different functional consequences of newly-described DNM1L alleles. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. Managing patients with encephalitis.

    PubMed

    Matata, Claire; Easton, Ava; Michael, Benedict; Evans, Becky; Ward, Deborah; Solomon, Tom; Kneen, Rachel

    2015-11-11

    This article provides an overview of encephalitis and addresses its diagnosis, some of the common presenting signs and symptoms, and the different aspects of nursing care required for these patients. In particular, it addresses how to explain encephalitis to the patient's relatives, the rehabilitation needs of these patients, and important aspects of discharge planning. Tests that are necessary for diagnosis in patients with suspected encephalitis and the importance of these are explained.

  8. Can "patient keeper" help in-patients?

    PubMed

    Al-Hinnawi, M F

    2009-06-01

    The aim of this paper is to present our "Patient Keeper" application, which is a client-server medical application. "Patient Keeper" is designed to run on a mobile phone for the client application and on a PC for the server application using J2ME and JAVA2, respectively. This application can help doctors during visits to their patients in hospitals. The client application allows doctors to store on their mobile phones the results of their diagnoses and findings such as temperature, blood pressure, medications, analysis, etc., and send this information to the server via short message service (SMS) for storage in a database. The server can also respond to any request from the client and send the result via Bluetooth, infrared, or over the air. Experimental results showed a significant improvement of the healthcare delivery and reduction for in-patient stay.

  9. Resocializing Aged Mental Patients

    ERIC Educational Resources Information Center

    Cohen, Stewart; And Others

    1975-01-01

    A special project for aged, hospitalized mental patients, drawing on home economics skills in a team approach to rehabilitation, provides skills training leading to patients' increased capacity for self-care, helps patients transfer from the hospital to some form of community life, and provides follow-up services. (Author/AJ)

  10. Panel-based testing for inherited colorectal cancer: a descriptive study of clinical testing performed by a US laboratory.

    PubMed

    Cragun, D; Radford, C; Dolinsky, J S; Caldwell, M; Chao, E; Pal, T

    2014-12-01

    Next-generation sequencing enables testing for multiple genes simultaneously ('panel-based testing') as opposed to sequential testing for one inherited condition at a time ('syndrome-based testing'). This study presents results from patients who underwent hereditary colorectal cancer (CRC) panel-based testing ('ColoNext(™) '). De-identified data from a clinical testing laboratory were used to calculate (1) frequencies for patient demographic, clinical, and family history variables and (2) rates of pathogenic mutations and variants of uncertain significance (VUS). The proportion of individuals with a pathogenic mutation who met national syndrome-based testing criteria was also determined. Of 586 patients, a pathogenic mutation was identified in 10.4%, while 20.1% had at least one VUS. After removing eight patients with CHEK2 mutations and 11 MUTYH heterozygotes, the percentage of patients with 'actionable' mutations that would clearly alter cancer screening recommendations per national guidelines decreased to 7.2%. Of 42 patients with an 'actionable' result, 30 (71%) clearly met established syndrome-based testing guidelines. This descriptive study is among the first to report on a large clinical series of patients undergoing panel-based testing for inherited CRC. Results are discussed in the context of benefits and concerns that have been raised about panel-based testing implementation.

  11. Does patient satisfaction affect patient loyalty?

    PubMed

    Kessler, Daniel P; Mylod, Deirdre

    2011-01-01

    This paper aims to investigate how patient satisfaction affects propensity to return, i.e. loyalty. Data from 678 hospitals were matched using three sources. Patient satisfaction data were obtained from Press Ganey Associates, a leading survey firm; process-based quality measures and hospital characteristics (such as ownership and teaching status) and geographic areas were obtained from the Centers for Medicare and Medicaid Services. The frequency with which end-of-life patients return to seek treatment at the same hospital was obtained from the Dartmouth Atlas. The study uses regression analysis to estimate satisfaction's effects on patient loyalty, while holding process-based quality measures and hospital and market characteristics constant. There is a statistically significant link between satisfaction and loyalty. Although satisfaction's effect overall is relatively small, contentment with certain hospitalization experience may be important. The link between satisfaction and loyalty is weaker for high-satisfaction hospitals, consistent with other studies in the marketing literature. RESEARCH LIMITATION/IMPLICATIONS: The US hospitals analyzed are not a random sample; the results are most applicable to large, non-profit teaching hospitals in competitive markets. Satisfaction ratings have business implications for healthcare providers and may be useful as a management tool for private and public purchasers. The paper is the first to show that patient satisfaction affects actual hospital choices in a large sample. Because patient satisfaction ratings are also correlated with other quality measures, the findings suggest a pathway through which individuals naturally gravitate toward higher-quality care.

  12. Patient blood management equals patient safety.

    PubMed

    Zacharowski, Kai; Spahn, Donat R

    2016-06-01

    Patient blood management (PBM) can be defined in many ways and may consist of hundreds of single measures to improve patient safety. Traditionally, PBM is based on three pillars and defined as (i) optimization of the endogenous red blood cell (RBC) mass through the targeted stimulation of erythropoiesis and the treatment of modifiable underlying disorders; (ii) minimization of diagnostic, interventional, and surgical blood loss to preserve the patient's RBC mass; and (iii) optimization of the patient-specific tolerance to anemia through strict adherence to physiological transfusion thresholds [1-4]. However, for this review, we have chosen the following three peri-interventional parts: (1) diagnosis and therapy of anemia, (2) optimal hemotherapy, and (3) minimization of hospital-acquired anemia. PBM is an evidence-based, multidisciplinary preventive, and therapeutic approach focusing each patient. The PBM concept involves the use of safe and effective medical and surgical methods and techniques designed to prevent peri-interventional anemia, rationalize use of blood products, and set good blood management measures in an effort to improve patient safety and outcome.

  13. Patients with chronic pain.

    PubMed

    Salama-Hanna, Joseph; Chen, Grace

    2013-11-01

    Preoperative evaluation of patients with chronic pain is important because it may lead to multidisciplinary preoperative treatment of patients' pain and a multimodal analgesia plan for effective pain control. Preoperative multidisciplinary management of chronic pain and comorbid conditions, such as depression, anxiety, deconditioning, and opioid tolerance, can improve patient satisfaction and surgical recovery. Multimodal analgesia using pharmacologic and nonpharmacologic strategies shifts the burden of analgesia away from simply increasing opioid dosing. In more complicated chronic pain patients, multidisciplinary treatment, including pain psychology, physical therapy, judicious medication management, and minimally invasive interventions by pain specialists, can improve patients' satisfaction and surgical outcome. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Amputation in Diabetic Patients.

    PubMed

    Singh, Gurjit; Chawla, S

    2006-01-01

    Foot ulcers and their complications are an important cause of morbidity and mortality in diabetes. The present study examines the amputation risk criterion and the long term outcome in terms of amputations and mortality in patients with diabetic foot. 27 patients with diabetic foot lesions were studied. There were 15 patients with early lesions and 10 with advanced lesions. 15 patients were managed conservatively including local amputations and 12 with lower extremity amputations. 80% patients were males in 45-59 years of age group and all patients had more than 6 years of poorly controlled diabetes. Precipitating factors included walking barefoot, history of minor trauma, infection, callosities or burns in 86% of patients. Major lower limb amputations were common in irregularly treated, poorly controlled diabetics due to infection in a limb devitalized by angiopathy and desensitised by neuropathy. Diabetic foot ulcers are associated with high morbidity and mortality. Mortality was higher in ischaemic ulcers than neuropathic ulcers.

  15. 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).

  16. ROC surface assessment of the ANB angle and Wits appraisal's diagnostic performance with a statistically derived 'gold standard': does normalizing measurements have any merit?

    PubMed

    Wellens, Hans L L; BeGole, Ellen A; Kuijpers-Jagtman, Annemarie M

    2017-08-01

    To assess the ANB angle's and Wits appraisal's diagnostic performance using an extended version of Receiver Operating Curve (ROC) analysis, which renders ROC surfaces. These were calculated for both the conventional and normalized cephalometric tests (calculated by exchanging the patient's reference landmarks with those of the Procrustes superimposed sample mean shape).The required 'gold standard' was derived statistically, by applying generalized Procrustes superimposition (GPS) and principal component analysis (PCA) to the digitized landmarks, and ordering patients based upon their PC2 scores. Digitized landmarks of 200 lateral cephalograms (107 males, mean age: 12.8 years, SD: 2.2, 93 females, mean age: 13.2 years, SD: 1.7) were subjected to GPS and PCA. Upon calculating the conventional and normalized ANB and Wits values, ROC surfaces were constructed by varying not just the cephalometric test's cut-off value within each ROC curve, but also the gold standard cut-off value over different ROC curves in 220 steps between -2 and 2 standard deviations along PC2. The volume under the resulting ROC surfaces (VUS) served as a measure of overall diagnostic performance. The statistical significance of the volume differences was determined using permutation tests (1000 rounds, with replacement). The diagnostic performance of the conventional ANB and Wits was remarkably similar for both Class I/II (81.1 and 80.75% VUS, respectively, P > 0.05). Normalizing the measurements improved all VUS highly significantly (91 and 87.2 per cent, respectively, P < 0.001). The conventional ANB and Wits do not differ in their diagnostic performance. Normalizing the measurements does seem to have some merit.

  17. Patient-centered Communication

    PubMed Central

    Swenson, Sara L; Buell, Stephanie; Zettler, Patti; White, Martha; Ruston, Delaney C; Lo, Bernard

    2004-01-01

    OBJECTIVE To investigate patient preferences for a patient-centered or a biomedical communication style. DESIGN Randomized study. SETTING Urgent care and ambulatory medicine clinics in an academic medical center. PARTICIPANTS We recruited 250 English-speaking adult patients, excluding patients whose medical illnesses prevented evaluation of the study intervention. INTERVENTION Participants watched one of three videotaped scenarios of simulated patient-physician discussions of complementary and alternative medicine (CAM). Each participant watched two versions of the scenario (biomedical vs. patient-centered communication style) and completed written and oral questionnaires to assess outcome measurements. MEASUREMENTS AND MAIN RESULTS Main outcome measures were 1) preferences for a patient-centered versus a biomedical communication style; and 2) predictors of communication style preference. Participants who preferred the patient-centered style (69%; 95% confidence interval [CI], 63 to 75) tended to be younger (82%[51/62] for age < 30; 68%[100/148] for ages 30–59; 55%[21/38] for age > 59; P < .03), more educated (76%[54/71] for postcollege education; 73%[94/128] for some college; 49%[23/47] for high school only; P = .003), use CAM (75%[140/188] vs. 55%[33/60] for nonusers; P = .006), and have a patient-centered physician (88%[74/84] vs. 30%[16/54] for those with a biomedical physician; P < .0001). On multivariate analysis, factors independently associated with preferring the patient-centered style included younger age, use of herbal CAM, having a patient-centered physician, and rating a “doctor's interest in you as a person” as “very important.” CONCLUSIONS Given that a significant proportion of patients prefer a biomedical communication style, practicing physicians and medical educators should strive for flexible approaches to physician-patient communication. PMID:15566435

  18. 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

  19. 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.

  20. 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

  1. UAVs and Patient Movement

    DTIC Science & Technology

    2016-04-01

    determining factor and is often the deciding element between life and death. An examination of the evolution of patient movement to make the case...AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY UAVs and PATIENT MOVEMENT by Brian R Blanchard, Major, USAF Doctor...depth look at the evolution of patient movement and the utilization of advanced technologies from to ultimately decrease the time to care. Future

  2. The Anxious Patient

    PubMed Central

    Mendel, Werner M.

    1965-01-01

    Anxiety appears in many disguises and mimics most other afflictions. Once the anxious patient has been recognized as such and a proper diagnosis is made, management of him is easily carried out within the framework of the medical transaction. Lack of awareness of underlying anxiety in a patient who presents with somatic complaints can lead to poor results for the patient and frustration for the physician. It is not the physician's role to remove all anxiety. Rather, it is his mission to manage the anxious patient so as to mediate the anxiety allowing for integrated adaptive function. PMID:14254966

  3. Histoplasmosis in immunosuppressed patients.

    PubMed

    Kauffman, C A; Israel, K S; Smith, J W; White, A C; Schwarz, J; Brooks, G F

    1978-06-01

    Infection with Histoplasma capsulatum in 58 patients whose immune responses were suppressed (Immunosuppressed patients) (16 from the present series and 42 described previously) was analyzed. The most common underlying diseases were Hodgkin's disease (29 per cent), chronic lymphocytic leukemia (19 per cent) and acute lymphocytic leukemia (17 per cent). Sixty-three per cent of the patients had received cytotoxic drugs, and 57 per cent had taken corticosteroids. Widely disseminated infection occurred in 88 per cent of the patients, with predominant involvement of lungs and organs of the reticuloendothelial system. Localized pulmonary infection was present in the remaining patients. The most useful diagnostic method was bone marrow biopsy with microscopic examination for the intracellular yeast form of H. capsulatum. Biopsy of oral lesions, lung, liver and lymph node also proved diagnostically helpful. Growth of H. capsulatum in culture was frequently too slow to be beneficial in diagnosing histoplasmosis in ill patients. Serologic methods were of little diagnostic help in this population of immunosuppressed patients. The response to amphotericin B therapy was excellent (6.7 per cent mortality rate) in those patients in whom the diagnosis was established early and in whom a full course of antifungal therapy could be given. In contrast, the mortality rate in patients who received no antifungal therapy or less than 1 g of amphotericin B was 100 per cent.

  4. [Therapeutic patient education revisited].

    PubMed

    Ruiz, Juan

    2014-06-04

    The therapeutic patient education is an absolute necessity in the management of chronic diseases including diabetes. This discipline promotes personal autonomy to live optimally, to achieve personal and professional projects, despite the constraints of the disease and treatments. The DAWN2 study demonstrates the systemic effects of this disease that goes beyond simple glycemic control. The biopsychosocial dimension needs to be better explored. Other assessment tools should be used to better manage these patients. Exploring the health literacy and numeracy are other tools that can explore the problems for socially disadvantaged patients. The main goal is development of patient capabilities and his environment for the development of the human person.

  5. [Single-patient rooms].

    PubMed

    Jensen, Elisabeth Brøgger

    2009-05-18

    The Danish government has allocated funding to achieve the goal of replacing 50% of all existing hospital buildings by new facilities. Facing such a building boom, the debate for and against single-patient rooms is in progress. A review of the literature shows that single-patient rooms have a direct impact on patient safety. Patient Safety Leadership Walkrounds and failure modes and effects analysis can be used for identifying risks before designing single rooms in future hospitals. The acuity adaptability model needs to be revised.

  6. [Impressibility of schizophrenic patients].

    PubMed

    Bazhin, E F; Korneva, T V; Lomachenkov, A S

    1978-01-01

    The authors studied the abilities to identify emotional states according to the acustico-phonetical symptoms of speech in 160 schizophrenic patients and 80 normals. These studies were performed with the aid of a specially elaborated tape recorder test. It was established that difficulties in accomplishing these tasks were found in schizophrenic patients with paranoid symptomatology. Patients with other clinical states, including sufficiently expressed specific disturbances in the emotional sphere, extremely subtly differentiated the emotional state of the announcers. These data are considered as proof of preserved impressive abilities in the majority of schizophrenic patients. The significance of these factors for the organization of psychosocial influences are discussed.

  7. The tourist as patient.

    PubMed

    Sorokin, M

    1975-08-02

    A review is presented of patients, mainly Australians and New Zealanders, who came to Fiji as tourists. One hundred and seven patients were seen in a six-month period in a general practice near Nadi International Airport, and 39 patients were admitted to the medical unit of the nearby Divisional Hospital over a two-year period. Attention is drawn to the need for informed advice to be given to patients about to embark on holidays abroad, and some of the common problems are discussed.

  8. 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)

  9. Time for patient payment strategies.

    PubMed

    Guyton, Elizabeth M; Madison, Richard D; DeMarco, Tina

    2005-10-01

    A patient payment strategy should have four objectives: Establish equitable and consistent policies and communicate them clearly to patients. Facilitate appropriate payment, regardless of the payer. Increase patients' awareness of their payment options and responsibilities. Enhance patient relations.

  10. The critically ill immunosuppressed patient

    SciTech Connect

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

    1987-01-01

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

  11. Induction of Specific MicroRNAs Inhibits Cutaneous Wound Healing*

    PubMed Central

    Pastar, Irena; Khan, Aly Azeem; Stojadinovic, Olivera; Lebrun, Elizabeth A.; Medina, Mayrin Correa; Brem, Harold; Kirsner, Robert S.; Jimenez, Joaquin J.; Leslie, Christina; Tomic-Canic, Marjana

    2012-01-01

    Chronic nonhealing wounds, such as venous ulcers (VUs), are a widespread and serious medical problem with high morbidity and mortality. The molecular pathology of VUs remains poorly understood, impeding the development of effective treatment strategies. Using mRNA expression profiling of VUs biopsies and computational analysis, we identified a candidate set of microRNAs with lowered target gene expression. Among these candidates, miR-16, -20a, -21, -106a -130a, and -203 were confirmed to be aberrantly overexpressed in a cohort study of 10 VU patients by quantitative PCR and in situ hybridizations. These microRNAs were predicted to target multiple genes important for wound healing, including early growth response factor 3, vinculin, and leptin receptor (LepR). Overexpression of the top up-regulated miRNAs, miR-21 and miR-130a, in primary human keratinocytes down-regulated expression of the endogenous LepR and early growth response factor 3. The luciferase reporter assay verified LepR as a direct target for miR-21 and miR-130a. Both miR-21 and miR-130a delayed epithelialization in an acute human skin wound model. Furthermore, in vivo overexpression of miR-21 inhibited epithelialization and granulation tissue formation in a rat wound model. Our results identify a novel mechanism in which overexpression of specific set of microRNAs inhibits wound healing, resulting in new potential molecular markers and targets for therapeutic intervention. PMID:22773832

  12. Neurotransmitters and Neuropeptides Expression in the Uterine Scar After Cesarean Section.

    PubMed

    Malvasi, Antonio; Cavallotti, Carlo; Gustapane, Sarah; Giacci, Francesco; Di Tommaso, Silvia; Vergara, Daniele; Mynbaev, Ospan A; Tinelli, Andrea

    2016-01-01

    Peptides and neuropeptides influence the uterine disorders of healing or cicatrization, chronic pelvic pain and disorder of pregnancy, labor and puerperium. They also promote changes in the lower uterine segment (LUS) during pregnancy, labor and delivery. We investigated the tissue quantity of neurotensin (NT), neuropeptide tyrosin (NPY) and Protein Gene Product 9.5 (PGP 9.5) in women submitted to elective cesarean section (CS) and urgent CS. During surgery, authors biopsied tissue samples of vesico-uterine space (VUS) to detect nerve fibers, and compared them. VUS samples from 106 patients have been evaluated with light microscopy, immunochemistry and Immunohistochemistry, and finally by Quantimet Leica analyzer software. Significantly higher amount of nerve fibers, containing NT, NPY and PGP 9.5 have been found in VUS tissue samples obtained during the first elective CS and during the first urgent CS were respectively 5±0.7, 7±0.6 and 5±0.9 CU and 2.5±0.5, 3.6±0.4 and 3.5±0.9 CU (p<0.05). This neurotransmitter reduction should indicate the inflammatory damage of cervical tissue for LUS over distension in dystocic-prolonged labor before CS. These results may be correlated with the decrease of NT, NPY and PGP 9.5, responsible for an optimal healing and LUS functions. In our opinion, the presence of neuropeptides reduction in uterine samples of women undergoing urgent CS may be due to a prolonged fetal head station in LUS, with a tissue denervation, in consequence of both overdistension and inflammatory process of the dystocic LUS. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  13. A systematic genetic assessment of 1,433 sequence variants of unknown clinical significance in the BRCA1 and BRCA2 breast cancer-predisposition genes.

    PubMed

    Easton, Douglas F; Deffenbaugh, Amie M; Pruss, Dmitry; Frye, Cynthia; Wenstrup, Richard J; Allen-Brady, Kristina; Tavtigian, Sean V; Monteiro, Alvaro N A; Iversen, Edwin S; Couch, Fergus J; Goldgar, David E

    2007-11-01

    Mutation screening of the breast and ovarian cancer-predisposition genes BRCA1 and BRCA2 is becoming an increasingly important part of clinical practice. Classification of rare nontruncating sequence variants in these genes is problematic, because it is not known whether these subtle changes alter function sufficiently to predispose cells to cancer development. Using data from the Myriad Genetic Laboratories database of nearly 70,000 full-sequence tests, we assessed the clinical significance of 1,433 sequence variants of unknown significance (VUSs) in the BRCA genes. Three independent measures were employed in the assessment: co-occurrence in trans of a VUS with known deleterious mutations; detailed analysis, by logistic regression, of personal and family history of cancer in VUS-carrying probands; and, in a subset of probands, an analysis of cosegregation with disease in pedigrees. For each of these factors, a likelihood ratio was computed under the hypothesis that the VUSs were equivalent to an "average" deleterious mutation, compared with neutral, with respect to risk. The likelihood ratios derived from each component were combined to provide an overall assessment for each VUS. A total of 133 VUSs had odds of at least 100 : 1 in favor of neutrality with respect to risk, whereas 43 had odds of at least 20 : 1 in favor of being deleterious. VUSs with evidence in favor of causality were those that were predicted to affect splicing, fell at positions that are highly conserved among BRCA orthologs, and were more likely to be located in specific domains of the proteins. In addition to their utility for improved genetics counseling of patients and their families, the global assessment reported here will be invaluable for validation of functional assays, structural models, and in silico analyses.

  14. Off-label-use of sulfur-hexafluoride in voiding urosonography for diagnosis of vesicoureteral reflux in children: A survey on adverse events

    PubMed Central

    Sauer, Alexander; Wirth, Clemens; Platzer, Isabel; Neubauer, Henning; Veldhoen, Simon; Dierks, Alexander; Kaiser, Reinhard; Kunz, Andreas; Beer, Meinrad; Bley, Thorsten

    2017-01-01

    AIM To evaluate the risk profile of sulfur hexafluoride in voiding urosonography (VUS) based on a large cohort of children. METHODS Since 2011 sulfur hexafluoride (SH, SonoVue®, Bracco, Italy) is the only ultrasound contrast available in the European Union and its use in children has not been approved. Within a 4-year-period, 531 children with suspected or proven vesicoureteral reflux (f/m = 478/53; mean age 4.9 years; 1 mo-25.2 years) following parental informed consent underwent VUS with administration of 2.6 ± 1.2 mL SH in a two-center study. A standardized telephone survey on adverse events was conducted three days later. RESULTS No acute adverse reactions were observed. The survey revealed subacute, mostly self-limited adverse events in 4.1% (22/531). The majority of observed adverse events (17/22) was not suspected to be caused by an allergic reaction: Five were related to catheter placement, three to reactivated urinary tract infections, five were associated with perineal disinfection before voiding urosonography or perineal dermatitis and four with a common cold. In five patients (0.9%) hints to a potential allergic cause were noted: Perineal urticaria was reported in three interviews and isolated, mild fever in two. These were minor self-limited adverse events with a subacute onset and no hospital admittance was necessary. Ninety-six point two percent of the parents would prefer future VUS examinations with use of SH. CONCLUSION No severe adverse events were observed and indications of self-limited minor allergic reactions related to intravesical administration of SH were reported in less than 1%. PMID:28224096

  15. 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…

  16. [Syndrome of recommended patient].

    PubMed

    Sanz Rubiales, A; del Valle Rivero, M L; Flores Pérez, L A; Hernansanz de la Calle, S; García Recio, C; López-Lara Martín, F

    2002-08-01

    "Syndrome of recommended patient" is manifested as the presence of numerous unexpected and unusual complications in patients that the treating physician is trying to give a better assistance. Even assuming that a few complications may appear by chance, there are several factors from daily clinical practice that facilitate the presence of such a syndrome, and some of them can be corrected in order to reduce its incidence. All of them come from the change on daily clinical practice on these patients, as if they do not fit for the attention provided for other people. These factors favouring the presence of this syndrome come from: patients' attitude, inefficient use of health resources, absence of an adequate register of clinical data and change in usual clinical practice on interpretation of diagnostic tests as well as in the indication of treatment of these patients. The best way to prevent this "syndrome of recommended patient" is to maintain, even within these patients, an attitude based on solid clinical knowledge and to follow up the same clinical rules accepted for other patients.

  17. Patient perspectives on quality.

    PubMed

    Siriwardena, A Niroshan; Gillam, Steve

    2014-01-01

    The patient perspective is central to quality improvement. This article describes how health services are involving individuals and the public in improving healthcare. It describes the importance and different methods of accessing patient and carer feedback on satisfaction, experience and outcomes, and explores current thinking on individual involvement, engagement in commissioning, and the role of the public in redesigning health services.

  18. Patient Telmonitoring at Home

    DTIC Science & Technology

    2007-11-02

    Fraga , M. Lama and J. Vila. “Intelligent telemonitoring of critical care patients,” IEEE Eng. Med. & Biol. Mag., vol. 18, pp. 80-88, July/August...1999. [6] J. Presedo, D. Castro, J. Vila, M. Fernández-Delgado, S. Fraga , M. Lama and S. Barro. “Wireless interface for monitored patients in Coronary

  19. The Patient as Teacher.

    ERIC Educational Resources Information Center

    Weisser, Roland J.; Medio, Franklin J.

    1985-01-01

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

  20. Orthopaedic patient education practice.

    PubMed

    Eloranta, Sini; Katajisto, Jouko; Leino-Kilpi, Helena

    2016-05-01

    The aim of this study was to explore orthopaedic nurses' perceptions of patient education practice; the educational skills of a nurse, the content, structure and educational approaches to patient education and its changes during nine years at a university hospital in Finland. The subjects of this survey were orthopaedic nurses at one university hospital - 56 nurses in 2001 and 51 nurses in 2010. On the whole, no statistically significant change had taken place in the nurses' patient education skills in the two periods compared. In 2001, the nurses discussed more often the learning objectives with patients compared to 2010. In both years, individual education sessions and written material were often used. In both years, the bio-physiological area of patient education was found to be dealt with most adequately, while the social area received less attention in 2010 than in 2001. According to our results, no change in a positive direction in nurses' patient education skills and the implementation of patient education can be seen over the past decade. The results of the study indicate clear development needs in patient education practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. A Patient Assessment Guide

    ERIC Educational Resources Information Center

    Fuller, Dorothy; Rosenaur, Janet Allan

    1974-01-01

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

  2. [Malnutrition in cancer patients].

    PubMed

    Antoun, Sami; Merad, Mansouriah; Raynard, Bruno; Ruffié, Pierre

    2006-11-30

    Malnutrition is common in cancer patients. Many factors contribute to weight loss: some of them can be related to diminished dietary intake, while others are more associated with metabolic changes induced by systemic inflammatory responses. This is why at a specific phase during the course of development, some cancers will benefit from nutritional support, while in theory, and others will benefit from anti-inflammatory treatment. Parenteral nutrition is indicated for severe malnourished surgical patients and for allogenic stem cell transplant patients. Tube feeding (enteral nutrition) should be considered for patients with a functional gut who are unable to ingest sufficient nutrients orally, for example head and neck cancer patients. The value of dietary counselling and oral nutritional support has not been proven in patients undergoing chemotherapy, which is why it is so difficult to propose recommendations. Some arguments seem to favour parenteral nutrition for patients with bowel obstruction suffering from advanced-stage incurable cancer. As the results of studies following omega-3 fatty acid-enriched oral nutritional support in palliative care patients are inconsistent, these products cannot be recommended.

  3. The right patient.

    PubMed

    Howrigon, Ron

    2012-01-01

    This article offers professional opinions and advice on how physicians should prepare in order to protect themselves and their practices during this turbulent time in healthcare reform. This article presents real-life scenarios to help physicians understand what they may face and what actions they should take in anticipation of the future in healthcare. The article focuses on the concept of "the right patient," defining the characteristics of patients that benefit the financial aspect of a practice and those who do not. Its purpose is not to encourage physicians to deny care to patients who are poorly insured or uninsured, but to guide in the establishment of a smart and safe balance between the two. Strategies are discussed on how to attract the right patient and what these patients mean to the practice. The importance of practice marketing is also highlighted, along with an emphasis on the necessity of change in order to survive in the future healthcare environment.

  4. [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.

  5. 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

  6. Genetic Counselors' Experiences Regarding Communication of Reproductive Risks with Autosomal Recessive Conditions found on Cancer Panels.

    PubMed

    Mets, Sarah; Tryon, Rebecca; Veach, Patricia McCarthy; Zierhut, Heather A

    2016-04-01

    The development of hereditary cancer genetic testing panels has altered genetic counseling practice. Mutations within certain genes on cancer panels pose not only a cancer risk, but also a reproductive risk for autosomal recessive conditions such as Fanconi anemia, constitutional mismatch repair deficiency syndrome, and ataxia telangiectasia. This study aimed to determine if genetic counselors discuss reproductive risks for autosomal recessive conditions associated with genes included on cancer panels, and if so, under what circumstances these risks are discussed. An on-line survey was emailed through the NSGC list-serv. The survey assessed 189 cancer genetic counselors' experiences discussing reproductive risks with patients at risk to carry a mutation or variant of uncertain significance (VUS) in a gene associated with both an autosomal dominant cancer risk and an autosomal recessive syndrome. Over half (n = 82, 55 %) reported having discussed reproductive risks; the remainder (n = 66, 45 %) had not. Genetic counselors who reported discussing reproductive risks primarily did so when patients had a positive result and were of reproductive age. Reasons for not discussing these risks included when a patient had completed childbearing or when a VUS was identified. Most counselors discussed reproductive risk after obtaining results and not during the informed consent process. There is inconsistency as to if and when the discussion of reproductive risks is taking place. The wide variation in responses suggests a need to develop professional guidelines for when and how discussions of reproductive risk for autosomal recessive conditions identified through cancer panels should occur with patients.

  7. 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

  8. 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.

  9. Patients with resistant hypertension.

    PubMed

    Amar, Jacques

    2007-06-01

    Hypertension remains uncontrolled in the majority of treated patients, especially those with multiple cardiovascular risk factors. This was demonstrated by a French study that showed that 70% of treated hypertensive patients are not controlled to the target level of 140/90 mmHg. This proportion reached 84% in hypertensive patients with diabetes (target level 130/85 mmHg). What are the reasons for this disappointing situation? Observational studies have shown that only a minority of patients with uncontrolled hypertension receive triple therapy including a diuretic. In this respect, self-measurement of blood pressure should improve the situation by allowing clinicians to base their decision to intensify hypertension treatment on more solid evidence than consultation blood pressure measurements alone. Patient-related factors may also contribute to this situation. Treated patients with uncontrolled hypertension often have multiple risk factors. This is associated with or is a source of poor treatment observance linked to patient psychological factors or a result of the increased consumption of medication. Finally, risk factors themselves may be responsible for problems with blood pressure control as a result of their detrimental effects on large arteries as well as the microvascular network. The early correction of such vascular anomalies is vital for medium and long-term blood pressure control.

  10. Bacteremia in hemodialysis patients

    PubMed Central

    Suzuki, Masashi; Satoh, Nobuhiko; Nakamura, Motonobu; Horita, Shoko; Seki, George; Moriya, Kyoji

    2016-01-01

    Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of the causative organisms of bacteremia in hemodialysis patients are Gram-positive bacteria. The ratio of resistant bacteria in hemodialysis patients compared to the general population is unclear. Several reports have indicated that hemodialysis patients have a higher risk of methicillin-resistant Staphylococcus aureus infection. The most common site of infection causing bacteremia is internal prostheses; the use of a hemodialysis catheter is the most important risk factor for bacteremia. Although antibiotic lock of hemodialysis catheters and topical antibiotic ointment can reduce catheter-related blood stream infection (CRBSI), their use should be limited to necessary cases because of the emergence of resistant organisms. Systemic antibiotic administration and catheter removal is recommended for treating CRBSI, although a study indicated the advantages of antibiotic lock and guidewire exchange of catheters over systemic antibiotic therapy. An infection control bundle recommended by the Center for Disease Control and Prevention succeeded in reducing bacteremia in hemodialysis patients with either a catheter or arteriovenous fistula. Appropriate infection control can reduce bacteremia in hemodialysis patients. PMID:27872830

  11. Nutrition of burned patients.

    PubMed

    Gudaviciene, Daiva; Rimdeika, Rytis; Adamonis, Kestutis

    2004-01-01

    Burns form 5-12% of all traumas. About 2,200 of patients are annually hospitalized in Lithuania. In most cases people of the employable age get burned. The treatment is often long-lasting, and afterwards recovered patients often have invalidity from burn sequels. The mortality of hospitalized burned patients is about 10%. The most common causes of death are pulmonary edema, pneumonia, sepsis and multiorgan failure. All these complications are related with insufficient nutrition. These complications are extremely frequent and dangerous for patients with more than 20% of body burned. The nutritional support of burned patient gives a possibility to increase the survival probability, to decrease complication rate and hospitalization time. Currently in Lithuania there are no standards for burned patient nutrition. More attention is given to strategy of surgical strategy and techniques, as well as antibiotic therapy. This article is the review of the different aspects of artificial nutrition of burned patient: indications, modes of nutrition, mixtures and terms of nutritional support.

  12. [Patient oriented healthcare planning].

    PubMed

    Fülöp, Gerhard

    2017-08-01

    Patient orientation has already been taken into account in healthcare planning approaches in Austria by using constantly improved routine health data, though primarily falling in the category of an indirect influence on or improvement of the individual patient-provider interaction. Data bases available in "Österreichische Gesundheitsinformationssystem (ÖGIS)" at Gesundheit Österreich GmbH (GÖG) have been used for years to both intensify the patient orientation within the needs-based planning framework (designed as "integrated regional healthcare planning", bearing the interactions between the sectors in mind) and to define and monitor the ten "Health Goals Austria". For the next few years, we can expect a further advancement and completion of the database in favour of healthcare planning to support the necessary adaptation and reorganization of the regional healthcare systems, the intensification of healthcare research and subsequently an improved patient orientation in Austria. In general, efforts are being made in Austria to improve the integration of the patient's perspective in the area of health care planning (e.g. by involving patients 'attorneys' or self-help groups). However, these efforts have not yet reached the stage of full implementation (inter alia also because the organizational potential for improvement or the quality of results from the patient's perception could not yet be adequately taken into account). Accordingly, further efforts to this end will be necessary in the upcoming years. Copyright © 2017. Published by Elsevier GmbH.

  13. Anesthesiologist: the patient's perception.

    PubMed

    Ribeiro, Carolina Sobrinho; Mourão, Joana Irene de Barros

    2015-01-01

    Anesthesia is still a major concern for patients, although the anesthetic complications have decreased significantly. Additionally, the role assigned to the anesthesiologist remains inaccurate. The aim of this study was to evaluate the concerns with anesthesia and assess the patient's knowledge about the anesthesiologist's duties. Prospective study conducted over three months with patients in the preoperative anesthetic visit in a university hospital. Demographic information about the level of education and prior anesthesia was obtained. The knowledge of patients regarding the anesthesiologists' education was evaluated. Patients' concerns and anesthesiologist and surgeon responsibilities were classified with a 5-point scale. The analysis was performed with SPSS 21, and p<0.05 was considered statistically significant. We included 204 patients, and 135 (66.2%) recognized the anesthesiologist as a specialist physician. Not waking up after surgery and postoperative infection were the main concerns compared to all others (p<0.05). Women expressed more concern than men about not waking up after surgery, nausea and postoperative vomiting, medical problems, and waking up during surgery (p<0.05). Ensure that patients do not wake up during surgery was the anesthesiologist task most recognized, compared to all other (p<0.05). The surgeon was more recognized (p<0.05) than the anesthesiologist in post-operative, antibiotics administration, and blood transfusions pain management. Patients need to be informed about the current safety of anesthesia and the anesthesiologist's functions. The patient involvement will demystify some fears and reassure the confidence in the health system. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  14. [Anesthesiologist: the patient's perception].

    PubMed

    Ribeiro, Carolina Sobrinho; Mourão, Joana Irene de Barros

    2015-01-01

    Anesthesia is still a major concern for patients, although the anesthetic complications have decreased significantly. Additionally, the role assigned to the anesthesiologist remains inaccurate. The aim of this study was to evaluate the concerns with anesthesia and assess the patient's knowledge about the anesthesiologist's duties. Prospective study conducted over three months with patients in the preoperative anesthetic visit in a university hospital. Demographic information about the level of education and prior anesthesia was obtained. The knowledge of patients regarding the anesthesiologists' education was evaluated. Patients' concerns and anesthesiologist and surgeon responsibilities were classified with a 5-point scale. The analysis was performed with SPSS 21, and p<0.05 was considered statistically significant. We included 204 patients, and 135 (66.2%) recognized the anesthesiologist as a specialist physician. Not waking up after surgery and postoperative infection were the main concerns compared to all others (p<0.05). Women expressed more concern than men about not waking up after surgery, nausea and postoperative vomiting, medical problems, and waking up during surgery (p<0.05). Ensure that patients do not wake up during surgery was the anesthesiologist task most recognized, compared to all other (p<0.05). The surgeon was more recognized (p<0.05) than the anesthesiologist in post-operative, antibiotics administration, and blood transfusions pain management. Patients need to be informed about the current safety of anesthesia and the anesthesiologist's functions. The patient involvement will demystify some fears and reassure the confidence in the health system. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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

    PubMed

    Pors, Anja Svejgaard

    2016-01-01

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

  16. Evaluation of Patient Welfare

    PubMed Central

    Piedmont, Eugene B.; Dornblaser, Bright M.

    1970-01-01

    A multifaceted attempt is made to measure patients' well-being quantitatively in a complex interdisciplinary research and experimental construction project. Parallel studies were conducted in adjoining traditionally shaped and spoke-design hospital buildings. Major innovations were made, in both plants, in the organization of nursing staffs and in communications and logistical support. Smaller nursing staffs achieved significant increases in time spent in direct patient (“bedside”) care, without negative effects on patient welfare, in both buildings; but these effects were maximized in the spoke-design building. PMID:5494267

  17. Respecting patient confidentiality.

    PubMed

    Price, Bob

    2015-02-03

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

  18. [Contraception in cardiac patients].

    PubMed

    Barrat, J; Nivet, M

    1976-01-01

    Contraception using IUDs and oral contraception, and sterilization in heart disease are discussed. IUDs are contraindicated in heart patients in whom bacterial infection might present special dangers (heart valve disease and certain congential heart defects), and in patients receiving long-term anticoagulant therapy, because of the increased risk of hemorrhage. Oral contraceptives are contraindicated because of the frequently observed water retention and weight gain, their effects on arterial blood pressure, and their contribution to thromboembolic desease. During sterilization procedures, particular attention should be given to anesthesia and to position. Contraindications are relative, depending on the patients' status and many other factors.

  19. [Fever in Cancer Patients].

    PubMed

    Cornely, Oliver Andreas; Mellinghoff, Sibylle Christiane

    2017-07-01

    Fever in cancer patients is a medical emergency until a severe infection has been ruled out. In case of neutropenia prompt diagnostic work-up should be paralleled by empiric antibiotic treatment. Underlying malignancy as well as treatments may impair immune response and thus pave the way for less virulent pathogens. So the spectrum of infections comprises both pathogens that cause disease in immunocompetent patients and a variety of rarer organisms. After collecting two pairs of blood cultures, broad-spectrum antibiotic treatment should commence within one to two hours. Depending on the individual patient's risk antimicrobial prophylaxis should be considered. © Georg Thieme Verlag KG Stuttgart · New York.

  20. The patient with ataxia.

    PubMed

    Maggs, F G

    2014-01-01

    In this article we look at the causes of ataxia, and how the patient presenting with ataxia should be managed. One of the difficulties in managing the patient with ataxia is that acute ataxia has many causes, but usually these can be teased out by means of a careful history and examination. Investigations can then be targeted at confirming or disproving the differential diagnosis. Some patients with ataxia need to be managed in hospital, but many can be investigated, and receive therapy, as an outpatient.

  1. Why Do Patients Bleed?

    PubMed Central

    Curnow, Jennifer; Pasalic, Leonardo; Favaloro, Emmanuel J.

    2016-01-01

    Patients undergoing surgical procedures can bleed for a variety of reasons. Assuming that the surgical procedure has progressed well and that the surgeon can exclude surgical reasons for the unexpected bleeding, then the bleeding may be due to structural (anatomical) anomalies or disorders, recent drug intake, or disorders of hemostasis, which may be acquired or congenital. The current review aims to provide an overview of reasons that patients bleed in the perioperative setting, and it also provides guidance on how to screen for these conditions, through consideration of appropriate patient history and examination prior to surgical intervention, as well as guidance on investigating and managing the cause of unexpected bleeding. PMID:28824979

  2. Educating the glaucoma patient.

    PubMed Central

    Rosenthal, A. R.; Zimmerman, J. F.; Tanner, J.

    1983-01-01

    Forty-nine patients with open-angle glaucoma and 32 controls were studied at each of 2 medical centres, one in California and one in England. A 12-point questionnaire was answered before, immediately after, and 6 months after viewing a 6 minute video film about glaucoma. The English glaucoma patients and controls showed lower initial knowledge than their American counterparts. Immediately after the film all groups had substantially improved their knowledge by answering 78-88% of the questions correctly. Recall study showed that both American groups had retained more than their British counterparts and that glaucoma patients retained more knowledge of their disease than did controls. The use of an educational video film in an outpatient setting is a simple and economical method of patient education applicable to both American and British subjects with open-angle glaucoma. PMID:6671096

  3. Patient satisfaction constructs.

    PubMed

    Rahman, Muhammad Sabbir; Osmangani, Aahad M

    2015-01-01

    The purpose of this paper is to examine the five-factor structure of patients' satisfaction constructs toward private healthcare service providers. This research is a cross-sectional study. A questionnaire-based survey was conducted with previous and current Bangladeshi patients. Exploratory factor analysis was employed to extract the underlying constructs. Five underlying dimensions that play a significant role in structuring the satisfaction perceived by Bangladeshi private healthcare patients are identified in this study. Practical implications - The main contribution of this study is identifying the dimensions of satisfaction perceived by Bangladeshi patients regarding private healthcare service providers. Healthcare managers adopt the five identified underlying construct items in their business practices to improve their respective healthcare efficiency while ensuring overall customer satisfaction.

  4. Leadership for patient care.

    PubMed

    Nackel, J G; Shelley, S R

    1991-01-01

    In an era of change in health-care delivery and, particularly, change in patient care, leadership is the cornerstone of change management. The environment of the 1990s will challenge even the most sophisticated and capable health-care executives. This paper discusses key aspects of leadership and models them to the patient-care setting. Leadership will be the differentiating factor as organizations seek competitive advantage.

  5. 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.

  6. [Patient safety: Glossary].

    PubMed

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

    2015-10-01

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

  7. Tuberculosis in HIV patient.

    PubMed

    Paudel, Bidhan Nidhi; Paudel, Punya; Paudel, Luna; Dhungana, Govinda; Amatya, Gyanendra Lal; Aryal, Choodamani; Kandel, Prakash

    2013-01-01

    Strict monitoring ofanti tuberculosis therapy and antiretroviral therapyis crucial for proper management of TB/HIV co-infected patients. Between December 2006 and December 2008 a prospective observational study was conducted among 135 TB/HIV co-infected patients visiting antiretroviral therapy in Seti Zonal Hospital, Dhangadi. The diagnosed TB patients were subjected to ATT through directly observed treatment short-course (DOTS) and its response was evaluated as per WHO guidelines. Among 135 studied subjects, 97 (71.9%) were males and over 119 (88 %) of the patients were in the age group 21 to 50. Of the total TB cases 92 (68.1%) presented pulmonary TB and 37.20% of the Extra-pulmonary Tuberculosis cases were lymph node TB. 72 (53.33%) of them had completed ATT, 11 (8.2%) transfer out and 17 (12.6%) were default. Majority of the patients presented PTB, and lymph node TB was found to be the most common EPTB. Comparatively, high efficacy of ATT was found in HIV patients visiting this resource poor setting.

  8. Chronically Critically Ill Patients

    PubMed Central

    Douglas, Sara L.; Daly, Barbara J.; Kelley, Carol Genet; O’Toole, Elizabeth; Montenegro, Hugo

    2007-01-01

    Background Chronically critically ill patients often have high costs of care and poor outcomes and thus might benefit from a disease management program. Objectives To evaluate how adding a disease management program to the usual care system affects outcomes after discharge from the hospital (mortality, health-related quality of life, resource use) in chronically critically ill patients. Methods In a prospective experimental design, 335 intensive care patients who received more than 3 days of mechanical ventilation at a university medical center were recruited. For 8 weeks after discharge, advanced practice nurses provided an intervention that focused on case management and interdisciplinary communication to patients in the experimental group. Results A total of 74.0% of the patients survived and completed the study. Significant predictors of death were age (P = .001), duration of mechanical ventilation (P = .001), and history of diabetes (P = .04). The disease management program did not have a significant impact on health-related quality of life; however, a greater percentage of patients in the experimental group than in the control group had “improved” physical health-related quality of life at the end of the intervention period (P = .02). The only significant effect of the intervention was a reduction in the number of days of hospital readmission and thus a reduction in charges associated with readmission. Conclusion The intervention was not associated with significant changes in any outcomes other than duration of readmission, but the supportive care coordination program could be provided without increasing overall charges. PMID:17724242

  9. Patient loyalty model.

    PubMed

    Sumaedi, Sik; Bakti, I Gede Mahatma Yuda; Rakhmawati, Tri; Astrini, Nidya Judhi; Yarmen, Medi; Widianti, Tri

    2015-07-06

    This study aims to investigate the simultaneous effect of subjective norm, perceived behavioral control and trust on patient loyalty. The empirical data were collected through survey. The respondents of the survey are 157 patients of a health-care service institution in Bogor, Indonesia. Multiple regressions analysis was performed to test the conceptual model and the proposed hypotheses. The findings showed that subjective norm and trust influence patient loyalty positively. However, this research also found that perceived behavioral control does not influence patient loyalty significantly. The survey was only conducted at one health-care service institution in Bogor, Indonesia. In addition, convenience sampling method was used. These conditions may cause that the research results can not be generalized to the other contexts. Therefore, replication research is needed to test the stability of the findings in the other contexts. Health-care service institutions need to pay attention to trust and subjective norm to establish patient loyalty. This study is believed to be the first to develop and test patient loyalty model that includes subjective norm, perceived behavioral control and trust.

  10. [Suicidal patient identification].

    PubMed

    Manzanedo Sagredo, María Isabel; Ortiz Fernández, María Inmaculada

    2012-01-01

    The daily evidence, in the course of professional practice shows the important role of nurses in detecting suicidal patient because the staff is in better accessibility unlimited dedication in front of a voluntary consultation and creation of an environment trust. The main objective of this plan is to identify patients at risk of suicidal behavior in psychiatric hospital settings. The basic procedures for achieving these goals are to use methods such as clinical interviews, observation and application of scales that tell us that a patient may be contemplating suicide. This assessment will take into account several variables: physical, psychological, behavioral, verbal, social, familial, demographic, etc. The aim is, likewise, discard myths about suicide which may mask important information and help to identify patients at risk. It should be noted that only a small number of suicides happen without warning. Most suicide give clear warnings of their intentions. These patients do not want to stop living, what they really want is to stop suffering, but his mental condition prevents them from thinking about other solutions while his thoughts focused on the negative aspects of his life without being able to take into account the positive. The result that the aim this plan of care is to prevent the suicide of patients in the hospital. For although not all suicides can be prevented, most do.

  11. [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

  12. Preventing Infections in Cancer Patients

    MedlinePlus

    ... Caregivers Flu Treatment for Cancer Patients and Survivors Flu Publications Stay Informed Cancer Home Information for Patients and Caregivers Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir Cancer patients ...

  13. Cytomegalovirus Colitis in Immunocompetent Patients

    PubMed Central

    Hussain, Qulsoom; Shafique, Khurram; Tasleem, Syed H; Hurairah, Abu

    2016-01-01

    Cytomegalovirus colitis is common in immunocompromised patients, but rare in immunocompetent patients. The present study not only represents the colonoscopy and pathological findings, but also applies the method of diagnosing and treating cytomegalovirus colitis in immunocompetent patients. PMID:27980888

  14. Choosing effective patient education materials

    MedlinePlus

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

  15. 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

  16. Patients' positive identification systems.

    PubMed

    Pagliaro, Pasqualepaolo; Turdo, Rosalia; Capuzzo, Enrico

    2009-10-01

    Blood safety must be maintained throughout the whole transfusion chain to prevent the transfusion of incorrect blood components. The estimated risk of an incorrect transfusion is in the order of 1 per 10,000 units of blood. Although several kinds of errors contribute to "wrong blood" events, 70% of errors occur in clinical areas with the most common being due to failure of the pre-transfusion bedside checking procedure. Several methods are available to reduce such errors. The I-TRAC Plus system by Immucor consists of an identification bracelet which is a bar-coded wristband and a handheld portable computer that identifies patients and blood bags by a scanner and prints the information through a portable printer. The labels attached on the blood order forms and on the sample tubes are read and recorded in the blood bank's informatics system (EmoNet INSIEL). Labels showing the bar-code of the assigned number, which includes the ID number of the patient, the ID number of the unit and a code identifying the kind of product and use (allogeneic or autologous), are generated and applied to the blood components. The transfusions are administered after checking the unit and the patient's wristband using the scanner of a portable PC. In 5 years a total of 71,400 units of blood components were transfused to 15,430 patients using the I-TRAC Plus system. The system prevented 12 cases of mis-identification of patients (5 in 2003, 0 in 2004, 1 in 2005, 1 in 2006 and 5 in 2007). In 2003 we introduced the use of a bar-code matching system between a patient's wristband and the blood bag to avoid mistakes at the bedside. In 5 years the system provided benefits by avoiding errors in the identification of patients, thus preventing "wrong blood" transfusions.

  17. Patient safety culture: finding meaning in patient experiences.

    PubMed

    Bishop, Andrea C; Cregan, Brianna R

    2015-01-01

    The purpose of this paper is to determine what patient and family stories can tell us about patient safety culture within health care organizations and how patients experience patient safety culture. A total of 11 patient and family stories of adverse event experiences were examined in September 2013 using publicly available videos on the Canadian Patient Safety Insitute web site. Videos were transcribed verbatim and collated as one complete data set. Thematic analysis was used to perform qualitative inquiry. All qualitative analysis was done using NVivo 10 software. A total of three themes were identified: first, Being Passed Around; second, Not Having the Conversation; and third, the Person Behind the Patient. Results from this research also suggest that while health care organizations and providers might expect patients to play a larger role in managing their health, there may be underlying reasons as to why patients are not doing so. The findings indicate that patient experiences and narratives are useful sources of information to better understand organizational safety culture and patient experiences of safety while hospitalized. Greater inclusion and analysis of patient safety narratives is important in understanding the needs of patients and how patient safety culture interventions can be improved to ensure translation of patient safety strategies at the frontlines of care. Greater acknowledgement of the patient and family experience provides organizations with an integral perspective to assist in defining and addressing deficiencies within their patient safety culture and to identify opportunities for improvement.

  18. The "Permanent" Patient Problem.

    PubMed

    Bruce, Courtenay R; Majumder, Mary A

    2014-01-01

    Patients who enter the health care system for acute care may become "permanent" patients of the hospital when a lack of resources precludes discharge to the next level of post-acute care. Legal, professional, and ethical norms prohibit physician and acute care hospital "dumping" of these patients. However, limitless use of hospital resources for indefinite stays is untenable. In the absence of hospital policy addressing this specific issue, the availability of financial support will be determined by health care professionals' willingness to advocate for the patient and negotiate with hospital administrators and the ability and willingness of administrators to authorize the use of hospital resources. We propose five mid-level ethical principles to guide advocacy and administrative decision-making about provision of financial support for post-acute care for those patients who cannot afford it. We use two actual, de-identified cases to illustrate how these principles can be used to make reasoned, consistent decisions about the provision of post-acute financial support. © 2014 American Society of Law, Medicine & Ethics, Inc.

  19. Thromboprophylaxis in nonsurgical patients.

    PubMed

    Streiff, Michael B; Lau, Brandyn D

    2012-01-01

    Venous thromboembolism (VTE) is an important cause of preventable morbidity and mortality in medically ill patients. Randomized controlled trials indicate that pharmacologic prophylaxis reduces deep venous thrombosis (relative risk [RR] = 0.46; 95% confidence interval [CI], 0.36-0.59) and pulmonary embolism (RR = 0.49; 95% CI, 0.33-0.72) with a nonsignificant trend toward more bleeding (RR = 1.36; 95% CI, 0.80-2.33]. Low-molecular-weight heparin (LMWH) and unfractionated heparin are equally efficacious in preventing deep venous thrombosis (RR = 0.85; 95% CI, 0.69-1.06) and pulmonary embolism (RR = 1.05; 95% CI, 0.47-2.38), but LMWH is associated with significantly less major bleeding (RR = 0.45; 95% CI, 0.23-0.85). LMWH is favored for VTE prophylaxis in critically ill patients. New VTE and bleeding risk stratification tools offer the potential to improve the risk-benefit ratio for VTE prophylaxis in medically ill patients. Intermittent pneumatic compression devices should be used for VTE prophylaxis in patients with contraindications to pharmacologic prophylaxis. Graduated compression stockings should be used with caution. VTE prevention in medically ill patients using extended-duration VTE prophylaxis and new oral anticoagulants warrant further investigation. VTE prophylaxis prescription and administration rates are suboptimal and warrant multidisciplinary performance improvement strategies.

  20. Mutation Update for UBE3A variants in Angelman syndrome.

    PubMed

    Sadikovic, Bekim; Fernandes, Priscilla; Zhang, Victor Wei; Ward, Patricia A; Miloslavskaya, Irene; Rhead, William; Rosenbaum, Richard; Gin, Robert; Roa, Benjamin; Fang, Ping

    2014-12-01

    Angelman syndrome is a neurodevelopmental disorder caused by a deficiency of the imprinted and maternally expressed UBE3A gene. Although de novo genetic and epigenetic imprinting defects of UBE3A genomic locus account for majority of Angelman diagnoses, approximately 10% of individuals affected with Angelman syndrome are a result of UBE3A loss-of-function mutations occurring on the expressed maternal chromosome. The variants described in this manuscript represent the analysis of 2,515 patients referred for UBE3A gene sequencing at our institution, along with a comprehensive review of the UBE3A mutation literature. Of these, 267 (10.62%) patients had a report issued for detection of a UBE3A gene nucleotide variant, which in many cases involved family studies resulting in reclassification of variants of unknown clinical significance (VUS). Overall, 111 (4.41%) probands had a nucleotide change classified as pathogenic or strongly favored to be pathogenic, 29 (1.15%) had a VUS, and 126 (5.0%) had a nucleotide change classified as benign or strongly favored to be benign. All variants and their clinical interpretations are submitted to NCBI ClinVar, a freely accessible human variation and phenotype database.

  1. Combining fetal sonography with genetic and allele pathogenicity studies to secure a neonatal diagnosis of Bardet–Biedl syndrome

    PubMed Central

    Ashkinadze, E.; Rosen, T.; Brooks, SS.; Katsanis, N.; Davis, EE.

    2013-01-01

    Bardet–Biedl syndrome (BBS) is a rare pediatric ciliopathy characterized by marked clinical variability and extensive genetic heterogeneity. Typical diagnosis of BBS is secured at a median of 9 years of age, and sometimes well into adolescence. Here, we report a patient in whom prenatal detection of increased nuchal fold, enlarged echogenic kidneys, and polydactyly prompted us to screen the most commonly mutated genes in BBS and the phenotypically and genetically overlapping ciliopathy, Meckel–Gruber syndrome (MKS). We identified the common Met390Arg mutation in BBS1 in compound heterozygosity with a novel intronic variant of unknown significance (VUS). Testing of mRNA harvested from primary foreskin fibroblasts obtained shortly after birth revealed the VUS to induce a cryptic splice site, which in turn led to a premature termination and mRNA degradation. To our knowledge, this is the earliest diagnosis of BBS in the absence of other affected individuals in the family, and exemplifies how combining clinical assessment with genetic and timely assays of variant pathogenicity can inform clinical diagnosis and assist with patient management in the prenatal and neonatal setting. PMID:22998390

  2. Exome Sequencing in a Family with Luminal-Type Breast Cancer Underpinned by Variation in the Methylation Pathway

    PubMed Central

    van der Merwe, Nicole; Peeters, Armand V.; Pienaar, Fredrieka M.; Bezuidenhout, Juanita; van Rensburg, Susan J.; Kotze, Maritha J.

    2017-01-01

    Panel-based next generation sequencing (NGS) is currently preferred over whole exome sequencing (WES) for diagnosis of familial breast cancer, due to interpretation challenges caused by variants of uncertain clinical significance (VUS). There is also no consensus on the selection criteria for WES. In this study, a pathology-supported genetic testing (PSGT) approach was used to select two BRCA1/2 mutation-negative breast cancer patients from the same family for WES. Homozygosity for the MTHFR 677 C>T mutation detected during this PSGT pre-screen step was considered insufficient to cause bilateral breast cancer in the index case and her daughter diagnosed with early-onset breast cancer (<30 years). Extended genetic testing using WES identified the RAD50 R385C missense mutation in both cases. This rare variant with a minor allele frequency (MAF) of <0.001 was classified as a VUS after exclusion in an affected cousin and extended genotyping in 164 unrelated breast cancer patients and 160 controls. Detection of functional polymorphisms (MAF > 5%) in the folate pathway in all three affected family members is consistent with inheritance of the luminal-type breast cancer in the family. PSGT assisted with the decision to pursue extended genetic testing and facilitated clinical interpretation of WES aimed at reduction of recurrence risk. PMID:28241424

  3. A computational method to classify variants of uncertain significance using functional assay data with application to BRCA1.

    PubMed

    Iversen, Edwin S; Couch, Fergus J; Goldgar, David E; Tavtigian, Sean V; Monteiro, Alvaro N A

    2011-06-01

    Besides revealing cancer predisposition variants or the absence of any changes, genetic testing for cancer predisposition genes can also identify variants of uncertain clinical significance (VUS). Classifying VUSs is a pressing problem, as ever more patients seek genetic testing for disease syndromes and receive noninformative results from those tests. In cases such as the breast and ovarian cancer syndrome in which prophylactic options can be severe and life changing, having information on the disease relevance of the VUS that a patient harbors can be critical. We describe a computational approach for inferring the disease relevance of VUSs in disease genes from data derived from an in vitro functional assay. It is based on a Bayesian hierarchical model that accounts for sources of experimental heterogeneity. The functional data correlate well with the pathogenicity of BRCA1 BRCT VUSs, thus providing evidence regarding pathogenicity when family and genetic data are absent or uninformative. We show the utility of the model by using it to classify 76 VUSs located in the BRCT region of BRCA1. The approach is both sensitive and specific when evaluated on variants previously classified using independent sources of data. Although the functional data are very informative, they will need to be combined with other forms of data to meet the more stringent requirements of clinical application. Our work will lead to improved classification of VUSs and will aid in the clinical decision making of their carriers. ©2011 AACR.

  4. Online patient information.

    PubMed

    Oakley, Amanda

    2002-09-01

    Information appropriate for patients with skin diseases is readily available on the Internet. Patients primarily seek disease-related information, but may also search for a dermatologist, shop for skin care products, or look to a consumer organization for support. Authoritative educational material is supplied by academic dermatologic associations and institutions and distributed by independent websites, large health portals, and search directories. Interactive opportunities include bulletin boards, ask-an-expert forums, and live chat. Although it is easy to find excellent dermatological information, the Internet is dynamic and unmoderated and patients can be misled or exploited by inaccurate or fraudulent websites. Health on the Net and other organizations have developed ethical principles to aid consumers in evaluating the quality of health-related information.

  5. Handedness in psychiatric patients.

    PubMed

    Fleminger, J J; Dalton, R; Standage, K F

    1977-11-01

    Eight hundred psychiatric patients and eight hundred controls completed a handedness preference questionnaire. There was no significant difference in handedness between the two samples, but, contrary to some previous reports, excess of sinistrality was not associated with male sex. The distribution of handedness was similar in neurotics and controls, but among psychotics in general there was a higher proportion of fully right-handed subjects. Among schizophrenics there was a significantly higher proportion of left-handed writers among males than females. There were relatively few left-handed writers of either sex among patients with affective psychosis. Female patients with personality disorders had a significantly higher proportion of mixed handedness than controls. The findings are considered in relation to suggestions that functional psychoses may be associated with asymmetrical cerebral dysfunction, and that poorly lateralized function may be related to anomalous psychological development.

  6. [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.

  7. Creating virtual ARDS patients.

    PubMed

    Das, Anup; Haque, Mainul; Chikhani, Marc; Wenfei Wang; Hardman, Jonathan G; Bates, Declan G

    2016-08-01

    This paper presents the methodology used in patient-specific calibration of a novel highly integrated model of the cardiovascular and pulmonary pathophysiology associated with Acute Respiratory Distress Syndrome (ARDS). We focus on data from previously published clinical trials on the static and dynamic cardio-pulmonary responses of three ARDS patients to changes in ventilator settings. From this data, the parameters of the integrated model were identified using an optimization-based methodology in multiple stages. Computational simulations confirm that the resulting model outputs accurately reproduce the available clinical data. Our results open up the possibility of creating in silico a biobank of virtual ARDS patients that could be used to evaluate current, and investigate novel, therapeutic strategies.

  8. Hypertension in aging patients.

    PubMed

    Logan, Alexander G

    2011-01-01

    Hypertension, especially isolated systolic hypertension, is commonly found in older (60-79 years of age) and elderly (≥80 years of age) people. Antihypertensive drug therapy should be considered in all aging hypertensive patients, as treatment greatly reduces cardiovascular events. Most classes of antihypertensive medications may be used as first-line treatment with the possible exception of α- and β-blockers. An initial blood pressure treatment goal is less than 140/90 mmHg in all older patients and less than 150/80 mmHg in the nonfrail elderly. The current paradigm of delaying therapeutic interventions until people are at moderate or high cardiovascular risk, a universal feature of hypertensive patients over 60 years of age, leads to vascular injury or disease that is only partially reversible with treatment. Future management will likely focus on intervening earlier to prevent accelerated vascular aging and irreversible arterial damage.

  9. Patients' preferences for information

    PubMed Central

    Kindelan, K.; Kent, G.

    1986-01-01

    In a study of patients' views of the type of information they would like to receive from the doctor 265 patients from four general practices were given a list of five areas of information — diagnosis, prognosis, treatment, aetiology and social effects of their illness — and asked to rank these in order of importance for that visit. In general, information on diagnosis and prognosis was the most highly valued, while the ways the illness would affect daily activities was the least preferred. Although information on treatment was rarely selected as the first preference it was often the second or third preference. Conversely, diagnosis was the first choice of the largest proportion of patients and the least valued information for 26%. PMID:3440990

  10. [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.

  11. The moderators of patient satisfaction.

    PubMed

    Tucker, Jessie L

    2002-01-01

    The purpose of this study was to determine which Department of Defense (DOD) active duty patient sociodemographic, health status, geographic location, and utilization factors, predict overall patient satisfaction with health care in military facilities. A theoretical framework developed from patient satisfaction and social identity theories and from previous empirical findings was used to develop a model to predict patient satisfaction and delineate moderating variables. The major finding indicated in this study was the significance of patients' characteristics in moderating their satisfaction. Principal components factor analysis and hierarchical linear regression revealed that patient specific factors predicted patients' satisfaction after controlling for factors depicting patients' evaluations of health system characteristics. Patient specific factors provided added, although very minimal, explanatory value to the determination of patients' satisfaction. The study findings can aid in the development of targeted, objectively prioritized programs of improvement and marketing by ranking variables using patients' passively derived importance schema.

  12. [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.

  13. [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.

  14. 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…

  15. Thromboprophylaxis for trauma patients

    PubMed Central

    Lozano, Luis Manuel Barrera; Perel, Pablo; Ker, Katharine; Cirocchi, Roberto; Farinella, Eriberto; Morales, Carlos Hernando

    2014-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of thromboprophylaxis in trauma patients on mortality and incidence of DVT and PE. To compare the effects of different thromboprophylaxis interventions and their relative effects according to the type of trauma. PMID:25267908

  16. A Patient's Best Friend.

    ERIC Educational Resources Information Center

    Haggard, Ann

    1985-01-01

    The author describes the development of a pet therapy program at a rehabilitation unit of a hospital. She discusses documentation of the success of pet therapy programs, picking out the right pets, responsibilities of caring for the pet, training the pet, patient response, and program policies. (CT)

  17. 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…

  18. [Autonomy and patient prisoners].

    PubMed

    García-Guerrero, J; Bellver-Capella, V; Blanco-Sueiro, R; Galán-Cortés, J C; Mínguez-Gallego, C; Serrat-Moré, D

    2007-10-01

    The authors study a recent Spanish High Court decision declaring liability on the Administration's part for the death of an inmate in a prison hospital. We analyse the Court's decision using legal, ethical, medical and social perspectives. The conclusions are that: 1. the Administration has no legitimate right to force a prisoner to take medical treatment, except in circumstances in which there is a grave and definite risk to the patient's life, or when the patient lacks capacity or when there is the risk of harm to the health of third parties; 2. That in the case of health decision making that might affect a patient, the Court has mounted a frontal attack on the autonomy of patients in prison; 3. That from a medical point of view the decision is discriminatory since it does not apply the same standards of measurement to all chronic illnesses that might be found in the prison context; 4. That it is inapplicable in daily practice due to the fact that its strictness of application would seriously affect the already highly fragile ordered coexistence that exists in a prison.

  19. A Patient's Best Friend.

    ERIC Educational Resources Information Center

    Haggard, Ann

    1985-01-01

    The author describes the development of a pet therapy program at a rehabilitation unit of a hospital. She discusses documentation of the success of pet therapy programs, picking out the right pets, responsibilities of caring for the pet, training the pet, patient response, and program policies. (CT)

  20. Facial esthetics and patient selection.

    PubMed

    Habbema, Loek

    2004-01-01

    Preventing patient dissatisfaction is a primary goal when performing botulinum toxin-A injections. By taking the correct approach with careful patient selection, ensuring safety and minimizing the risk of complications and side effects, the practitioner can largely eliminate patient dissatisfaction with this therapy. Basic understanding of facial esthetics and concepts of beauty are helpful to optimize patient satisfaction.

  1. Patient-Clinician Communication

    PubMed Central

    Cecere, Laura M.; Reinke, Lynn F.; Ganzini, Linda; Udris, Edmunds M.; Moss, Brianna R.; Bryson, Chris L.; Curtis, J. Randall; Au, David H.

    2010-01-01

    Background: High quality patient-clinician communication is widely advocated, but little is known about which health outcomes are associated with communication for patients with COPD. Methods: Using a cross-sectional study of 342 veterans enrolled in a randomized controlled trial, we evaluated the association of communication, measured with the quality of communication (QOC) instrument, with subject-reported quality of clinician care, breathing problem confidence, and general self-rated health. We measured these associations using general estimating equations and adjusted odds ratios (OR) of patient-reported outcomes associated with one-point changes in QOC scores. Results: Nearly one-half of the subjects reported receiving the best imaginable care (47%), whereas fewer reported being confident with their breathing problems all the time (29%) or in very good or excellent health (15%). General communication was associated with best-imagined quality of care (OR, 4.29; 95% CI, 2.84-6.48; P < .001) and confidence in dealing with breathing problems all the time (OR, 1.74; 95% CI, 1.34-2.25; P < .001) but not general self-rated health (OR, 1.19; 95% CI, 0.92-1.55; P = .19). Specific clinician behaviors with larger associations with higher quality care included listening, caring, and attentiveness. The associations between general communication and quality care increased over time (P for interaction .03). Conclusions: Communication between patients and clinicians is associated with quality of care and confidence in dealing with breathing problems, and this association may change over time. Attention to specific communication strategies may lead to improvements in the care of patients with COPD. PMID:20299633

  2. Improving patient education for patients with low literacy skills.

    PubMed

    Mayeaux, E J; Murphy, P W; Arnold, C; Davis, T C; Jackson, R H; Sentell, T

    1996-01-01

    Patients who misunderstand their diagnosis and treatment plans usually exhibit poor compliance. The 90 million adult Americans with low literacy skills struggle to understand such essential health information as discharge instructions, consent forms, oral instructions and drug labels. The Joint Commission on Accreditation of Health Organizations (JCAHO) now requires that instructions be given on a level understandable to the patient. Most physicians tend to give too much information on too high a level for many patients to understand. Physicians who speak in simpler language, repeat their instructions and demonstrate key points, while avoiding too many directives, enhance their patients' understanding. Combining easy-to-read written patient education materials with oral instructions has been shown to greatly enhance patient understanding. To be effective with patients whose literacy skills are low, patient education materials should be short and simple, contain culturally sensitive graphics and encourage desired behavior. Compliance with therapy also may be improved by including family members in the patient education process.

  3. Activities Patients and Nurses Undertake to Promote Patient Participation.

    PubMed

    Tobiano, Georgia; Marshall, Andrea; Bucknall, Tracey; Chaboyer, Wendy

    2016-07-01

    To describe and understand activities patients and nurses undertake to enact patient participation in nursing care. This observational study was conducted on two medical units at a public hospital in Australia. Twenty-eight nurse-patient dyads were observed for at least 4 hr. Data were collected from November 2013 to February 2014. Field notes were collected and were analyzed both inductively and deductively. Nurse-patient interactions promoted patient participation through dialogue and knowledge sharing. Less evident was patient involvement in planning or self-care. Nurses exerted control over patient care, which influenced the extent of patient participation. Patient participation appears to be difficult to enact. Nurses' controlling approach, influenced by organizational issues, was in conflict with a patient-centered approach to care. Nurse-patient communication is one aspect of patient-centered care enacted more frequently. Nurses may benefit from strategies at the individual and organizational level to enhance their patient-centered practices. Fostering nurses' communication may enhance patient-centered practices in hospitals. © 2016 Sigma Theta Tau International.

  4. Parametric three-way receiver operating characteristic surface analysis using mathematica.

    PubMed

    Heckerling, P S

    2001-01-01

    Three-way receiver operating characteristic (ROC) surface analysis involves the calculation of a volume under an ROC surface (VUS), which is a measure of discriminatory accuracy of 2 diagnostic tests for 3 diseases. Nonparametric methods for calculating VUS and its standard error have been developed. The author presents the code for roc3D, a Mathematica computer program for performing parametric ROC surface analysis. roc3D calculates VUS assuming a multinormal distribution of test results in the 3 diseased populations, provides user-specified pointwise confidence limits for VUS, and displays a 3-dimensional plot of the ROC surface. Limitations of the roc3D program are discussed.

  5. Communicating with Latino patients.

    PubMed

    de Pheils, Pilar Bernal; Saul, Naledi Marie

    2009-09-01

    This article describes the efforts of the University of California, San Francisco, School of Nursing to develop the Spanish language and cultural competency skills of advanced practice nursing students by establishing an elective course, Communicating with the Latino Patient. The need for this training is reflected in the literature, which has shown that language barriers decrease patient satisfaction and quality of care and increase the likelihood of medical error. Fifty-seven first-year master's students participated in this course. The effectiveness of the training was monitored during and after each course by self-assessment surveys of the participants' language acquisition. The data suggest that the most successful outcomes result from limiting class size, emphasizing high interactivity, and incorporating clinical experiences in the instruction, as well as focusing exclusively on intermediate-level speakers when resources are limited. Training can be time consuming and costly, yet graduates agreed that the training was imperative and valuable.

  6. Visualising patient flow.

    PubMed

    Jensen, Andrew; Boyle, Justin; Khanna, Sankalp

    2012-01-01

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

  7. Mucormycosis in immunochallenged patients.

    PubMed

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

    2008-07-01

    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.

  8. Management of headache patients.

    PubMed

    Sances, Grazia; Catarci, Teresa

    2010-01-01

    Headache is a very common complaint, in both primary care and in specialist settings. Headache patients account for around 20% of all outpatients seen in neurological practices and their management, particularly when they present with intractable headache, or are suspected of having secondary headaches, can be a challenge for the clinician. All the guidelines agree that the diagnosis of headache is merely clinical and that testing is not recommended if the individual is not significantly more likely than anyone else in the general population to have a significant abnormality. A full history of the temporal profile of the headache should be gathered first: when it first started, the circumstances of its onset, whether it has remained the same over time, and, if not, in what way it has changed. The patient should be questioned carefully about the specific characteristics of the attacks (frequency, duration, severity of the pain, efficacy of the treatments). It is also necessary to establish whether there is a history of other diseases and to investigate gynecological and psychological history, and family history. History alone allows a diagnosis of probable primary headache. Signs of a possible secondary headache must be carefully sought in all patients, even in apparently clear-cut cases. The guidelines recommend careful investigation of new headaches or those whose features have recently changed in order to exclude secondary headache. Once a secondary headache has been reasonably ruled out, it can help the patient to investigate possible comorbid pathologies and suggest appropriate lifestyle changes. Copyright © 2011 Elsevier B.V. All rights reserved.

  9. Patient Safety in Surgery

    PubMed Central

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

    2006-01-01

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

  10. [What is patient autonomy?

    PubMed

    Durand, Guillaume

    What does patient autonomy mean? If an autonomous choice is defined as an objective and rational choice, is the doctor's prescription not always the best route? Our contemporary democracies are marked by moral and religious pluralism which obliges society to respect a multiplicity of choices of existence. Three levels are important in terms of autonomy: a range of intellectual capacities, freedom with regard to constraints (external and internal), the capacity to be in control of one's existence.

  11. 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

  12. 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.

  13. "The impatient patient".

    PubMed

    Bos, Lodewijk; Carroll, Denis; Marsh, Andy

    2008-01-01

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

  14. The visually impaired patient.

    PubMed

    Rosenberg, Eric A; Sperazza, Laura C

    2008-05-15

    Blindness or low vision affects more than 3 million Americans 40 years and older, and this number is projected to reach 5.5 million by 2020. In addition to treating a patient's vision loss and comorbid medical issues, physicians must be aware of the physical limitations and social issues associated with vision loss to optimize health and independent living for the visually impaired patient. In the United States, the four most prevalent etiologies of vision loss in persons 40 years and older are age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy. Exudative macular degeneration is treated with laser therapy, and progression of nonexudative macular degeneration in its advanced stages may be slowed with high-dose antioxidant and zinc regimens. The value of screening for glaucoma is uncertain; management of this condition relies on topical ocular medications. Cataract symptoms include decreased visual acuity, decreased color perception, decreased contrast sensitivity, and glare disability. Lifestyle and environmental interventions can improve function in patients with cataracts, but surgery is commonly performed if the condition worsens. Diabetic retinopathy responds to tight glucose control, and severe cases marked by macular edema are treated with laser photocoagulation. Vision-enhancing devices can help magnify objects, and nonoptical interventions include special filters and enhanced lighting.

  15. 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.

  16. Pain in burn patients.

    PubMed

    Latarjet, J; Choinère, M

    1995-08-01

    While severe pain is a constant component of the burn injury, inadequate pain management has been shown to be detrimental to burn patients. Pain-generating mechanisms in burns include nociception, primary and secondary hyperalgesia and neuropathy. The clinical studies of burn pain characteristics reveal very clear-cut differences between continuous pain and pain due to therapeutic procedures which have to be treated separately. Some of the main features of burn pain are: (1) its long-lasting course, often exceeding healing time, (2) the repetition of highly nociceptive procedures which can lead to severe psychological disturbances if pain control is inappropriate. Pharmaco-therapy with opioids is the mainstay for analgesia in burned patients, but non-pharmacological techniques may be useful adjuncts. Routine pain evaluation is mandatory for efficient and safe analgesia. Special attention must be given to pain in burned children which remains too often underestimated and undertreated. More educational efforts from physicians and nursing staff are necessary to improve pain management in burned patients.

  17. Gastric Cancer in Young Patients

    PubMed Central

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

    2013-01-01

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

  18. Defining patient centricity with patients for patients and caregivers: a collaborative endeavour

    PubMed Central

    Yeoman, Guy; Furlong, Patricia; Seres, Michael; Binder, Helena; Chung, Helena; Garzya, Vincenzo; Jones, Rachel RM

    2017-01-01

    Background Patient engagement is an essential aspect in the research/development of biopharmaceutical products and disease management. Improving the lives of patients requires a deep understanding of their medical conditions, experiences, needs and priorities. However, a consistent definition of patient centricity is lacking. A series of initiatives was conducted to define patient centricity and its important principles impacting the biopharmaceutical industry. Methods Interviews, questionnaires and literature reviews were conducted involving key stakeholders to initially identify issues of importance to patients, healthcare providers and payers. Subsequently, two identical workshops which included 22 patients/carers created a definition of patient centricity and the healthcare values important to patients/caregivers. Outputs were tested in a validation exercise involving patients in predominantly US (n=470) and European (n=703) patient forums. Results Initial research provided deeper understanding of patient needs and key topics of interest that were used to cocreate a definition of patient centricity and 10 associated principles of importance to the biopharmaceutical industry. Wider testing of these outputs among predominantly US/European patient communities confirmed their validity. Patient centricity should be defined as ‘Putting the patient first in an open and sustained engagement of the patient to respectfully and compassionately achieve the best experience and outcome for that person and their family’. Important principles for patients focused on education/information, cocreation, access and transparency. Conclusions The development of a consistent definition of patient centricity and its associated principles provides an opportunity for biopharmaceutical companies to adopt and use these as a reference point for consistent patient engagement throughout the product life cycle. PMID:28890797

  19. Defining patient centricity with patients for patients and caregivers: a collaborative endeavour.

    PubMed

    Yeoman, Guy; Furlong, Patricia; Seres, Michael; Binder, Helena; Chung, Helena; Garzya, Vincenzo; Jones, Rachel Rm

    2017-04-01

    Patient engagement is an essential aspect in the research/development of biopharmaceutical products and disease management. Improving the lives of patients requires a deep understanding of their medical conditions, experiences, needs and priorities. However, a consistent definition of patient centricity is lacking. A series of initiatives was conducted to define patient centricity and its important principles impacting the biopharmaceutical industry. Interviews, questionnaires and literature reviews were conducted involving key stakeholders to initially identify issues of importance to patients, healthcare providers and payers. Subsequently, two identical workshops which included 22 patients/carers created a definition of patient centricity and the healthcare values important to patients/caregivers. Outputs were tested in a validation exercise involving patients in predominantly US (n=470) and European (n=703) patient forums. Initial research provided deeper understanding of patient needs and key topics of interest that were used to cocreate a definition of patient centricity and 10 associated principles of importance to the biopharmaceutical industry. Wider testing of these outputs among predominantly US/European patient communities confirmed their validity. Patient centricity should be defined as 'Putting the patient first in an open and sustained engagement of the patient to respectfully and compassionately achieve the best experience and outcome for that person and their family'. Important principles for patients focused on education/information, cocreation, access and transparency. The development of a consistent definition of patient centricity and its associated principles provides an opportunity for biopharmaceutical companies to adopt and use these as a reference point for consistent patient engagement throughout the product life cycle.

  20. 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…

  1. Heartburn in patients with achalasia.

    PubMed Central

    Spechler, S J; Souza, R F; Rosenberg, S J; Ruben, R A; Goyal, R K

    1995-01-01

    Heartburn, the main symptom of gastrooesophageal reflux disease (GORD), might be expected to occur infrequently in achalasia, a disorder characterised by a hypertensive lower oesophageal sphincter (LOS) that fails to relax. Nevertheless, it is often described by patients with achalasia. The medical records of 32 patients with untreated achalasia who complained of heartburn, and of 35 similar patients who denied the symptom, were reviewed to explore the implications of heartburn in this condition. Data on endoscopic and manometric findings, and on the onset and duration of oesophageal symptoms were collected. Three patterns of heartburn were observed: (1) in 8 patients (25%) the onset of heartburn followed the onset of dysphagia, (2) in 15 patients (47%) heartburn preceded the onset of dysphagia and persisted as dysphagia progressed, and (3) in 9 patients (28%), heartburn preceded the onset of dysphagia and stopped as dysphagia progressed. The mean (SD) basal LOS pressure in the patients with heartburn (38 (16) mm Hg) was significantly lower than that in patients without the symptom (52 (26) mm Hg); the lowest LOS pressure (29 (11) mm Hg) was observed in the subset of patients whose heartburn preceded the onset of dysphagia and then stopped. It is concluded that patients who have achalasia with heartburn have lower basal LOS pressures than patients who have achalasia without this symptom. In some patients with achalasia, the appearance of dysphagia is heralded by the disappearance of longstanding heartburn. For these patients, it is speculated that achalasia develops in the setting of underlying GORD. PMID:7590421

  2. The challenge of patient adherence

    PubMed Central

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

    2005-01-01

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

  3. Angle closure in younger patients.

    PubMed Central

    Chang, Brian M; Liebmann, Jeffrey M; Ritch, Robert

    2002-01-01

    PURPOSE: Angle-closure glaucoma is rare in children and young adults. Only scattered cases associated with specific clinical entities have been reported. We evaluated the findings in patients in our database aged 40 or younger with angle closure. METHODS: Our database was searched for patients with angle closure who were 40 years old or younger. Data recorded included age at initial consultation; age at the time of diagnosis; gender; results of slit-lamp examination, gonioscopy, and ultrasound biomicroscopy (from 1993 onward); clinical diagnosis; and therapy. Patients with previous incisional surgery were excluded, as were patients with anterior chamber proliferative mechanisms leading to angle closure. RESULTS: Sixty-seven patients (49 females, 18 males) met entry criteria. Mean age (+/- SD) at the time of consultation was 34.4 +/- 9.4 years (range, 3-68 years). Diagnoses included plateau iris syndrome (35 patients), iridociliary cysts (8 patients), retinopathy of prematurity (7 patients), uveitis (5 patients), isolated nanophthalmos (3 patients), relative pupillary block (2 patients), Weill-Marchesani syndrome (3 patients), and 1 patient each with Marfan syndrome, miotic-induced angle closure, persistent hyperplastic primary vitreous, and idiopathic lens subluxation. CONCLUSION: The etiology of angle closure in young persons is different from that in the older population and is typically associated with structural or developmental ocular anomalies rather than relative pupillary block. Following laser iridotomy, these eyes should be monitored for recurrent angle closure and the need for additional laser or incisional surgical intervention. PMID:12545694

  4. Patient Safety: Do Your Homework

    MedlinePlus

    American Society of Plastic Surgeons Home Cosmetic Reconstructive Before & After Photos Find A Surgeon Patient Safety News Patients of Courage About ASPS Menu More Call for a nearby plastic surgeon you can trust | 1-800-514-5058 ...

  5. Leptospirosis in elderly patients.

    PubMed

    Gancheva, Galya Ivanova

    2013-01-01

    Leptospirosis is a re-emerging zoonosis with broad clinical spectrum and high mortality in severe forms. The aim of this study was to analyze clinical manifestations, laboratory findings, epidemiological data, and management in elderly patients with leptospirosis. Toward that end, we performed a descriptive analysis of 15 leptospirosis elderly cases (age 60-78 years) treated at the Clinic of Infectious Diseases of University Hospital - Pleven (1976-2012). Patients were serologically confirmed by microscopic agglutination test. Twelve cases (80%) presented with the severe form of leptospirosis. Co-morbidity (hypertonic diseases, chronic pulmonary diseases, chronic alcohol abuse, and diabetes) was registered in 13 cases. All cases had fever, oliguria, conjunctival suffusions, hepatosplenomegaly. Jaundice (14/93%), hemorrhagic diathesis (13/87%), vomiting (11/73%), abdominal pain (10/67%), myalgia (7/47%) and hypotension (7/47%) also were observed. Renal dysfunction was expressed by increased blood urea nitrogen (mean 38.1±24.1mmol/L) and serum creatinine (mean 347.6±179.8μmol/L). Hepatic dysfunction was expressed by increased total serum bilirubin level (mean 274.6±210.7μmol/L) and slightly elevated aminotransferases (ASAT mean 125.8±61.6IU/L; ALAT mean 131.3±126.5IU/L). Five cases (33%) had a lethal outcome. In conclusion, leptospirosis in elderly patients is associated with severe course and higher risk for death, and requires prompt intensive treatment. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

  6. Podcasting: contemporary patient education.

    PubMed

    Abreu, Daniel V; Tamura, Thomas K; Sipp, J Andrew; Keamy, Donald G; Eavey, Roland D

    2008-04-01

    Portable video technology is a widely available new tool with potential to be used by pediatric otolaryngology practices for patient and family education. Podcasts are media broadcasts that employ this new technology. They can be accessed via the Internet and viewed either on a personal computer or on a handheld device, such as an iPod or an MP3 player. We wished to examine the feasibility of establishing a podcast-hosting Web site. We digitally recorded pediatric otologic procedures in the operating room and saved the digital files to DVDs. We then edited the DVDs at home with video-editing software on a personal computer. Next, spoken narrative was recorded with audio-recording software and combined with the edited video clips. The final products were converted into the M4V file format, and the final versions were uploaded onto our hospital's Web site. We then downloaded the podcasts onto a high-quality portable media player so that we could evaluate their quality. All of the podcasts are now on the hospital Web site, where they can be downloaded by patients and families at no cost. The site includes instructions on how to download the appropriate free software for viewing the podcasts on a portable media player or on a computer. Using this technology for patient education expands the audience and permits portability of information. We conclude that a home computer can be used to inexpensively create informative surgery demonstrations that can be accessed via a Web site and transferred to portable viewing devices with excellent quality.

  7. Carctol: Profit before Patients?

    PubMed Central

    Ernst, Edzard

    2009-01-01

    Summary Background Carctol is a herbal remedy that recently was widely reported to offer a cure for a range of cancers. This article is aimed at evaluating the evidence that supports this claim. Methods In addition to numerous websites, we conducted systematic searches in six electronic databases. Any factual information relating to Carctol was considered. Results The websites provided the composition of the herbal mixture and numerous claims as to its effectiveness. However, not a single scientific study of any style was found. Conclusions The claim that Carctol is of any benefit to cancer patients is not supported by scientific evidence. PMID:20877681

  8. Rehabilitation of cancer patients.

    PubMed

    Pandey, M; Thomas, B C

    2001-01-01

    With the developments in cancer treatment, more and more patients are surviving their disease. However, very little emphasis is being placed to rehabilitate these cancer survivors. Ignorance, social structure, stigma attached in seeking psychological help, and poor communication skills of oncology staff all contribute to poor rehabilitative efforts. The priority of governmental agencies and health efforts to fight rampant communicable diseases, malnutrition, maternal health, and the frequent natural calamities, puts rehabilitation movements in the back seat. Treatment and prevention of disability and its rehabilitation requires comprehensive and multidisciplinary approach. There is an urgent need to promote physical and psychological rehabilitation.

  9. The patient-friendly practice.

    PubMed

    Dooley, Sharon Kay

    2006-01-01

    In today's medical marketplace, patients see themselves as consumers of healthcare with certain customer-service expectations. The medical practice that is indifferent or resistant to these changes is at risk. Having a good understanding of patient-friendly changes can help a practice survive in a changing environment. A patient-friendly office will continue to meet the needs of the patient by adopting this new practice style.

  10. Patient-centered healthcare design.

    PubMed

    Stichler, Jaynelle F

    2011-12-01

    Patient-centered care focuses on the patient's and family's experience in the hospital, and the design of the healthcare environment should support the patient-centered care concept. The purpose of this facility design department is to expand nurse leaders' knowledge and competencies in health facility design and enable them to take leadership roles in design efforts. This article focuses on healthcare design guiding principles and features to support organizational cultural initiatives such as patient- and family-centered care and Planetree.

  11. Patient safety--who cares?

    PubMed

    Schwappach, David L B; Conen, Dieter

    2012-07-16

    Medical errors and adverse events are a serious threat to patients worldwide. In recent years methodologically sound studies have demonstrated that interventions exist, can be implemented and can have sustainable, measurable positive effects on patient safety. Nonetheless, system-wide progress and adoption of safety practices is slow and evidence of improvements on the organisational and systems level is scarce and ambiguous. This paper reports on the Swiss Patient Safety Conference in 2011 and addresses emerging issues for patient safety and future challenges.

  12. 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

  13. Systems Thinking and Patient Safety

    DTIC Science & Technology

    2005-01-01

    1 Prologue Systems Thinking and Patient Safety Paul M. Schyve Patient safety is a prominent theme in health care delivery today. This should...been “unenlightened,” to say the least; we would not have been able to apply systems thinking to patient safety. Even today, preventable patient...in the minds of many, to be met with blame and punishment. But systems thinking is now ubiquitous in health care—due, in large measure, to its

  14. Nutritional screening in surgical patients.

    PubMed

    Thompson, J S; Burrough, C A; Green, J L; Brown, G L

    1984-03-01

    Routine nutritional screening of patients admitted to the surgical services confirms a substantial prevalence of malnutrition. Identification of the malnourished patient and the patient who is likely to become malnourished should be done as early as possible in the hospital stay and usually requires only simple, readily available parameters. Nutritional screening is only the first step in the optimal nutritional management of surgical patients. This information should be used to determine the need for further nutritional assessment, the appropriate consultation, and nutritional therapy.

  15. [Glaucoma in the melanoderm patient].

    PubMed

    Denis, P

    2004-06-01

    Much less marginal in France than believed, glaucoma in the melanoderm patient comes early in life, with a more aggressive progression leading to blindness twice as often as in the Caucasian patient. Generally open-angle glaucoma, it may be related to anatomical ocular characteristics of the Black population. Its management is not very different from that of glaucoma in the Caucasian patient.

  16. 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…

  17. Dental problems in epileptic patients.

    PubMed

    Zioło, Anna; Mielnik-Błaszczak, Maria

    2004-01-01

    On the grounds of literature and own clinical experience, pathological changes in epilepitic patients have been described. Dental management procedures in these patients have also been presented. The unquestionable importance of prophylaxis, which may markedly minimize the impact of epilepsy on the incidence of mouth diseases, has been emphasised. It has also been stated that epileptic patients should receive specialised and integrated dental treatment.

  18. Malnutrition in Patients With Cancer.

    PubMed

    Gyan, Emmanuel; Raynard, Bruno; Durand, Jean-Philippe; Lacau Saint Guily, Jean; Gouy, Sébastien; Movschin, Marie Lespiau; Khemissa, Faiza; Flori, Nicolas; Oziel-Taieb, Sandrine; Bannier Braticevic, Cécile; Zeanandin, Gilbert; Hebert, Christophe; Savinelli, Francesco; Goldwasser, François; Hébuterne, Xavier

    2017-01-01

    Malnutrition is a critical predictor of toxicity and outcome in patients with cancer and may be perceived differently by patients, relatives, and physicians. To assess the prevalence of malnutrition in oncology departments and to compare it with the perceptions of nutrition status by patients themselves, their closest relatives, and attending physicians. A 1-day multicentric cross-sectional survey on the prevalence of malnutrition was conducted in different oncology departments using patient-, relative-, and physician-specific questionnaires. Malnutrition was defined by a weight loss ≥5% within 1 month or ≥10% within 6 months, a body mass index ≤18.5 kg/m(2) in patients aged <70 years or ≤21 kg/m(2) in patients aged ≥70 years, and/or albuminemia <35 g/L. Questionnaires for assessing medical condition, knowledge of nutrition status, and perceptions of the impact of malnutrition on daily life were distributed to consenting patients, attending physicians, and closest relatives. A total of 2197 patients were included, and 2071 and 976 questionnaires were collected from patients and relatives, respectively. Prevalence of malnutrition was 39%. Physicians overestimated malnutrition (44%), whereas patients and relatives underestimated it (22% and 23%, respectively, P < .001). Conversely, malnutrition-associated symptoms were underestimated by physicians compared with patients and relatives. We found a prevalence of malnutrition of 39%: it was underestimated by patients and relatives and overestimated by physicians.

  19. Managing the chronically late patient.

    PubMed

    Baum, Neil

    2014-01-01

    Every practice has patients who are chronically late. This wrecks havoc with your schedule and makes you less productive. Patients can be trained to respect your time and arrive in the office on time. This article discusses several approaches to managing the chronically late patient.

  20. Patient perception of wound photography.

    PubMed

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

    2016-06-01

    The objectives of this study were to provide an assessment of photographic documentation of the wound from the patients' perspective and to evaluate whether this could improve patients' understanding of and involvement in their wound care. Our results revealed that most patients visiting the wound care clinic have difficult-to-see wounds (86%). Only 20% of patients monitor their wounds and instead rely on clinic or nurse visits to track the healing progress. There was a significant association between patients' ability to see their wound and their subsequent memory of the wound's appearance. This was especially true for patients who had recently begun visiting the wound care clinic. This relationship was not present in patients who had visited the clinic for 3  or more years. Patients reported that the inability to see their wounds resulted in feeling a loss of autonomy. The majority of patients reported that photographing their wounds would help them to track the wound progress (81%) and would afford them more involvement in their own care (58%). This study provides a current representation of wound photography from the patients' perspective and reveals that it can motivate patients to become more involved in the management of their wounds - particularly for patients with difficult-to-see wounds. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  1. Patient involvement in clinical teaching.

    PubMed Central

    Grant, V J

    1994-01-01

    This paper presents findings from a longitudinal study of patient refusals (as reported by graduating medical students) to take part in the teaching function of public hospitals. Results from a smaller study of non-patients' attitudes are also reported. Findings are discussed in terms of patients' rights, issues of personal privacy, medical education, and the public good. PMID:7861431

  2. Use of patient-controlled psychiatric hospital admissions: patients' perspective.

    PubMed

    Ellegaard, Trine; Bliksted, Vibeke; Lomborg, Kirsten; Mehlsen, Mimi

    2017-07-01

    By patient-controlled admission (PCA), psychiatric patients with a PCA contract can initiate a brief admission without a health professional gatekeeper. However, research regarding use of PCA is scarce. In this Danish multi-centre study, motives for and satisfaction with PCA were explored. During a 1-year period, patients from 11 Danish mental health units evaluated PCA using a questionnaire developed for the purpose. In total, 190 patients evaluated 462 admissions. The majority had concluded a PCA contract to receive early help. PCA was mostly initiated because of mental health conditions, but also because of social and everyday problems. The purpose was mainly to be at peace and prevent symptom increase. Patients from units with a quarantine period felt more ready for discharge than the others. Patients were in general satisfied with PCA (61.7%), but patients who hoped for improved medication or wished to obtain more care were less satisfied. Patients can use PCA as a means to receive timely help. Motives for patients seeking help are not limited to mental conditions. Expectations that cannot be met within the organizational structure of the PCA programme are associated with less satisfaction. However, regional differences in structures were associated with satisfaction. Patients who had access to shorter PCAs were more satisfied, and a quarantine period may even help patients become more ready for discharge. A brief admission period does not cause dissatisfaction at discharge and can be used in the clinical setting.

  3. [Patient education in pre-dialysis -- patient-led forums].

    PubMed

    Heatley, S A

    2006-01-01

    In order for patients to make an informed choice about renal replacement therapies, it is important that they are given sufficient and appropriate information, which must include explanations about their condition and likely outcomes with or without treatment. Furthermore information regarding the reality of living with dialysis, its strict regimes and patient's commitment to self care are imperative to enable patients to adapt to a life changing, ongoing, often relentless treatment. Encouraging patients to take control of their chronic illness through the provision of education support and choice is fundamental to the successful outcomes of the patient's journey through the pre-dialysis phase of their illness. This paper describes the implementation of Patient-led Forums designed to offer an education programme for pre-dialysis patients and the benefits gained by those who have attended.

  4. Writing to patients: 'putting the patient in the picture'.

    PubMed

    Reilly, M O; Cahill, M; Perry, I J

    2005-02-01

    We have explored consultant, general practitioner and patient attitudes toward the proposal that following an outpatient consultation, consultants should consider communicating directly with patients in the form of a summary letter, with a copy to the referring general practitioner or other professionals as appropriate. We conducted in-depth interviews with a purposive sample of 20 consultants, 16 patients and 12 general practitioners. The consultants and general practitioners were both involved in the care of participating patients. Patients highlighted the likely value of summary letters including, increased knowledge, improvement recall of the clinical encounter, and reassurance. Clinicians were concerned that patients would not understand letters from consultants. Additional concerns included the impact of letter on consultant-general practitioner relationship and medico-legal issues. These findings reflect fundamental differences in expectations about the nature and quality of communications between doctors and their patients.

  5. Patient population controls.

    PubMed

    Carey, R Neill

    2013-03-01

    Quality control (QC) procedures incorporating patient means, or average of normals (AoN) algorithms, have been used in hematology laboratories and large reference laboratories for decades to monitor analytical processes during the periods between the testing of reference sample QC materials. With the advent of middleware that includes AoN capability, these QC procedures are now available to many more laboratories, including medium-sized hospital laboratories. AoN procedures can improve the control of tests that have low "sigma-metrics," such as electrolytes, where relatively low numbers of patient results can be averaged to provide a high probability of detecting medically significant errors. QC of nearly one-third of the tests whose AoN capabilities have been studied would possibly benefit from AoN procedures in medium-sized laboratories. To obtain satisfactory performance, laboratories must tailor the applications of AoN procedures to their particular volumes and test characteristics. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. 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.

  7. The Patient Who Falls

    PubMed Central

    Tinetti, Mary E.; Kumar, Chandrika

    2013-01-01

    Falls are common health events that cause discomfort and disability for older adults and stress for caregivers. Using the case of an older man who has experienced multiple falls and a hip fracture, this article, which focuses on community-living older adults, addresses the consequences and etiology of falls; summarizes the evidence on predisposing factors and effective interventions; and discusses how to translate this evidence into patient care. Previous falls; strength, gait, and balance impairments; and medications are the strongest risk factors for falling. Effective single interventions include exercise and physical therapy, cataract surgery, and medication reduction. Evidence suggests that the most effective strategy for reducing the rate of falling in community-living older adults may be intervening on multiple risk factors. Vitamin D has the strongest clinical trial evidence of benefit for preventing fractures among older men at risk. Issues involved in incorporating these evidence-based fall prevention interventions into outpatient practice are discussed, as are the trade-offs inherent in managing older patients at risk of falling. While challenges and barriers exist, fall prevention strategies can be incorporated into clinical practice. PMID:20085954

  8. 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

  9. Depression in geriatric patients.

    PubMed

    Abbas Asghar-Ali, A; Braun, U K

    2009-02-01

    While the most serious of depressive illnesses in the elderly is major depressive disorder, patients' quality of life can be significantly impacted by dysthmic disorder, sub-threshold depression (minor depression), or a depressive disorder due to a general medical condition, all of which have been shown to be more prevalent than major depression in the community dwelling population of older adults. Older adults are also more likely to develop grief reaction and frequently deal with issues of bereavement. This review will discuss the diagnoses of all relevant depressive diagnoses that primary care physicians are likely to encounter. Among the many different assessment tools that screen for depression the briefest instruments are a two-question screening tool recommended by the U.S. Preventive Services Task Force and, specifically developed for older adults, the Geriatric Depression Scale (GDS) that is available in a short 15- Yes/No-question version. Many medical illnesses are associated with depressive symptoms. The focus in this review is on dementing illnesses/cerebrovascular disease, dementia of the Alzheimer's type, and Parkinson disease. First-line pharmacological therapy of depression includes selective serotonin inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Side effects of particular drugs can often be geared towards achieving additional benefits, e.g. weight gain associated with the use of some SSRISs may be helpful for patients with dementia.

  10. Increasing patient engagement: patients' responses to viewing problem lists online.

    PubMed

    Wright, A; Feblowitz, J; Maloney, F L; Henkin, S; Ramelson, H; Feltman, J; Bates, D W

    2014-01-01

    To characterize the opinions, emotions, and actions taken by patients who viewed their electronic problem list via an online personal health record (PHR). An online survey of patients who viewed their problem lists, as maintained by their healthcare provider, in a web-based PHR linked to an electronic health record for the first time. A total 3,649 patients completed the survey, yielding a response rate of 42.1%. Patient attitudes towards the problem list function were positive overall, with 90.4% rating it at least somewhat useful and 86.7% reporting they would probably or definitely use it again. Nearly half (45.6%) of patients identified at least one major or minor problem missing from their list. After viewing the list, 56.1% of patients reported taking at least one action in response, with 32.4% of patients reporting that they researched a condition on the Internet, 18.3% reported that they contacted their healthcare provider and 16.7% reported changing or planning to change a health behavior (patients could report multiple actions). 64.7% of patients reported feeling at least somewhat happy while viewing their problem list, though others reported feeling sad (30.4%), worried (35.7%) or scared (23.8%) (patients could report multiple emotions). A smaller number of patients reported feeling angry (16.6%) or ashamed (14.3%). Patients who experienced an emotional response were more likely to take action. Overall, patients found the ability to view their problem lists very useful and took action in response to the information. However, some had negative emotions. More research is needed into optimal strategies for supporting patients receiving this information.

  11. Pulmonary metastasectomy in pediatric patients.

    PubMed

    Erginel, Basak; Gun Soysal, Feryal; Keskin, Erbug; Kebudi, Rejin; Celik, Alaaddin; Salman, Tansu

    2016-02-02

    This study aims to evaluate the outcomes of pulmonary metastasectomy resections in pediatric patients. We retrospectively reviewed the medical records of 43 children who were operated on in the Pediatric Surgery Clinic between January 1988 and 2014. Forty-three children (26 boys; 17 girls; mean age 10±4.24 years, range 6 months-18 years) who underwent pulmonary metastasectomy resection were included in the study. The patients were evaluated based on age, gender, history of disease, surgical procedures, complications, duration of hospitalization, duration of chest tube placement, and procedure outcome. Indications for pediatric resections were oncological. Metastasis was secondary to Wilms' tumor in 14 patients, osteosarcoma in 7 patients, Ewing's sarcoma in 5 patients, rhabdomyosarcoma in 5 patients, lymphoma in 3 patients, hepatoblastoma in 2 patients, and other tumors in 7 patients. A total of 59 thoracotomies were performed. Approaches utilized included unilateral posterolateral thoracotomy (n=33), bilateral posterolateral thoracotomy (n=8), and sternotomy (n=2). Wedge resection was the procedure of choice (n=44). In selected cases, 11 segmentectomies, 3 lobectomies, and 1 pneumonectomy were performed. There was no perioperative mortality. One patient suffered prolonged air leak and three patients from fever. All patients received chemotherapy. Radiotherapy was administered to 16 patients (37.2%). Of those 16 patients, 7 had Wilms' tumor, 6 had Ewing's sarcoma/PNET, and 3 were rhabdomyosarcoma patients. During a median follow-up of 3 years, the overall survival was 74.4%. Multidisciplinary treatment involving pediatric oncologists, surgeons, and radiation oncologists is necessary to obtain positive results in children who have pulmonary metastases of oncological diseases. Wedge resection is a suitable option for children because less lung tissue is resected.

  12. Financial Distress in Cancer Patients

    PubMed Central

    de Souza, Jonas A.; Wong, Yu-Ning

    2013-01-01

    Novel diagnostic and therapeutic options offer hope to cancer patients with both localized and advanced disease. However, many of these treatments are often costly and even well-insured patients can face high out-of-pocket costs. Families may also be at risk of financial distress due to lost wages and other treatment-related expenses. Research is needed to measure and characterize financial distress in cancer patients and understand how it affects their quality of life. In addition, health care providers need to be trained to counsel patients and their families so they can make patient-centered treatment decisions that reflect their preferences and values. PMID:24349677

  13. 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

  14. [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.

  15. Individual patient information to select patients for different radiation techniques.

    PubMed

    Quik, E H; Feenstra, T L; Postmus, D; Slotman, B J; Leemans, C R; Krabbe, P F M; Langendijk, J A

    2016-07-01

    Proton therapy is an emerging technique in radiotherapy which results in less dose to the normal tissues with similar target dose than photon therapy, the current standard. Patient-level simulation models support better decision making on which patients would benefit most. A simulation model was developed tracking individual patients' status regarding the primary tumour and multiple complications. As a proof of principle, the model was populated based on information from a cohort of 1013 head and neck cancer patients. Dose-volume parameters for photon and proton radiation treatment plans were then fed into the model to compare outcomes in terms of length and quality of life and select patients that would benefit most. The illustrative model could adequately replicate the outcomes of photon therapy in the cohort. Improvements from proton therapy varied considerably between patients. The model projects medium-term outcomes for specific individuals and determines the benefits of applying proton rather than photon therapy. While the model needs to be fed with more and especially recent data before being fully ready for use in clinical practice, it could already distinguish between patients with high and low potential benefits from proton therapy. Benefits are highest for patients with both good prognosis and high expected damage to adjacent organs. The model allows for selecting such patients a priori based on patient relevant outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. [Management of splenectomized patients].

    PubMed

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

    2003-09-06

    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.

  17. EUS in pediatric patients.

    PubMed

    Attila, Tan; Adler, Douglas G; Hilden, Kristen; Faigel, Douglas O

    2009-11-01

    The knowledge of EUS use in children is limited. We investigated the indications, feasibility, safety, and clinical utility of EUS in the management of pediatric GI, pancreatobiliary, and mediastinal diseases. Retrospective study. Two tertiary referral university hospitals. Consecutive children age younger than 18 years referred over a 7-year period for EUS evaluation. Forty EUS scans were performed in 38 children with a mean age of 13.5 years. The indications for pancreatobiliary endosonography were pancreatitis (n = 10), solid pancreatic mass (n = 7), cystic pancreatic mass (n = 1), cyst in the setting of chronic pancreatitis (n = 1), suspected annular pancreas (n = 1), celiac plexus block (n = 1), suspected common bile duct stone (n = 1), abdominal pain and atrophic pancreas (n = 1), ampullary adenoma (n = 1), and abnormal MRCP in a patient with jaundice (n = 1). The indications for gastric EUS were mucosal lesions (n = 2) and subepithelial lesions (n = 4). The indications for mediastinal endosonography were mediastinal masses/lymph nodes (n = 5). The remaining evaluations were performed for esophageal stricture (n = 1), unexplained abdominal pain (n = 1), unexplained abdominal pain with celiac axis block (n = 1), and perirectal fluid collection (n = 1). EUS-guided FNA (EUS-FNA) was performed in 12 (30%) cases and established the correct diagnosis in 9 (75%). EUS-guided fine-needle injections for celiac axis block were performed in 2 (5%) cases. The procedure was successful in all patients, and no complications related to sedation, EUS, or EUS-FNA were encountered. Retrospective study. EUS and EUS-FNA are feasible and safe and have a significant impact on the management of pediatric GI, pancreatobiliary, and mediastinal diseases.

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

    PubMed

    Costello, Margaret

    2015-11-01

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

  19. Can patient safety be measured by surveys of patient experiences?

    PubMed

    Solberg, Leif I; Asche, Stephen E; Averbeck, Beth M; Hayek, Anita M; Schmitt, Kay G; Lindquist, Tim C; Carlson, Richard R

    2008-05-01

    A study was conducted to test whether patient reports of medical errors via surveys could produce sufficiently accurate information to be used as a measure of patient safety. A survey mailed regularly by a large multispecialty medical group to recent patients to assess their satisfaction and error experiences was expanded to collect more details about the patient-perceived errors. Following an initial mailing to 3,109 patients and parents of child patients soon after they had office visits in June 2005, usable mailed or phone follow-up responses were obtained from 1,998 respondents (65.1% adjusted). Responses were reviewed through a two-stage process that included chart audits and implicit physician reviewer judgments. The analysis categorized the review results and compared patient-reported errors with satisfaction. Of the 1,998 respondents, 219 (11.0%) reported 247 separate incidents, for a rate of 12.4 errors per 100 patients. After complete review, only 5 (2.0%) of these incidents were judged to be real clinician errors. Most appeared to represent misunderstandings or behavior/communication problems, but 15.4% lacked sufficient information to categorize. Women, Hispanics, and those aged 41-60 years were most likely to report errors. Those respondents making error reports were much more likely to report visit dissatisfaction than those not reporting them (odds ratio [OR] = 13.8, p < .001). Although patient reports of perceived errors might be useful to improve the patient experience of care, they cannot be used to measure technical medical errors and patient safety reliably without added evaluation. This study's findings need to be replicated elsewhere before generalizing from one metropolitan region and a patient population that is about two-thirds members of one health plan.

  20. [Autonomy of the patient with chronic diseases: from passive patient to active patient].

    PubMed

    González Mestre, Assumpció

    2014-01-01

    Due to social, economic and cultural changes, there has been a transformation of Health Services around the world. A new figure has emerged from this: the Active Patient, more responsible, with more information and willing to change his life as a chronic patient. In order to respond to this new situation, several countries have established initiatives such as self-reliance programmes for chronic patients. The aim of this article is to underline the Expert Patient Programme Catalonia(®) and to explain its operation and the results obtained up until now. The purpose of this program is to improve the experience of chronic disease by patients, from meetings in which an expert patient provides his knowledge and experiences to a group of patients with the same disease, with the aim of promoting changes in habits and lifestyles that improve the quality of life and the coexistence of the person with his chronic process.

  1. 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. PMID:27752619

  2. Hallux ulceration in diabetic patients.

    PubMed

    ElMakki Ahmed, Mohamed; Tamimi, Abdulhakim O; Mahadi, Seif I; Widatalla, Abubakr H; Shawer, Mohamed A

    2010-01-01

    We undertook a prospective cohort study to assess risk factors associated with hallux ulceration, and to determine the incidence of healing or amputation, in consecutive patients with diabetes mellitus who were treated over the observation period extending from September 2004 to March 2005, at the Jabir Abu Eliz Diabetic Centre, Khartoum City, Sudan. There were 122 diabetic patients in the cohort (92 males and 30 females) with an overall mean age of 58 +/- 9 years. Fifty-three percent of patients had complete healing within 8 weeks and 43% healed within 20 weeks. The overall mean time to healing was 16 +/- 8 weeks. In 32 (26.2%) patients, osteomyelitic bone was removed, leaving a healed and boneless hallux. The hallux was amputated in 17 (13.9%) patients; in 2 (1.6%) patients it was followed by forefoot amputation and in 7 (5.7%) patients by below-the-knee amputation. In 90 (73.8%) patients the initial lesion was a blister. In conclusion, hallux ulceration is common in patients with diabetes mellitus and is usually preceded by a blister. Neuropathy, foot deformity, and wearing new shoes are common causative factors; and ischemia, osteomyelitis, any form of wound infection, and the size of the ulcer are main outcome determinants. Complete healing occurred in 103 (85%) of diabetic patients with a hallux ulcer. Vascular intervention is important relative to limb salvage when ischemia is the main cause of the ulcer.

  3. Improving emergency department patient flow.

    PubMed

    Jarvis, Paul Richard Edwin

    2016-06-01

    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.

  4. Creating the ideal patient experience.

    PubMed

    Purcărea, Th.V

    2016-01-01

    Healthcare industry continues to evolve under conditions of intense competition in approaching health prevention, protection, and promotion. Therefore, healthcare providers are challenged to always ensure better patient experience, winning patients' satisfaction, and loyalty and remain competitive on today's healthcare market. Healthcare markets bring together professionals and their patients into real collaborative relationships, which empower patients to contribute to the healthcare improvement. Within this competitive landscape, which is also characterized by digital health tools boosting patients' awareness and controlling their own health, medical providers need to be perceived as skilled and trustworthy in relying on patients' needs, expectations, and sacrifices are required in order to obtain the promised benefits. Moreover, while constantly providing a holistic assessment of the healthcare services' and experience attributes, acting on feedback and reaching healthcare service excellence, providing a better understanding of all the touch points with their patients and improving the quality and consistency of all these touch points, all these are achieved by employees, who are truly connected to the healthcare business. Today, patients are systematically becoming aware of the diversity of their choices, being increasingly involved in making better healthcare choices, and, so, more and more innovative products are introduced, targeting new patient segments. Findings from the last three years have shown that patients may achieve better outcomes due to the stakeholders' commitment to innovation within the context of the big-data revolution, by building new values.

  5. [Electroconvulsive therapy in nonconsenting patients].

    PubMed

    Besse, M; Methfessel, I; Wiltfang, J; Zilles, D

    2017-01-01

    Electroconvulsive therapy (ECT) is a potent and successful method for the treatment of severe psychiatric disorders. Severe depressive and psychotic disorders may lead to legal incapacity and inability to consent. In Germany, administration of ECT against the patient's will is feasible under certain constellations and is regulated under the terms of the guardianship law. This article outlines the prevalence, effectiveness and tolerability of ECT when applied in nonconsenting patients. Case report and literature review. The literature on ECT as a treatment in nonconsenting patients is relatively sparse. In 2008 the prevalence in Germany was less than 0.5 % of all patients receiving ECT. Case reports and case series suggest a good and equal level of effectiveness when compared to consenting patients. In the course of treatment the majority of patients consented to receive further ECT and retrospectively judged ECT as helpful. The use of ECT is a highly effective treatment in severe psychiatric disorders even when administered as treatment in nonconsenting patients. It can be lifesaving and lead to a rapid improvement of symptoms and relief from severe suffering also from the patients' perspective. Thus, it seems unethical not to consider ECT as a treatment against the nonautonomous will of legally incompetent patients in individual cases. Nevertheless, physicians should always seek to obtain the patients' consent as soon as possible for both legal and ethical reasons.

  6. Additional value of screening for minor genes and copy number variants in hypertrophic cardiomyopathy.

    PubMed

    Mademont-Soler, Irene; Mates, Jesus; Yotti, Raquel; Espinosa, Maria Angeles; Pérez-Serra, Alexandra; Fernandez-Avila, Ana Isabel; Coll, Monica; Méndez, Irene; Iglesias, Anna; Del Olmo, Bernat; Riuró, Helena; Cuenca, Sofía; Allegue, Catarina; Campuzano, Oscar; Picó, Ferran; Ferrer-Costa, Carles; Álvarez, Patricia; Castillo, Sergio; Garcia-Pavia, Pablo; Gonzalez-Lopez, Esther; Padron-Barthe, Laura; Díaz de Bustamante, Aranzazu; Darnaude, María Teresa; González-Hevia, José Ignacio; Brugada, Josep; Fernandez-Aviles, Francisco; Brugada, Ramon

    2017-01-01

    Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited heart disease. Next-generation sequencing (NGS) is the preferred genetic test, but the diagnostic value of screening for minor and candidate genes, and the role of copy number variants (CNVs) deserves further evaluation. Three hundred and eighty-seven consecutive unrelated patients with HCM were screened for genetic variants in the 5 most frequent genes (MYBPC3, MYH7, TNNT2, TNNI3 and TPM1) using Sanger sequencing (N = 84) or NGS (N = 303). In the NGS cohort we analyzed 20 additional minor or candidate genes, and applied a proprietary bioinformatics algorithm for detecting CNVs. Additionally, the rate and classification of TTN variants in HCM were compared with 427 patients without structural heart disease. The percentage of patients with pathogenic/likely pathogenic (P/LP) variants in the main genes was 33.3%, without significant differences between the Sanger sequencing and NGS cohorts. The screening for 20 additional genes revealed LP variants in ACTC1, MYL2, MYL3, TNNC1, GLA and PRKAG2 in 12 patients. This approach resulted in more inconclusive tests (36.0% vs. 9.6%, p<0.001), mostly due to variants of unknown significance (VUS) in TTN. The detection rate of rare variants in TTN was not significantly different to that found in the group of patients without structural heart disease. In the NGS cohort, 4 patients (1.3%) had pathogenic CNVs: 2 deletions in MYBPC3 and 2 deletions involving the complete coding region of PLN. A small percentage of HCM cases without point mutations in the 5 main genes are explained by P/LP variants in minor or candidate genes and CNVs. Screening for variants in TTN in HCM patients drastically increases the number of inconclusive tests, and shows a rate of VUS that is similar to patients without structural heart disease, suggesting that this gene should not be analyzed for clinical purposes in HCM.

  7. Febrile neutropaenia in cancer patients.

    PubMed

    Walwyn, M; Nicholson, A; Lee, M G; Wharfe, G; Frankson, M A

    2010-03-01

    Febrile neutropaenia is a common complication of chemotherapy in cancer patients. Empirical antibiotic regimes are based on the epidemiological characteristics of bacterial isolates globally and locally. This study retrospectively reviewed all cases of febrile neutropaenia in patients with confirmed cancer admitted at the University Hospital of the West Indies in the four-year period between, January 1, 2003 and December 31, 2006 and who received chemotherapy. Cases were identified from blood culture records and hospital charts which were reviewed to determine the aetiological agents causing bacteraemia, their antimicrobial susceptibilities and clinicalfeatures. These cases were compared with non-neutropaenic cancer patients admitted with fever. A total of 197 febrile episodes in cancer patients were reviewed. Thirty-seven per cent had febrile neutropaenia while 62% were non-neutropaenic. Acute myeloid leukaemia was the most common haematological malignancy and the most common solid tumour was breast cancer. Twenty-six per cent of patients had a positive blood culture. In febrile neutropaenic patients, Escherichia coli was the most common organism isolated followed by coagulase-negative staphylococci while in non-neutropaenic patients, coagulase-negative staphylococci was most common. Acinetobacter infections was prominent in non-neutropaenic patients but absent in neutropaenic patients. More than one organism was cultured in 9 neutropaenic and 18 non-neutropaenic patients. Mortality was 10.8% in neutropaenic and 24.4% in non-neutropaenic patients. Gram-negative organisms are the predominant isolates in febrile neutropaenic episodes in this cohort of patients. Non-neutropaenic patients had an increased mortality with an increase in Acinetobacter infections and multiple isolates.

  8. Primary hyperparathyroidism in pediatric patients.

    PubMed

    Kollars, Josh; Zarroug, Abdalla E; van Heerden, Jon; Lteif, Aida; Stavlo, Penny; Suarez, Luis; Moir, Christopher; Ishitani, Michael; Rodeberg, David

    2005-04-01

    Primary hyperparathyroidism (HPT) is unusual in children. We reviewed our experience with HPT to better characterize these children. The retrospective review of patients <19 years old who underwent parathyroid resection for primary HPT from 1970 to 2000 was performed at a single institution.. Fifty-two patients were identified. Median age was 16.8 years (range: 4-18.9) with a female-to-male ratio of 3:2. Eighty-five percent had an elevated parathyroid hormone (PTH) level, and 15% had an inappropriately normal PTH level during hypercalcemia. Serum calcium was elevated in all patients except for 2 with multiple endocrine neoplasma (MEN)-IIA and 1 with familial non-MEN HPT, but both had elevated PTH levels. Alkaline phosphatase levels were significantly higher in children with documented bone involvement. At presentation 41 patients (79%) were symptomatic and end-organ damage (nephrocalcinosis, nephrolithiasis, acute pancreatitis, or bone involvement) occurred in 23 patients (44%). Thirty-four patients (65%) had a single adenoma; hyperplasia was identified in 16 patients (27%), and of these cases, 57% occurred in patients diagnosed with MEN-I. Short-term complications included transient hypocalcemia in 29 patients (56%) and transient vocal cord paralysis in 2 patients (4%). Long-term complications were significant for permanent hypocalcemia in 2 patients (4%) and no recurrent laryngeal nerve injuries. No parathyroid abnormalities were identified during exploration in 4 (8%) children. Long-term follow-up was achieved in 98% of patients for a mean and median of 13 years. Resolution of hypercalcemia was achieved in 94% of cases. The diagnosis of primary HPT in pediatric patients is frequently delayed, is commonly symptomatic, and has significant morbidity. For children in whom HPT is suspected, evaluation of serum calcium and PTH levels is diagnostic in 100% of children. Parathyroid resection is effective at restoring normal serum calcium, has few complications, and is

  9. Patient-Specific Orthopaedic Implants.

    PubMed

    Haglin, Jack M; Eltorai, Adam E M; Gil, Joseph A; Marcaccio, Stephen E; Botero-Hincapie, Juliana; Daniels, Alan H

    2016-11-01

    Patient-specific orthopaedic implants are emerging as a clinically promising treatment option for a growing number of conditions to better match an individual's anatomy. Patient-specific implant (PSI) technology aims to reduce overall procedural costs, minimize surgical time, and maximize patient outcomes by achieving better biomechanical implant fit. With this commercially-available technology, computed tomography or magnetic resonance images can be used in conjunction with specialized computer programs to create preoperative patient-specific surgical plans and to develop custom cutting guides from 3-D reconstructed images of patient anatomy. Surgeons can then place these temporary guides or "jigs" during the procedure, allowing them to better recreate the exact resections of the computer-generated surgical plan. Over the past decade, patient-specific implants have seen increased use in orthopaedics and they have been widely indicated in total knee arthroplasty, total hip arthroplasty, and corrective osteotomies. Patient-specific implants have also been explored for use in total shoulder arthroplasty and spinal surgery. Despite their increasing popularity, significant support for PSI use in orthopaedics has been lacking in the literature and it is currently uncertain whether the theoretical biomechanical advantages of patient-specific orthopaedic implants carry true advantages in surgical outcomes when compared to standard procedures. The purpose of this review was to assess the current status of patient-specific orthopaedic implants, to explore their future direction, and to summarize any comparative published studies that measure definitive surgical characteristics of patient-specific orthopaedic implant use such as patient outcomes, biomechanical implant alignment, surgical cost, patient blood loss, or patient recovery.

  10. Informing patients: a guide for providing patient health information.

    PubMed

    Tang, P C; Newcomb, C

    1998-01-01

    To understand and address patients' need for information surrounding ambulatory-care visits. The authors conducted two patient focus groups regarding patient education. The first covered general information needs of patients and the second explored their reactions to a computer-generated patient handout that was developed in response to the results of the first focus group and implemented in a clinic. Participants sought information about their health--generally after the encounter with their caregiver. They wanted a permanent record of personal health data and relevant educational information. Participants recommended that the information be concise, clear, and illustrated with graphics if appropriate. Receiving health-related information from their providers favorably affected the participants' trust in, relationship with, and confidence in their physicians. When given printouts with graphic trends depicting their responses to therapy, participants reported that they were more motivated to adhere to a treatment plan and were more satisfied with their care. Based on the results of the focus groups, we developed a set of attributes (P.A.T.I.E.N.T.) to guide the development of patient and consumer health information. Patients participating in our focus groups felt that providing printed summary information to patients at the end of a clinic visit improves their understanding of their care, enhances their relationships with providers, improves their satisfaction with care, and motivates them to adhere to treatment plans. Further empirical studies are necessary to test their perceptions.

  11. [Patient education in cystic fibrosis: what skills for the patient?].

    PubMed

    David, V; Iguenane, J; Ravilly, S

    2007-01-01

    In France since 2002 two major changes have occurred in the management of patients with cystic fibrosis: systematic neonatal screening and the establishment of specialised CF centres. One of the roles of the CF centres is therapeutic education of the patients and their families. The proposed educational approach consists of 4 steps: an educational diagnosis to assess the patient; an educational contract based on the capabilities and objectives previously identified by the team; implementation of the education programme which organises the teaching of the patient and, finally, evaluation. With the goal of facilitating the establishment of patient education in the CF centres we present the learning objectives for patients suffering from cystic fibrosis, based on the capabilities that the patients need to acquire in the course of the education programme. Based on the capabilities and learning objectives of the patients the working party are developing valid tools for the instructor/carer. They present the outcomes of the meetings, the educational principles of implementation and the respective roles of the patient and the carer.

  12. Patient reported outcomes and patient empowerment in clinical genetics services.

    PubMed

    McAllister, M; Dearing, A

    2015-08-01

    Evaluation of clinical genetics services (CGS), including genetic counseling and genetic testing, has been problematic. Patient mortality and morbidity are unlikely to be directly improved by interventions offered in CGS. Patient-reported outcomes (PROs) are not routinely measured in CGS evaluation, but this may change as patient-reported outcome measures (PROMs) become a key part of how healthcare services are managed and funded across the world. However, there is no clear consensus about which PROMs are most useful for CGS evaluation. This review summarizes the published research on how PROs from CGS have been measured and how patients may benefit from using those services, with a focus on patient empowerment. Many patient benefits (PROs) identified repeatedly in the research literature can be re-interpreted within a patient empowerment framework. Other important PROs identified include family functioning, social functioning, altruism, sense of purpose, enabling development of future research and treatment/participating in research. Well-validated measures are available to capture (dimensions of) patient empowerment. Although generic measures of family functioning are available, suitable measures capturing social functioning, development of future treatments, and altruism were not identified in this review. Patient empowerment provides one useful approach to measuring PROs from CGS.

  13. Patient opinion regarding patient-centered medical home fundamentals.

    PubMed

    Wexler, Randell K; King, Dana E; Andrews, Mark

    2012-04-01

    Although conceptually there is agreement on how the Patient-Centered Medical Home (PCMH) should be organized, there is little information regarding which PCMH components are the most important to patients. An anonymous, voluntary survey was administered to patients at three US academic medical centers. Questions sought opinions regarding the National Committee for Quality Assurance's key components and essential elements of the PCMH. Analysis of the survey responses was conducted using SAS version 9.1. A total of 780 surveys were returned. Patients expressed believing strongly that the ability to coordinate care, help patients to manage their own disease, and track laboratory results were the most important aspects of a PCMH office. There were no differences in response to the survey according to age, sex, race, or site. Patients listed care coordination, patient self-management, and improved access to care as the top priority attributes of a PCMH. Patients were consistent in their opinions that care coordination, access, and patient self-management were the most important elements of a PCMH.

  14. Provider and patient perception of psychiatry patient health literacy.

    PubMed

    Bacon, Opal; Vandenberg, Amy; May, Meghan E

    2017-01-01

    Inadequate health literacy in adults is a nationwide issue that is associated with worse health outcomes. There is a paucity of literacy regarding rates of inadequate health literacy in psychiatric populations. The aim of the study was to identify an existing tool that would easily identify patients who had inadequate health literacy, so that a targeted intervention could be performed. Secondarily we attempted to compare rates of inadequate health literacy with providers' perception of patients' health literacy. We assessed health literacy in a psychiatric population by administering the Brief Health Literacy Survey (BHLS). Additionally, all psychiatry residents, psychiatrists, nurse practitioners, pharmacists, and social workers were surveyed to assess their perception of patient health literacy. Differences between patient health literacy and provider expectations of patient health literacy were compared. Inadequate health literacy was identified in 31 out of 61 patients (50.8%) using 2 questions from the BHLS. Only 9 (29%) of patients who were identified as having inadequate health literacy were identified by both BHLS questions. In contrast, almost 100% of providers identified their patients, in general, as having inadequate health literacy. These results identify a higher rate of health literacy in a psychiatric inpatient population than in the general population. However, providers at this institution likely over-identify health literacy. This highlights the need for a health literacy tool that can easily target patients with inadequate health literacy for an intervention.

  15. [Anemia in peritoneal dialysis patients].

    PubMed

    Lausević, Mirjana; Nesić, Vidosava; Jovanović, Natasa; Stojimirović, Biljana

    2006-01-01

    A normocytic normochromic anemia is one of the first signs of renal failure. Since anemia increases morbidity and mortality, its elimination is one of the essential objectives of the treatment. Human recombinant erythropoietin (rHuEPO) has changed the therapeutical approach to anemia. The aim of the present study was to compare efficacy of anemia correction in peritoneal dialysis patients depending on treatment and dialysis modality. The study is the retrospective analysis of 64 patients who presented to our Clinic in 2003. Eighteen (28.13%) patients were treated with rHuEPO, 14 (28%) underwent continuous ambulatory peritoneal dialysis (CAPD), 2 (100%)--automated peritoneal dialysis (APD) and 2 (33.3%)--intermittent peritoneal dialysis (IPD). Mean hemoglobin level was 98.6 +/- 17.82 g/l in patients treated with rHuEPO versus 98.81 +/- 15.14 g/l in patients without rHuEPO treatment. Erythropoietin requirements were 3392.85 +/- 1211.77 IU/week All patients received iron supplementation during rHuEPO therapy. Mean serum ferritin levels were 463.41 +/- 360 ug/l. Transferrin saturation (TSAT) was 0.35 +/- 0.16%. No difference of serum iron and TSAT levels was found between CAPD and IPD patients. The degree of anemia significantly differed between CAPD and IPD patients. A total of 17.11% of PD patients were given blood transfusions, most frequently during the first three months after the onset of dialysis. Our conclusion is that the number of patients receiving rHuEPO should be increased, as 50% of our patients should be substituted, while only 28% are being treated. As 50% of patients receiving rHuEPO failed to reach target Hgb levels, higher EPO doses should be considered. Iron stores should be continuously monitored, particularly in patients receiving rHuEPO, since iron deficiency is an important problem for patients undergoing peritoneal dialysis, especially during erythropoietin therapy. Oral iron supplementation is satisfactory in the majority of patients, and iron

  16. Prioritization strategies for patient evacuations.

    PubMed

    Childers, Ashley Kay; Mayorga, Maria E; Taaffe, Kevin M

    2014-03-01

    Evacuation from a health care facility is considered last resort, and in the event of a complete evacuation, a standard planning assumption is that all patients will be evacuated. A literature review of the suggested prioritization strategies for evacuation planning-as well as the transportation priorities used in actual facility evacuations-shows a lack of consensus about whether critical or non-critical care patients should be transferred first. In addition, it is implied that these policies are "greedy" in that one patient group is given priority, and patients from that group are chosen to be completely evacuated before any patients are evacuated from the other group. The purpose of this paper is to present a dynamic programming model for emergency patient evacuations and show that a greedy, "all-or-nothing" policy is not always optimal as well as discuss insights of the resulting optimal prioritization strategies for unit- or floor-level evacuations.

  17. Web Applications for Patient Communication.

    PubMed

    Lewis, Kristopher; Reicher, Murray A

    2016-12-01

    Communication between imaging professionals and patients can help achieve many goals, including improved patient understanding of imaging-related diagnostic and treatment options, better compliance with appropriate imaging screening procedures, and improved efficiency of service. The explosive growth of out-of-pocket consumer spending on health care has heightened health care shopping, thus making patient communication an important goal of any imaging practice or health care organization. Furthermore, the Merit-Based Incentive Payment System introduced by CMS will publicly disclose physicians' quality ratings, which are in part dependent on patient engagement. The authors summarize the rationale for web communication with patients, the range of content that should be considered, and the technology options. The aim is to help imaging providers develop organized patient communication strategic and implementation plans. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  18. Nutritional Alert in hospitalized patients.

    PubMed

    Brieux, Humberto Fernán Mandirola; Kaminker, Diego; Campos, Fernando; Guillen, Sebastian; Alejandris, Javier; Luna, Daniel; Baum, Analia; de Quirós, Fernán Gonzalez Bernaldo

    2014-01-01

    The objective of the study is to assess a nutritional risk alert using an Informatics System in hospitalized patients versus the conventional methodology. We studied 400 medical patients at the Belgrano Hospital Critical Care Unit. We considered two groups of 200 patients. In the first the group (Control Group), nutritional risk was diagnosed in a traditional way. In the second group (Alarm Group), nutritional risk was diagnosed with an alert system. The alert was triggered when a patient showed low levels of, at least, two of the following variables: albumin, cholesterol, triglyceride, lymphocyte or low body mass index (BMI). Nutritional risk was detected in 20.3% of the Control Group patients while, in the Alert Group, nutritional risk was detected in 34.3% of the patients; the difference between the two groups was significant (p<0.001), with a sensitivity rate of 99% and a specificity rate of 98%. Malnutrition is more easily detected when using an alert system.

  19. Oral lesions in haemopathic patients.

    PubMed

    Grande, M; Milano, V; Desiate, A; Martinelli, A; Iaffaldano, B

    1990-03-01

    This paper deals with the oral manifestations observed in patients with haemolymphopathies and oral complications associated with systemic cytotoxic chemotherapy and/or radiation therapy. We report the percentage of oral manifestations observed in 30 patients treated with cytotoxic drugs for malignant haemolymphopathies or other tumors after 2-4 cycles of systemic combinations chemotherapy. No sex or age differences were recorded except for abnormalities of taste present only in 13% treated patients older than 50. Stomatitis was more frequent in patients with malignant haemolymphopathies than in patient with other neoplastic diseases, probably due to the fact that in the former group neutropenia and thrombocytopenia induced by bone marrow infiltration or by more aggressive combination chemotherapy are most frequent. An oral care protocol for these patients is suggested.

  20. Trading patients. Lessons from Scandinavia.

    PubMed

    Botten, Grete; Grepperud, Sverre; Nerland, Sölve Mikal

    2004-09-01

    The next few decades will bring about more trade in services, among them health care. This paper describes a recent project on cross-border trading of patients initiated by the Norwegian parliament (The Patient Bridge). This health policy reform met some resistance among hospital physicians. However, patients were willing to participate if being properly informed and supported by local health care workers. The Patient Bridge turned out to be a relatively expensive project partly because of the transaction costs involved (transportation and escort) and partly because of high treatment costs. Excessive treatment costs were a result of insufficient cost-consciousness in the purchasing organization. The Patient Bridge revealed large price differentials not only between Norwegian and foreign hospitals, but also between hospitals abroad, even within the same country. This finding points to the possibilities of reaching mutual gains from trading patients across borders.

  1. Nurses' perceptions of patient rounding.

    PubMed

    Neville, Kathleen; Lake, Kristen; LeMunyon, Danielle; Paul, Darilyn; Whitmore, Karen

    2012-02-01

    This descriptive pilot study explored hospital staff nurses' perceptions toward the practice of patient rounding. Rounding has re-emerged as a standard practice initiative among nurses in hospitals and has been associated with a decrease in call lights and falls, increased patient satisfaction and safety, and quieter nursing units. Regardless of these outcomes, controversy exists among nurses regarding rounding. The Nurses' Perception of Patient Rounding Scale (K. Neville, unpublished manuscript, 2010) was developed to gain an understanding of nurses' perceptions of rounding. Nurses identified rounding as valuable and perceived hourly rounding to be beneficial to patients and families but significantly less beneficial to their own professional practice. Challenges to rounding as a practice include issues of documentation, patient ratios, and skill mix. Findings support the need for further research to address the challenges of patient rounding for nursing.

  2. Pneumonia in renal transplant patients.

    PubMed Central

    Bowie, D. M.; Marrie, T. J.; Janigan, D. T.; MacKeen, A. D.; Belitsky, P.; MacDonald, A. S.; Lannon, S. G.; Cohen, A. D.

    1983-01-01

    Between January 1976 and March 1982, 28 episodes of pneumonia occurred in 26 renal transplant patients. The overall mortality rate was 46%. Of the 16 patients with nosocomial pneumonia 9 (56%) died, whereas of the 12 patients with community-acquired pneumonia 4 (33%) died. In all 9 cases of unknown cause the response to empiric treatment was prompt, whereas in 4 of the 10 cases of monomicrobial pneumonia and 8 of the 9 cases of polymicrobial pneumonia the patient died. Cytomegalovirus was the sole cause of the pneumonia in two patients and a contributing cause, along with aerobic gram-negative bacteria, in another five, four of whom also had a fungal infection. Two patients, both of whom survived, had nosocomial Legionnaires' disease. PMID:6342741

  3. [Nursing approaches toward postoperative pain in patients: patients' opinions].

    PubMed

    Yılmaz, Meryem; Gürler, Hesna

    2011-04-01

    We aimed in this defining study to determine patients' opinions about nursing practices with respect to their postoperative pain and their satisfaction with these practices. Data were collected by two questionnaires that were prepared by the researchers. The collected data were evaluated with chi-square and number, frequency tests. Of the 360 patients participating in this study, 61.4% were women, 83% were over 40 years old and 88% had low educational level. 60.4% had no previous surgery experience. It was determined that 30.6% of patients had undergone heart-lung (cardiovascular system, CVS) and 25.5% gastrointestinal system (GIS) surgery. It was found that 96.4% of patients experienced pain while coughing and 81.9% while getting out of bed. 96.4% of patients reported difficulty in coughing, 78.3% difficulty in mobilization and 46.7% difficulty in breathing because of postoperative pain. It was determined that patients who underwent CVS, TAH+BSO and GIS operations experienced more pain while coughing and trying to get out of bed, while patients who underwent discectomy experienced more pain while walking. There was a significant difference between types of operation and pain (p<0.05) and between activities in which patients experienced difficulty and types of operation (p<0.05). The patients stated that nurses did not use a pain scale, provide information about how pain could be relieved, demonstrate what they needed to do during the activities that caused pain, assist the patients to reposition to relieve the pain, or use any non-pharmacological interventions. Nevertheless, all of the patients were satisfied with the analgesics that were administered by nurses for pain relief.

  4. Implementing national patient safety alerts.

    PubMed

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

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

  5. [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.

  6. [Pulmonary Rehabilitation for Cancer Patients].

    PubMed

    Yamamoto, Kazuo; Gemma, Akihiko

    2015-07-01

    Dyspnea occurs in most cancer patients and is often associated with severe pain. Pulmonary rehabilitation has become increasingly important to improve ADL and QOL and to relieve pain that results from dyspnea. Although pulmonary rehabilitation is now provided mainly during the perioperative period, it has been recognized as an effective procedure for patients before, during, or after chemotherapy or radiotherapy. It is also useful for patients with advanced or terminal cancer. However, an evidence-based cancer rehabilitation procedure has to be established.

  7. Corneal Protection for Burn Patients

    DTIC Science & Technology

    2012-07-01

    cornea’s defense mechanisms and subsequent events that may lead to cornea opacification and the need for cornea transplant . Currently these patients...cornea’s defense mechanisms and subsequent events that may lead to cornea opacification and the need for cornea transplant . Currently these patients...resistant crosslinked amniotic membranes for treating cornea of burn patients that were produced in Years 1 and 2. Major findings: Identified

  8. [Sophrology for patients in oncology].

    PubMed

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

    2015-11-01

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

  9. Scripting patienthood with patient clothing.

    PubMed

    Topo, Päivi; Iltanen-Tähkävuori, Sonja

    2010-06-01

    The potential of care environments to promote patient healing has gained increasing attention over the last decade, with evidence-based designs used to explore developments in this field. Medical textiles, such as clothes provided to patients, are part of the care environment in many countries. Our study focuses on patients' experiences of such clothing. The goal of this research is to understand how patienthood is constructed in relation to patient clothing and the practices around their use. The study is based on four group interviews involving a total of 12 people with experience of being patients in a hospital or of visiting residential care environments. We employed an active interview format, and the medical textiles currently used in Finnish hospitals and residential care facilities were available for scrutiny during the interviews. Content analyses were carried out on the interview transcripts. Patient clothing was critically evaluated by the participants; they experienced giving up their own clothes as akin to a rite of passage into their new role as a patient. The low status of a patient in a hospital environment was symbolised by the outworn appearance of patient clothing and the problems in protecting privacy. Patient clothing was also felt to provide limited possibilities for being active and in some cases was found to be annoying or even harmful and upsetting. For patients, being dressed in patient clothing may be symbolic of lower status and narrowed agency in everyday life. We can conclude that artefacts such as clothing worn in care environments need to be given attention when considering possibilities for improving care.

  10. Expert patients: learning from HIV.

    PubMed

    Cooke, Molly

    2011-04-01

    The outbreak of HIV in the early 1980s saw widespread activism among patients and community supporters. The author, a young physician in San Francisco at the time, describes how coming of age as a clinician in the midst of this activism affected her concept of the patient-physician relationship. The insistence of a particular patient, Robert, on specifying his treatment goals illustrates that even people with substantial cognitive challenges can participate in their own care in an egalitarian and active manner.

  11. Patient or customer?

    PubMed

    Parker, J M

    1999-01-01

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

  12. NPC1 is enriched in unexplained early onset ataxia: a targeted high-throughput screening.

    PubMed

    Synofzik, Matthis; Harmuth, Florian; Stampfer, Miriam; Müller Vom Hagen, Jennifer; Schöls, Ludger; Bauer, Peter

    2015-11-01

    Niemann-Pick disease type C (NP-C) is a rare autosomal-recessive neurodegenerative disease featuring pleiotropic neurological, psychiatric and visceral manifestations. Since many of the adult manifestations can be non-specific or missed, NP-C often goes undetected in adult-onset patients. Here we hypothesized that targeted high-throughput sequencing allows identifying NP-C patients among subjects with unexplained early-onset ataxia (EOA) and, moreover, that this population is enriched for NPC1 mutations. From 204 consecutive EOA patients, all 108 subjects with an established diagnosis were removed (including 4 NPC1 patients), yielding a target cohort of 96 subjects with unexplained EOA, but without primary suspicion of NP-C. This cohort was investigated for NPC1/NPC2 mutations using a high-coverage HaloPlex gene panel including 122 ataxia genes. Among 96 samples, we identified 4 known NPC1 mutations, 3 novel NPC1 missense variants of uncertain significance (VUS) and 1 novel NPC2 missense VUS. The total mutant allele frequency (8/192 = 4.17 %) was significantly enriched compared with control population data (1.57 %; p = 0.011). Two NPC1-positive patients were identified (both with non-specific incipient clinical features), giving a NPC1 patient frequency of 2/96 = 2.1 % in unexplained EOA and of 6/204 = 2.9 % in the total EOA series. NPC1 mutations are substantially enriched in unexplained EOA, demonstrating EOA as a risk-group for NP-C disease. Targeted high-throughput sequencing allows to identify also those NP-C patients with non-specific conditions where the diagnosis has initially been missed. This method does not require having considered NP-C during differential diagnosis, but allows identification of NP-C as part of the default analysis.

  13. Psychological distress and patient satisfaction.

    PubMed

    Greenley, J R; Young, T B; Schoenherr, R A

    1982-04-01

    Psychologically distressed patients and clients of health care and social service organizations are found to report somewhat more dissatisfaction with services than do the nondistressed. Four explanations for this relationship are examined: 1) the psychologically distressed are generally dissatisfied; 2) service providers react negatively to the psychologically distressed; 3) psychologically distressed patients are dissatisfied when service providers do not respond to their psychological needs; and 4) patients who deny their psychological distress tend to be dissatisfied. The results show that the psychologically distressed report more dissatisfaction because of the very high levels of dissatisfaction found among patients who deny having personal problems.

  14. Violent psychiatric patients: a study.

    PubMed

    Kermani, E J

    1981-04-01

    In a study of fifty-three violent psychiatric patients in a psychiatric hospital setting, it was found that there are two distinct major groups of violent patients--one of patients with a long history of antisocial behavior who are often chronically homicidal and suicidal, and another of patients who neither have a history of destructive behavior nor exhibit homicidal or suicidal tendencies. The latter become acutely assaultive only during the course of psychiatric illness. The personality traits and background associated with these two groups offer additional contrasts. Each group presents different problems and, of major importance to the psychiatric practioner, each group requires different management.

  15. Patients' responsibilities in medical ethics.

    PubMed

    Draper, Heather; Sorell, Tom

    2002-08-01

    Patients have not been entirely ignored in medical ethics. There has been a shift from the general presumption that 'doctor knows best' to a heightened respect for patient autonomy. Medical ethics remains one-sided, however. It tends (incorrectly) to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences. In this respect, medical ethics remains largely paternalistic, requiring doctors to protect patients from the consequences of their decisions. This is reflected in a one-sided account of duties in medical ethics. Duties fall mainly on doctors and only exceptionally on patients. Medical ethics may exempt patient from obligations because they are the weaker or more vulnerable party in the doctor-patient relationship. We argue that vulnerability does not exclude obligation. We also look at other ways in which patient responsibilities flow from general ethics: for instance, from responsibilities to others and to the self, from duties of citizens, and from the responsibilities of those who solicit advice. Finally, we argue that certain duties of patients counterbalance an otherwise unfair capacity of doctors as helpers.

  16. 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.

  17. 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.

  18. Strategies for improving patient compliance.

    PubMed

    Strand, J

    1994-01-01

    Achieving patient compliance in taking prescribed medications is a formidable challenge for all clinicians. As PAs, we have daily opportunities to communicate with patients and improve their compliance. An office-based compliance program, combining patient education and behavior-modification components, can be beneficial in this regard. Strategies for improving compliance include giving clear, concise, and logical instructions in familiar language, adapting drug regimens to daily routines, eliciting patient participation through self-monitoring, and providing educational materials that promote overall good health in connection with medical treatment.

  19. Patient Transport via Commercial Airlines

    PubMed Central

    Macnab, Andrew John

    1992-01-01

    Because the frequency of patient transport from one hospital to another is increasing and the popularity of air travel continues to rise, physicians should be aware of the procedures for patient transport by commercial airlines. Major airlines in Canada have experienced personnel and established procedures that facilitate the transportation of patients with special medical needs. By working with the airline medical health officers and using up-to-date equipment, physicians can achieve safe, cost-effective transport of appropriate patients via commercial aircraft. PMID:21221401

  20. Nutritional assessment of surgical patients.

    PubMed

    Brown, C S; Stegman, M R

    1988-10-01

    In order to test the sensitivity and specificity of the East Orange Nutritional Screening Form (EONSF), nutritional assessments were performed on a random sample of 10% of general medical/surgical admissions at a large midwestern veteran's administration hospital. Patients were followed until discharge to determine if they met the standard criteria of additional nutritional support. The tool correctly identified patients at nutritional risk (sensitivity) 95% of the time and patients not at nutritional risk (specificity) 89% of the time. It proved to be an effective, low-cost tool for identifying patients at risk and for planning appropriate nutritional strategies.

  1. Engaging patients through your website.

    PubMed

    Snyder, Kimberlee; Ornes, Lynne L; Paulson, Pat

    2014-01-01

    Legislation requires the healthcare industry to directly engage patients through technology. This paper proposes a model that can be used to review hospital websites for features that engage patients in their healthcare. The model describes four levels of patient engagement in website design. The sample consisted of 130 hospital websites from hospitals listed on 2010 and 2011 Most Wired Hospitals. Hospital websites were analyzed for features that encouraged patient interaction with their healthcare according to the levels in the model. Of the four levels identified in the model, websites ranged from "informing" to "collaborative" in website design. There was great variation of features offered on hospital websites with few being engaging and interactive.

  2. Effective writing that attracts patients.

    PubMed

    Baum, Neil

    2015-01-01

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

  3. What can Crohn's patients eat?

    PubMed

    McDonald, P J; Fazio, V W

    1988-08-01

    Seventy-one patients with Crohn's disease were interviewed about their diet. All had undergone surgery for the condition. Thirty-seven patients had an ileostomy and 34 patients did not. Information about the effect of 32 foodstuffs and drinks, what advice had been given, who had given it, and the patients' attitude to food, was obtained. Twenty-seven fit health workers acted as a control group. Corn, nuts, fizzy drinks, raw fruits, shellfish and pickles in the ileostomy patients and nuts, raw fruit and tomatoes in the non-ileostomy patients gave rise to problems. These differences were statistically significant (P less than 0.01) when compared to the control group. Chicken, white bread, rice, potatoes and lamb were the foods least likely to provoke symptoms in all the groups. "Eat what you can" was the commonest dietary advice given and physicians were the most important source of that advice. More than half of the patients thought their diet was adequate but more Crohn's patients than controls took regular vitamin supplements. Although only two patients considered that diet might be responsible for their disease, most thought dietary factors important in controlling symptoms or aiding recovery.

  4. Disclosing adverse events to patients.

    PubMed

    Cantor, Michael D; Barach, Paul; Derse, Arthur; Maklan, Claire W; Wlody, Ginger Schafer; Fox, Ellen

    2005-01-01

    The rationale for, and recommended approaches to, disclosing adverse events to patients are examined on the basis of the experience of the Veterans Health Administration (VHA). The VHA's National Ethics Committee endorses a general policy requiring the routine disclosure of adverse events to patients and offers practical recommendations for implementation. Disclosure is required when the adverse event (1) has a perceptible effect on the patient that was not discussed in advance as a known risk; (2) necessitates a change in the patient's care; (3) potentially poses an important risk to the patient's future health, even if that risk is extremely small; (4) involves providing a treatment or procedure without the patient's consent. From an ethical perspective, disclosure is required and should not be limited to cases in which the injury is obvious or severe. Disclosure of near misses is also discretionary but is advisable at times. In general, disclosure by a clinician involved in the patient's care is appropriate. Although a variety of psychological and cultural factors may make clinicians and organizations reluctant to disclose adverse events to patients, the arguments favoring routine disclosure are compelling. Organizations should develop clear policies supporting disclosure and should create supportive environments that enable clinicians to meet their ethical obligations to disclose adverse events to patients and families.

  5. Orthodontic treatment in oncological patients.

    PubMed

    Mituś-Kenig, Maria; Łoboda, Magdalena; Marcinkowska-Mituś, Agata; Durka-Zajac, Magdalena; Pawłowska, Elzbieta

    2015-01-01

    The progress in oncological treatment has led to the current increase of childhood cancer survival rate to 80%. That is why orthodontists more and more frequently consult patients who had completed a successful anti-cancer therapy in childhood. Oncological treatments such as chemotherapy, radiotherapy or supportive immunosuppressive therapy cause numerous side effects in growing patients, connected i.a. with growth, the development of teeth or the viscerocranium. This is a special group of patients that needs an optimised plan of orthodontic treatment and often has to accept a compromise result. The purpose of the current work is to discuss the results of orthodontic treatment in patients after an anti-cancer therapy. Time of treatment was 12,5 months. In 6 patients (from 40 undergoing orthodontic therapy) we haven't reached a normocclusion, in 9 patients we should have stopped the therapy because of the recurrence. In 11 patients we found mucosa inflammation and in 1 patient the therapy stopped before the end because of very low oral hygiene level. Bearing in mind the limited number of original works on the above topic in Polish medical literature, the study has been carried out in order to make Polish orthodontists more acquainted with the topic and the standards of dealing with an oncological patient.

  6. Patient Symptomatology in Anal Dysplasia.

    PubMed

    Hicks, Caitlin W; Wick, Elizabeth C; Leeds, Ira L; Efron, Jonathan E; Gearhart, Susan L; Safar, Bashar; Fang, Sandy H

    2015-06-01

    High-resolution anoscopy (HRA) is becoming increasingly advocated as a method of screening for anal dysplasia in high-risk patients. To describe, through HRA findings, the association between patient symptomatology and anal dysplasia among patients at high risk for anal dysplasia. Univariable and multivariable analyses were conducted of data from a prospectively maintained HRA database on all patients undergoing HRA with biopsy from November 1, 2011, to March 13, 2014, at a tertiary care HRA clinic. Data included demographics, medical history and comorbidities, HIV status and related measures (CD4 cell counts, HIV viral load, and use of highly active antiretroviral therapy), sexual orientation (when available), patient symptoms at initial presentation, physical examination findings, anal Papanicolaou (Pap) smear findings. High-resolution anoscopy diagnosis of high- vs low-grade dysplasia or no dysplasia. One hundred sixty-one HRA biopsy specimens (mean [SEM], 1.77 [0.11] biopsy specimens per patient) were obtained from 91 patients (mean [SEM] age, 45.7 [1.2] years; 61 men [67%]; 47 black patients [52%]; and 70 human immunodeficiency virus-positive patients [77%]). Twenty-seven patients (30%) had high-grade dysplasia, 26 had low-grade dysplasia (29%), and 38 had no dysplasia (42%). The majority of patients (63 [69%]) were asymptomatic (anal pain, 11 [12%]; bleeding, 14 [15%]; and pruritus, 10 [11%]). Forty-one patients (45%) presented with anal pain (odds ratio, 5.25; 95% CI, 1.44-21.82; P = .02), and patients with either high- or low-grade dysplasia were more likely to present with anal lesions on physical examination compared with patients without dysplasia (odds ratio, 4.34; 95% CI, 1.78-11.20; P = .002). Multivariable analysis suggested that anal pain was independently associated with high-grade dysplasia (odds ratio, 6.42; 95% CI, 1.18-43.3; P = .03). Anal dysplasia is a silent disease that is frequently asymptomatic. However, patients with anal

  7. Nurse Burnout and Patient Satisfaction

    PubMed Central

    Vahey, Doris C.; Aiken, Linda H.; Sloane, Douglas M.; Clarke, Sean P.; Vargas, Delfino

    2010-01-01

    Background Amid a national nurse shortage, there is growing concern that high levels of nurse burnout could adversely affect patient outcomes. Objectives This study examines the effect of the nurse work environment on nurse burnout, and the effects of the nurse work environment and nurse burnout on patients' satisfaction with their nursing care. Research Design/Subjects We conducted cross-sectional surveys of nurses (N = 820) and patients (N = 621) from 40 units in 20 urban hospitals across the United States. Measures Nurse surveys included measures of nurses' practice environments derived from the revised Nursing Work Index (NWI-R) and nurse outcomes measured by the Maslach Burnout Inventory (MBI) and intentions to leave. Patients were interviewed about their satisfaction with nursing care using the La Monica-Oberst Patient Satisfaction Scale (LOPSS). Results Patients cared for on units that nurses characterized as having adequate staff, good administrative support for nursing care, and good relations between doctors and nurses were more than twice likely as other patients to report high satisfaction with their care, and their nurses reported significantly lower burnout. The overall level of nurse burnout on hospital units also affected patient satisfaction. Conclusions Improvements in nurses' work environments in hospitals have the potential to simultaneously reduce nurses' high levels of job burnout and risk of turnover and increase patients' satisfaction with their care. PMID:14734943

  8. Nurse burnout and patient satisfaction.

    PubMed

    Vahey, Doris C; Aiken, Linda H; Sloane, Douglas M; Clarke, Sean P; Vargas, Delfino

    2004-02-01

    Amid a national nurse shortage, there is growing concern that high levels of nurse burnout could adversely affect patient outcomes. This study examines the effect of the nurse work environment on nurse burnout, and the effects of the nurse work environment and nurse burnout on patients' satisfaction with their nursing care. RESEARCH DESIGN/SUBJECTS: We conducted cross-sectional surveys of nurses (N=820) and patients (N=621) from 40 units in 20 urban hospitals across the United States. Nurse surveys included measures of nurses' practice environments derived from the revised Nursing Work Index (NWI-R) and nurse outcomes measured by the Maslach Burnout Inventory (MBI) and intentions to leave. Patients were interviewed about their satisfaction with nursing care using the La Monica-Oberst Patient Satisfaction Scale (LOPSS). Patients cared for on units that nurses characterized as having adequate staff, good administrative support for nursing care, and good relations between doctors and nurses were more than twice likely as other patients to report high satisfaction with their care, and their nurses reported significantly lower burnout. The overall level of nurse burnout on hospital units also affected patient satisfaction. Improvements in nurses' work environments in hospitals have the potential to simultaneously reduce nurses' high levels of job burnout and risk of turnover and increase patients' satisfaction with their care.

  9. [Eyelash alterations in anophthalmic patients].

    PubMed

    Narikawa, Silvia; Schellini, Silvana Artioli; Padovani, Carlos Roberto Pereira; Padovani, Carlos Roberto

    2007-01-01

    To evaluate the eyelash alterations in anophthalmic cavity patients. An observational study was done looking for eyelash alterations in anophthalmic cavity patients at "Faculdade de Medicina de Botucatu". Eyelash alterations were observed in 70.7% of the anophthalmic patients. The most frequently observed eyelash alterations were eyelash ptosis (24.4%), reduction in the quantity (19.5%), trichomegaly (19.5%), trichiasis (14.6%) and entropium (17.0%). The anophthalmic cavity patients have eyelash alteration and ptosis, reduction in quantity, trichomegaly, trichiasis are the most common observed situations. Further studies are needed to know more about it.

  10. [Patient information in radiooncology Information seeking behaviour and patient characteristics].

    PubMed

    Pour-Haring, Herta Farassati; Volleritsch, Christa; Roth, Roswith

    2009-01-01

    Provision of relevant and accurate information is an important factor for patient-satisfaction. This study investigated the self-assessed level of information, information needs and sources of information of patients undergoing radiotherapy in correlation between socio-demographic, medical and psychological variables. A self-ministered questionnaire designed to measure the self-assessed level of information and information needs was distributed to 133 cancer patients before (t(1)) and 14 days after the first medical consultation (t(2)). "Anxiety" and "Social desirability" were assessed at t(1) and four groups of coping methods (repressive, sensitive, anxious, non-defensive/non-anxious) were derived. Sources of information were elicited at t(2). The self-assessed level of information increased, while the demand for information declined. Female patients felt better informed than males. Older patients had a lower self-assessed level of information than younger patients. Among the four groups using different methods of coping, the repressive group wanted the least information. Generally medical consultations were preferred and other sources of information rarely were used. Where there are a large number of older patients with a low educational background, the use of computers is not appropriate at the moment. It can, however, be assumed that the next generation of patients will have a more practical knowledge of computers, and will thus make better use of this method of communication.

  11. The Patient-Centered Medical Home and Patient Experience

    PubMed Central

    Martsolf, Grant R; Alexander, Jeffrey A; Shi, Yunfeng; Casalino, Lawrence P; Rittenhouse, Diane R; Scanlon, Dennis P; Shortell, Stephen M

    2012-01-01

    Objective To examine the relationship between practices' reported use of patient-centered medical home (PCMH) processes and patients' perceptions of their care experience. Data Source Primary survey data from 393 physician practices and 1,304 patients receiving care in those practices. Study Design This is an observational, cross-sectional study. Using standard ordinary least-squares and a sample selection model, we estimated the association between patients' care experience and the use of PCMH processes in the practices where they receive care. Data Collection We linked data from a nationally representative survey of individuals with chronic disease and two nationally representative surveys of physician practices. Principal Findings We found that practices' use of PCMH processes was not associated with patient experience after controlling for sample selection as well as practice and patient characteristics. Conclusions In our study, which was large, but somewhat limited in its measures of the PCMH and of patient experience, we found no association between PCMH processes and patient experience. The continued accumulation of evidence related to the possibilities of the PCMH, how PCMH is measured, and how the impact of PCMH is gauged provides important information for health care decision makers. PMID:22670806

  12. 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…

  13. Current status of patient-controlled analgesia in cancer patients.

    PubMed

    Ripamonti, C; Bruera, E

    1997-03-01

    Patient-controlled analgesia (PCA) is a relatively new technique in which patients are able to self-administer small doses of opioid analgesics when needed. Many different devices are available for opioid infusion, including a syringe pump, disposable plastic cylinder, and battery-operated computer-driven pump. These devices allow patients to choose an intermittent (demand) bolus, continuous infusion, or both modes of administration. Parameters, such as route, drug concentration dose, frequency, and maximum daily or hourly dose, are programmed by the physician. The patient decides whether or not to take a dose. Devices can be used to deliver the drug into a running intravenous infusion, the epidural space, or subcutaneously. Controlled trials indicate that PCA is probably superior to regular opioid administration in postoperative pain. Reported advantages include greater patient satisfaction, decreased sedation and anxiety, and reduced nursing time and hospitalization. Preliminary experience suggests that PCA is also useful and safe for cancer pain, but further research is greatly needed.

  14. Pain management: association with patient satisfaction among emergency department patients.

    PubMed

    Bhakta, Hemangini C; Marco, Catherine A

    2014-04-01

    Patient satisfaction with emergency care is associated with timeliness of care, empathy, technical competence, and information delivery. Previous studies have demonstrated inconsistent findings regarding the association between pain management and patient satisfaction. This study was undertaken to determine the association between pain management and patient satisfaction among Emergency Department (ED) patients presenting with acute painful conditions. In this survey study, a standardized interview was conducted at the Emergency Department at the University of Toledo Medical Center in May-July 2011. Participants were asked to answer 18 questions pertaining to patient satisfaction. Additional data collected included demographic information, pain scores, and clinical management. Among 328 eligible participants, 289 (88%) participated. The mean triage pain score on the verbal numeric rating scale was 8.2 and the mean discharge score was 6.0. The majority of patients (52%) experienced a reduction in pain of 2 or more points. Participants received one pain medication dose (44%), two medication doses (14%), three medication doses (5%), or four medication doses (2%). Reduction in pain scores of 2 or more points was associated with a higher number of medications administered. Reduction in pain scores was associated with higher satisfaction as scored on questions of patient perceptions of adequate assessment and response to pain, and treatment of pain. There was a significant association between patient satisfaction and a reduction in pain of 2 or more points and number of medications administered. Effective pain management is associated with improved patient satisfaction among ED patients with painful conditions. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. 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

  16. Patient safety culture among nurses.

    PubMed

    Ammouri, A A; Tailakh, A K; Muliira, J K; Geethakrishnan, R; Al Kindi, S N

    2015-03-01

    Patient safety is considered to be crucial to healthcare quality and is one of the major parameters monitored by all healthcare organizations around the world. Nurses play a vital role in maintaining and promoting patient safety due to the nature of their work. The purpose of this study was to investigate nurses' perceptions about patient safety culture and to identify the factors that need to be emphasized in order to develop and maintain the culture of safety among nurses in Oman. A descriptive and cross-sectional design was used. Patient safety culture was assessed by using the Hospital Survey on Patient Safety Culture among 414 registered nurses working in four major governmental hospitals in Oman. Descriptive statistics and general linear regression were employed to assess the association between patient safety culture and demographic variables. Nurses who perceived more supervisor or manager expectations, feedback and communications about errors, teamwork across hospital units, and hospital handoffs and transitions had more overall perception of patient safety. Nurses who perceived more teamwork within units and more feedback and communications about errors had more frequency of events reported. Furthermore, nurses who had more years of experience and were working in teaching hospitals had more perception of patient safety culture. Learning and continuous improvement, hospital management support, supervisor/manager expectations, feedback and communications about error, teamwork, hospital handoffs and transitions were found to be major patient safety culture predictors. Investing in practices and systems that focus on improving these aspects is likely to enhance the culture of patient safety in Omani hospitals and others like them. Strategies to nurture patient safety culture in Omani hospitals should focus upon building leadership capacity that support open communication, blame free, team work and continuous organizational learning. © 2014 International

  17. National survey of hospital patients.

    PubMed Central

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

    1994-01-01

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

  18. 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

  19. Patient Perspectives on Biosimilar Insulin

    PubMed Central

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

    2014-01-01

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

  20. [Psychotherapy institutions and their patients].

    PubMed

    Rudolf, G; von Essen, C; Porsch, U; Grande, T

    1988-01-01

    This article investigates a number of institutions and private practices involved in the Berlin psychotherapy study from the point of view of their patients and their offerings in the area of therapy. Certain similarities have been found to exist between the institutions in the sex and age structure of the patients as well as in terms of the high level of previous experience with psychotherapy and psychoanalysis and previous medical measures. None of the institutions or practices saw primarily socially privileged patients, as is sometimes maintained. To a considerable degree the people they see live in a destabilized situation or one that is not yet stabilized and enjoy little social certainty (ca. 50%). The rate of the indication for psychotherapy and its actual initiation varies considerably from one institution to another. It runs the spectrum from the municipal counseling services, whose little motivated patients are only open to psychotherapy at all at a rate of 50% (actual therapy 22%) to patients in private psychotherapeutic practices who have gone through a long motivational process and who begin therapy at a rate of 70%. Study of the relationship between the location of the institution and the area in which the patients live shows on the one hand a tendency toward regionalism insofar as institutions are preferred by the patients who live near by. On the other hand, these special institutions are also sought out by patients from more distant locations and from differently structured areas; these patients are represented to the same degree as patients from the immediate area. Although psychotherapeutic institutions are often situated in the "better" residential areas, their patients are by no means only from such privileged areas but from all regions, including those that are socially weak.

  1. Elderly patients also have rights

    PubMed Central

    Pérez‐Cárceles, M D; Lorenzo, M D; Luna, A; Osuna, E

    2007-01-01

    Background Sharing information with relatives of elderly patients in primary care and in hospital has to fit into the complex set of obligations, justifications and pressures concerning the provision of information, and the results of some studies point to the need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day‐to‐day care of older people. Objectives To know the frequency with which “capable” patients over 65 years of age receive information when admitted to hospital, the information offered to the families concerned, the person who gives consent for medical intervention, and the degree of satisfaction with the information received and the healthcare provided. Method A descriptive questionnaire given to 200 patients and 200 relatives during the patients' stay in hospital. Results Only 5% of patients confirmed that they had been asked whether information could be given to their relatives. A significantly higher proportion of relatives received information on the successive stages of the care offered than did patients themselves. As the age of the patients increased, so the number who were given information, understood the information and were asked for their consent for complementary tests decreased. The degree of satisfaction with the information offered was high for both patients and relatives (86.5% and 84%, respectively), despite the irregularities observed. Conclusions The capacity of elderly patients to participate in the decision‐making process is frequently doubted simply because they have reached a certain age and it is thought that relatives should act as their representatives. In Spain, the opinion of the family and doctors appears to play a larger role in making decisions than does the concept of patient autonomy. PMID:18055902

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

    PubMed

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

    2016-03-01

    In this study, we compared cancer patients preference for computerised (tablet/web-based) surveys versus paper. We also assessed whether the understanding of a cancer-related topic, pharmacogenomics is affected by the survey format, and examined differences in demographic and medical characteristics which may affect patient preference and understanding. Three hundred and four cancer patients completed a tablet-administered survey and another 153 patients completed a paper-based survey. Patients who participated in the tablet survey were questioned regarding their preference for survey format administration (paper, tablet and web-based). Understanding was assessed with a 'direct' method, by asking patients to assess their understanding of genetic testing, and with a 'composite' score. Patients preferred administration with tablet (71%) compared with web-based (12%) and paper (17%). Patients <65 years old, non-Caucasians and white-collar professionals significantly preferred the computerised format following multivariate analysis. There was no significant difference in understanding between the paper and tablet survey with direct questioning or composite score. Age (<65 years) and white-collar professionals were associated with increased understanding (both P = 0.03). There was no significant difference in understanding between the tablet and print survey in a multivariate analysis. Patients overwhelmingly preferred computerised surveys and understanding of pharmacogenomics was not affected by survey format. © 2015 John Wiley & Sons Ltd.

  3. 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…

  4. 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…

  5. Virtual Patients in Pharmacy Education

    PubMed Central

    Jabbur-Lopes, Monique O.; Mesquita, Alessandra R.; Silva, Leila M. A.; De Almeida Neto, Abilio

    2012-01-01

    A review of the literature relating to the use of virtual patients in teaching pharmaceutical care to pharmacy students was conducted. Only 7 articles met the inclusion criteria for the review and 4 of the studies were conducted in North America. Few articles identified by the review used virtual patient technology that was true-to-life and/or validated. PMID:22761533

  6. 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

  7. Rhinoplasty in Middle Eastern Patients.

    PubMed

    Sajjadian, Ali

    2016-01-01

    Rhinoplasty in patients of Middle Eastern origin requires complete understanding of nasal morphology and an individualized approach to create a racially congruent and aesthetically pleasing outcome. In this article, common anatomic features and characteristics and detailed steps, surgical techniques, and operative maneuvers that can lead to predictable outcome in rhinoplasty of Middle Eastern patients are discussed.

  8. Patient safety: honoring advanced directives.

    PubMed

    Tice, Martha A

    2007-02-01

    Healthcare providers typically think of patient safety in the context of preventing iatrogenic injury. Prevention of falls and medication or treatment errors is the typical focus of adverse event analyses. If healthcare providers are committed to honoring the wishes of patients, then perhaps failures to honor advanced directives should be viewed as reportable medical errors.

  9. Burns in Morbidly Obese Patients,

    DTIC Science & Technology

    1992-12-01

    tract infection and one episode C obesity. The clinical records of these patients were reviewed in of sinusitis. Two patients had documented bacteremias...veloped pneumonia and two developed tracheobronchitis. 0 Research, seven of whom clearly fulfilled the criteria for morbid There were one urinary

  10. Corneal Protection for Burn Patients

    DTIC Science & Technology

    2012-07-01

    cornea transplant . Currently these patients receive frequent application of topical lubricants and anti-inflammatory medications, an imperfect solution...of the degradation-resistant crosslinked amniotic membranes for treating cornea of burn patients that were produced in Years 1 and 2. Major findings...Identified membrane stiffness as a critical parameter for a successful cornea -protective membrane and quantitatively assessed this parameter

  11. Corneal Protection for Burn Patients

    DTIC Science & Technology

    2011-07-01

    cornea transplant . Currently these patients receive frequent application of topical lubricants and anti-inflammatory medications, an imperfect... cornea as is done in amniotic membrane transplantation . However we proposed and, have now tested, an alternative method for securing the... cornea of burn patients that were produced in Year 1. Major findings: Established that 2 and 3 layer crosslinked amniotic membrane composites are more

  12. 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…

  13. 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.

  14. Scurvy in hospitalized elderly patients.

    PubMed

    Raynaud-Simon, A; Cohen-Bittan, J; Gouronnec, A; Pautas, E; Senet, P; Verny, M; Boddaert, J

    2010-06-01

    The aim of this study was to systematically screen hospitalized elderly patients for clinical symptoms of scurvy and to confirm the diagnosis with biological measures. Geriatric acute care ward. Scurvy symptoms (one or more among perifollicular hyperkeratosis, petechiae or bruises, haemorrhagic features caused by venous puncture, severe gingivitis). We compared associated diseases, nutritional status, need for assistance for feeding, serum albumin, transthyretin, B9 and B12 vitamins, iron status and Serum Ascorbic Acid Level (SAAL) and outcome (in-hospital mortality) between scurvy and scurvy free patients. 18 patients with clinical symptoms of scurvy (scurvy group) were identified out of 145 consecutive patients (12%). They were compared to 23 consecutive control patients with no clinical symptoms of scurvy (scurvy-free group). SAAL was significantly lower (1.09 +/- 1.06 vs 4.87 +/- 4.2 mg x L-1, p < .001) and vitamin C deficiency more frequent (94 vs 30 %, p < .001) in the scurvy group. Moreover, in scurvy group, coronary heart disease (39 vs 9 %, p=.028), need for assistance for feeding (56 vs 13 %, p=.006) and in-hospital deaths (44 vs 9 %, p=.012) were more frequent. Ninety-four percent of patients with clinical symptoms of scurvy had vitamin C deficiency. Our results suggest that in hospitalized elderly patients, clinical symptoms allow scurvy diagnosis. Scurvy could be a frequent disease in elderly patients admitted to acute geriatric ward.

  15. Gadobutrol in Renally Impaired Patients

    PubMed Central

    Michaely, Henrik J.; Aschauer, Manuela; Deutschmann, Hannes; Bongartz, Georg; Gutberlet, Matthias; Woitek, Ramona; Ertl-Wagner, Birgit; Kucharczyk, Walter; Hammerstingl, Renate; De Cobelli, Francesco; Rosenberg, Martin; Balzer, Thomas; Endrikat, Jan

    2017-01-01

    Objective The aim of this study was to assess the potential risk of gadobutrol-enhanced magnetic resonance imaging (MRI) in patients with moderate to severe renal impairment for the development of nephrogenic systemic fibrosis (NSF). Materials and Methods We performed a prospective, international, multicenter, open-label study in 55 centers. Patients with moderate to severe renal impairment scheduled for any gadobutrol-enhanced MRI were included. All patients received a single intravenous bolus injection of gadobutrol at a dose of 0.1 mmol/kg body weight. The primary target variable was the number of patients who develop NSF within a 2-year follow-up period. Results A total of 908 patients were enrolled, including 586 with moderate and 284 with severe renal impairment who are at highest risk for developing NSF. The mean time since renal disease diagnosis was 1.83 and 5.49 years in the moderate and severe renal impairment cohort, respectively. Overall, 184 patients (20.3%) underwent further contrast-enhanced MRI with other gadolinium-based contrast agents within the 2-year follow-up. No patient developed symptoms conclusive of NSF. Conclusions No safety concerns with gadobutrol in patients with moderate to severe renal impairment were identified. There were no NSF cases. PMID:27529464

  16. 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.

  17. 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…

  18. [Delirium in patients with cancer].

    PubMed

    Staniszewska, Agnieszka; Kłoszewska, Iwona

    2007-01-01

    Delirium is a frequent complication of cancer. It is the cause of patients' suffering and due to worsening of communication, the impediment to clinical assessment. It lowers the quality of life of family caregivers as well. Instant diagnosis and therapy of delirium are essential in clinical practice. In this review etiology, prevalence, clinical features and management of delirium in cancer patients are described.

  19. 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…

  20. 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)

  1. 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.

  2. Preoperative anxiety in neurosurgical patients.

    PubMed

    Perks, Anna; Chakravarti, Sucharita; Manninen, Pirjo

    2009-04-01

    Anxiety is common in surgical patients, with an incidence of 60% to 92%. There is little information on the incidence and severity of preoperative anxiety in patients scheduled for neurosurgery. The aim of this study was to measure the level of preoperative anxiety in neurosurgical patients and to assess any influencing factors. After the Institutional Review Board approval and informed written consent, 100 patients booked for neurosurgery were interviewed preoperatively. Each patient was asked to grade their preoperative anxiety level on a verbal analog scale, Amsterdam Preoperative Anxiety and Information Scale, and a set of specific anxiety-related questions. The anxiety scores and the responses to the questions were compared between the sex, age, weight, diagnosis, and history of previous surgery. The mean age (+/-SD) was 50+/-13 years. The preoperative diagnosis was tumor (n=64), aneurysm (n=14), and other (n=22). Overall verbal analog scale was 5.2+/-2.7; the score was higher for female (5.8+/-2.8) than male patients (4.6+/-2.5) (P<0.05). Amsterdam Preoperative Anxiety and Information Scale anxiety and knowledge scores were greater for surgery than for anesthesia. Questionnaire results showed that the most common anxieties were waiting for surgery, physical/mental harm, and results of the operation. In conclusion, our study showed that neurosurgical patients have high levels of anxiety, with a higher incidence in females. There was a moderately high need for information, particularly in patients with a high level of preoperative anxiety.

  3. 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…

  4. 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.

  5. China's Vocational Universities. ERIC Digest.

    ERIC Educational Resources Information Center

    Ding, Anning

    This ERIC Digest describes the development and characteristics of vocational universities (VUs) in China. In response to the demand for increased numbers of trained technical workers in the 1980's, VUs developed and the higher vocational education system in China was reformed. Currently, 101 vocational universities are in existence in China. These…

  6. What to Expect from a Virtual University

    ERIC Educational Resources Information Center

    Vignare, Karen

    2009-01-01

    Virtual universities (VUs) were formed to open up access to higher education for new and existing students, and they continue to grow and thrive. They come in all sizes and organizational and business models, and most differ from their founding institutions. However, VUs face more rigorous requirements for accountability and reporting. Most of…

  7. Voiding urosonography: Contrast-enhanced ultrasound cystography to diagnose vesico-ureteric reflux: A pilot study.

    PubMed

    Babu, Ramesh; Gopinath, Vinu; Sai, Venkata

    2015-01-01

    We report two children with hydronephrosis, in whom we have utilized voiding urosonography (VUS) in the evaluation of vesico-ureteric reflux. With wider availability of ultrasound contrast agents and high-end ultrasound machines, VUS is likely to become a popular tool to diagnose or exclude VUR.

  8. Oocyte cryopreservation in oncological patients.

    PubMed

    Porcu, Eleonora; Fabbri, Raffaella; Damiano, Giuseppe; Fratto, Rosita; Giunchi, Susanna; Venturoli, Stefano

    2004-04-05

    The use of chemotherapy and radiotherapy in oncological patients may reduce their reproductive potential. Sperm cryopreservation has been already used in men affected by neoplastic disease. Oocyte cryopreservation might be an important solution for these patients at risk of losing ovarian function. A program of oocyte cryopreservation for oncological patients is also present in our center. From June 1996 to January 2000, 18 patients awaiting chemotherapy and radiotherapy for neoplastic disease were included in our oocyte cryopreservation program. Our experience documents that oocyte storage may be a concrete and pragmatic alternative for oncological patients. The duration of oocyte storage does not seem to interfere with oocyte survival as pregnancies occurred even after several years of gamete cryopreservation in liquid nitrogen.

  9. Patient discomfort following periapical surgery.

    PubMed

    Christiansen, René; Kirkevang, Lise-Lotte; Hørsted-Bindslev, Preben; Wenzel, Ann

    2008-02-01

    The aim of the study was to assess patient discomfort following periapical surgery. Forty-two patients with apical periodontitis were allocated to apicectomy with either smoothening of the gutta-percha root filling or a retrograde root filling with mineral trioxide aggregate (MTA). Pooling all patients, VAS score for pain peaked 3 hours postoperatively (mean VAS = 29). The VAS score for swelling peaked 1 day postoperatively (mean VAS = 41). Patients' overall perception of postoperative discomfort was induced by (questions asked at the day for suture removal): Oral awareness (36 yes, 6 no); swelling (30 yes, 12 no); compromised chewing ability (18 yes, 24 no); pain (15 yes, 27 no). There was no correlation between the operating time and VAS scores for pain and swelling (r < or = .25, P > .11). Patients experienced little pain and moderate swelling after periapical surgery. Oral awareness was the most reported reason for postoperative discomfort. The operating time was not a decisive factor in relation to postoperative discomfort.

  10. Developing patient safety in dentistry.

    PubMed

    Pemberton, M N

    2014-10-01

    Patient safety has always been important and is a source of public concern. Recent high profile scandals and subsequent reports, such as the Francis report into the failings at Mid Staffordshire, have raised those concerns even higher. Mortality and significant morbidity associated with the practice of medicine has led to many strategies to help improve patient safety, however, with its lack of associated mortality and lower associated morbidity, dentistry has been slower at systematically considering how patient safety can be improved. Recently, several organisations, researchers and clinicians have discussed the need for a patient safety culture in dentistry. Strategies are available to help improve patient safety in healthcare and deserve further consideration in dentistry.

  11. Endodontics and the ageing patient.

    PubMed

    Johnstone, M; Parashos, P

    2015-03-01

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

  12. Are rhinoplasty patients potentially mad?

    PubMed

    Slator, R; Harris, D L

    1992-01-01

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

  13. Mediating consolation with suicidal patients.

    PubMed

    Gilje, Fredricka; Talseth, Anne-Grethe

    2007-07-01

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

  14. Prosocial capabilities in Alzheimer's patients.

    PubMed

    Bosch-Domènech, Antoni; Nagel, Rosemarie; Sánchez-Andrés, Juan V

    2010-01-01

    To examine the decision making of Alzheimer's patients in a simple, classic game focusing on their capabilities to implement social norms and common social preferences. Patients with Stage I (very mild and mild) Alzheimer's disease (AD) were asked to participate in a dictator game, a type of game in which a subject has to decide how to allocate a certain amount of money between himself and another person. When we compared the results of treatments involving AD patients (at an early stage) with those of identical treatments involving patients with mild cognitive impairment or healthy elderly controls, with similar ages and social backgrounds, we did not find statistically significant differences. This finding suggests that Stage I AD patients are as capable of making decisions involving basic social norms and preferences as other individuals of their age. Whatever brain structures are affected by the disease, they do not appear to influence, at this early stage, the neural basis for cooperation-enhancing social interactions.

  15. Computers in medicine: patients' attitudes

    PubMed Central

    Cruickshank, P. J.

    1984-01-01

    Data are presented from two surveys where a 26-item questionnaire was used to measure patients' attitudes to diagnostic computers and to medical computers in general. The first group of respondents were 229 patients who had been given outpatient appointments at a hospital general medical clinic specializing in gastrointestinal problems, where some had experienced a diagnostic computer in use. The second group of respondents were 416 patients attending a group general practice where there was no computer. Patients who had experience of the diagnostic computer or a personal computer had more favourable attitudes to computers in medicine as did younger people and males. The two samples of patients showed broadly similar attitudes, and a notable finding was that over half of each group believed that, with a computer around, the personal touch of the doctor would be lost. PMID:6471021

  16. Hormone therapy for transgender patients

    PubMed Central

    2016-01-01

    Many transgender men and women seek hormone therapy as part of the transition process. Exogenous testosterone is used in transgender men to induce virilization and suppress feminizing characteristics. In transgender women, exogenous estrogen is used to help feminize patients, and anti-androgens are used as adjuncts to help suppress masculinizing features. Guidelines exist to help providers choose appropriate candidates for hormone therapy, and act as a framework for choosing treatment regimens and managing surveillance in these patients. Cross-sex hormone therapy has been shown to have positive physical and psychological effects on the transitioning individual and is considered a mainstay treatment for many patients. Bone and cardiovascular health are important considerations in transgender patients on long-term hormones, and care should be taken to monitor certain metabolic indices while patients are on cross-sex hormone therapy. PMID:28078219

  17. 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

  18. Do patient assessments of primary care differ by patient ethnicity?

    PubMed Central

    Taira, D A; Safran, D G; Seto, T B; Rogers, W H; Inui, T S; Montgomery, J; Tarlov, A R

    2001-01-01

    OBJECTIVE: To determine if patient assessments (reports and ratings) of primary care differ by patient ethnicity. DATA SOURCES/STUDY DESIGN: A self-administered patient survey of 6,092 Massachusetts employees measured seven defining characteristics of primary care: (1) access (financial, organizational); (2) continuity (longitudinal, visit based); (3) comprehensiveness (knowledge of patient, preventive counseling); (4) integration; (5) clinical interaction (communication, thoroughness of physical examinations); (6) interpersonal treatment; and (7) trust. The study employed a cross-sectional observational design. PRINCIPAL FINDINGS: Asians had the lowest primary care performance assessments of any ethnic group after adjustment for socioeconomic and other factors. For example, compared to whites, Asians had lower scores for communication (69 vs. 79, p = .001) and comprehensive knowledge of patient (56 vs. 48, p = .002), African Americans and Latinos had less access to care, and African Americans had less longitudinal continuity than whites. CONCLUSIONS: We do not know what accounts for the observed differences in patient assessments of primary care. The fact that patient reports as well as the more subjective ratings of care differed by ethnicity suggests that quality differences might exist that need to be addressed. PMID:11775667

  19. Patients as educators: interprofessional learning for patient-centred care.

    PubMed

    Towle, Angela; Godolphin, William

    2013-01-01

    Patients with chronic conditions have unique expertise that enhances interprofessional education. Although their active involvement in education is increasing, patients have minimal roles in key educational tasks. A model that brings patients and students together for patient-centred learning, with faculty playing a supportive role, has been described in theory but not yet implemented. To identify issues involved in creating an educational intervention designed and delivered by patients and document outcomes. An advisory group of community members, students and faculty guided development of the intervention (interprofessional workshops). Community educators (CEs) were recruited through community organizations with a healthcare mandate. Workshops were planned by teams of key stakeholders, delivered by CEs, and evaluated by post-workshop student questionnaires. Workshops were delivered by CEs with epilepsy, arthritis, HIV/AIDS and two groups with mental health problems. Roles and responsibilities of planning team members that facilitated control by CEs were identified. Ten workshops attended by 142 students from 15 different disciplines were all highly rated. Workshop objectives defined by CEs and student learning both closely matched dimensions of patient-centredness. Our work demonstrates feasibility and impact of an educational intervention led by patient educators facilitated but not controlled by faculty.

  20. Longitudinal deteriorations in patient reported outcomes in patients with COPD.

    PubMed

    Oga, Toru; Nishimura, Koichi; Tsukino, Mitsuhiro; Sato, Susumu; Hajiro, Takashi; Mishima, Michiaki

    2007-01-01

    Goals of effective management of patients with chronic obstructive pulmonary disease (COPD) include relieving their symptoms and improving their health status. We examined how such patient reported outcomes would change longitudinally in comparison to physiological outcomes in COPD. One hundred thirty-seven male outpatients with stable COPD were recruited for the study. The subjects health status was evaluated using the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ). Their dyspnoea using the modified Medical Research Council (MRC) scale and their psychological status using the Hospital Anxiety and Depression Scale (HADS) were assessed upon entry and every 6 months thereafter over a 5-year period. Pulmonary function and exercise capacity as evaluated by peak oxygen uptake (VO2) on progressive cycle ergometry were also followed over the same time. Using mixed effects models to estimate the slopes for the changes, scores on the SGRQ, the CRQ, the MRC and the HADS worsened in a statistically significant manner over time. However, changes only weakly correlated with changes in forced expiratory volume in 1s (FEV(1)) and peak (VO2). We demonstrated that although changes in pulmonary function and exercise capacity are well known in patients with COPD, patient reported outcomes such as health status, dyspnoea and psychological status also deteriorated significantly over time. In addition, deteriorations in patient reported outcomes only weakly correlated to changes in physiological indices. To capture the overall deterioration of COPD from the subjective viewpoints of the patients, patient reported outcomes should be followed separately from physiological outcomes.

  1. Patient/Family Education for Newly Diagnosed Pediatric Oncology Patients.

    PubMed

    Landier, Wendy; Ahern, JoAnn; Barakat, Lamia P; Bhatia, Smita; Bingen, Kristin M; Bondurant, Patricia G; Cohn, Susan L; Dobrozsi, Sarah K; Haugen, Maureen; Herring, Ruth Anne; Hooke, Mary C; Martin, Melissa; Murphy, Kathryn; Newman, Amy R; Rodgers, Cheryl C; Ruccione, Kathleen S; Sullivan, Jeneane; Weiss, Marianne; Withycombe, Janice; Yasui, Lise; Hockenberry, Marilyn

    There is a paucity of data to support evidence-based practices in the provision of patient/family education in the context of a new childhood cancer diagnosis. Since the majority of children with cancer are treated on pediatric oncology clinical trials, lack of effective patient/family education has the potential to negatively affect both patient and clinical trial outcomes. The Children's Oncology Group Nursing Discipline convened an interprofessional expert panel from within and beyond pediatric oncology to review available and emerging evidence and develop expert consensus recommendations regarding harmonization of patient/family education practices for newly diagnosed pediatric oncology patients across institutions. Five broad principles, with associated recommendations, were identified by the panel, including recognition that (1) in pediatric oncology, patient/family education is family-centered; (2) a diagnosis of childhood cancer is overwhelming and the family needs time to process the diagnosis and develop a plan for managing ongoing life demands before they can successfully learn to care for the child; (3) patient/family education should be an interprofessional endeavor with 3 key areas of focus: (a) diagnosis/treatment, (b) psychosocial coping, and (c) care of the child; (4) patient/family education should occur across the continuum of care; and (5) a supportive environment is necessary to optimize learning. Dissemination and implementation of these recommendations will set the stage for future studies that aim to develop evidence to inform best practices, and ultimately to establish the standard of care for effective patient/family education in pediatric oncology.

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

    PubMed

    Boehm, O; Baumgarten, G; Hoeft, A

    2016-06-01

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

  3. Patient activation and improved outcomes in HIV-infected patients.

    PubMed

    Marshall, Rebecca; Beach, Mary Catherine; Saha, Somnath; Mori, Tomi; Loveless, Mark O; Hibbard, Judith H; Cohn, Jonathan A; Sharp, Victoria L; Korthuis, P Todd

    2013-05-01

    The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression. To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients. Cross-sectional survey. 433 patients receiving care in four HIV clinics. An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications. Patient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count > 200 cells/mL(3), HIV-1 RNA < 400 copies/mL (viral suppression), and patient-reported adherence. Overall, patient activation was high (mean PAM = 72.3 [SD 16.5, range 34.7-100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p < .001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p < .001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count > 200 cells/mL(3) (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence. Higher patient activation was associated with more favorable HIV outcomes. Interventions to improve patient activation should be developed and tested for their ability to

  4. 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

  5. [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. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  6. Patient Empowerment: Myths and Misconceptions

    PubMed Central

    Anderson, Robert M.; Funnell, Martha M.

    2009-01-01

    Objective The purpose of this article is to clarify the concept of empowerment and to correct common misconceptions about its use in diabetes care and education. Methods The patient empowerment approach is well suited to helping patients make self-selected changes related to weight, nutrition, and physical activity. Although the concept of patient empowerment has become an integral part of diabetes education, an accurate understanding and authentic application of empowerment has not occurred as readily. The empowerment approach is clarified and common misconceptions have been corrected. Results Embracing empowerment means making a paradigm shift that is often difficult because the traditional approach to care is embedded in the training and socialization of most health care professionals (HCP). Conclusion Unlike the traditional approach, empowerment is not something one does to patients. Rather, empowerment begins when HCPs acknowledge that patient are in control of their daily diabetes care. Empowerment occurs when the HCPs goal is to increase the capacity of patients to think critically and make autonomous, informed decisions. Empowerment also occurs when patients are actually making autonomous, informed decisions about their diabetes self-management. Practice Implications Clarity about all aspects of the empowerment approach is essential if it is to be used effectively. PMID:19682830

  7. Psychological care in trauma patients.

    PubMed

    Mohta, Medha; Sethi, A K; Tyagi, Asha; Mohta, Anup

    2003-01-01

    The clinician manages trauma patients in the emergency room, operation theatre, intensive care unit and trauma ward with an endeavour to provide best possible treatment for physical injuries. At the same time, it is equally important to give adequate attention to behavioural and psychological aspects associated with the event. Knowledge of the predisposing factors and their management helps the clinician to prevent or manage these psychological problems. Various causes of psychological disturbances in trauma patients have been highlighted. These include pain, the sudden and unexpected nature of events and the procedures and interventions necessary to resuscitate and stabilise the patient. The ICU and trauma ward environment, sleep and sensory deprivation, impact of injury on CNS, medications and associated pre-morbid conditions are also significant factors. Specific problems that concern the traumatised patients are helplessness, humiliation, threat to body image and mental symptoms. The patients react to these stressors by various defence mechanisms like conservation withdrawal, denial, regression, anger, anxiety and depression. Some of them develop delirium or even more severe problems like acute stress disorder or post-traumatic stress disorder. Physical, pharmacological or psychological interventions can be performed to prevent or minimise these problems in trauma patients. These include adequate pain relief, prevention of sensory and sleep deprivation, providing familiar surroundings, careful explanations and reassurance to the patient, psychotherapy and pharmacological treatment whenever required.

  8. 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

  9. 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

  10. Creating the ideal patient experience

    PubMed Central

    Purcărea, Th.V

    2016-01-01

    Healthcare industry continues to evolve under conditions of intense competition in approaching health prevention, protection, and promotion. Therefore, healthcare providers are challenged to always ensure better patient experience, winning patients’ satisfaction, and loyalty and remain competitive on today’s healthcare market. Healthcare markets bring together professionals and their patients into real collaborative relationships, which empower patients to contribute to the healthcare improvement. Within this competitive landscape, which is also characterized by digital health tools boosting patients’ awareness and controlling their own health, medical providers need to be perceived as skilled and trustworthy in relying on patients’ needs, expectations, and sacrifices are required in order to obtain the promised benefits. Moreover, while constantly providing a holistic assessment of the healthcare services’ and experience attributes, acting on feedback and reaching healthcare service excellence, providing a better understanding of all the touch points with their patients and improving the quality and consistency of all these touch points, all these are achieved by employees, who are truly connected to the healthcare business. Today, patients are systematically becoming aware of the diversity of their choices, being increasingly involved in making better healthcare choices, and, so, more and more innovative products are introduced, targeting new patient segments. Findings from the last three years have shown that patients may achieve better outcomes due to the stakeholders’ commitment to innovation within the context of the big-data revolution, by building new values. PMID:27928442

  11. 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.

  12. [Peritoneal dialysis in obstetric patients].

    PubMed

    Briones-Garduño, Jesús Carlos; Díaz de León-Ponce, Manuel Antonio; Rodríguez-Roldán, Martín; Briones-Vega, Carlos Gabriel; Torres-Pérez, Juan

    2006-01-01

    The prevalence of acute renal failure (ARF) in obstetric patients in our country is estimated to be between 3 and 42.8%. The most important causes are preeclampsia, especially when associated with thrombotic microangiopathy and hemolysis and less frequently to hemorrhagic shock. Early peritoneal dialysis (EPD) is the temporary treatment. For these patients, 100 % recovery in renal function was observed. When ARF is associated with multiple organ failure (MOF), the reported mortality ranges between 0 and 20 %. To describe clinical features and medical outcomes of patients treated with early peritoneal dialysis in pregnancy complicated by ARF. A case series was conducted at the Research Unit of the Instituto Materno Infantil del Estado de México. We reviewed the cases of patients admitted to the ICU matching the criteria for ARF. They were divided into two groups: those who received EPD vs. those who did not require EPD. The most important national series were included describing the association with preeclampsia and thrombotic microangiopathy with hemolysis. In a 5-year period, 1272 patients were admitted to the ICU; in 38 patients ARF was documented requiring peritoneal dialysis. In nine cases ARF was associated with thrombotic microangiopathy with hemolysis, two cases of stillbirth, and one case of mortality with MOF. A 100% recovery in renal function was observed in all cases, using 1.5% solution with an average of 34 dialysis treatments. The early use of peritoneal dialysis in obstetric patients with ARF has a good prognosis.

  13. [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

    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.

  14. [The AIDS patient in anesthesia].

    PubMed

    Jalowy, A; Flesche, C W; Lorenz, C

    1997-02-01

    Treatment of a patient with Acquired Immune Deficiency Syndrome (AIDS) is very challenging, and makes great demands on the anaesthesiologist. Any of an AIDS patient's vital organ systems may be compromised, either by the human immunodeficiency virus (HIV) itself, opportunistic infections, by tumours, or as a result of AIDS-related drug therapies. Infections of the lungs (e.g., Pneumocystis carinii pneumonia) are prevalent, and cardiac impairment can be found in as many as 50% of AIDS patients. In addition, disorders of the central and peripheral nervous system and water and electrolyte imbalances are often seen. Perioperatively, the AIDS patient is especially prone to infections as a result of a compromised immune system. The choice of anaesthetic procedure for the AIDS patient-aside from the type of operation-depends on the severity of the illness and progression of organ impairment. All anaesthesia personnel must be careful to avoid infection, as they frequently come in contact with the blood or body fluids of their patients. However, the risk of being infected by an AIDS patient is very low, provided hygiene regulations are followed strictly. The rate of seroconversion after accidental needle-stick injury is below 1%. If exposure does occur, regular serologic controls should be continued for one year. Prophylactic treatment with azidothymidine after exposition to HIV is recommended.

  15. Communicating with the rheumatic patient.

    PubMed

    Wright, V; Hopkins, R

    1977-05-01

    To explore the meanings attached to words by patients and doctors, a multiple-choice questionnaire was given to 214 rheumatic patients, 110 non-rheumatic patients, 227 rheumatologists and 36 general practitioners. Words and phrases dealt with symptoms in descriptive terms, common disorders and parts of the body relevant to rheumatology. Poor agreement was obtained for 'back' among rheumatologists and hospital doctors, and for 'arthritis' among general practitioners. The word 'sciatica' means very different things to different doctors. Among rheumatic sufferers good agreement was only reached for 'rheumatism' and 'hereditary'. Non-rheumatic sufferers obtained better agreement than the rheumatic patients. This may have been due to more in the professional classes among the former group. The poorest agreement among rheumatic patients was for 'numbness', 'sciatica', 'slipped disc', 'vertebra', 'cervical', 'spinal cord', 'arthritis', 'deformity', 'anaemia', 'ligaments', 'osteoarthritis', 'lumbar', 'sacrum' and 'back'. Poor doctor-patient correlation between patients and rheumatologists occurred for 'numbness', 'spinal cord', 'cervical', 'sacrum', 'loin', 'slipped disc', 'arthritis', 'osteoarthritis' and 'steroids'.

  16. Informational Needs of Postmastectomy Patients

    PubMed Central

    Yeşilyurt, Duygu Soydaş; Fındık, Ümmü Yıldız

    2016-01-01

    Objective The aim of this study was to determine informational needs of postmastectomy patients. Materials and Methods This descriptive study was conducted in the general surgery clinics of a university health center for medical research and practice with 72 voluntary patients. For data collection, a patient identification form was used, which was prepared by the researchers in accordance with the literature. Results The mean age of the patients was 52.66±13.39 years, 87% were married, 58% had primary school education, 76% had moderate economic status, and 53% had undergone simple mastectomy. It was determined that 83% of the patients wanted to be informed about hospital and home care interventions, 82% about symptoms and prevention of post-surgical problems, 76% regarding breast cancer and treatment options, and in the range of 54–68%, patients wanted information on the effects of surgery on the body, shoulder and arm exercises, breast self-examination, the effects of breast cancer on family and work life, lymphedema and prevention interventions. Conclusion We recommend that patients with mastectomy should be informed about topics including care interventions, breast cancer and treatment options, effects of surgery, and reducing these effects.

  17. [Neurologically critical patient. Nurses' care].

    PubMed

    López Díaz, Cristina

    2009-12-01

    Handling a neurologically critical patient requires some necessary knowledge and aptitudes in order to avoid risks and complications which could worsen a patient's prognosis. To that end, in this article the author deals with two important points nursing personnel need to bear in mind: the distinct methods and catheters which can be used to monitor intracranial pressure, obtaining an important parameter for evaluation purposes and therapeutic follow-up on these patients, placing special emphasis on ventricular drainage and nursing care, and the operations nurses take when dealing with patients who present a risk of intracranial hypertension, setting up a protocol based on seven necessities in the Virginia Henderson model: breathing, elimination, temperature, hygiene and skin, feeding and hydration, mobility and safety. In each of these necessities, the author studies the problems these patients present, identifying them with a series of diagnoses according to NANDA (North American Nursing Diagnosis Association), and defining the care or nursing activities for each of them, which will prove essential to prevent cerebral ischemia after suffering a primary cerebral injury due to a "TCE"(Cranial Encephalic Trauma) hemorrhage, etc. Nurses' role in caring for neurologically critical patients proves to be of vital importance since these professionals must be capable of evaluating, preventing, controlling and identifying those risk situations which neurologically critical patients could present, avoiding possible complications, aiding their recuperation, and providing quality health care.

  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.

  19. Contribution of patient and hospital characteristics to adverse patient incidents.

    PubMed Central

    Elnicki, R A; Schmitt, J P

    1980-01-01

    The 1974 medical malpractice "crisis" brought about extensive legislation and insurance regulation in the United States. Hospitals in many states are now required to support risk management programs that include investigation and systematic analyses of adverse patient incidents. However, no research supports the hypothesis that systematic analysis of adverse patient incidents can identify contributory factors. In this study, a simple prediction model was used to estimate relationships between adverse incidents and selected patient and environmental characteristics in a large hospital. While some of the incident-characteristic relationships were significant, none of the estimated equations yielded results that could be logically translated into policy recommendations for the hospital. These results point to the need for further research. The benefits that positive research results would have for patients, hospitals, an the bill-paying public are obvious. Additional negative results would suggest that many legislative bodies and regulatory agencies were presumptions in requiring hospitals to conduct analyses of incidents. PMID:7461973

  20. Standardized patient care guidelines reduce infectious morbidity in appendectomy patients.

    PubMed

    Helmer, Kenneth S; Robinson, Emily K; Lally, Kevin P; Vasquez, J C; Kwong, Karen L; Liu, Terrence H; Mercer, David W

    2002-06-01

    Surgical wound infection and intra-abdominal abscess remain common infectious complications after appendectomy, especially in the setting of a perforated or gangrenous appendix. We therefore developed a clinical protocol for the management of appendicitis to decrease postoperative infectious complications. Between January 1, 1999, and December 31, 1999, 206 patients with appendicitis were treated on protocol. Retrospectively, the charts were reviewed for all protocol patients as well as for 232 patients with appendicitis treated in the year prior to protocol initiation. Data were collected on surgical wound infections and intra-abdominal abscesses. There were significantly fewer infectious complications in the protocol group than in the nonprotocol group (20 [9%] versus 8 [4%]; P <0.05). In patients with a perforated or gangrenous appendix, the infectious complication rate was reduced from 33% to 13% (P <0.05). The incidence of infectious complications after appendectomy can be significantly reduced with a standardized approach to antibiotic therapy and wound management.

  1. Shader Lamps Virtual Patients: the physical manifestation of virtual patients.

    PubMed

    Rivera-Gutierrez, Diego; Welch, Greg; Lincoln, Peter; Whitton, Mary; Cendan, Juan; Chesnutt, David A; Fuchs, Henry; Lok, Benjamin

    2012-01-01

    We introduce the notion of Shader Lamps Virtual Patients (SLVP) - the combination of projector-based Shader Lamps Avatars and interactive virtual humans. This paradigm uses Shader Lamps Avatars technology to give a 3D physical presence to conversational virtual humans, improving their social interactivity and enabling them to share the physical space with the user. The paradigm scales naturally to multiple viewers, allowing for scenarios where an instructor and multiple students are involved in the training. We have developed a physical-virtual patient for medical students to conduct ophthalmic exams, in an interactive training experience. In this experience, the trainee practices multiple skills simultaneously, including using a surrogate optical instrument in front of a physical head, conversing with the patient about his fears, observing realistic head motion, and practicing patient safety. Here we present a prototype system and results from a preliminary formative evaluation of the system.

  2. Falls and balance confidence in persons with and without injection-related venous ulcers.

    PubMed

    Pieper, Barbara; Templin, Thomas N; Goldberg, Allon; DiNardo, Ellen; Wells, Margaret

    2013-01-01

    With aging of injection users and the high occurrence of venous disease in their legs, falls are a potential health problem. We examined falls and balance confidence in persons with (VU+) and without (VU-) injection-related venous ulcers (VUs). This study used a cross-sectional, retrospective, comparative design with 31 participants VU+ and 30 VU- recruited in a medical clinic. Participants' legs were assessed for clinical manifestations of venous disease. Participants completed background and fall questionnaires and the Activities-specific Balance Confidence (ABC) Scale. Participants included 35 men and 26 women (mean age = 54 years); 93% were African American. Falling in the past year was reported by 65% of patients VU+ and 40% VU- (P = 0.048); 29 of these patients fell 2 or more times in the past year. Higher scores on the ABC Scale (N = 61) were significantly related to fewer falls (r = -0.68). Activities-specific Balance Confidence scores were lower/worse for the patients VU+ (P = 0.039). Area under the receiver operating curve for patients VU+ was significant; we found area under the curve of 0.84 and a cutoff score of 80.3% for ABC predictive of recurrent fallers with sensitivity of 84% and specificity of 83%. The ABC test had an internal consistency reliability of 0.97. Persons VU+ reported worse balance confidence and more falls than those without these ulcers. The ABC test was related to falls. With aging of injection users and increased occurrence of VUs, examining balance confidence and falls is crucial in long-term patient safety.

  3. Contribution of germline mutations in cancer predisposition genes to tumor etiology in young women diagnosed with invasive breast cancer.

    PubMed

    Rummel, Seth K; Lovejoy, Leann; Shriver, Craig D; Ellsworth, Rachel E

    2017-08-01

    Although breast cancer in young women accounts for <10% of diagnoses annually, tumors in young patients exhibit more aggressive characteristics and higher mortality rates. Determination of the frequency of germline mutations in cancer predisposition genes is needed to improve the understanding of breast cancer etiology in young women. All female patients enrolled in the Clinical Breast Cancer Project between 2001 and 2015 and diagnosed with invasive breast cancer before age 40 were included in this study. Family history was classified using the NCCN Familial Risk Assessment guidelines. Targeted sequencing of 94 cancer predisposition genes was performed using peripheral blood DNA. Variants were detected using VariantStudio and classified using ClinVar. Seven percent (141/1980) of patients were young women and 44 had a significant family history. Sequencing was completed for 118 women with genomic DNA. Pathogenic mutations were present in 27 patients: BRCA1 (n = 10), BRCA2 (n = 12), TP53 (n = 1), and CHEK2 (n = 4). Mutations classified as pathogenic were also detected in APC (n = 1) and MUTYH (n = 2). Variants of uncertain significance (VUS) were detected in an additional 17 patients in ten genes. Pathogenic mutations in high- and moderate-risk breast cancer genes were detected in 23% of young women with an additional 3% having pathogenic mutations in colon cancer predisposition genes. VUS were observed in 14% of women in genes such as ATM, BRCA2, CDH1, CHEK2, and PALB2. Identification of those non-genetic factors is critical to reduce the burden of breast cancer in this population.

  4. Hospitalizations in elderly glioblastoma patients.

    PubMed

    Moroney, Claire; Perry, James R; Tsang, Derek S; Bilodeau, Denise; Mueller, Chris; Soliman, Hany; Myrehaug, Sten; Sahgal, Arjun; Tseng, Chia-Lin; Tsao, May N

    2017-08-11

    Elderly glioblastoma (GB) patients are at risk of hospitalizations due to the morbidity of the disease and possible treatment toxicity. In this observational cohort study, 255 newly diagnosed GB patients age 65 years and older were included. Survival, emergency room visits and admissions to an acute care hospital were determined. Mean and median total health care costs were calculated. Risk factors for Emergency room visits and acute care hospital admissions were determined. Median overall survival was 6 months. The majority of patients (68%) had at least one visit to the emergency department and 77% had at least one admission to acute care. The mean and median total costs (hospital, ambulatory, physician billing, other health care costs) per patient were $162,479.78 (CAN) and $125,511.00 (CAN), respectively. Treatment with radiation or treatment with radio-chemotherapy was associated with a relative risk (RR) of 2.31 (95% CI: 1.44-3.7; P=0.0005) and 2.19 (95% CI: 1.28-3.74; P=0.004), respectively for emergency department visits as compared to patients who were managed with comfort measures only. Patients with a baseline ECOG 0 had a RR of 1.71 (95% CI: 1.06-2.77; P=0.0289) and patients with baseline ECOG 1 had a RR of 1.49 (0.98-2.26; P=0.0623) for hospital admission as compared to patients with ECOG 4. A large proportion of elderly GB patients (particularly those with good baseline performance status who underwent active treatment) presented to the emergency department and had at least one admission to acute care.

  5. [The patient and his family].

    PubMed

    Schweitzer, Susanne; van Oorschot, Birgitt; Köhler, Norbert; Leppert, Karena; Steinbach, Kerstin; Hausmann, Christopher; Anselm, Reiner

    2005-06-01

    Medical decision-making models focus on doctor-patient relationship. The impact of the family, specifically the involvement of the relatives in the information- and decision-making process have rarely been evaluated yet. Within the project "Patient as partners - cancer patients and their involvement in medical decision making" progressive disease cancer patients, their relatives and doctors as well as Thuringian general practitioners have been interviewed with regard to their attitudes (among others) towards the medical system and information and decision making processes. From the patient's point of view, the family is highly important in decision-making (very important/important 80.3 %). 73 % of the patients, but only 58 % of the relatives feel very good/good informed about the treatment. With regard to prognosis, 30 % of the patients and 27 % of the relatives feel less/poorly informed. 83.7 % of the relatives believe they cannot influence treatment decisions. According to this, Thuringian general practitioners judge the influence of family members on treatment decisions quite low (very high/high 12.9 %, partly 37.4 %, low/not possible 49.7 %), though the relatives' wish for involvement is seen quite realistic (89 % of the GP's believe that the family wants to be involved). From the patients point of view, the family has got a high status with regard to medical decision-making. In palliative cancer patients doctors should offer an early and continuous involvement of relatives in information and decision-making processes in order to reduce misjudgements and frustration within the families.

  6. Maintaining primacy of the patient perspective in the development of patient-centered patient reported outcomes

    PubMed Central

    Garver, Amanda; Ljungberg, Inger H.; Schladen, Manon M.; Groah, Suzanne L.

    2017-01-01

    The objectives of this study were to describe and demonstrate a new model of developing patient reported outcomes (PROs) that are patient-centered, and to test the hypothesis that following this model would result in a qualitatively different PRO than if the typical PRO development model were followed. The typical process of developing PROs begins with an initial list of signs or symptoms originating from clinicians or PRO developers; patient validation of this list ensures that the list (i.e., the new PRO) is interpretable by patients, but not that patient perspectives are central or even represented. The new model begins with elicitation from clinicians and patients independently and separately. These perspectives are formally analyzed qualitatively, and the results are iteratively integrated by researchers, supporting clinical relevance and patient centeredness. We describe the application of this new model to the development of a PRO for urinary signs and symptoms in individuals with neuropathic bladder, and test the hypothesis that the two processes generate qualitatively different instruments using a national validation sample of 300 respondents. Of its 29 items, the new instrument included 13 signs/symptoms derived from existing clinical practice guidelines, with 16 others derived from the patient/focus groups. The three most-endorsed items came from the patients, and the three least-endorsed items came from clinical guidelines. Thematic qualitative analysis of the elicitation process, as well as the results from our national sample, support the conclusion that the new model yields an instrument that is clinically interpretable, but more patient-centered, than the typical model would have done in this context. PMID:28257414

  7. Emergency department team communication with the patient: the patient's perspective.

    PubMed

    McCarthy, Danielle M; Ellison, Emily P; Venkatesh, Arjun K; Engel, Kirsten G; Cameron, Kenzie A; Makoul, Gregory; Adams, James G

    2013-08-01

    Effective communication is important for the delivery of quality care. The Emergency Department (ED) environment poses significant challenges to effective communication. The objective of this study was to determine patients' perceptions of their ED team's communication skills. This was a cross-sectional study in an urban, academic ED. Patients completed the Communication Assessment Tool for Teams (CAT-T) survey upon ED exit. The CAT-T was adapted from the psychometrically validated Communication Assessment Tool (CAT) to measure patient perceptions of communication with a medical team. The 14 core CAT-T items are associated with a 5-point scale (5 = excellent); results are reported as the percent of participants who responded "excellent." Responses were analyzed for differences based on age, sex, race, and operational metrics (wait time, ED daily census). There were 346 patients identified; the final sample for analysis was 226 patients (53.5% female, 48.2% Caucasian), representing a response rate of 65.3%. The scores on CAT-T items (reported as % "excellent") ranged from 50.0% to 76.1%. The highest-scoring items were "let me talk without interruptions" (76.1%), "talked in terms I could understand" (75.2%), and "treated me with respect" (74.3%). The lowest-scoring item was "encouraged me to ask questions" (50.0%). No differences were noted based on patient sex, race, age, wait time, or daily census of the ED. The patients in this study perceived that the ED teams were respectful and allowed them to talk without interruptions; however, lower ratings were given for items related to actively engaging the patient in decision-making and asking questions. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Individual health services

    PubMed Central

    Schnell-Inderst, Petra; Hunger, Theresa; Hintringer, Katharina; Schwarzer, Ruth; Seifert-Klauss, Vanadin Regina; Gothe, Holger; Wasem, Jürgen; Siebert, Uwe

    2011-01-01

    Background The German statutory health insurance (GKV) reimburses all health care services that are deemed sufficient, appropriate, and efficient. According to the German Medical Association (BÄK), individual health services (IGeL) are services that are not under liability of the GKV, medically necessary or recommendable or at least justifiable. They have to be explicitly requested by the patient and have to be paid out of pocket. Research questions The following questions regarding IGeL in the outpatient health care of GKV insurants are addressed in the present report: What is the empirical evidence regarding offers, utilization, practice, acceptance, and the relation between physician and patient, as well as the economic relevance of IGeL? What ethical, social, and legal aspects are related to IGeL? For two of the most common IGeL, the screening for glaucoma and the screening for ovarian and endometrial cancer by vaginal ultrasound (VUS), the following questions are addressed: What is the evidence for the clinical effectiveness? Are there sub-populations for whom screening might be beneficial? Methods The evaluation is divided into two parts. For the first part a systematic literature review of primary studies and publications concerning ethical, social and legal aspects is performed. In the second part, rapid assessments of the clinical effectiveness for the two examples, glaucoma and VUS screening, are prepared. Therefore, in a first step, HTA-reports and systematic reviews are searched, followed by a search for original studies published after the end of the research period of the most recent HTA-report included. Results 29 studies were included for the first question. Between 19 and 53% of GKV members receive IGeL offers, of which three-quarters are realised. 16 to 19% of the insurants ask actively for IGeL. Intraocular tension measurement is the most common single IGeL service, accounting for up to 40% of the offers. It is followed by ultrasound assessments

  9. Improving oral hygiene for patients.

    PubMed

    Bonetti, Debbie; Hampson, Victoria; Queen, Kerry; Kirk, Donna; Clarkson, Jan; Young, Linda

    2015-01-13

    Systematic reviews and patient safety initiatives recommend that oral hygiene should be part of routine patient care. However, evidence suggests it is often neglected in hospitals and care homes. Research recommends encouraging beliefs that support oral hygiene, and teaching nurses appropriate skills, as necessary prerequisites to implementing best practice in hospital wards. This article describes a pilot study of an educational workshop on oral hygiene. Results from the pilot study suggest that this workshop is a feasible intervention for a service-wide trial. The literature suggests that other interventions are required to complement this approach if nurses are to make oral hygiene a priority in daily patient care.

  10. How important is patient education?

    PubMed

    Ramos-Remus, C; Salcedo-Rocha, A L; Prieto-Parra, R E; Galvan-Villegas, F

    2000-12-01

    The prevalence and disability rate of rheumatic diseases are increasing. It seems that non-medical causes play an important role in the morbidity, disability and mortality of these patients. Efforts to reduce their impact are extremely important. Patient education is thought to be one way to limit disability in rheumatic diseases and to achieve an improvement in quality of life. In this chapter, we review the influence of non-medical causes of morbidity on disease outcome, some basic aspects of education and the evidence of the effectiveness of patient education in diseases such as ankylosing spondylitis, systemic lupus erythematosus, rheumatoid arthritis and fibromyalgia syndrome.

  11. Patient risk from interproximal radiography

    SciTech Connect

    Gibbs, S.J.; Pujol, A. Jr.; Chen, T.S.; Malcolm, A.W.; James, A.E. Jr.

    1984-09-01

    Computer simulation methods for determining patient dose from dental radiography have demonstrated that patient risk from a two-film interproximal examination ranges from 1.1 X 10(-8) to 3.4 X 10(-7) using 90-kVp beams, depending on film speed, projection technique, and age and sex of the patient. Further, changing from a short-cone round-beam to a long-cone technique with rectangular collimation reduces risk by a factor of 2.9, independent of other factors.

  12. The doctor-patient relationship.

    PubMed

    Gordon, H H

    1983-08-01

    This essay focuses on the doctor-patient relationship as a measure of ethical behavior by the physician. The perspective is derived from commitment as a religious humanist to the Judaic heritage, and experience in hospitals. The ethical responsibility to be competent professionally is presupposed. Emphasis is placed on the need of the physician to respect the autonomy of the patient as person, thus to limit the paternalism inherent in the physician's position, and to re-enforce this with compassion. Judaic sources supporting such conduct are cited. Exception is taken to decisions by civil and rabbinic judges which disregard the intimacy of the doctor-patient relationship.

  13. Erectile dysfunction in COPD patients.

    PubMed

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

    2016-02-01

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

  14. 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

  15. Erythropoietic protoporphyria patients in Slovenia.

    PubMed

    Marko, P B; Miljković, J; Gorenjak, M; Povalej, P; Kansky, A

    2007-09-01

    There are only scarce epidemiological data on the prevalence of erythropoietic protoporphyria (EPP) in a given population. The aim of this study was to assess the prevalence of EPP within the Slovenian population. The patients were selected by routine examination of photosensitive patients and by studying hospital records. A quantitative spectrophotometric method was used to assess protoporphyrin, with values larger than 530 nm/l considered elevated. 32 EPP patients were detected, which allows us to estimate the prevalence of EPP in Slovenia at 1.75 per 100,000 inhabitants.

  16. [The magnetotherapy of hypertension patients].

    PubMed

    Ivanov, S G; Smirnov, V V; Solov'eva, F V; Liashevskaia, S P; Selezneva, L Iu

    1990-01-01

    A study was made of the influence of the constant MKM2-1 magnets on patients suffering from essential hypertension. Continuous action of the magnetic field, created by such magnets, on the patients with stage II essential hypertension was noted to result in a decrease of arterial pressure without the occurrence of any side effects and in a simultaneous reduction of the scope of drug administration. Apart from that fact, magnetotherapy was discovered to produce a beneficial effect on the central hemodynamics and microcirculation. The use of the MKM2-1 magnets may be regarded as a feasible method of the treatment of essential hypertension patients at any medical institution.

  17. Fluid Therapy for Pediatric Patients.

    PubMed

    Lee, Justine A; Cohn, Leah A

    2017-03-01

    Young puppies and kittens have unique physiologic needs in regards to fluid therapy, which must address hydration, vascular fluid volume, electrolyte disturbances, or hypoglycemia. Pediatric patients have a higher fluid requirement compared with adults and can rapidly progress from mild dehydration to hypovolemia. Simultaneously, their small size makes overhydration a real possibility. Patient size complicates fluid administration because catheters used in larger pets may be difficult to place. Routes of fluid administration used in the neonate or pediatric patient include oral, subcutaneous, intraperitoneal, intraosseous, and intravenous. Clinicians should be aware of the pros and cons of each route. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. [Patients's with aphasia communication problems].

    PubMed

    Matuszak, Katarzyna; Bonikowska, Agata; Kuczma, Monika; Hagner, Wojciech

    2011-01-01

    Aphasia is a speech disorder caused by disorders of speech centre in brain cortex. Patient with aphasia compensates communication disorders by communication strategy, witch are spontaneous mechanisms, and uses individual rehabilitation methods. Compensation mechanisms are divided in to: phonetic, inflective, formative, semantic, discursive and structural. Patients with aphasia early therapy have to be individual and consists in not only articulation correction, but in establish over verbal contact or verbal, and improvement this contacts, to create patients ability of communication with society. Later therapy is oriented on improvement of cognitive functions for possibility of participation in social live and if it is possible for return to work.

  19. Diarrhea in the immunocompromised patient.

    PubMed

    Krones, Elisabeth; Högenauer, Christoph

    2012-09-01

    Diarrhea is a common problem in patients with immunocompromising conditions. The etiologic spectrum differs from patients with diarrhea who have a normal immune system. This article reviews the most important causes of diarrhea in immunocompromised patients, ranging from infectious causes to noninfectious causes of diarrhea in the setting of HIV infection as a model for other conditions of immunosuppression. It also deals with diarrhea in specific situations, eg, after hematopoietic stem cell or solid organ transplantation, diarrhea induced by immunosuppressive drugs, and diarrhea in congenital immunodeficiency syndromes.

  20. Alcoholic patients with secondary depression.

    PubMed

    Schuckit, M

    1983-06-01

    This study of alcoholic patients with and without secondary depression showed that the two groups were almost identical in demographic characteristics, early-life antisocial problems, quantity and frequency of drinking, and family history of affective disorder. The depressed patients reported slightly more alcoholism in their first-degree male relatives and tended to have more alcohol-related life problems. The only significant difference between the two groups was that the depressed patients were heavier users of drugs other than alcohol. Thus severe depression in alcoholics may be related to a greater intake of drugs in addition to alcohol.

  1. Simulated Patients vs. Standardized Patients in Objective Structured Clinical Examinations

    PubMed Central

    Austin, Zubin; Gregory, Paul; Tabak, Diana

    2006-01-01

    Objectives To describe the use of patient-actors as educators in a senior-level pharmacy practice course, and to contrast the value and application of “standardized patient” and “simulated patient” educational methodologies. Design The objective structured clinical examination (OSCE) of the licensing examination were utilized during and at the end of the course along with external assessment to determine the impact of this educational methodology. Interviews with a randomly selected cohort of 14 students were undertaken 3 years after graduation and licensure to evaluate long-term impact of this course. Assessment Overall, students responded positively to the shift from “standardized” patients to “simulated” patients, recognizing their value in teaching clinical and pharmaceutical care skills. Concerns were expressed regarding objectivity in assessment and individual grading. Over 98% of students successfully passed the OSCE component of the licensing examination. Long-term follow-up suggests students valued this approach to education and that it provided them with a foundation for better understanding of the psychosocial needs of patients in practice. Conclusions Simulated-patient educators can play an important role in the pharmacy curriculum, and can complement practitioner-educators in providing students with a real-world context for understanding complex patient care needs. PMID:17149448

  2. 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.

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

    PubMed

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

    2009-11-01

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

  4. Patient choice modelling: how do patients choose their hospitals?

    PubMed

    Smith, Honora; Currie, Christine; Chaiwuttisak, Pornpimol; Kyprianou, Andreas

    2017-04-11

    As an aid to predicting future hospital admissions, we compare use of the Multinomial Logit and the Utility Maximising Nested Logit models to describe how patients choose their hospitals. The models are fitted to real data from Derbyshire, United Kingdom, which lists the postcodes of more than 200,000 admissions to six different local hospitals. Both elective and emergency admissions are analysed for this mixed urban/rural area. For characteristics that may affect a patient's choice of hospital, we consider the distance of the patient from the hospital, the number of beds at the hospital and the number of car parking spaces available at the hospital, as well as several statistics publicly available on National Health Service (NHS) websites: an average waiting time, the patient survey score for ward cleanliness, the patient safety score and the inpatient survey score for overall care. The Multinomial Logit model is successfully fitted to the data. Results obtained with the Utility Maximising Nested Logit model show that nesting according to city or town may be invalid for these data; in other words, the choice of hospital does not appear to be preceded by choice of city. In all of the analysis carried out, distance appears to be one of the main influences on a patient's choice of hospital rather than statistics available on the Internet.

  5. 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…

  6. 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…

  7. Learning from patients: students' perceptions of patient-instructors.

    PubMed

    Henriksen, Ann-Helen; Ringsted, Charlotte

    2011-09-01

    Prior research on the use of patients as teachers has focused on testing the effectiveness of this practice and exploring its benefits for students. However, very little is known about the added value of patient teaching and how it relates to patient-centred learning. The aim of this study was to explore whether there is added value in using patients as instructors in health professions education and, if there is, to examine how it is constituted. Group interviews were conducted with physiotherapy and occupational therapy students who had attended a 3-hour optional class entitled 'Thoughtful joint examination and respectful patient contact'. This class was delivered by patient-instructors (PIs), who were patients with rheumatism certified to teach. A semi-structured interview guide was used. Interviews continued until data saturation occurred (seven interviews). The interviews were recorded and transcribed verbatim. Data were analysed using content analysis. The main finding of this study is that PI sessions facilitate a learning environment in which the content matter is complemented by the provision of realism and individual perspectives on rheumatism, the pedagogical format is characterised by authenticity and intimacy in the style of instruction and feedback, and the PI-student relationship is characterised by balanced teacher-student power relations that support the legitimacy of learning and make space for the asking of questions and the making of mistakes. This study indicates that, in terms of power relations, the PI-student relationship differs from those between faculty teachers and students, and students and patients in the clinic. The formation of a professional identity by students may clash with the fulfilment of their learning tasks in the clinical environment. The study indicates that patient-centredness can be fostered in the PI-student relationship. This is probably supported by the absence of faculty staff involvement in PI teaching sessions

  8. 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. (c) 2015 APA, all rights reserved).

  9. 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

  10. CCCT - Patient Advocate Steering Committee

    Cancer.gov

    The Patient Advocate Steering Committee (PASC) works to ensure advocates involved with the Scientific Steering Committees (SSCs) are completely integrated in the development, implementation, and monitoring of clinical trials within those groups.

  11. Helping Patients To Quit Smoking

    PubMed Central

    Bass, Frederic

    1989-01-01

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

  12. Patient Safety Threat - Syringe Reuse

    MedlinePlus

    ... HAIs HICPAC One & Only Campaign A Patient Safety Threat – Syringe Reuse Recommend on Facebook Tweet Share ... need to be aware of a very serious threat to their health – the reuse of needles or ...

  13. [Ergotherapy of severely burned patients].

    PubMed

    Nickerl, U; Resag, I

    1995-04-01

    Occupational therapy for severely burned patients includes individual exercise programmes, activities of daily living (ADL), assessment of the need for technical aids, splinting and pressure bandages, as well as psychological and social support. There are different focal points in the three stages of treatment. In the burn-care unit (first stage), if necessary, the patient is provided with splints. At this time the first contact is made. In the burn-care ward (second stage), the occupational therapy is focused on individual exercise programmes, dynamic splinting, ADL, and preparation for discharge from hospital. In the outpatient department (third stage), the aims of occupational therapy are: providing the patients with pressure bandages, checking of splints, assessment of the need for technical aids and special support if the patients have difficulties at home and work.

  14. 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.

  15. Patient compliance with antihypertensive medication.

    PubMed Central

    Hershey, J C; Morton, B G; Davis, J B; Reichgott, M J

    1980-01-01

    Self-reported medication taking compliance behavior of 132 high blood pressure patients was analyzed using an expanded version of the health belief model. Subjects were selected through random sampling procedures from regular hypertension program sessions at a large urban hospital. A questionnaire was constructed to measure the model components, and interviews were conducted with each patient. Bivariate analysis showed that control over health matters, dependence on providers, perceived barriers, duration of treatment, and others' nonconfirming experience were significantly related to compliance (p < .05). Log-linear multivariate analysis revealed that three of these five variables--control over health matters, perceived barriers, and duration of treatment--contributed independently to patient compliance. Self-reported medication taking was significantly related to blood pressure control (p < .02). These data provide the basis for developing interventions for providers to facilitate the medication taking behavior of clinic patients. PMID:7416325

  16. [Food habits among HIV patients].

    PubMed

    Parrilla Saldaña, Josefa; Muñoz Sánchez, Isabel; Peñalver Jiménez, Carmen; Castro Rodríguez, Encarnación; Quero Haro, Antonia; Largo García, Esperanza

    2003-01-01

    The authors analyze the eating habits of a group of 108 patients suffering from HIV. The authors elaborate a chart about the composition and distribution of foods which contains all the required food groups necessary for a complete diet. This food chart lists the variable of this study as well as the frequency of their consummation. Once this chart was drawn up, it was approved by the Nutrition and Dietetic Unit at the Virgen de Valma University Hospital. Among the results obtained, there is a relationship between the necessity these patients have regarding eating a complete diet and diverse nutrients that are easy to chew as well as an abundance of liquids. The article "Nutrition for Patients suffering from HIV" written by the same authors published in the Revista ROL de Enfermera 2002; 25(12):816-820, is recommended in order to have a more complete understanding of this topic, nutrition for patients suffering from HIV.

  17. Should Immunocompromised Patients Have Pets?

    PubMed Central

    Steele, Russell W.

    2008-01-01

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

  18. Cockroach hypersensitivity in asthmatic patients.

    PubMed

    Pola, J; Valdivieso, R; Zapata, C; Moneo, I; Duce, F; Larrad, L; Losada, E

    1988-01-01

    Hypersensitivity to cockroach antigen has been recognized as an important cause of perennial allergic rhinitis and asthma. To assess the frequency of cockroach hypersensitivity in our country, 150 asthmatic atopic subjects were studied using skin testing and in vitro assays for cockroach-specific IgE antibodies (Oriental and German cockroaches). Twenty-two of 61 patients who had a positive history of cockroach exposure had positive skin tests, and only 3 of 89 patients who had no history of exposure had positive skin reactions. Of 25 patients with positive skin tests, 23 showed specific IgE antibodies against oriental and German cockroaches using RAST and EIA techniques. In summary, approximately 15% of asthmatic atopics in Madrid area are sensitive to cockroaches (positive skin test + specific IgE antibodies). These results indicate that cockroach hypersensitivity should be considered in every patient with perennial asthma.

  19. 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

  20. Bathing a patient in bed

    MedlinePlus

    ... You will need: Large bowl of warm water Soap (regular or non-rinse soap) Two washcloths or sponges Dry towel Lotion Shaving ... skin, then gently apply a small amount of soap. Check with the patient to make sure you ...

  1. Transfusion medicine in trauma patients

    PubMed Central

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

    2011-01-01

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

  2. 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

  3. Should patients complete the course?

    PubMed

    Griffiths, Matt

    2017-08-23

    In a recent article in the British Medical Journal (BMJ), a group of experts including infectious disease specialists and microbiologists discussed whether patients should stop taking antibiotics when they feel better.

  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. The patient with daily headaches.

    PubMed

    Maizels, Morris

    2004-12-15

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

  6. [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. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Sleep in patients with schizophrenia

    PubMed Central

    2015-01-01

    Numerous electrophysiological and neuroimaging studies have reported neurophysiological and cognitive deficits in schizophrenia patients during wakefulness. However, these findings have been inconsistently replicated across different groups of patients, thus complicating the identification of underlying neuronal defects. Sleep minimizes possible waking-related confounds, including decreased motivation and presence of active symptoms. Additionally, the two main sleep rhythms, slow waves and spindles, reflect the intrinsic activity of corticothalamic circuits and are associated with cognitive activities, including learning and memory, occurring during wakefulness. In this review I will present the most relevant sleep findings in schizophrenia, with particular emphasis on several recent studies that have consistently reported sleep spindle deficits in patients with schizophrenia. I will then elaborate on how these findings may contribute to a better understanding of the neurobiology of schizophrenia as well as to the development of novel pharmacological and non-pharmacological interventions to ameliorate the symptoms and cognitive impairments of schizophrenia patients. PMID:26430610

  8. 'The patient is medically cleared'.

    PubMed

    Beale, Chloe; Turner, Trevor

    2013-09-01

    It is standard practice for psychiatric nurses and junior doctors working in emergency departments to ask that patients be 'medically cleared' before psychiatric admission or even assessment. However, there is a lack of agreement over what this process should entail.

  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. Psychotherapists' dreams about their patients.

    PubMed

    Kron, Tamar; Avny, Nadav

    2003-06-01

    This study examines therapists' dreams about their patients from the Jungian and the relational perspectives. Few clinical and empirical references to this subject are to be found in the literature. In the present study 31 dreams were collected from 22 therapists. Dreams were collected using anonymous self-report inventory. The research focused on three theoretical research questions: 1. What themes appear in the manifest content of therapists' dreams about their patients? 2. What contributions are made by Jungian interpretation of therapists' dreams about their patients? 3. To what extent are masochistic contents present in the manifest content of therapists' dreams about their patients? The first question was addressed using categorical content analysis of a) themes common to different dreams and b) pre-determined themes for all dreams. The third research question was addressed using Beck's (1967) 'Masochistic Dream' measure. Among the themes common to different dreams were: therapist-patient role reversal; therapist and/or patient attends and remains in meeting, departs/doesn't depart; cancellation of therapy session; sexuality between therapist and patient; aggression; presence vs. absence; non-verbal relationship and communication; time; driving vs. stopping. With regard to pre-determined themes it was found that in 20 of the 31 dreams, the therapist had a negative experience and was characterized as vulnerable. Likewise it was found that 26 out of 31 dreams took place in either a) a street, a road, a route, a corridor; b) en route to somewhere; c) a therapy room and/or building; d) a house. With regard to the contribution of Jungian interpretations of the dreams it was found that 17 of the dreams had diagnostic and prognostic elements, 4 of which were initial dreams, 9 of them were compensatory dreams and in 14 it was found that the patient represents the shadow of the therapist. With regard to the third question it was found that 18 of the 31 dreams met Beck

  11. Corneal temperature in schizophrenia patients.

    PubMed

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

    2005-12-01

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

  12. 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.

  13. Paradoxical emboli in elderly patients.

    PubMed

    Vella, M; McNabb, R; Lewis, R; Sulke, N; Poston, R; Lugon, M

    1992-01-01

    We report two elderly patients who each had a patent foramen ovale (PFO) and were considered to have had paradoxical emboli. In one patient the PFO was detected by contrast two-dimensional echocardiography, whereas in the other it was demonstrated at post-mortem examination. This is an unusual but treatable condition, particularly difficult to diagnose in older people and probably occurring more frequently than is generally suspected.

  14. 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

  15. Delirium in hospitalized older patients.

    PubMed

    Inouye, S K

    1998-11-01

    Delirium is a common, serious problem for hospitalized older patients. Recognition of delirium poses challenges requiring cognitive assessment and knowledge of the clinical course. Delirium often is of multiple causes and is associated with a poor long-term prognosis. Nonpharmacologic approaches for delirium management are recommended; pharmacologic management should be reserved for patients who pose a danger to themselves or others. Importantly, delirium and its complications may be preventable through a targeted risk factor approach.

  16. Emergency Department Rotational Patient Assignment.

    PubMed

    Traub, Stephen J; Stewart, Christopher F; Didehban, Roshanak; Bartley, Adam C; Saghafian, Soroush; Smith, Vernon D; Silvers, Scott M; LeCheminant, Ryan; Lipinski, Christopher A

    2016-02-01

    We compare emergency department (ED) operational metrics obtained in the first year of a rotational patient assignment system (in which patients are assigned to physicians automatically according to an algorithm) with those obtained in the last year of a traditional physician self-assignment system (in which physicians assigned themselves to patients at physician discretion). This was a pre-post retrospective study of patients at a single ED with no financial incentives for physician productivity. Metrics of interest were length of stay; arrival-to-provider time; rates of left before being seen, left subsequent to being seen, early returns (within 72 hours), and early returns with admission; and complaint ratio. We analyzed 23,514 visits in the last year of physician self-assignment and 24,112 visits in the first year of rotational patient assignment. Rotational patient assignment was associated with the following improvements (percentage change): median length of stay 232 to 207 minutes (11%), median arrival to provider time 39 to 22 minutes (44%), left before being seen 0.73% to 0.36% (51%), and complaint ratio 9.0/1,000 to 5.4/1,000 (40%). There were no changes in left subsequent to being seen, early returns, or early returns with admission. In a single facility, the transition from physician self-assignment to rotational patient assignment was associated with improvement in a broad array of ED operational metrics. Rotational patient assignment may be a useful strategy in ED front-end process redesign. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  17. Intragastric Balloon for Overweight Patients

    PubMed Central

    Martins Fernandes, Flavio Augusto; Lima, Diego L.; Rao, Prashanth; Shadduck, Phillip P.; Montandon, Isabelle D.; de Souza Barros, Juscielle; Rodrigues, Ingrid Lais Vieira

    2016-01-01

    Background and Objectives: Current treatments for overweight adults include reduced-calorie diet, exercise, behavior modification, and selective use of medications. Many achieve suboptimal results with these measures and progress to obesity. Whether the intragastric balloon (IGB), a reversible device approved for treatment of obesity, is a safe and effective option in overweight adults is less well studied. We conducted a study to prospectively analyze the safety and effectiveness of IGB in overweight adults, to compare the results to a simultaneously studied cohort of obese patients, and to share procedural tips for safe IGB placement and removal. Methods: One hundred thirty-nine patients were evaluated in this prospective, nonrandomized study. Twenty-six overweight [body mass index (BMI), 26–30)] and 113 obese (BMI > 30) patients underwent outpatient, endoscopic IGB placement under intravenous sedation. The IGB was filled with a 550–900 mL (average, 640 mL) solution of saline, radiological contrast, and methylene blue, with an approximate final proportion of 65:2:1. The patients were followed up at 1–2 weeks and then monthly for 6 months. At 6 months, they underwent IGB removal via an esophageal overtube to optimize safety, and then they were observed for 6 more months. Results: IGB time was 190 ± 36 d in the overweight patients and 192 ± 43 d in the obese patients. Symptoms of IGB intolerance included nausea and pain, which were transiently present in 50–95% of patients for several days, and necessitated early IGB removal in 6% of patients. There were no procedure-related complications and no IGB-related esophagitis, erosion, perforation, or obstruction. The percentage of excess weight loss (EWL%) was 96 ± 54% in the overweight group and 41 ± 26% in the obese group (P < 0.001). Conclusion: In overweight adults failing standard treatments, IGB placement for 6 months had an acceptable safety profile and excellent weight loss. PMID:26955259

  18. [Risk management and patient safety].

    PubMed

    Lessing, C

    2009-06-01

    Risk management and patient safety are of indisputable importance for the quality of health care. At the same time they confront all professional groups in the health system with high demands. The Action Alliance for Patient Safety inc. wants to demonstrate ways in which measures for avoiding errors and improving safety can reach the healthcare practice. Interdisciplinary cooperation and the availability of mutually developed materials are the maxims of the work of the society.

  19. [Ocular changes in dialysis patients].

    PubMed

    Popa, M; Nicoară, S

    2000-01-01

    The study analyzes the ocular aspects in patients receiving hemodialysis, in order to define the importance of the ophthalmological exam as prognosis and follow-up parameter. The prospective study includes 84 patients with renal insufficiency who received hemodialysis between 1994-1998. The ocular aspects and their connection with the dialysis and the basic disease are described and analyzed. The most important were the retinal vascular complications: hypertensive retinopathy, anterior optic ischaemic neuropathy, central retinal artery occlusion, diabetic retinopathy.

  20. [Orthodontic treatment in periodontal patients].

    PubMed

    Krausz, E; Einy, S; Aizenbud, D; Levin, L

    2011-07-01

    Orthodontic treatment poses a significant challenge in patients suffering from periodontal disease. Providing orthodontic treatment to periodontal patients should be carefully planned and performed in a tight collaboration between the orthodontist and periodontist. Resolution and stabilization of the periodontal condition is a pre-requisite for orthodontic treatment initiation. Careful oral hygiene performance and highly frequent recall periodontal visits are also crucial. Pre- or post- orthodontic periodontal surgery might help providing better treatment outcomes.

  1. Depression and the Suicidal Patient.

    PubMed

    Kuo, Dick C; Tran, Mina; Shah, Asim A; Matorin, Anu

    2015-11-01

    Depression is the most common psychiatric illness in the general community, with 3% to 4% of depressives dying by suicide today. Studies have shown that depression has considerable morbidity and mortality. This article focuses on depressed patients and their management within the emergency department. Understanding the intricacies of the interview process and identifying which patients need immediate attention are important skills for the emergency physician.

  2. Dental management of anticoagulated patients.

    PubMed

    Carr, M M; Mason, R B

    1992-10-01

    Today's trend toward ambulatory medical care will bring more pharmacological problems into the dental office. While the dental management of patients taking oral anticoagulants is controversial, current research supports the contention that they can be safely treated on an outpatient basis. The use of the International Normalized Ratio (INR) has made better estimates of prothrombin time possible, and patients can be maintained in a narrow therapeutic range. Postoperative hemorrhage can be avoided or controlled with local hemostatic agents.

  3. 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.

  4. 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

  5. Hypnotherapy and the Suicidal Patient

    PubMed Central

    Glick, Daniel

    1973-01-01

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

  6. EPS: An Epidemiologic Patient Simulator

    PubMed Central

    Lewis, James Scott

    1981-01-01

    EPS is an automated patient case simulator which presents the user (student) with a mock patient that he may interview, as in a standard medical history; examine, as in a physical examination; evaluate, through XRAY and other laboratory studies; and finally, diagnose. The foundation of the system is a mathematical description of the relevant epidemiological data for each disease simulated. This is referred to as the DISEASE MODEL.

  7. Information technologies and patient safety.

    PubMed

    Ellner, Scott J; Joyner, Paul W

    2012-02-01

    Advances in health information technology provide significant opportunities for improvements in surgical patient safety. The adoption and use of electronic health records can enhance communication along the surgical spectrum of care. Bar coding and radiofrequency identification technology are strategies to prevent retained surgical sponges and for tracking the operating room supply chain. Computerized intraoperative monitoring systems can improve the performance of the operating room team. Automated data registries collect patient information to be analyzed and used for surgical quality improvement.

  8. Cultural competence and simulated patients.

    PubMed

    Paroz, Sophie; Daele, Amaury; Viret, Francine; Vadot, Sara; Bonvin, Raphaël; Bodenmann, Patrick

    2016-10-01

    Cultural competence education is central in addressing the socio-cultural factors that affect health care; however, there is little agreement over the best teaching approach. Although simulated patients are widely used in medical education, little is known about their application to cultural competence education. At the Department of Ambulatory Care and Community Medicine, University of Lausanne, the content of a cultural competence education module for resident doctors was recently restructured, with a final session emphasising previous principles through a simulated patient-doctor encounter. We tested the feasibility of cultural competence training with simulated patients. We created two complementary case scenarios based on real clinical practice and focused on specific clinical skills. An interdisciplinary team trained two simulated patients, and a 90-minute pilot session took place. General satisfaction was high and the increased opportunity for interaction was greatly appreciated. According to the learners, the simulated case setting was relevant for improving self-reflection and cultural sensitivity: applying skills in the session enhanced perceived impact for 'real-world' practice. We tested the feasibility of cultural competence training with simulated patients The use of patient-centred simulated clinical practice as a teaching approach seems to be advantageous in increasing providers' self-reflection about cultural competence and intensifying the impact of cultural competence education in clinical practice, and hopefully will improve the quality of care for every patient. Case scenarios based on a diversity of socio-cultural factors and oriented towards a broad skills set would seem preferable to avoid cultural drift and to enhance the learning of cultural approaches that are adaptable to every patient. © 2016 John Wiley & Sons Ltd.

  9. Seeing Patients Through Genetic Lenses

    PubMed Central

    FELCONE, LINDA HULL

    2005-01-01

    Biotechnology is changing how doctors ‘see’ patients and disease processes. Optical probes and computer-assisted genetic screening tools let researchers peer into the structure and functions of cellular proteins on a molecular level. Soon, this clearer vision of individual patients will be available in the clinic, making drug and biologic treatments safer. These new lenses will push medicine toward risk prediction and away from acute intervention. PMID:23393472

  10. 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

  11. Optimising patient outcomes in myeloma.

    PubMed

    Harousseau, Jean-Luc

    2010-05-01

    Multiple myeloma (MM) is an incurable disease, and the goal of therapy is to prolong survival. Newer therapies (thalidomide, lenalidomide, and bortezomib) have contributed to the recent improvements in survival. Optimal integration of these newer therapies into standard practice may be aided by better methods of risk stratification. Supplementation of existing risk stratification methods with new prognostic information, such as cytogenetic data and gene expression profiles, may improve prognostication and help to identify appropriate treatment. The advent of newer therapies has also prompted a reassessment of traditional endpoints and goals of therapy, such as complete response. While complete response correlates with survival in some cases, the correlation is not consistent across all treatment regimens and patient groups, and is therefore not always the most appropriate goal of therapy. With the aim of prolonging survival, trials are currently evaluating newer therapies as long-term maintenance therapy or as prevention therapy for patients with smouldering myeloma. Given that these patients are often asymptomatic and free of clinically active disease, success in this setting depends highly on long-term tolerability of these agents. The available evidence suggests that their adverse event profiles are distinct, predictable, and manageable with careful monitoring and intervention as appropriate. Treatment of MM should therefore be tailored to the individual patient based on the goals of therapy, patient condition, expected adverse events, and patient preference. Copyright 2010 Elsevier Ltd. All rights reserved.

  12. Caring for visually impaired patients.

    PubMed

    Orrico, Kathleen B

    2013-01-01

    To raise pharmacist awareness about the needs and concerns of our patients with visual impairment and to review useful strategies to foster medication adherence. As patient-centered pharmacists, we need to understand the challenges faced by our patients with low vision and tailor pharmaceutical care to best fit their needs. Evidence-based best practices in labeling and written communication have been developed by the American Foundation for the Blind in partnership with the American Society of Consultant Pharmacists. These recommendations include the use of specific font styles, minimum font size, and other standards known to enhance usability for those with limited vision. Recent advances in assistive technologies such as audio output and object recognition software can be used to ease the medication-taking process and effectively communicate important drug and safety information in a manner that can be understood by those with low vision. In July 2012, the Prescription Accessible Drug Labeling Promotion Act of 2012 (HR 4087) was signed into law. This new legislation is an addition to the Food and Drug Administration Safety and Innovation Act, which required the development and ultimate implementation by pharmacies of national best practices intended to improve the accessibility of prescription drug labeling for the visually impaired. As a patient-centered profession, we need to advocate for our patients with special needs by partnering with government and patient groups to support and enact legislation intended to enhance people's ability to adhere to drug therapy.

  13. [Fertility in testicular cancer patients].

    PubMed

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

    2015-03-01

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

  14. Cancer patient satisfaction with care.

    PubMed

    Wiggers, J H; Donovan, K O; Redman, S; Sanson-Fisher, R W

    1990-08-01

    A diagnosis of cancer places considerable stress on patients and requires them to make major adjustments in many areas of their lives. As a consequence, considerable demands are placed on health care providers to satisfy the complex care needs of cancer patients. Currently, there is little available information to indicate the extent to which cancer patients are satisfied with the quality of care they receive. The present study assessed the perceptions of 232 ambulatory cancer patients about the importance of and satisfaction with the following aspects of care: doctors technical competence and interpersonal and communication skills, accessibility and continuity of care, hospital and clinic care, nonmedical care, family care, and finances. The results indicate that all 60 questionnaire items used were considered to reflect important aspects of care, but that greater importance was given to the technical quality of medical care, the interpersonal and communication skills of doctors, and the accessibility of care. Most patients were satisfied with the opportunities provided to discuss their needs with doctors, the interpersonal support of doctors, and the technical competence of doctors. However, few patients were satisfied with the provision of information concerning their disease, treatment, and symptom control and the provision of care in the home and to family and friends.

  15. 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.

  16. [Delusion in the critical patient].

    PubMed

    Palencia-Herrejón, E; Romera, M A; Silva, J A

    2008-02-01

    Delirium, the acute confusional syndrome, is a common although infradiagnosed problem in the critically ill patient, especially the hypoactive subtype. Risk factors for delirium are previous cognitive disturbances, some comorbidities, ambiental factors and the acute organic alterations of critical illness. Delirium is associated to an increase in short and long term mortality, prolongation of mechanical ventilation, increased Intensive Care Unit (ICU) and hospital length of stay, and cognitive impairment after hospital discharge. In the last years several tools have been developed to detect delirium in critically ill patients. The Intensive Care Delirium Screening Checklist (ICDSC) and the Confusion Assessment Method for ICU patients (CAM-ICU) have been validated and are useful even in patients receiving mechanical ventilation. Some interventions on specific risk factors can decrease the incidence of delirium in hospitalized patients. Treatment of delirium is based on the identification and correction of contributing factors, the introduction of support measures, and pharmacological therapy for symptomatic control. Halloperidol is the first line therapy of delirium in the critically ill patient, while experience with atypical neuroleptics and other drugs is limited, precluding to do recommendations about its use. Neuroleptic drugs can produce severe side effects and need careful dosage and monitoring. When agitation is important, can be necessary the simultaneous use of benzodiazepines or propofol, and some times, the temporal and protocolized application of physical restraints.

  17. Spiritual care in hospitalized patients

    PubMed Central

    Yousefi, Hojjatollah; Abedi, Heidar Ali

    2011-01-01

    BACKGROUND: Spiritual needs are among an individual's essential needs in all places and times. With his physical and spiritual dimensions and the mutual effect of these two dimensions, human has spiritual needs as well. These needs are an intrinsic need throughout the life; therefore, they will remain as a major element of holistic nursing care. One of the greatest challenges for nurses is to satisfy the patients’ spiritual needs. METHODS: This is a qualitative study with hermeneutic phenomenological approach. Data were collected from 16 patients hospitalized in internal medicine-surgery wards and 6 nurses in the respective wards. Data were generated by open-ended interview and analyzed using Diekelmann's seven-stage method. Rigorousness of findings was confirmed by use of this method as well as team interpretation, and referring to the text and participants. RESULTS: In final interpretation of the findings, totally 10 sub-themes, three themes including formation of mutual relation with patient, encouraging the patient, and providing the necessary conditions for patient's connection with God, and one constitutive pattern, namely spiritual need of hospitalized patients. CONCLUSIONS: Spiritual needs are those needs whose satisfaction causes the person's spiritual growth and make the person a social, hopeful individual who always thanks God. They include the need for communication with others, communication with God, and being hopeful. In this study, the three obtained themes are the spiritual needs whose satisfaction is possible in nursing system. Considering these spiritual aspects accelerates patient's treatment. PMID:22039390

  18. [Orthodontics for mentally handicapped patients].

    PubMed

    Remmelink, H J

    2006-12-01

    The mentally handicapped exhibit a 3 times higher incidence of malocclusions and related functional problems than the general population. In contrast there is little available literature relating to the orthodontic treatment of handicapped patients. Based on published articles on orthodontic treatment of disabled patients the following recommendations can be given. First of all for each patient a 'problem list' should be drawn up, based on the diagnosis. In this list the orthodontic problems are formulated. Additionally, the list makes clear who is responsible for providing services related to orthodontic care, such as oral hygiene and transportation of the patient to the orthodontist. When deciding whether or not orthodontic treatment should be administered to a patient with a mental handicap the same functional and aesthetic considerations as with any other orthodontic case must be taken into account. Furthermore, the severity of the handicap and possible associated psychosocial and medical limitations as well as the extent to which it will be possible to treat the patient have to be considered. Contraindications are a severe mental handicap, inability to remain still in the dental chair, insufficient co-operation of parents/carers, open bite resulting from abnormal oral function, and a mild malocclusion. The orthodontic treatment should aim for an acceptable result, and not for orthodontic perfection.

  19. Toothbrush pressures of orthodontic patients.

    PubMed

    White, L

    1983-02-01

    The intention of this study was to determine whether toothbrushing pressures varied significantly between groups of orthodontic patients who were good toothbrushers and those who were poor toothbrushers. Seventy-two patients undergoing full-banded orthodontic treatment were selected from the author's practice and were subjectively paired by him according to their habitual oral hygiene. One group of thirty-six patients who habitually displayed poor oral hygiene was compared to a group of thirty-six patients who habitually displayed good oral hygiene. A specially designed strain gauge with a force-averaging feedback mechanism was attached to each patient's manual toothbrush, and the force with which that patient brushed was averaged and recorded in pounds. The poor brushers averaged 0.20 pound, whereas the average pressure of the good brushers was 0.89 pound. The statistical evidence indicates that the difference between the two groups is highly significant and is unlikely to be due to chance alone. This study has shown that toothbrush pressures can be easily and accurately measured. The attempt to objectify a single characteristic of toothbrushing behavior in an orthodontic population is an effort to avoid the medical model explanation of behavior vis-a-vis the nonspecific and subjective word attitude. Future studies will determine whether poor toothbrushers can be changed into good toothbrushers through the progressive acquisition of greater toothbrushing forces.

  20. 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

  1. Peripapillary Retinoschisis in Glaucoma Patients

    PubMed Central

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

    2016-01-01

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

  2. [GASTRIC CANCER IN YOUNG PATIENTS

    PubMed

    Quispe, Dolly; Ruiz, Eloy; Celis, Juan; Berrospi, Francisco; Payet, Eduardo

    2000-01-01

    OBJECTIVE: In order to determine a the clinicopatological features in young patients with gastric cancer and compare them with aged patients.PATIENTS AND METHODS: For this study, we selected the clinical charts from the total of patients with histological proved diagnosis of gastric adenocarcinoma admitted at the INEN between 1980 and 1996 whose age was less than 31 year (Young group, n =92). As a comparison group (Average Group) we chose of the same universe, a random sample of 184 patients between 50 to 70 years of age. Epidemiological, clinical and histological features, operability and resecability, TNM stage, type of surgery and follow-up of both groups were analyzed.RESULTS: In the Young Group in compared with Average Group, females were more frequent (73.9% vs. 50.5% p<0.001); mucocelular type (70% vs. 31.0%, p<0.001) and undifferentiated carcinoma (75% vs. 32.6%, p>0.001). The mean survival time in the Young Group was 74.9 months and in the Average Group was 36.03 months (p=0.26), there were no significant differences in the survival between resecability and sex (p=0.10 and p=0.41).CONCLUSION: The females and undifferentiated carcinoma was the most frequent features in the young patients with gastric cancer. The survival in this group is better than the average group but this was a no significant difference because the diagnosis was made in late stages.

  3. Significance of Sonographically Demonstrated Ureteral Dilatation in Evaluation of Vesicoureteral Reflux Verified with Voiding Urosonography in Children with Urinary Tract Infection

    PubMed Central

    Carovac, Aladin; Zubovic, Sandra Vegar; Carovac, Marklena; Pasic, Irmina Sefic

    2015-01-01

    Objectives: The aim of this study was to determine sensitivity, specificity, and predictive values of sonographically demonstrated ureteral dilatation in detecting vesicoureteral reflux (VUR). Methods: Ethical approval from the Ethical Committee of Clinical Center University of Sarajevo and parental consent were obtained for this prospective study involving 120 children with history of urinary tract infections (UTIs). Ultrasound examination included the evaluation of the urinary tract, with a special emphasis on evaluation of ureteral dilatation. Voiding urosonography (VUS) was carried out according to a standard protocol with the use of ultrasound contrast agent Sono Vue of second generation. Ureteral diameter greater than 3 mm was considered pathological. Proven VUR was graded into one of three stages. Results: Infectio tracti urinarii recidivans was referral diagnosis in the majority of patients. The average age of patients was 4.33 ± 3.88 years (from 2 months to 16 years of age). VUS findings were normal in 59 (49.2%), and pathological in 61 (50.8%) patients. Statistical analysis showed significant correlation between type and grade of VUR. Our data confirmed predominance of VUR in females and in children under the age of 5. Statistically significant correlation between ureteral dilatation and the existence of VUR was found, with relatively high sensitivity (67.2%), specificity (81.4%), and high positive (78.8%) and negative predictive value (70.6%), total diagnostic accuracy of 74.2% in detecting VUR, and significantly increased probability (20 – 25%) of detecting VUR in patients with sonographically confirmed ureteral dilatation. Conclusion: Sonographically confirmed ureteral dilatation can be used as a predictor of VUR in children with UTIs, and in combination with other predictors, might find a place in an evidence-based selective strategy in children with suspected VUR. PMID:26635432

  4. Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine.

    PubMed

    Landewé, R; Dougados, M; Mielants, H; van der Tempel, H; van der Heijde, D

    2009-06-01

    To study the relationship between disease activity, radiographic damage and physical function in patients with ankylosing spondylitis (AS) PATIENTS AND METHODS: Baseline and 2-year data of the Outcome in Ankylosing Spondylitis International Study (OASIS)(217 patients) were used. Physical function was expressed by the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI); disease activity by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and by erythrocyte sedimentation rate and C-reactive protein; and structural damage by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Syndesmophyte- and non-syndesmophyte sum cores, and numbers of affected (bridged) vertebral units were derived from the mSASSS. Univariate correlations were calculated on baseline values using the Spearman rank correlation. Multivariate associations were investigated by generalised estimating equations (GEE) on baseline and 2-year data. mSASSS correlated moderately well with BASFI (Spearman's r = 0.45) and DFI (r = 0.38). BASDAI correlated well with BASFI (r = 0.66) and DFI (r = 0.59). Correlation coefficients for mSASSS versus BASFI and DFI decreased by increasing levels of BASDAI, being zero at the highest quintile of BASDAI. GEE showed that both BASDAI and mSASSS independently and significantly helped to explain either BASFI or DFI. Results were similar for syndesmophyte sum score, non-syndesmophyte sum score, number of affected VUs or number of VUs with bridging. The lumbar part of the mSASSS contributed similarly to the cervical part in explaining BASFI/DFI. Physical function impairment in AS is independently caused by patient-reported disease activity and the level of structural damage of the lumbar and cervical spine. Syndesmophytes and other radiographic abnormalities contribute to physical function impairment.

  5. Patients assessing students' assignments; making the patient experience real.

    PubMed

    Munro, Jane; Whyte, Fiona; Stewart, Jim; Letters, Andrew

    2012-02-01

    The care of patients with inflammatory bowel disease (IBD) frequently falls short of the highest standards. This is noted in several publications, including national standards, despite nursing students being taught the importance of listening to and understanding patients. Teaching staff at the University of Glasgow primarily responsible for teaching third year undergraduate nursing students undertook a radical rethink of the planning, delivery and assessment of lectures on IBD. The subject had previously been delivered in a modified lecture format. Although the topic could be included in the end-of-year exams, there was little evidence to show whether this traditional teaching method had any effect on students' clinical practice. In a novel approach to learning and assessment, students were invited to research and produce an information leaflet for newly diagnosed patients with IBD. The leaflets were then assessed and grades awarded by an expert panel of patients and carers. Such enquiry based learning (EBL) intended to demonstrate in practice, the key role patients can play in both undergraduate nurse education and in service planning and delivery in the National Health Service (NHS). The panel found the exercise both interesting and insightful, while the students reported being invigorated and felt the expert assessment meant they were forced to achieve a higher level of work. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. A Patient Safety Dilemma: Obesity in the Surgical Patient.

    PubMed

    Goode, Victoria; Phillips, Elayne; DeGuzman, Pamela; Hinton, Ivora; Rovnyak, Virginia; Scully, Kenneth; Merwin, Elizabeth

    2016-12-01

    Patient safety and the delivery of quality care are major concerns for healthcare in the United States. Special populations (eg, obese patients) need study in order to support patient safety, quantify risks, advance education for healthcare-workers, and establish healthcare policy. Obesity is a complex chronic disease and is considered the second leading cause of preventable death in the United States with approximately 300,000 deaths per year. Obesity is recognized by the Agency for Healthcare Research and Quality (AHRQ) as a comorbid condition. These concerns emphasize the need to focus further research on the obese patient. Through the use of clinical and administrative data, this study examines the incidence of adverse outcomes in the obese surgical population through AHRQ Patient Safety Indicators (PSI) and allows for the engagement PSIs as measures to guide and improve performance. In this study, the surgical population was overwhelmingly positive for obesity. Body mass index (BMI) was also a significant positive predictor for 2 of 3 postoperative outcomes. This finding suggests that as BMI reaches the classification of obesity, the risk of these adverse outcomes increases. It further suggests there exists a threshold BMI that requires anticipation of alterations to systems and processes to revise outcomes. Copyright© by the American Association of Nurse Anesthetists.

  7. 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.

  8. [Nutritional support in stroke patients].

    PubMed

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

    2014-01-01

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

  9. 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

  10. [Enteral nutrition in burn patients].

    PubMed

    Pereira, J L; Garrido, M; Gómez-Cía, T; Serrera, J L; Franco, A; Pumar, A; Relimpio, F; Astorga, R; García-Luna, P P

    1992-01-01

    Nutritional support plays an important role in the treatment of patients with burns. Due to the severe hypercatabolism that develops in these patients, oral support is insufficient in most cases, and this makes it essential to initiate artificial nutritional support (either enteral or parenteral). Enteral nutrition is more physiological than parenteral, and data exist which show that in patients with burns, enteral nutrition exercises a protective effect on the intestine and may even reduce the hypermetabolic response in these patients. The purpose of the study was to evaluate the effectiveness and tolerance of enteral nutritional support with a hypercaloric, hyperproteic diet with a high content of branched amino acids in the nutritional support of patients suffering from burns. The study included 12 patients (8 males and 4 females), admitted to the Burns Unit. Average age was 35 +/- 17 years (range: 21-85 years). The percentage of body surface affected by the burns was 10% in two cases, between 10-30% in three cases, between 30-50% in five cases and over 50% in two cases. Initiation of the enteral nutrition was between twenty-four hours and seven days after the burn. The patients were kept in the unit until they were discharged, and the average time spent in the unit was 31.5 days (range: 17-63 days). Total energetic requirements were calculated based on Harris-Benedict, with a variable aggression factor depending on the body surface burned, which varied from 2,000 and 4,000 cal day. Nitrogenous balance was determined on a daily basis, and plasmatic levels of total proteins, albumin and prealbumin on a weekly basis. There was a significant difference between the prealbumin values at the initiation and finalization of the enteral nutrition (9.6 +/- 2.24 mg/dl compared with 19.75 +/- 5.48 mg/dl; p < 0.001). The nitrogenous balance improved, changing from -5.4 in the second week to positive values by the fourth and fifth weeks of treatment. Tolerance to the enteral

  11. 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.

  12. [Depressive disorders in diabetic patients].

    PubMed

    Manoudi, F; Chagh, R; Benhima, I; Asri, F; Diouri, A; Tazi, I

    2012-10-01

    Diabetes is a public health problem. Its global prevalence was 2.8% in 2000 and it will reach 4.4% in 2030 to be 366 million diabetics. In Morocco, this true "epidemic" affects 6.6% of the population. Many epidemiologic studies have shown that patients with diabetes are more susceptible to depression. Diabetes and depression align in a non-accidental way and complicate one another. We report a cross-sectional study conducted in association with the endocrinology department of the Mohammed VI university hospital during the period spread between April and September 2006. The aim was to evaluate the prevalence of depressive disorders in patients with diabetes and to describe their sociodemographic and clinical profile. The study included 187 patients. The scales used were the Mini International Neuropsychiatric Interview (MINI) and Hamilton's depression. Sociodemographics and diabetic characteristics were evaluated by self-questionnaire. The average age of our patients was 53±14 years and the percentage of females was high: 71.2%. Diabetes type 2 was the most representative (85.6%), diabetes type 1 (11.8%) and gestational diabetes (2.7%). Half of diabetics were treated with an association of healthy dietary measures (MHD) and oral anti-diabetics; 31.6% were under MHD and insulin therapy; 33.2% of patients had acute complications and 43.5% had degenerative complications. Only 11 patients (5.9%) had antecedents of depression. The prevalence of major depressive episode was 41.2%; 27.8% of patients suffered from dysthymia and 21.9% from double depression. Hamilton's depression scale indicates that all depressed patients had mild depression (total of 17 items from 8 to 17). Major depressive episode and dysthymia were frequent in out patients. Dysthymia was predominant in diabetic patients in the 46 to 55 years age group, never been schooled and without any comorbidity. The vast majority of patients with EDM had type 2 diabetes with 89.6%, 7.8% type 1 diabetes and 2

  13. 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

  14. 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.

  15. Survival of Sami cancer patients.

    PubMed

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

    2012-07-02

    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. 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. 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. 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. Long distances to medical care or Sami ethnicity have no influence on the cancer patient survival in Northern Finland.

  16. Survival of Sami cancer patients.

    PubMed

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

    2012-01-01

    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. 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. 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. 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. Long distances to medical care or Sami ethnicity have no influence on the cancer patient survival in Northern Finland.

  17. Insomnia in Patients with COPD

    PubMed Central

    Budhiraja, Rohit; Parthasarathy, Sairam; Budhiraja, Pooja; Habib, Michael P.; Wendel, Christopher; Quan, Stuart F.

    2012-01-01

    Study Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be associated with sleep disturbances. However, the correlates of insomnia in COPD patients have not been well characterized. The aim of the current study was to describe the prevalence of insomnia disorder in COPD and to elucidate the demographic and clinical characteristics of COPD patients that are associated with insomnia. Design: Cross-sectional study. Setting: Clinic-based sample from an academic hospital. Participants: Patients with stable COPD. Measurements: An interviewer-conducted survey was administered to 183 participants with COPD. Seventy-two of these participants (30 with and 42 without insomnia) maintained a sleep diary and underwent actigraphy for 7 days. Results: Insomnia (chronic sleep disturbance associated with impaired daytime functioning) was present in 27.3% of participants. Current tobacco users (odds ratio (OR), 2.13) and those with frequent sadness/anxiety (OR, 3.57) had higher odds, but oxygen use was associated with lower odds (OR, 0.35) of insomnia. Patients with insomnia had worse quality of life and a higher prevalence of daytime sleepiness. Actigraphy revealed shorter sleep duration and lower sleep efficiency, and a sleep diary revealed worse self-reported sleep quality in participants with insomnia. Conclusion: Insomnia disorder is highly prevalent in patients with COPD; current tobacco use and sadness/anxiety are associated with a higher prevalence, and oxygen use with a lower prevalence of insomnia; patients with insomnia have poorer quality of life and increased daytime sleepiness; and insomnia is associated with worse objective sleep quality. Citation: Budhiraja R; Parthasarathy S; Budhiraja P; Habib MP; Wendel C; Quan SF. Insomnia in patients with COPD. SLEEP 2012;35(3):369-375. PMID:22379243

  18. Patient Informatics: Technology in the Service of Patient Care

    PubMed Central

    Brennan, Patricia Flatley

    1990-01-01

    Care of the patient at home challenges the health care system with both the quantity and diversity of services required. Informatics technologies may provide mechanisms to relieve the burden of traditional services while meeting the unique needs of home-based patients in a timely and effective manner. Capitalizing on an existing, free, public-access computer network we developed the COMPUTERLINK, a set of utilities designed to provide home-care support to persons living with AIDS/ARC (PLWA) in the community. The pilot study presented here we demonstrate the feasibility of using home-based computer networks to provide information, communication and decision assistance to PLWA. The success experienced with this particular group provides sufficient encouragement to extend this intervention to other groups of community-based patients.

  19. Research without informed patient consent in incompetent patients.

    PubMed

    Dobb, G J

    2015-05-01

    Most patients needing intensive care cannot give informed consent to participation in research. This includes the most acutely and severely ill, with the highest mortality and morbidity where research has the greatest potential to improve patient outcomes. In these circumstances consent is usually sought from a substitute decision maker, but while survivors of intensive care believe substitute decision makers will look after their interests, evidence suggests substitute decision makers are poorly equipped for this task. Various models have been suggested for research without patient informed consent when intervention is urgent and cannot wait until first person consent is possible, including a waiver of consent if conditions are met. A nationally consistent model is proposed for Australia with a robust process for initial waiver of consent followed by first person consent to further research-related procedures or ongoing follow-up when this can be competently provided.

  20. [Tracheotomy in brain injured patients: which patients? Why? When? How?].

    PubMed

    Richard, I; Hamon, M-A; Ferrapie, A-L; Rome, J; Brunel, P; Mathé, J-F

    2005-06-01

    The aim of this study is to determine, from the data available in the literature, the indications of tracheostomy in brain injured patients, the incidence and risk factors for complications and the follow-up required until decannulation. The incidence of tracheostomy is 10% in TBI and 50 to 70% in subpopulations with a Glasgow Coma Scale (GCS) below 9. Early complications are not specific. The most frequent late complication is laryngotracheal stenosis, which occurs in 15% and is more frequently observed in the most severe patients with major hypertonia. It is likely that tracheostomy, if needed, should be performed early and the prognosis as to whether it will be required, can be made at the end of the first week. The follow-up of these patients includes surveillance of multiresistant colonisations and systematic performance of fibroscopy before decannulation. Cuffless, small diameters, soft tracheostomy tubes, are preferred on the long-term unless the risk of aspiration remains high.

  1. Incorporating the Patient into Urologic Cancer Research.

    PubMed

    Gore, John L

    2017-09-01

    Patient engagement in research has been increasingly prioritized by funders and adopted by health researchers. In this Seminars issue, we explore several different mechanisms of engagement in the reciprocal relationship between patients and researchers. This includes the generation of understandable patient health information, how patients engage in treatment decision-making for urologic cancers, patient involvement in the development of research ideas and research design, and patient engagement in their personalized survivorship care. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. [Patients' decision for aesthetic surgery].

    PubMed

    Fansa, H; Haller, S

    2011-12-01

    Aesthetic surgery is a service which entails a high degree of trust. Service evaluation prior to provision is difficult for the patient. This leads to the question of how to manage the service successfully while still focusing on the medical needs. The decision to undergo an operation is not influenced by the operation itself, but by preoperative events which induce the patient to have the operation done. According to "buying decisions" for products or in service management, the decision for an aesthetic operation is extensive; the patient is highly involved and actively searching for information using different directed sources of information. The real "buying decision" consists of 5 phases: problem recognition, gathering of information, alternative education, purchase decision, and post purchase behaviour. A retrospective survey of 40 female patients who have already undergone an aesthetic operation assessed for problem recognition, which types of information were collected prior to the appointment with the surgeon, and why the patients have had the operation at our hospital. They were also asked how many alternative surgeons they had been seen before. Most of the patients had been thinking about undergoing an operation for several years. They mainly used the web for their research and were informed by other (non-aesthetic) physicians/general practitioners. Requested information was about the aesthetic results and possible problems and complications. Patients came based on web information and because of recommendations from other physicians. 60% of all interviewees did not see another surgeon and decided to have the operation because of positive patient-doctor communication and the surgeon's good reputation. Competence was considered to be the most important quality of the surgeon. However, the attribute was judged on subjective parameters. Environment, office rooms and staff were assessed as important but not very important. Costs of surgery were ranked second

  3. Prescribing and partnership with patients

    PubMed Central

    Bond, Christine; Blenkinsopp, Alison; Raynor, David K

    2012-01-01

    There have been widespread changes in society and the roles of professionals. This change is also reflected in health care, where there is now acceptance of the need to involve patients in decision making. In prescribing specifically, the concordance agenda was developed alongside these initiatives to encourage improved medication taking and reduce wastage. However the extent to which these partnerships are delivered in practice remains unclear. This paper explores some of the issues to be considered when preparing patients and professionals for partnership and summarizes the limited evidence of barriers to, and benefits of, this approach. Firstly patients must be given the confidence, skills and knowledge to be partners. They need information about medicines, provided in ways known to be acceptable to them. Likewise professionals may need new skills to be partners. They need to understand the patient agenda and may need training and support to change the ways in which they consult with patients. There are also practical issues such as the perceived increase in time taken when consulting in partnership mode, room layout, computer interfaces and record keeping. Health care professionals other than doctors are also expected to behave in partnership mode, whether this is as prescribers in their own right or in supporting the prescribing of others. Whilst much has been claimed for the benefit of partnership approaches, hard evidence is limited. However whilst there is still much more to understand there will be no going back to the paternalistic model of the mid 20th century. PMID:22621201

  4. Patient blood management in Europe

    PubMed Central

    Shander, A.; Van Aken, H.; Colomina, M. J.; Gombotz, H.; Hofmann, A.; Krauspe, R.; Lasocki, S.; Richards, T.; Slappendel, R.; Spahn, D. R.

    2012-01-01

    Summary Preoperative anaemia is common in patients undergoing orthopaedic and other major surgery. Anaemia is associated with increased risks of postoperative mortality and morbidity, infectious complications, prolonged hospitalization, and a greater likelihood of allogeneic red blood cell (RBC) transfusion. Evidence of the clinical and economic disadvantages of RBC transfusion in treating perioperative anaemia has prompted recommendations for its restriction and a growing interest in approaches that rely on patients' own (rather than donor) blood. These approaches are collectively termed ‘patient blood management’ (PBM). PBM involves the use of multidisciplinary, multimodal, individualized strategies to minimize RBC transfusion with the ultimate goal of improving patient outcomes. PBM relies on approaches (pillars) that detect and treat perioperative anaemia and reduce surgical blood loss and perioperative coagulopathy to harness and optimize physiological tolerance of anaemia. After the recent resolution 63.12 of the World Health Assembly, the implementation of PBM is encouraged in all WHO member states. This new standard of care is now established in some centres in the USA and Austria, in Western Australia, and nationally in the Netherlands. However, there is a pressing need for European healthcare providers to integrate PBM strategies into routine care for patients undergoing orthopaedic and other types of surgery in order to reduce the use of unnecessary transfusions and improve the quality of care. After reviewing current PBM practices in Europe, this article offers recommendations supporting its wider implementation, focusing on anaemia management, the first of the three pillars of PBM. PMID:22628393

  5. Conditional Reasoning in Schizophrenic Patients.

    PubMed

    Kornreich, Charles; Delle-Vigne, Dyna; Brevers, Damien; Tecco, Juan; Campanella, Salvatore; Noël, Xavier; Verbanck, Paul; Ermer, Elsa

    2017-01-01

    Conditional reasoning (if p then q) is used very frequently in everyday situations. Conditional reasoning is impaired in brain-lesion patients, psychopathy, alcoholism, and polydrug dependence. Many neurocognitive deficits have also been described in schizophrenia. We assessed conditional reasoning in 25 patients with schizophrenia, 25 depressive patients, and 25 controls, using the Wason selection task in three different domains: social contracts, precautionary rules, and descriptive rules. Control measures included depression, anxiety, and severity of schizophrenia measures as a Verbal Intelligence Scale. Patients with schizophrenia were significantly impaired on all conditional reasoning tasks compared to depressives and controls. However, the social contract and precautions tasks yielded better results than the descriptive tasks. Differences between groups disappeared for social contract but remained for precautions and descriptive tasks when verbal intelligence was used as a covariate. These results suggest that domain-specific reasoning mechanisms, proposed by evolutionary psychologists, are relatively resilient in the face of brain network disruptions that impair more general reasoning abilities. Nevertheless, patients with schizophrenia could encounter difficulties understanding precaution rules and social contracts in real-life situations resulting in unwise risk-taking and misunderstandings in the social world.

  6. Verbal hallucinations in psychotic patients.

    PubMed

    Ettinger, B; Telerand, A; Kronenberg, Y; Gaoni, B

    1991-01-01

    "Verbal hallucinations" are sentences that psychotic patients may say repeatedly throughout a conversation which are out of context or unconnected to the topic of conversation. These hallucinations are not the outcome of a remembrance of an experience or an event and do not bring about any emotional relief or catharsis, but they supply valuable information. They resemble Jacques Lacan's description of the psychotic mechanism "Forclusion." This mechanism relates to experiences that did not undergo the process of primary symbolization through language, and experiences where words were attached but were not bound to the language structure. The result being that these experiences did not enter into the unconscious discourse of the subject. This information can reappear as verbal hallucinations in the psychotic patient. In such cases, the therapist, with the assistance of the patient's family, must investigate the meaning of the verbal hallucinations through research into the patient's and family's history in the phase prior to language development. When such a connection is discovered, the therapist must then bridge the hallucinations with the events unknown to the patient but contained in his subconscious. The therapist's role in such cases resembles that of a parent with a child: To translate the subject's experience through language from the physical schema to the body image and symbolic plane and in so doing, give meaning to meaninglessness. In our paper three short clinical cases are presented.

  7. Care models for polypathological patients.

    PubMed

    Fernández Moyano, A; Machín Lázaro, J M; Martín Escalante, M D; Aller Hernandez, M B; Vallejo Maroto, I

    Polypathological patients have specific clinical, functional, psychoaffective, social, family and spiritual characteristics. These patients are generally elderly and frail and have frequent decompensations. They frequently use healthcare resources, have significant functional impairment and have a high index of dependence. This results in a significant social impact, high mortality and a high consumption of resources. The current healthcare models have not answered these needs, which causes problems with accessibility to healthcare services, a lack of coordination among these services, a higher probability of adverse events related to polypharmacy and a high consumption of resources. In the past decade, the healthcare models have changed and are characterized by work in multidisciplinary and interlevel teams, patient self-care, the availability of tools for decision making, information and communication systems and prevention. The goal is to have prepared and proactive health teams and an informed and active patient population. The assessment of health results, processes and the costs for these programs is still based on moderate to low evidence. It is therefore not an easy task to determine the type and intensity of interventions or to determine the patient groups that could gain more benefits. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Patient adherence to allergy immunotherapy.

    PubMed

    Reisacher, William R; Visaya, Jiovani M

    2013-06-01

    This article reviews the literature on patient adherence to two different approaches to allergen-specific immunotherapy for allergic disease. Factors related to adherence in general, as well as the various methods used to measure adherence, will be discussed. Although a complex interaction of factors related to both the physician and the patient influence the adherence to a particular therapeutic regimen, effective communication between these two parties and the simplicity of the regimen are frequently noted to be of primary importance. Variability with respect to the definition of adherence, the method of measuring adherence, and the length of the measuring period has resulted in a wide range of adherence rates to allergy immunotherapy reported in the literature. Patients most often site inconvenience, side-effects, and poor efficacy as reasons for discontinuing allergy immunotherapy. Adherence to therapy not only improves individual patient outcomes, but also helps determine the best treatment modalities and reduces the burden of disease on society. As new methods of delivering immunotherapy are being developed, such as allergy immunotherapy tablets and oral mucosal immunotherapy, the factors associated with patient adherence should be carefully considered.

  9. Immunoglobulin levels of vitiligo patients.

    PubMed

    Ali, Rubaiya; Ahsan, Mohammad Shamsul; Azad, Mohammad Abul Kalam; Ullah, Md Ashik; Bari, Wasimul; Islam, Sheikh Nazrul; Yeasmin, Sabina; Hasnat, Abul

    2010-01-01

    In the present study, the serum immunoglobulin profiles of vitiligo patients were compared with that of cohort control and evaluated the correlation between immunoglobulin level with their socioeconomic factors and nutritional status. Thirty vitiligo patients were recruited randomly from the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh for this study. Thirty healthy individuals as control group matched by age, sex, education and socioeconomic factors to the patient group were selected. Serum immunoglobulin concentrations were determined by turbidimetry method using immunoglobulin kit. The concentration of IgG and IgA decreased significantly (P<0.05), but the change of IgM was not significant. Socioeconomic data revealed that most of the patients were young and female. Moreover statistical analysis revealed that there was significant correlation between immunoglobulin (IgG and IgA only) concentrations and BMI and number of depigmented patches with IgG concentrations. Finally it can be concluded that the change of serum immunoglobulin concentration in vitiligo patients could be due to the disease condition as pathomechanism suggested the aberrations in cellular immunity. But study with larger number of population is required for further evaluation of the relationship between the immune response and disease state to confirm these findings.

  10. [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.

  11. 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).

  12. OPSI threat in hematological patients

    PubMed Central

    Serio, B; Pezzullo, L; Giudice, V; Fontana, R; Annunziata, S; Ferrara, I; Rosamilio, R; De Luca, C; Rocco, M; Montuori, N; Selleri, C

    Overwhelming post-splenectomy infection (OPSI) is a rare medical emergency, mainly caused by encapsulated bacteria, shortly progressing from a mild flu-like syndrome to a fulminant, potentially fatal, sepsis. The risk of OPSI is higher in children and in patients with underlying benign or malignant hematological disorders. We retrospectively assessed OPSI magnitude in a high risk cohort of 162 adult splenectomized patients with malignant (19%) and non malignant (81%) hematological diseases, over a 25-year period: 59 of them splenectomized after immunization against encapsulated bacteria, and 103, splenectomized in the previous 12-year study, receiving only life-long oral penicillin prophylaxis. The influence of splenectomy on the immune system, as well as the incidence, diagnosis, risk factors, preventive measures and management of OPSI are also outlined. OPSI occurred in 7 patients (4%) with a median age of 37 years at time interval from splenectomy ranging from 10 days to 12 years. All OPSIs occurred in non immunized patients, except one fatal Staphylococcus aureus -mediated OPSI in a patient adequately immunized before splenectomy. Our analysis further provides evidence that OPSI is a lifelong risk and that current immune prophylaxis significantly decreases OPSI development. Improvement in patients’ education about long-term risk of OPSI and increased physician awareness to face a potentially lethal medical emergency, according to the current surviving sepsis guidelines, represent mandatory strategies for preventing and managing OPSI appropriately. PMID:24251241

  13. 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.

  14. [Nutrition therapy of cancer patients].

    PubMed

    Lövey, József

    2017-09-20

    The majority of cancer patients becomes malnourished during the course of their disease. Malnutrition deteriorates the efficiency of all kinds of oncologic interventions. As a consequence of it, treatment-related toxicity increases, hospital stay is lengthened, chances of cure and survival as well as the quality of life of the patients worsen. Nutritional status therefore influences all aspects of outcome of oncology care. In spite of this the use of nutritional therapy varies across health care providers but its application is far from being sufficient during active oncology interventions as well as rehabilitation and supportive care. It threatens not only the outcome and quality of life of cancer patients but also the success of oncologic treatments which often demand high input of human and financial resources. Meanwhile application of nutritional therapy is legally regulated in Hungary and a very recent update of the European guideline on cancer patient nutrition published in 2017 is available. Moreover, cost effectiveness of nutritional therapy has been proven in a number of studies. In this review we present the basics of nutritional therapy including nutritional screening and evaluation, nutritional plan, the role of nutrition support teams, oral, enteral and parenteral nutrition, the use of different drugs and special nutrients and the follow-up of the patients.

  15. Prognosis of mechanically ventilated patients.

    PubMed Central

    Papadakis, M A; Lee, K K; Browner, W S; Kent, D L; Matchar, D B; Kagawa, M K; Hallenbeck, J; Lee, D; Onishi, R; Charles, G

    1993-01-01

    In this Department of Veterans Affairs cooperative study, we examined predictors of in-hospital and 1-year mortality of 612 mechanically ventilated patients from 6 medical intensive care units in a retrospective cohort design. The outcome variable was vital status at hospital discharge and after 1 year. The results showed that 97% of patients were men, the mean age was 63 +/- 11 years (SD), and hospital mortality was 64% (95% confidence interval, 60% to 68%). Within the next year, an additional 38% of hospital survivors died, for a total 1-year mortality of 77% (95% confidence interval, 73% to 80%). Hospital and 1-year mortality, respectively, for patients older than 70 years was 76% and 94%, for those with serum albumin levels below 20 grams per liter it was 92% and 96%, for those with an Acute Physiology and Chronic Health Evaluation II (APACHE II) score greater than 35 it was 91% and 98%, and for patients who were being mechanically ventilated after cardiopulmonary resuscitation it was 86% and 90%. The mortality ratio (actual mortality versus APACHE II-predicted mortality) was 1.15. Conclusions are that patient age, APACHE II score, serum albumin levels, or the use of cardiopulmonary resuscitation may identify a subset of mechanically ventilated veterans for whom mechanical ventilation provides little or no benefit. PMID:8128673

  16. Aztreonam pharmacokinetics in burn patients.

    PubMed Central

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

    1991-01-01

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

  17. Therapeutic inferences for individual patients.

    PubMed

    Flores, Luis

    2015-06-01

    Increased awareness of the gap between controlled research and medical practice has raised concerns over whether the special attention of doctors to probability estimates from clinical trials really improves the care of individuals. Evidence-based medicine has acknowledged that research results are not applicable to all kinds of patients, and consequently, has attempted to overcome this limitation by introducing improvements in the design and analysis of clinical trials. A clinical case is used to highlight the premises required to support reasonable extrapolations from controlled research to individuals. Then, the prospects of two key methodological improvements - pragmatic randomized controlled trials and subgroup analysis - are critically appraised. A principle to guide therapeutic inferences is suggested. According to this principle, the probabilities of interest for purposes of therapeutic decision making are those of the set defined by everything that is relevant to the patient and the outcome of interest at the time of the decision. It is argued that the conditions necessary to authorize automatic extrapolations of research results to specific patients are highly demanding. Furthermore, these requirements are rarely accomplished in real practice, even in the event that probability estimates come from samples generally taken as representative and are derived from specific subsets of patients. Clinicians should generally avoid unreflective extrapolations from research and address, as explicitly as possible, the challenge of estimating probabilities for individual patients. A key element of this task is the integration of data from research and non-research sources. © 2014 John Wiley & Sons, Ltd.

  18. Patient involvement. The Derby Theatre Project experience.

    PubMed

    Ainsworth, David

    2003-12-01

    Patient involvement adds power and value to service redesign. Patient views can be extremely powerful when influencing clinical staff. They also provide a strong management case for change. Patient choice should be built into any service redesign. A model for improvement should form a template that can be amended to suit patient need and should take account of patient views. Patient views should be objective. Patients can give a better opinion of how services should be shaped when given a choice of what could be done. A model should offer different routes along a journey so that patients can say what they would prefer to happen.

  19. PATIENT-REPORTED OUTCOMES (PROs): PUTTING THE PATIENT PERSPECTIVE IN PATIENT-CENTERED OUTCOMES RESEARCH

    PubMed Central

    Snyder, Claire F.; Jensen, Roxanne E.; Segal, Jodi B.; Wu, Albert W.

    2013-01-01

    Patient-centered outcomes research (PCOR) aims to improve care quality and patient outcomes by providing information that patients, clinicians, and family members need regarding treatment alternatives, and emphasizing patient input to inform the research process. PCOR capitalizes on available data sources and generates new evidence to provide timely and relevant information and can be conducted using prospective data collection, disease registries, electronic medical records, aggregated results from prior research, and administrative claims. Given PCOR’s emphasis on the patient perspective, methods to incorporate patient-reported outcomes (PROs) are critical. PROs are defined by the U.S. Food & Drug Administration as “Any report coming directly from patients… about a health condition and its treatment.” However, PROs have not routinely been collected in a way that facilitates their use in PCOR. Electronic medical records, disease registries, and administrative data have only rarely collected, or been linked to, PROs. Recent technological developments facilitate the electronic collection of PROs and linkage of PRO data, offering new opportunities for putting the patient perspective in PCOR. This paper describes the importance of and methods for using PROs for PCOR. We (1) define PROs; (2) identify how PROs can be used in PCOR, and the critical role of electronic data methods for facilitating the use of PRO data in PCOR; (3) outline the challenges and key unanswered questions that need to be addressed for the routine use of PROs in PCOR; and (4) discuss policy and research interventions to accelerate the integration of PROs with clinical data. PMID:23774513

  20. Antibiotic resistance in cancer patients.

    PubMed

    Gudiol, Carlota; Carratalà, Jordi

    2014-08-01

    Bacterial infection is one of the most frequent complications in cancer patients and hematopoietic stem cell transplant recipients. In recent years, the emergence of antimicrobial resistance has become a significant problem worldwide, and cancer patients are among those affected. Treatment of infections due to multidrug-resistant (MDR) bacteria represents a clinical challenge, especially in the case of Gram-negative bacilli, since the therapeutic options are often very limited. As the antibiotics active against MDR bacteria present several disadvantages (limited clinical experience, higher incidence of adverse effects, and less knowledge of the pharmacokinetics of the drug), a thorough acquaintance with the main characteristics of these drugs is mandatory in order to provide safe treatment to cancer patients with MDR bacterial infections. Nevertheless, the implementation of antibiotic stewardship programs and infection control measures is the cornerstone for controlling the development and spread of these MDR pathogens.

  1. Polyneuropathy in critically ill patients.

    PubMed Central

    Bolton, C F; Gilbert, J J; Hahn, A F; Sibbald, W J

    1984-01-01

    Five patients developed a severe motor and sensory polyneuropathy at the peak of critical illness (sepsis and multiorgan dysfunction complicating a variety of primary illnesses). Difficulties in weaning from the ventilator as the critical illness subsided and the development of flaccid and areflexic limbs were early clinical signs. However, electrophysiological studies, especially needle electrode examination of skeletal muscle, provided the definite evidence of polyneuropathy. The cause is uncertain, but the electrophysiological and morphological features indicate a primary axonal polyneuropathy with sparing of the central nervous system. Nutritional factors may have played a role, since the polyneuropathy improved in all five patients after total parenteral nutrition had been started, including the three patients who later died of unrelated causes. The features allow diagnosis during life, and encourage continued intensive management since recovery from the polyneuropathy may occur. Images PMID:6094735

  2. Liver Illness and Psychiatric Patients

    PubMed Central

    Carrier, Paul; Debette-Gratien, Marilyne; Girard, Murielle; Jacques, Jérémie; Nubukpo, Philippe; Loustaud-Ratti, Véronique

    2016-01-01

    Patients with psychiatric disorders are usually more exposed to multiple somatic illnesses, including liver diseases. Specific links are established between psychiatric disorders and alcohol hepatitis, hepatitis B, and hepatitis C in the population as a whole, and specifically in drug abusers. Metabolic syndrome criteria, and associated steatosis or non-alcoholic steato-hepatitis (NASH) are frequent in patients with chronic psychiatric disorders under psychotropic drugs, and should be screened. Some psychiatric medications, such as neuroleptics, mood stabilizers, and a few antidepressants, are often associated with drug-induced liver injury (DILI). In patients with advanced chronic liver diseases, the prescription of some specific psychiatric treatments should be avoided. Psychiatric disorders can be a limiting factor in the decision-making and following up for liver transplantation. PMID:28123443

  3. 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.

  4. Hypertension in patients with pheochromocytoma.

    PubMed

    Hanna, N N; Kenady, D E

    1999-12-01

    Adrenal-dependent hypertension syndromes are uncommon forms of hypertension. They include primary aldosteronism, pheochromocytoma, Cushing"s syndrome, and congenital adrenal hyperplasia. Pheochromocytomas are the cause of hypertension in 0.1% to 0.2% of hypertensive patients. Excess catecholamine release and other neural and humoral mechanisms contribute to the pathophysiology of hypertension. Patients with pheochromocytomas have a potentially curable cause of endocrine hypertension and, if undetected, pheochromocytomas confer a high risk for morbidity and mortality, especially during surgical procedures and pregnancy. All patients with incidental adrenal tumors, regardless of tumor size, should be biochemically screened for pheochromocytoma (especially before resection or needle biopsy) to avoid precipitation of a lethal hypertensive crisis.

  5. 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.

  6. Zinc supplementation in burn patients.

    PubMed

    Caldis-Coutris, Nancy; Gawaziuk, Justin P; Logsetty, Sarvesh

    2012-01-01

    Micronutrient supplementation is a common practice throughout many burn centers across North America; however, uncertainty pertaining to dose, duration, and side effects of such supplements persists. The authors prospectively collected data from 23 hospitalized patients with burn sizes ranging from 10 to 93% TBSA. Each patient received a daily multivitamin and mineral supplement, 50 mg zinc (Zn) daily, and 500 mg vitamin C twice daily. Supplements were administered orally or enterally. Albumin, prealbumin, C-reactive protein, serum Zn, and serum copper were measured weekly during hospital admission until levels were within normal reference range. Our study concluded that 50 mg daily dose of Zn resulted in normal serum levels in 19 of 23 patients at discharge; 50 mg Zn supplementation did not interfere with serum copper levels; and Zn supplements, regardless of administration route, did not result in gastrointestinal side effects.

  7. Gas gangrene in orthopaedic patients.

    PubMed

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

    2013-01-01

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

  8. Diagnostic patient studies in surgery

    SciTech Connect

    Sigel, B.

    1986-01-01

    The author's approach has been to present topics that relate to general as well as some specialty applications of patient studies. These topics include all major imaging modes in use today, the commoner endoscopic procedures, and function analyses applicable to most workups of the cardiac, genitourinary, respiratory, gastrointestinal, and neurologic systems. For most of the patient studies described in this book the author has selected procedures that a surgeon is more likely to request directly. Such procedures may be new or well established. This book aims to acquaint the surgeon with some new procedures and to summarize the current status of other test that might be required during the management of a surgical patient.

  9. 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

  10. Gas Gangrene in Orthopaedic Patients

    PubMed Central

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

    2013-01-01

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

  11. Lung cancer in elderly patients

    PubMed Central

    Diso, Daniele; Onorati, Ilaria; Anile, Marco; Mantovani, Sara; Rendina, Erino A.

    2016-01-01

    There is a worldwide-accepted evidence of a population shift toward older ages. This shift favors an increased risk of developing lung cancer that is primarily a disease of older populations. Decision making is extremely difficult in elderly patients, since this group is under-represented in clinical trials with only 25% of them historically opening to patients older than 65 years. For all these reasons, a “customized” preoperative assessment to identify physiological or pathological frailty should be encouraged since standard tools may be less reliable. The work already done to improve patient selection for lung surgery in the elderly population clearly shows that surgical resection seems the treatment of choice for early stage lung cancer. Further studies are required to improve outcome by reducing postoperative morbidity and mortality. PMID:27942414

  12. Patient specific physical anatomy models.

    PubMed

    Cameron, B M; Holmes, D R; Rettmann, M E; Robb, R A

    2008-01-01

    The advent of small footprint stereo-lithographic printers and the ready availability of segmentation and surface modeling software provide a unique opportunity to create patient-specific physical models of anatomy, validation of image guided intervention applications against phantoms that exhibit naturally occurring anatomic variation. Because these models can incorporate all structures relevant to a procedure, this allows validation to occur under realistic conditions using the same or similar techniques as would be used in a clinical application. This in turn reduces the number of trials and time spent performing in-vivo validation experiments. In this paper, we describe our general approach for the creation of both non-tissue and tissue-mimicking patient-specific models as part of a general-purpose patient emulation system used to validate image guided intervention applications.

  13. Evaluating the patient with fibromyalgia.

    PubMed

    Culpepper, Larry

    2010-09-01

    Once the physician has identified fibromyalgia as a potential diagnosis, further evaluation is warranted, both to understand the full dimensions of fibromyalgia and to evaluate other potential causes of the patient's symptoms. For example, mood disorders, sleep disorders, and daytime fatigue are often present in patients with fibromyalgia and often are closely related to pain. In addition, a number of physical conditions can mimic fibromyalgia and must be considered in the patient's evaluation. These include endocrine conditions, neurologic disorders, musculoskeletal diseases, and medication-related side effects. Taking a complete medical history and performing a thorough physical examination, including a complete laboratory assessment, can be very helpful in confirming the diagnosis or establishing an alternate diagnosis. © Copyright 2010 Physicians Postgraduate Press, Inc.

  14. Patient advocacy: the technologist's role.

    PubMed

    Church, Elizabeth J

    2004-01-01

    This article provides an overview of the various ways in which imaging professionals can demonstrate patient advocacy on a day-to-day basis and throughout their careers. Advocacy encompasses a wide range of attitudes and activities, and implementing its principles can bring new enthusiasm to the workplace and increase job satisfaction. After completing this article, readers will: Describe the fundamental aspects of advocacy. Know how to handle conflict and explain why conflict is necessary. Understand the challenges to advocacy. Apply patient advocacy in the context of diagnostic imaging. Recognize the radiologic technologist's important role in ensuring patient safety. Identify how professional codes and standards, as well as federal and state laws, encourage advocacy efforts.

  15. Candidemia in major burns patients.

    PubMed

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

    2016-06-01

    Major burn patients have characteristics that make them especially susceptible to candidemia, but few studies focused on this have been published. The objectives were to evaluate the epidemiological, microbiological and clinical aspects of candidemia in major burn patients, determining factors associated with a poorer prognosis and mortality. We conducted a retrospective observational study of candidemia between 1996 and 2012 in major burn patients admitted to the La Fe University Hospital, Valencia, Spain. The study included 36 episodes of candidemia in the same number of patients, 55.6% men, mean age 37.33 years and low associated comorbidity. The incidence of candidemia varied between 0.26 and 6.09 episodes/1000 days stay in the different years studied. Candida albicans was the most common species (61.1%) followed by Candida parapsilosis (27.8%). Candidemia by C. krusei, C. glabrata or C. tropicalis were all identified after 2004. Central vascular catheter (CVC) was established as a potential source of candidemia in 36.1%, followed by skin and soft tissues of thermal injury (22.2%) and urinary tract (8.3%). Fluconazole was used in 19 patients (52.7%) and its in vitro resistance rate was 13.9%. The overall mortality was 47.2%, and mortality related to candidemia was 30.6%. Factors associated with increased mortality were those related to severe infection and shock. CVC was the most usual focus of candidemia. Fluconazole was the most common antifungal drug administered. The management of candidemia in major burn patients is still a challenge. © 2016 Blackwell Verlag GmbH.

  16. Seizure Treatment in Transplant Patients

    PubMed Central

    Shepard, Paul W.

    2013-01-01

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

  17. Erectile dysfunction in psoriasis patients.

    PubMed

    Cabete, Joana; Torres, Tiago; Vilarinho, Tiago; Ferreira, Ana; Selores, Manuela

    2014-01-01

    An association between psoriasis and sexual dysfunction has been explored. However, not much is known about the factors behind erectile dysfunction in these patients. To compare the prevalence and the severity of erectile dysfunction in patients with and without psoriasis and to determine potential associations between erectile dysfunction and psoriasis patients' characteristics. An observational cross-sectional study was conducted at two tertiary hospital-based Dermatology departments. Consecutive adult men with psoriasis or other skin conditions were recruited. Data were collected using an anonymous, self-completed, designed questionnaire, which included the Dermatology Life Quality Index and the 5-item version of the International Index of Erectile Function. A total of 135 psoriasis patients and 201 controls were included. Psoriasis patients had a higher prevalence of erectile dysfunction than controls (61.5% vs 43.8%, p = 0.001), and an increased risk of more severe forms of erectile dysfunction. Dermatology Life Quality Index, genital psoriasis and psoriasis duration were not associated with the presence of erectile dysfunction. In multivariate logistic regression, psoriasis and diabetes were found to be independent risk factors for erectile dysfunction with estimated odds ratios of 2.28 (CI 95%, 1.40-3.27) and 3.49 (CI 95%, 1.40-8.66), respectively. This study suggests psoriasis as a risk factor for erectile dysfunction. Atherosclerosis is a plausible connecting link, adding up to the already acknowledged effect of psychological factors in these patients. From a clinical standpoint, because erectile dysfunction may precede overt cardiovascular disease, it can be used as a precocious marker of cardiovascular risk in psoriatic men.

  18. [Psychological adaptation in coronary patients].

    PubMed

    Egger, J

    1984-08-31

    Summarizing some essential results from empirical investigations about the individual adaptation and coping with coronary heart diseases five principles are formulated: It ist not possible to predict the individual reactions to a coronary disease from the knowledge of the pathophysiological aspects. The behaviour pattern of these patients are different and complex determined. The individual reactions to the outbreak of the disease equally depend on familial, occupational, social and public health care factors on one side and on intrapsychical factors of the patient on the other side (i.e. personality structure, psychological status before the event etc.). The fact of a coronary or myocardial disease does not necessarily lead to a life-crisis or maladaptation. For the patient's style of life positive and/or negative effects of the disease can be differentiated. The patient's appraisal of a therapeutic success depends therefore on the intraindividual reinforcement-value of such a success. Adaptation and coping strategies are not uniform in phenomenological or time aspects. The emotional, cognitive and behavioural patterns primarily tend to help to cope with anxiety and uncertainty (f.i. denial, depression, aggression, building up a new identity). In the patient's mind a myocardial infarction is not necessarily the most important event in his actual life-situation. Concerning the heart disease fears about the own capacity of work and financial outcome are dominant. They are followed by concerns about the medical prognosis or course of disease, family life and partnership, satisfaction with future life and its meaning, and aspects of the social or ecological environment. Over all these patients show relatively optimistic prospects to their own future.

  19. Hepatitis C in hemodialysis patients

    PubMed Central

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

    2015-01-01

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

  20. Postpartum Patient Teaching Success: Implications from Nursing and Patient Perspectives

    ERIC Educational Resources Information Center

    Day, Dawn

    2014-01-01

    A recent examination of postpartum patient satisfaction scores in an inner-city hospital revealed decreased satisfaction of discharge teaching practices. Guided by Knowles' model of andragogy and Donabedian's model of structure-process-outcome, the purpose of this study was to gain an understanding of how the structure and process of discharge…