WorldWideScience

Sample records for patients experience multiple

  1. Experiences of patients with multiple sclerosis from group counseling

    OpenAIRE

    Mazaheri, Mina; Fanian, Nasrin; Zargham-Boroujeni, Ali

    2011-01-01

    BACKGROUND: Group counseling is one of the most important methods in somatic and psychological rehabilitation of the multiple sclerosis (M.S.) patients. Knowing these patients? experiences, feelings, believes and emotion based on learning in group is necessary to indicate the importance of group discussion on quality of life of the patients. This study was done to achieve experiences of M.S. patients from group training. METHODS: This was a qualitative study using phenomenological method. The...

  2. Experiences of patients with multiple sclerosis from group counseling.

    Science.gov (United States)

    Mazaheri, Mina; Fanian, Nasrin; Zargham-Boroujeni, Ali

    2011-01-01

    Group counseling is one of the most important methods in somatic and psychological rehabilitation of the multiple sclerosis (M.S.) patients. Knowing these patients' experiences, feelings, believes and emotion based on learning in group is necessary to indicate the importance of group discussion on quality of life of the patients. This study was done to achieve experiences of M.S. patients from group training. This was a qualitative study using phenomenological method. The samples were selected using purposeful sampling. Ten patients from M.S. society who had passed group training were included in the study. The group training was done through seven sessions weekly and voluntarily. The participants were interviewed using in-depth interview. The average time of each interview was between 30-50 minutes which has been recorded digitally and moved to a compact disc to transcribe and analysis. The data analyzed using 7-step Colaizzi method. The data were transformed into 158 codes, 12 sub-concepts and 4 main concepts including emotional consequences, communication, quality of life and needs. M.S can lead to multiple problems in patients such as somatic, behavioral, emotional and social disorders. Group psychotherapy is one of the methods which can decrease these problems and improve rehabilitation of the patients. Group discussion helps patients to overcome adverse feelings, behaviors and thoughts and guides them to move in a meaningful life. It also can improve quality of life and mental health of the patients.

  3. Capturing the experiences of patients across multiple complex interventions: a meta-qualitative approach.

    Science.gov (United States)

    Webster, Fiona; Christian, Jennifer; Mansfield, Elizabeth; Bhattacharyya, Onil; Hawker, Gillian; Levinson, Wendy; Naglie, Gary; Pham, Thuy-Nga; Rose, Louise; Schull, Michael; Sinha, Samir; Stergiopoulos, Vicky; Upshur, Ross; Wilson, Lynn

    2015-09-08

    The perspectives, needs and preferences of individuals with complex health and social needs can be overlooked in the design of healthcare interventions. This study was designed to provide new insights on patient perspectives drawing from the qualitative evaluation of 5 complex healthcare interventions. Patients and their caregivers were recruited from 5 interventions based in primary, hospital and community care in Ontario, Canada. We included 62 interviews from 44 patients and 18 non-clinical caregivers. Our team analysed the transcripts from 5 distinct projects. This approach to qualitative meta-evaluation identifies common issues described by a diverse group of patients, therefore providing potential insights into systems issues. This study is a secondary analysis of qualitative data; therefore, no outcome measures were identified. We identified 5 broad themes that capture the patients' experience and highlight issues that might not be adequately addressed in complex interventions. In our study, we found that: (1) the emergency department is the unavoidable point of care; (2) patients and caregivers are part of complex and variable family systems; (3) non-medical issues mediate patients' experiences of health and healthcare delivery; (4) the unanticipated consequences of complex healthcare interventions are often the most valuable; and (5) patient experiences are shaped by the healthcare discourses on medically complex patients. Our findings suggest that key assumptions about patients that inform intervention design need to be made explicit in order to build capacity to better understand and support patients with multiple chronic diseases. Across many health systems internationally, multiple models are being implemented simultaneously that may have shared features and target similar patients, and a qualitative meta-evaluation approach, thus offers an opportunity for cumulative learning at a system level in addition to informing intervention design and

  4. Strategies to reduce hyperthermia in ambulatory multiple sclerosis patients.

    Science.gov (United States)

    Edlich, Richard F; Buschbacher, Ralph M; Cox, Mary Jude; Long, William B; Winters, Kathryne L; Becker, Daniel G

    2004-01-01

    Approximately 400,000 Americans have multiple sclerosis. Worldwide, multiple sclerosis affects 2.5 million individuals. Multiple sclerosis affects two to three times as many women as men. The adverse effects of hyperthermia in patients with multiple sclerosis have been known since 1890. While most patients with multiple sclerosis experience reversible worsening of their neurologic deficits, some patients experience irreversible neurologic deficits. In fact, heat-induced fatalities have been encountered in multiple sclerosis patients subjected to hyperthermia. Hyperthermia can be caused through sun exposure, exercise, and infection. During the last 50 years, numerous strategies have evolved to reduce hyperthermia in individuals with multiple sclerosis, such as photoprotective clothing, sunglasses, sunscreens, hydrotherapy, and prevention of urinary tract infections. Hydrotherapy has become an essential component of rehabilitation for multiple sclerosis patients in hospitals throughout the world. On the basis of this positive hospital experience, hydrotherapy has been expanded through the use of compact aquatic exercise pools at home along with personal cooling devices that promote local and systemic hypothermia in multiple sclerosis patients. The Multiple Sclerosis Association of America and NASA have played leadership roles in developing and recommending technology that will prevent hyperthermia in multiple sclerosis patients and should be consulted for new technological advances that will benefit the multiple sclerosis patient. In addition, products recommended for photoprotection by The Skin Cancer Foundation may also be helpful to the multiple sclerosis patient's defense against hyperthermia. Infections in the urinary tract, especially detrusor-external sphincter dyssynergia, are initially managed conservatively with intermittent self-catheterization and pharmacologic therapy. In those cases, refractory to conservative therapy, transurethral external

  5. Multiple sclerosis patients' experiences in relation to the impact of the kinect virtual home-exercise programme: a qualitative study.

    Science.gov (United States)

    Palacios-Ceña, Domingo; Ortiz-Gutierrez, Rosa M; Buesa-Estellez, Almudena; Galán-Del-Río, Fernando; Cachon Perez, José M; Martínez-Piedrola, Rosa; Velarde-Garcia, Juan F; Cano-DE-LA-Cuerda, Roberto

    2016-06-01

    Neurorehabilitation programs are among the most popular therapies aimed at reducing the disabilities that result from multiple sclerosis. Video games have recently gained importance in the rehabilitation of patients with motor neurological dysfunctions. Currently, the studies describing the perspective of patients with multiple sclerosis who have participated in rehabilitation programmes via home-based video games are almost inexistent. The aim of this paper was to explore the experiences of multiple sclerosis patients who performed a virtual home-exercise programme using Kinect. A qualitative research enquiry was conducted as part of a study that examined postural control and balance after a 10-week Kinect home-exercise programme in adults with multiple sclerosis. Patients were recruited from a Neurology Unit of a University Hospital. The inclusion criteria were: subjects aged between 20 and 60 years, diagnosed with multiple sclerosis for over 2 years based on the McDonald Criteria; with an EDSS score ranging from 3 to 5. Purposeful sampling method was implemented. The data collection consisted of unstructured interviews, using open questions, and thematic analysis was conducted. Guidelines for conducting qualitative studies established by the Consolidated Criteria for Reporting Qualitative Research were followed. Twenty-four patients with a mean age of 36.69 were included. Four main themes emerged from the data: 1) regaining previous capacity and abilities. The patients described how, after the treatment with Kinect they felt more independent; 2) sharing the disease. The patients sharing the experience of living with MS with their family, thanks to the use of Kinect; 3) adapting to the new treatment. This refers to how the use of the videogame console incorporated novelties to their rehabilitation programme; and 4) comparing oneself. This refers to the appearance of factors that motivate the patient during KVHEP. The patients' experiences gathered in this study

  6. Abnormal pain perception in patients with Multiple System Atrophy.

    Science.gov (United States)

    Ory-Magne, F; Pellaprat, J; Harroch, E; Galitzsky, M; Rousseau, V; Pavy-Le Traon, A; Rascol, O; Gerdelat, A; Brefel-Courbon, C

    2018-03-01

    Patients with Parkinson's disease or Multiple System Atrophy frequently experience painful sensations. The few studies investigating pain mechanisms in Multiple System Atrophy patients have reported contradictory results. In our study, we compared pain thresholds in Multiple System Atrophy and Parkinson's disease patients and healthy controls and evaluated the effect of l-DOPA on pain thresholds. We assessed subjective and objective pain thresholds (using a thermotest and RIII reflex), and pain tolerance in OFF and ON conditions, clinical pain, motor and psychological evaluation. Pain was reported in 78.6% of Multiple System Atrophy patients and in 37.5% of Parkinson's disease patients. In the OFF condition, subjective and objective pain thresholds were significantly lower in Multiple System Atrophy patients than in healthy controls (43.8 °C ± 1.3 vs 45.7 °C ± 0.8; p = 0.0005 and 7.4 mA ± 3.8 vs 13.7 mA ± 2.8; p = 0.002, respectively). They were also significantly reduced in Multiple System Atrophy compared to Parkinson's disease patients. No significant difference was found in pain tolerance for the 3 groups and in the effect of l-DOPA on pain thresholds in Multiple System Atrophy and Parkinson's disease patients. In the ON condition, pain tolerance tended to be reduced in Multiple System Atrophy versus Parkinson's disease patients (p = 0.05). Multiple System Atrophy patients had an increase in pain perception compared to Parkinson's disease patients and healthy controls. The l-DOPA effect was similar for pain thresholds in Multiple System Atrophy and Parkinson's disease patients, but tended to worsen pain tolerance in Multiple System Atrophy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Inequalities in reported cancer patient experience by socio-demographic characteristic and cancer site: evidence from respondents to the English Cancer Patient Experience Survey.

    Science.gov (United States)

    Saunders, C L; Abel, G A; Lyratzopoulos, G

    2015-01-01

    Patient experience is a critical dimension of cancer care quality. Understanding variation in experience among patients with different cancers and characteristics is an important first step for designing targeted improvement interventions. We analysed data from the 2011/2012 English Cancer Patient Experience Survey (n = 69,086) using logistic regression to explore inequalities in care experience across 64 survey questions. We additionally calculated a summary measure of variation in patient experience by cancer, and explored inequalities between patients with cancers treated by the same specialist teams. We found that younger and very old, ethnic minority patients and women consistently reported worse experiences across questions. Patients with small intestine/rarer lower gastrointestinal, multiple myeloma and hepatobiliary cancers were most likely to report negative experiences whereas patients with breast, melanoma and testicular cancer were least likely (top-to-bottom odds ratio = 1.91, P patients with cancers treated by the same specialty for five of nine services (P patients with ovarian, multiple myeloma, anal, hepatobiliary and renal cancer reported notably worse experiences than patients with other gynaecological, haematological, gastrointestinal and urological malignancies respectively. Initiatives to improve cancer patient experience across oncology services may be suitably targeted on patients at higher risk of poorer experience. © 2014 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.

  8. Experience of gratitude, awe and beauty in life among patients with multiple sclerosis and psychiatric disorders.

    Science.gov (United States)

    Büssing, Arndt; Wirth, Anne Gritli; Reiser, Franz; Zahn, Anne; Humbroich, Knut; Gerbershagen, Kathrin; Schimrigk, Sebastian; Haupts, Michael; Hvidt, Niels Christian; Baumann, Klaus

    2014-04-30

    Feelings of gratitude and awe facilitate perceptions and cognitions that go beyond the focus of illness and include positive aspects of one's personal and interpersonal reality, even in the face of disease. We intended to measure feelings of gratitude, awe, and experiences of beauty in life among patients with multiple sclerosis and psychiatric disorders, particularly with respect to their engagement in specific spiritual/religious practices and their life satisfaction. We conducted a cross-sectional survey with standardized questionnaires to measure engagement in various spiritual practices (SpREUK-P) and their relation to experiences of Gratitude, Awe and Beauty in Life and life satisfaction (BMLSS-10). In total, 461 individuals (41 ± 13 years; 68% women) with multiple sclerosis (46%) and depressive (22%) or other psychiatric disorders (32%) participated. Among participants, 23% never, 43% rarely, 24% often, and 10% frequently experienced Gratitude. In contrast, 41% never, 37% rarely, 17% often, and 6% frequently experienced Awe. Beauty in Life was never experienced by 8% of the sample, and 28% rarely, 46% often, and 18% frequently experienced it. Gratitude (F = 9.2; p = .003) and Beauty in Life (F = 6.0; p = .015) were experienced significantly more often by women than men. However, the experience of Awe did not differ between women and men (F = 2.2; n.s.). In contrast to our hypothesis, Gratitude/Awe cannot explain any relevant variance in patients' life satisfaction (R2 = .04). Regression analyses (R2 = .42) revealed that Gratitude/Awe can be predicted best by a person's engagement in religious practices, followed by other forms of spiritual practices and life satisfaction. Female gender was a weak predictor and underlying disease showed no effect. Gratitude/Awe could be regarded as a life orientation towards noticing and appreciating the positive in life--despite the symptoms of disease. Positive spirituality/religiosity seems

  9. Patients with multiple contact allergies

    DEFF Research Database (Denmark)

    Carlsen, Berit Christina; Andersen, Klaus Ejner; Menné, Torkil

    2008-01-01

    Patients with multiple contact allergies, also referred to as polysensitized, are more frequent than predicted from prevalence of single sensitivities. The understanding of why some people develop multiple contact allergies, and characterization of patients with multiple contact allergies...... of developing multiple contact allergies. Evidence of allergen clusters among polysensitized individuals is also reviewed. The literature supports the idea that patients with multiple contact allergies constitute a special entity within the field of contact allergy. There is no generally accepted definition...... of patients with multiple contact allergies. We suggest that contact allergy to 3 or more allergens are defined as multiple contact allergies....

  10. Therapeutic use of sport climbing for patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Ana Ožura

    2009-05-01

    Full Text Available Sport climbing is a form of exercise that requires complex and variable movement. Because of the use of the so-called "top-rope system", this is a safe activity appropriate for individuals with physical disabilities. Therefore, climbing might prove to be an effective form of therapy for patients with multiple sclerosis. Multiple sclerosis is a chronic neurological disease that may include motor and cognitive deficits as well as affective disturbances. The illness is characterized by multifocal areas of brain damage (plaques, as consequence of autoimmune inflammation. Sport climbing might be a potentially useful activity for treating spasticity, improving a person's self image and certain aspects of cognition, such as attention and executive functions, as well as for managing emotional disturbances. All of the above are areas where patients with multiple sclerosis might be in need of assistance. The article also describes the experience of a patient with multiple sclerosis who was enrolled in our climbing program. Future research is needed to evaluate the effect of climbing therapy for patients with multiple sclerosis.

  11. Ensinando e aprendendo com portadores de Esclerose Múltipla: relato de experiência Enseñando y aprendiendo com los portatodes de Esclerósis Multiple: relato de experiencia Teaching and learning with Multiple Sclerosis patients: experience report

    Directory of Open Access Journals (Sweden)

    Lúcia Helena Rios Barbosa de Almeida

    2007-08-01

    Full Text Available Relatode experiência realizado para descrever a vivência de um grupo de estudantes de Enfermagem da Universidade Federal do Piauí, diante da realidade do ser portador de Esclerose Múltipla. A experiência evidencia a necessidade de uma equipe integrada para obter conhecimentos fundamentais e oferecer uma assistência holística ao portador. Enfatiza-se o impacto das ações desenvolvidas pelos estudantes, na Associação Piauiense de Esclerose Múltipla, possibilitando-os a conviver melhor com as dificuldades advindas com a doença. Além disso, a comunidade em geral é favorecida através dos conhecimentos repassados mediante atividades desenvolvidas pelo grupo. Concluímos que um conhecimento mais amplo acerca de uma patologia ainda tão cheia de mistérios só é possível quando se alia teoria à realidade do paciente.Este es un relato de una experiência de trabajo realizado por un grupo de estudiantes de Enfermería de la Universidad Federal de Piauí, sobre la siutación de un portador de Esclerosis Multiple. La experiencia demuestra la necesidad de un equipo integrado para obtener conocimientos fundamentales y ofrecer una asistencia integral al portador. Aquí se enfatiza las acciones desarrolladas por los estudiantes, dentro de la APPEM (Asociación Piauiense de Esclerósis Multiple, posible a coexistir mejor él las dificultades que se sucedierón con la enfermedad. Favorecen la comunidad en general con el conocimiento repasado por medio de las actividades desarrolladas para el grupo. Un conocimiento más amplio acerca de una patología llena de misterios, solo es posible, cuando se junta la teoria a la realidad del paciente.This report describes the experience of a group of nursing students from Universidad Federal do Piauí, in face of the reality of multiple sclerosis patient. The experience highlight the necessity of an integrated team to achieve fundamental knowledge and to offer a holistic assistance to the patient. The

  12. Features of Coping with Disease in Iranian Multiple Sclerosis Patients: a Qualitative Study.

    Science.gov (United States)

    Dehghani, Ali; Dehghan Nayeri, Nahid; Ebadi, Abbas

    2018-03-01

    Introduction: Coping with disease is of the main components improving the quality of life in multiple sclerosis patients. Identifying the characteristics of this concept is based on the experiences of patients. Using qualitative research is essential to improve the quality of life. This study was conducted to explore the features of coping with the disease in patients with multiple sclerosis. Method: In this conventional content analysis study, eleven multiple sclerosis patients from Iran MS Society in Tehran (Iran) participated. Purposive sampling was used to select participants. Data were gathered using semi structured interviews. To analyze data, a conventional content analysis approach was used to identify meaning units and to make codes and categories. Results: Results showed that features of coping with disease in multiple sclerosis patients consists of (a) accepting the current situation, (b) maintenance and development of human interactions, (c) self-regulation and (d) self-efficacy. Each of these categories is composed of sub-categories and codes that showed the perception and experience of patients about the coping with disease. Conclusion: Accordingly, a unique set of features regarding features of coping with the disease were identified among the patients with multiple sclerosis. Therefore, working to ensure the emergence of, and subsequent reinforcement of these features in MS patients can be an important step in improving the adjustment and quality of their lives.

  13. Perspectives and experiences of Dutch multiple sclerosis patients and multiple sclerosis-specialized neurologists on injectable disease-modifying treatment

    NARCIS (Netherlands)

    Visser, Leo H.; Heerings, Marco A.; Jongen, Peter J.; van der Hiele, Karin

    2016-01-01

    Background: The adherence to treatment with injectable disease-modifying drugs (DMDs) in multiple sclerosis (MS) may benefit from adequate information provision and management of expectations. The communication between patients and physicians is very important in this respect. The current study

  14. Perspective and Experiences of Iranian People With Multiple Sclerosis Regarding Leisure: A Qualitative Study

    OpenAIRE

    Ghanbari; Shayanpour

    2015-01-01

    Background Multiple Sclerosis, as a progressive disease, influences most of occupational performance areas. Objectives This study was conducted to describe the perspectives and experiences regarding leisure of people with multiple sclerosis in Ahvaz city, Iran. Patients and Methods The study was a descriptive phenomenological study using purposeful sampling. Data saturation was ach...

  15. Coping strategies and mood profiles in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Aysel Milanlioglu

    2014-07-01

    Full Text Available Objective: The aim of the present study was to investigate the coping strategies, mood characteristics and the association between these aspects in patients diagnosed with multiple sclerosis and healthy subjects. Method: Fifty consecutive patients who were diagnosed with multiple sclerosis according to McDonald criteria and thirty-one healthy subjects were included in the study. In addition to the sociodemographic form, Expanded Disability Status Scale (EDSS, Coping Orientation for Problem Experiences Scale (COPE, and Profile of Mood States (POMS tests were applied to the participants. Results: Non-functional coping strategies were significantly higher in the secondary-progressive type (p≤0.05. Depression-dejection, fatigue-inertia and total POMS scores were significantly higher in the secondary-progressive type (p≤0.05. Conclusion: The results of our study demonstrate the importance of rehabilitation programs that encourage exercise among patients with multiple sclerosis to increase vigor-activity levels.

  16. Chromosomal radiosensitivity in patients with multiple sclerosis

    International Nuclear Information System (INIS)

    Milenkova, Maria; Milanov, Ivan; Kmetska, Ksenia; Deleva, Sofia; Popova, Ljubomira; Hadjidekova, Valeria; Groudeva, Violeta; Hadjidekova, Savina; Domínguez, Inmaculada

    2013-01-01

    Highlights: • We studied radiosensitivity to in vitro γ-irradiated lymphocytes from MS patients. • Immunotherapy in RRMS patients reduced the yield of radiation induced MN. • The group of treated RRMS accounts for the low radiosensitivity in MS patients. • Spontaneous yield of MN was similar in treated and untreated RRMS patients. - Abstract: Multiple sclerosis is a clinically heterogeneous autoimmune disease leading to severe neurological disability. Although during the last years many disease-modifying agents as treatment options for multiple sclerosis have been made available, their mechanisms of action are still not fully determined. In the present study radiosensitivity in lymphocytes of patients with relapsing–remitting multiple sclerosis, secondary progressive multiple sclerosis and healthy controls was investigated. Whole blood cultures from multiple sclerosis patients and healthy controls were used to analyze the spontaneous and radiation-induced micronuclei in binucleated lymphocytes. A subgroup of patients with relapsing–remitting multiple sclerosis was treated with immunomodulatory agents, interferon β or glatiramer acetate. The secondary progressive multiple sclerosis patients group was not receiving any treatment. Our results reveal that the basal DNA damage was not different between relapsing–remitting and secondary progressive multiple sclerosis patients, and healthy controls. No differences between gamma-irradiation induced micronuclei frequencies in binucleated cells from relapsing–remitting and secondary progressive multiple sclerosis patients, and healthy controls were found either. Nevertheless, when we compared the radiation induced DNA damage in binucleated cells from healthy individuals with the whole group of patients, a reduction in the frequency of micronuclei was obtained in the patients group. Induced micronuclei yield was significantly lower in the irradiated samples from treated relapsing–remitting multiple

  17. Chromosomal radiosensitivity in patients with multiple sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Milenkova, Maria; Milanov, Ivan; Kmetska, Ksenia [III Neurological Clinic, University Hospital Saint Naum, Sofia (Bulgaria); Deleva, Sofia; Popova, Ljubomira; Hadjidekova, Valeria [Laboratory of Radiation Genetics, NCRRP, Sofia (Bulgaria); Groudeva, Violeta [Department of Diagnostic Imaging, University Hospital St. Ekaterina, Sofia (Bulgaria); Hadjidekova, Savina [Department of Medical Genetics, Medical University, Sofia (Bulgaria); Domínguez, Inmaculada, E-mail: idomin@us.es [Department of Cell Biology, Faculty of Biology, University of Seville, Avda. Reina Mercedes 6, 41012 (Spain)

    2013-09-15

    Highlights: • We studied radiosensitivity to in vitro γ-irradiated lymphocytes from MS patients. • Immunotherapy in RRMS patients reduced the yield of radiation induced MN. • The group of treated RRMS accounts for the low radiosensitivity in MS patients. • Spontaneous yield of MN was similar in treated and untreated RRMS patients. - Abstract: Multiple sclerosis is a clinically heterogeneous autoimmune disease leading to severe neurological disability. Although during the last years many disease-modifying agents as treatment options for multiple sclerosis have been made available, their mechanisms of action are still not fully determined. In the present study radiosensitivity in lymphocytes of patients with relapsing–remitting multiple sclerosis, secondary progressive multiple sclerosis and healthy controls was investigated. Whole blood cultures from multiple sclerosis patients and healthy controls were used to analyze the spontaneous and radiation-induced micronuclei in binucleated lymphocytes. A subgroup of patients with relapsing–remitting multiple sclerosis was treated with immunomodulatory agents, interferon β or glatiramer acetate. The secondary progressive multiple sclerosis patients group was not receiving any treatment. Our results reveal that the basal DNA damage was not different between relapsing–remitting and secondary progressive multiple sclerosis patients, and healthy controls. No differences between gamma-irradiation induced micronuclei frequencies in binucleated cells from relapsing–remitting and secondary progressive multiple sclerosis patients, and healthy controls were found either. Nevertheless, when we compared the radiation induced DNA damage in binucleated cells from healthy individuals with the whole group of patients, a reduction in the frequency of micronuclei was obtained in the patients group. Induced micronuclei yield was significantly lower in the irradiated samples from treated relapsing–remitting multiple

  18. Exploring Canadian Women's Multiple Abortion Experiences: Implications for Reducing Stigma and Improving Patient-Centered Care.

    Science.gov (United States)

    LaRoche, Kathryn J; Foster, Angel M

    2018-05-24

    Roughly one-third of all abortions in Canada are subsequent abortions. However, few published reports showcase women's voices or explore women's experiences on this topic. Our study aimed to understand better the ways that women who have had multiple abortions talk about and view those experiences. Between 2012 and 2016, we conducted in-depth interviews with 41 Canadian women who had a total of 87 abortions in the 5 years preceding the interviews. We audio-recorded and transcribed all English- and French-language interviews and analyzed our data for content and themes using a multiphased iterative approach and inductive and deductive techniques. Women described their abortion experiences as unique life events, even in cases when the overarching circumstances surrounding the pregnancies were similar. Participants recalled multiple factors that influenced their decisions to terminate, including their relationship status; level of support from family and friends; financial situation; health status; previous reproductive health, pregnancy, and abortion experiences; and desire to parent. In general, a previous abortion demystified the abortion process but did not play a significant role in decision making. Women described intensified feelings of shame and both internalized and externalized stigma surrounding their decision to have more than one abortion. However, the overwhelming majority were confident in their decisions. The often-used phase "repeat abortion" fails to capture women's experiences and the complex decision making surrounding each pregnancy. Efforts to reframe the narrative of multiple abortions, including among health care providers, could help reduce the amplified stigma associated with having more than one lifetime abortion. Copyright © 2018 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  19. The INEL beryllium multiplication experiment

    International Nuclear Information System (INIS)

    Smith, J.R.; King, J.J.

    1991-03-01

    The experiment to measure the multiplication of 14-MeV neutrons in bulk beryllium has been completed. The experiment consists of determining the ratio of 56 Mn activities induced in a large manganese bath by a central 14-MeV neutron source, with and without a beryllium sample surrounding the source. In the manganese bath method a neutron source is placed at the center of a totally-absorbing aqueous solution of MnSo 4 . The capture of neutrons by Mn produces a 56 Mn activity proportional to the emission rate of the source. As applied to the measurement of the multiplication of 14- MeV neutrons in bulk beryllium, the neutron source is a tritium target placed at the end of the drift tube of a small deuteron accelerator. Surrounding the source is a sample chamber. When the sample chamber is empty, the neutrons go directly to the surrounding MnSO 4 solution, and produce a 56 Mn activity proportional to the neutron emission rate. When the chamber contains a beryllium sample, the neutrons first enter the beryllium and multiply through the (n,2n) process. Neutrons escaping from the beryllium enter the bath and produce a 56 Mn activity proportional to the neutron emission rate multiplied by the effective value of the multiplication in bulk beryllium. The ratio of the activities with and without the sample present is proportional to the multiplication value. Detailed calculations of the multiplication and all the systematic effects were made with the Monte Carlo program MCNP, utilizing both the Young and Stewart and the ENDF/B-VI evaluations for beryllium. Both data sets produce multiplication values that are in excellent agreement with the measurements for both raw and corrected values of the multiplication. We conclude that there is not real discrepancy between experimental and calculated values for the multiplication of neutrons in bulk beryllium. 12 figs., 11 tabs., 18 refs

  20. EXPERIENCE OF SUCCESSFUL ACNEFORM ERUPTIONS TREATMENT IN PATIENT WITH MULTIPLE MELANOMA

    Directory of Open Access Journals (Sweden)

    O. V. Minkina

    2016-01-01

    Full Text Available Objective: to describe the results of the joint monitoring and diversified treatment of oncologists and dermatologists those patient with multiple recurrent melanoma who received over a long period a targeted anti-cancer therapy, which was complicated by side-effect as widespread acneform rush, resistant to traditional treatment. Patient A., born in 1988, was followed up and got a treatment more than 2 years in oncology out-patient clinic diagnosed with “Melanoma of the front surface of the left leg T2bN0M0 IIA”. Subsequently, the patient was verified metastasis in the inginal lymph nodes, in the soft tissues of the hips, to liver. Acute adverse reaction has developed in a short time after getting the anti-tumor target therapy as generalized acneform rush and itching of the skin. Skin symptoms accompanied by pronounced psychological and emotional stress, therefore, dermatologists have been invited to provide additional medical assistance to this patient. Due to the fact that subsequent traditional anti-acne algorithms of topical and oral treatment was not such effective, there was made a decision to use an alternative supporting external therapy, which did not have similar examples of usage previously. Results. External application of tacrolimus ointment in combination with other drugs and then as a mono-therapy, allows us in a rather short period achieve a stable and pronounced regression of skin pathological lesions, to return to the previously cancelled initial drug dose of the anti-tumor target therapy, to change significantly components of the patient’s quality of life. Conclusion. The search for additional and alternative treatment approaches for similar patients, as in our case, remains relevant for specialists and patients themselves. This case is an example of alternative approach to the tacrolimus topical application in patient with drug-mediated acneform rush.

  1. Quality of life and patient preferences: identification of subgroups of multiple sclerosis patients.

    Science.gov (United States)

    Rosato, Rosalba; Testa, Silvia; Oggero, Alessandra; Molinengo, Giorgia; Bertolotto, Antonio

    2015-09-01

    The aim of this study was to estimate preferences related to quality of life attributes in people with multiple sclerosis, by keeping heterogeneity of patient preference in mind, using the latent class approach. A discrete choice experiment survey was developed using the following attributes: activities of daily living, instrumental activities of daily living, pain/fatigue, anxiety/depression and attention/concentration. Choice sets were presented as pairs of hypothetical health status, based upon a fractional factorial design. The latent class logit model estimated on 152 patients identified three subpopulations, which, respectively, attached more importance to: (1) the physical dimension; (2) pain/fatigue and anxiety/depression; and (3) instrumental activities of daily living impairments, anxiety/depression and attention/concentration. A posterior analysis suggests that the latent class membership may be related to an individual's age to some extent, or to diagnosis and treatment, while apart from energy dimension, no significant difference exists between latent groups, with regard to Multiple Sclerosis Quality of Life-54 scales. A quality of life preference-based utility measure for people with multiple sclerosis was developed. These utility values allow identification of a hierarchic priority among different aspects of quality of life and may allow physicians to develop a care programme tailored to patient needs.

  2. Herpes zoster in multiple myeloma patients during bortezomib treatment

    Directory of Open Access Journals (Sweden)

    I. N. Nazarova

    2011-01-01

    Full Text Available Recent advances in multiple myeloma (MM treatment associated with new drug use including bortezomib. Experiences in wide ambul atory drug use confirm therapy success for this serious disease, but at the same time reveals the most common side effects. One of th e most significant is the reactivation of Herpes zoster , which leads to decrease MM therapy results because of inability to perform standard therapy in these patients. Literature data and own experiences about reactivation of Herpes zoster during bortezomib therapy as monothe rapy and in combination, which varies from 7 to 34% according to different authors and 25% of own experiences, is presented. Treatment and preventive schedule of this complication are shown.

  3. Understanding patient experience

    DEFF Research Database (Denmark)

    Andersen, Tariq O.; Andersen, Pernille R. D.; Kornum, Anders C.

    2017-01-01

    , safety) arise from getting feedback on symptoms and from continuous and comforting interaction with clinicians. With this paper, we aim to sensitise UX researchers and designers of patient-centred e-health by proposing three UX dimensions: connectedness, comprehension, and compassion.......The term 'patient experience' is currently part of a global discourse on ways to improve healthcare. This study empirically explores what patient experience is in cardiac remote monitoring and considers the implications for user experience (UX). Through interviews around the deployment of a mobile...... app that enables patients to collaborate with clinicians, we unpack experiences in six themes and present narratives of patients' lifeworlds. We find that patients' emotions are grounded in negative feelings (uncertainty, anxiety, loss of hope) and that positive experiences (relief, reassurance...

  4. Antecedents of Coping with the Disease in Patients with Multiple Sclerosis: A Qualitative Content Analysis.

    Science.gov (United States)

    Dehghani, Ali; Dehghan Nayeri, Nahid; Ebadi, Abbas

    2017-01-01

    Due to many physical and mental disorders that occur in multiple sclerosis patients, identifying the factors affecting coping based on the experiences of patients using qualitative study is essential to improve their quality of life. This study was conducted to explore the antecedents of coping with the disease in patients with multiple sclerosis. This is a qualitative study conducted on 11 patients with multiple sclerosis in 2015 in Tehran, Iran. These patients were selected based on purposive sampling. Data were collected using semi-structured and in-depth interviews and coded. These data were analyzed using the conventional content analysis. The rigor of qualitative data using the criteria proposed by Guba and Lincoln were assessed. Five main categories were revealed: (1) social support, (2) lenience, (3) reliance on faith, (4) knowledge of multiple sclerosis and modeling, and (5) economic and environmental situation. Each category had several distinct sub-categories. The results of this study showed that coping with multiple sclerosis is a complex, multidimensional and contextual concept that is affected by various factors in relation to the context of Iran. The findings of the study can provide the healthcare professionals with deeper recognition and understanding of these antecedents to improve successful coping in Iranian patients suffering from multiple sclerosis.

  5. Whole body MR in patients with multiple myeloma

    International Nuclear Information System (INIS)

    Piekarek, A.; Sosnowski, P.; Nowicki, A.; Komarnicki, M.

    2009-01-01

    Background: Multiple myeloma is a cancer of plasma cells which leads to bone marrow infiltration. Aim: Whole-body MR is the most sensitive imaging method available to detect multiple myeloma lesions. Ma terial and methods: MR scans were performed in 100 patients with multiple myeloma who were receiving treatment in the Haematology Clinic in Poznan in the years 2005 - 2006. Whole-body MR scans were performed with general coil 1.0 T in STIR sequences and T1 sequences, in coronal and sagittal planes with scanning area covering the head, neck, trunk and the limbs (FOV for specific regions was 36 -48 cm). The bone lesions were classified as focal (monofocal/multifocal lesions), infiltrative, mixed and 'salt and pepper' type. Depending on the size of the lesions the patients were included in one of three groups according to Salmon-Durie Plus classification. Results: Four main types of multiple myeloma were distinguished based on MR scans: focal (48 patients; monofocal in 10 patients), infiltrative (17 patients), mixed type (19 patients) and 'salt and pepper' type (4 patients). The remaining 12 patients had no multiple myeloma lesions in the bone marrow. Additionally, in 18% of patients a soft tissue mass could be observed. According to Salmon-Durie Plus categorisation 27 subjects were classified as having stage I, 16 patients stage and 57 patients stage III disease. In 12% of patients MR data changed the disease staging. Conclusions: WB MR is a sensitive and effective diagnostic method with an important impact on staging and further treatment of multiple myeloma. (authors)

  6. Immunoparesis in newly diagnosed Multiple Myeloma patients

    DEFF Research Database (Denmark)

    Sorrig, Rasmus; Klausen, Tobias W.; Salomo, Morten

    2017-01-01

    Immunoparesis (hypogammaglobulinemia) is associated to an unfavorable prognosis in newly diagnosed Multiple myeloma (MM) patients. However, this finding has not been validated in an unselected population-based cohort. We analyzed 2558 newly diagnosed MM patients in the Danish Multiple Myeloma...

  7. Sexual Experiences of Chinese Patients Living With an Ostomy.

    Science.gov (United States)

    Zhu, Xiaomei; Chen, Yongyi; Tang, Xinhui; Chen, Yupan; Liu, Yangyu; Guo, Wei; Liu, Aizhong

    The purpose of this study was to examine the sexual experience of Chinese patients with ostomy and associated factors. A prospective descriptive study using self-report questionnaires. Seventy-five Chinese participants who underwent ostomy surgery in a large cancer specialist hospital in the Hunan province between 2008 and 2013. Data were collected face-to-face by the investigators in an outpatient setting from 75 participants who completed the Arizona Sexual Experience Inventory Scale (ASEX). The t test was used to compare variances between sexual function and dysfunction subgroups. A multiple linear regression model was used to analyze factors influencing sexual life after ostomy surgery. The mean ASEX score was 20.56 (5.378) years, which is higher than the standard for sexual dysfunction. The main subsection of sexual dysfunction included sexual arousal, orgasm ability, vaginal lubrication/penile erection, and sexual satisfaction. Significant differences in the ASEX score were observed in subgroups of age, gender, educational level, family relations, operation modes, stoma type, operation time, complications, supporters, self-care ability, and sexual life guidance. Multiple stepwise regression analysis indicated that family relations, operation modes, ostomy type, complications, and sexual life guidance affected sexual experience. The findings of this study demonstrate that patients with ostomy experience sexual dysfunction and many factors influence their quality of sexual life. WOC nurses and other healthcare providers should consider providing sexual health education for both the patient and spouse to improve the self-care capacity and quality of sexual life following ostomy surgery.

  8. ASSISTments Dataset from Multiple Randomized Controlled Experiments

    Science.gov (United States)

    Selent, Douglas; Patikorn, Thanaporn; Heffernan, Neil

    2016-01-01

    In this paper, we present a dataset consisting of data generated from 22 previously and currently running randomized controlled experiments inside the ASSISTments online learning platform. This dataset provides data mining opportunities for researchers to analyze ASSISTments data in a convenient format across multiple experiments at the same time.…

  9. Fingolimod Prescribed for the Treatment of Multiple Sclerosis in Patients Younger Than Age 18 Years.

    Science.gov (United States)

    Fragoso, Yara Dadalti; Alves-Leon, Soniza Vieira; Barreira, Amilton Antunes; Callegaro, Dagoberto; Brito Ferreira, Maria Lucia; Finkelsztejn, Alessandro; Gomes, Sidney; Magno Goncalves, Marcus Vinicius; Moraes Machado, Maria Iris; Marques, Vanessa Daccach; Cunha Matta, Andre Palma; Papais-Alvarenga, Regina Maria; Apostolos Pereira, Samira Luisa; Tauil, Carlos Bernardo

    2015-08-01

    There have been no clinical trials for approval of medications for treating multiple sclerosis in patients younger than age 18 years. All treatments are based on personal experience and data from open observational studies. Fingolimod is an oral drug for multiple sclerosis that has been shown to be efficient and safe in adults. The aim of our study is to describe patients with multiple sclerosis who started treatment with fingolimod before the age of 18 years. Seventeen patients treated with fingolimod were identified in the Brazilian database of children and adolescents with multiple sclerosis. The average time of use of the drug was 8.6 months. Fingolimod showed a good safety and efficacy profile in these patients, all of whom had very active multiple sclerosis. After starting treatment with fingolimod, only one patient had a relapse and a new lesion on magnetic resonance imaging. The patients' degree of disability did not progress. No major adverse events were reported in relation to the first dose of the drug, nor in the short- and medium-term treatment. No patient has been followed for longer than 18 months, thus limiting long-term conclusions. Off-label use of fingolimod in patients younger than age 18 years may be a good therapeutic option for multiple sclerosis control. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. The Multiple-Patient Simulation Toolkit: Purpose, Process, and Pilot.

    Science.gov (United States)

    Beroz, Sabrina; Sullivan, Nancy; Kramasz, Vanessa; Morgan, Patricia

    Educating nursing students to safely care for multiple patients has become an important but challenging focus for nurse educators. New graduate nurses are expected to manage care for multiple patients in a complex and multifaceted health care system. With patient safety as a priority, multiple-patient assignments are necessary in order for nursing students to learn how to effectively prioritize and delegate care. The purpose of this project was the construction of an adaptable and flexible template for the development of multiple-patient simulations. Through utilization, the template moved to a toolkit adding an operational guide, sample-populated template, and bibliography.

  11. Multiple neoplasms, single primaries, and patient survival

    Directory of Open Access Journals (Sweden)

    Amer MH

    2014-03-01

    Full Text Available Magid H Amer Department of Medicine, St Rita's Medical Center, Lima, OH, USA Background: Multiple primary neoplasms in surviving cancer patients are relatively common, with an increasing incidence. Their impact on survival has not been clearly defined. Methods: This was a retrospective review of clinical data for all consecutive patients with histologically confirmed cancer, with emphasis on single versus multiple primary neoplasms. Second primaries discovered at the workup of the index (first primary were termed simultaneous, if discovered within 6 months of the index primary were called synchronous, and if discovered after 6 months were termed metachronous. Results: Between 2005 and 2012, of 1,873 cancer patients, 322 developed second malignancies; these included two primaries (n=284, and three or more primaries (n=38. Forty-seven patients had synchronous primaries and 275 had metachronous primaries. Patients with multiple primaries were predominantly of Caucasian ancestry (91.0%, with a tendency to develop thrombosis (20.2%, had a strong family history of similar cancer (22.3%, and usually presented with earlier stage 0 through stage II disease (78.9%. When compared with 1,551 patients with a single primary, these figures were 8.9%, 15.6%, 18.3%, and 50.9%, respectively (P≤0.001. Five-year survival rates were higher for metachronous cancers (95% than for synchronous primaries (59% and single primaries (59%. The worst survival rate was for simultaneous concomitant multiple primaries, being a median of 1.9 years. The best survival was for patients with three or more primaries (median 10.9 years and was similar to the expected survival for the age-matched and sex-matched general population (P=0.06991. Conclusion: Patients with multiple primaries are usually of Caucasian ancestry, have less aggressive malignancies, present at earlier stages, frequently have a strong family history of similar cancer, and their cancers tend to have indolent

  12. Experiment of neutron multiplication in lead

    International Nuclear Information System (INIS)

    Jiang Wenmian; Chen Yuan; Liu Rong; Guo Haiping; Shen Jian

    1994-01-01

    The experiments of neutron multiplication in bulk lead have been performed with a total absorption detector (TAD). A hollow polyethylene sphere is used as neutron moderator and absorber of the TAD, which inner and outer diameters are 56 cm and 138 cm respectively. Slow neutron density in TAD is detected with a 6 Li glass scintillator. For Pb thicknesses of 5, 10, 15, 19.6 and 23.1 cm, the neutron multiplications are 1.301, 1.492, 1.599, 1.713 and 1.745 respectively. Overall experimental error is 2.7%. The calculational neutron multiplications with the 1-D ANISN code and ENDF/B-VI file are agreed with experimental ones within experimental error. Moreover, some factors of systematic error of TAD were investigated experimentally, but obvious factors have not been observed yet. (author)

  13. Clinical experience with THC:CBD oromucosal spray in patients with multiple sclerosis-related spasticity.

    Science.gov (United States)

    Koehler, Jürgen; Feneberg, Wolfgang; Meier, Martin; Pöllmann, Walter

    2014-09-01

    This detailed medical charts' data collection study conducted at a multiple sclerosis (MS) clinic in Germany evaluated the effectiveness of tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray in patients with resistant MS spasticity. Over a 15-month timeframe, THC:CBD spray was initiated in 166 patients. Mean follow-up was 9 months. In all, 120 patients remained on treatment for a response rate of 72%. THC:CBD spray was used as add-on therapy in 95 patients and as monotherapy in 25 patients to achieve best-possible therapeutic results. Among responders, the mean spasticity 0-10 numerical rating scale (NRS) score decreased by 57%, from 7.0 before treatment to 3.0 within 10 days of starting THC:CBD spray. The mean dosage was 4 sprays/day. Most patients who withdrew from treatment (40/46) had been receiving THC:CBD spray for less than 60 days. Main reasons for treatment discontinuation were: adverse drug reactions, mainly dizziness, fatigue and oral discomfort (23 patients; 13.9%); lack of efficacy (14 patients; 8.4%); or need for a baclofen pump (9 patients; 5.4%). No new safety signals were noted with THC:CBD spray during the evaluation period. In this routine clinical practice setting at an MS clinic in Germany, THC:CBD spray was effective and well tolerated as add-on therapy or as monotherapy in a relevant proportion of patients with resistant MS spasticity.

  14. Multiple neoplasms, single primaries, and patient survival

    International Nuclear Information System (INIS)

    Amer, Magid H

    2014-01-01

    Multiple primary neoplasms in surviving cancer patients are relatively common, with an increasing incidence. Their impact on survival has not been clearly defined. This was a retrospective review of clinical data for all consecutive patients with histologically confirmed cancer, with emphasis on single versus multiple primary neoplasms. Second primaries discovered at the workup of the index (first) primary were termed simultaneous, if discovered within 6 months of the index primary were called synchronous, and if discovered after 6 months were termed metachronous. Between 2005 and 2012, of 1,873 cancer patients, 322 developed second malignancies; these included two primaries (n=284), and three or more primaries (n=38). Forty-seven patients had synchronous primaries and 275 had metachronous primaries. Patients with multiple primaries were predominantly of Caucasian ancestry (91.0%), with a tendency to develop thrombosis (20.2%), had a strong family history of similar cancer (22.3%), and usually presented with earlier stage 0 through stage II disease (78.9%). When compared with 1,551 patients with a single primary, these figures were 8.9%, 15.6%, 18.3%, and 50.9%, respectively (P≤0.001). Five-year survival rates were higher for metachronous cancers (95%) than for synchronous primaries (59%) and single primaries (59%). The worst survival rate was for simultaneous concomitant multiple primaries, being a median of 1.9 years. The best survival was for patients with three or more primaries (median 10.9 years) and was similar to the expected survival for the age-matched and sex-matched general population (P=0.06991). Patients with multiple primaries are usually of Caucasian ancestry, have less aggressive malignancies, present at earlier stages, frequently have a strong family history of similar cancer, and their cancers tend to have indolent clinical behavior with longer survival rates, possibly related to genetic predisposition

  15. Multiple giant cell lesions in a patient with Noonan syndrome with multiple lentigines

    NARCIS (Netherlands)

    van den Berg, Henk; Schreuder, Willem Hans; Jongmans, Marjolijn; van Bommel-Slee, Danielle; Witsenburg, Bart; de Lange, Jan

    2016-01-01

    A patient with Noonan syndrome with multiple lentigines (NSML) and multiple giant cell lesions (MGCL) in mandibles and maxillae is described. A mutation p.Thr468Met in the PTPN11-gene was found. This is the second reported NSML patient with MGCL. Our case adds to the assumption that, despite a

  16. Experience of Glatiramer Acetate in the Treatment of Relapsing-Remitting Multiple Sclerosis Patients

    Directory of Open Access Journals (Sweden)

    Özlem Taşkapılıoğlu

    2012-03-01

    Full Text Available OBJECTIVE: Glatiramer acetate (GA has been shown to reduce the number of relapses and improve outcomes in relapsing-remitting multiple sclerosis (RRMS patients. The aim of this study is to investigate the efficacy and side effects of GA in RRMS patients treated with it. METHODS: We retrospectively reviewed all the records of RRMS patients treated with GA in our hospital from January 1990 to December 2010. We evaluated 114 records but 71 patients (48 women, 23 men were included in the study due to incompleteness in the other records. Demographic characteristics, time from first symptom to diagnosis, time from diagnosis to treatment, number of relapses and Expanded Disability Status Scale (EDSS scores before and after the treatment, treatment duration, side effects, the other agents used in MS treatment during the disease duration and the presence of oligoclonal bands were recorded. RESULTS: The mean age of the patients and mean GA treatment duration were 41,85±9,05 years and 28,73 months, respectively. The mean number of relapses before and after the treatment were 2.30±1.16 and 0,52±1.24 respectively. The number of relapses reduced in 64 (90,14%, unchanged in 4 (5,63% and increased in 3 (4,23% patients after GA treatment. The mean EDSS scores before and after the treatment were 2,56±1,46 and 2,04±1,68 respectively. Before GA treatment, 63,4% of all patients had EDSS scores three or more. After the treatment 50,6% of all patients had EDSS scores three or more. GA was the first choice immunomodulatory treatment in 71,8% and the second choice in 28,2% of the patients. The treatment discontinued in 8 (11,3% patients and the reason was the severe side effect in only one patient (1,4%. CONCLUSION: Glatiramer acetate decreased the number of relapses and EDSS score with tolerable side effects.

  17. Perspectives from the Patient and the Healthcare Professional in Multiple Sclerosis: Social Media and Patient Education.

    Science.gov (United States)

    Kantor, Daniel; Bright, Jeremy R; Burtchell, Jeri

    2018-06-01

    A diagnosis of multiple sclerosis (MS) is life-altering. Because the course of MS is heterogeneous, patients may face uncertainty in terms of long-term physical and cognitive challenges, potential loss of employment, and the risk of social isolation. Patients often turn to the Internet and social media for information about MS and its management, and to seek out fellow patients and support groups. Here, we examine the use of social media and the Internet among patients with MS, considering its impact on patient education. We consider the access that these conduits provide not only to other patients with MS but also to a wealth of disease-related information online. These themes are further illustrated with first-hand experiences of the patient author and her physician. We also explore the impact of the Internet and social media on the education and support of patients with MS from the healthcare professional's (HCP's) perspective, including opportunities for HCPs to promote disease education among their patients, and the advantages that arise from patients being better informed about their disease. The rise of the Internet and social media has changed the patient experience, helping patients to support each other, to educate themselves proactively about their condition, and to participate more actively in decisions relating to disease management than perhaps was the case historically. Funding Novartis Pharmaceuticals Corporation.

  18. Structured diagnostic imaging in patients with multiple trauma

    International Nuclear Information System (INIS)

    Linsenmaier, U.; Rieger, J.; Rock, C.; Pfeifer, K.J.; Reiser, M.; Kanz, K.G.

    2002-01-01

    Purpose. Development of a concept for structured diagnostic imaging in patients with multiple trauma.Material and methods. Evaluation of data from a prospective trial with over 2400 documented patients with multiple trauma. All diagnostic and therapeutic steps, primary and secondary death and the 90 days lethality were documented.Structured diagnostic imaging of multiple injured patients requires the integration of an experienced radiologist in an interdisciplinary trauma team consisting of anesthesia, radiology and trauma surgery. Radiology itself deserves standardized concepts for equipment, personnel and logistics to perform diagnostic imaging for a 24-h-coverage with constant quality.Results. This paper describes criteria for initiation of a shock room or emergency room treatment, strategies for documentation and interdisciplinary algorithms for the early clinical care coordinating diagnostic imaging and therapeutic procedures following standardized guidelines. Diagnostic imaging consists of basic diagnosis, radiological ABC-rule, radiological follow-up and structured organ diagnosis using CT. Radiological trauma scoring allows improved quality control of diagnosis and therapy of multiple injured patients.Conclusion. Structured diagnostic imaging of multiple injured patients leads to a standardization of diagnosis and therapy and ensures constant process quality. (orig.) [de

  19. Impacts of patient characteristics on hospital care experience in 34,000 Swedish patients

    Directory of Open Access Journals (Sweden)

    Wolf Axel

    2012-06-01

    Full Text Available Abstract Background Standardized patient surveys are widely used for assessing quality of healthcare from the patient perspective. An important purpose of such surveys is to identify disparities in care among different patient groups. The purpose of this study was to 1. evaluate aspects of the validity of the adapted Swedish version of the Picker Patient Care Experience -15 (PPE-15 survey and 2. examine the explanatory value of various socio-demographic and health characteristics in predicting patients’ care experiences. Methods A retrospective cross-sectional study design was used. Patients discharged from internal medicine wards at regional and university hospitals in different parts of Sweden during 2010 were invited to participate in the regularly administered national care-experience survey for hospital care. The internal validity of the PPE-15 was assessed with Cronbach’s alpha and item-scale correlations. Pearson product–moment correlation coefficients were used to compare PPE-15 total scores with overall care satisfaction ratings and Spearman correlation coefficients were used to compare PPE-15 total scores with various patient characteristics. Multiple linear regression analysis was performed to examine the influence of various patient characteristics on PPE-15 scores. Results The response rate was 66% (n = 34 603. Cronbach’s alpha was 0.87. The correlation between the PPE-15 total score and overall care satisfaction was high (0.62, p  Conclusions Our results supported the internal validity of the Swedish adapted version of the PPE-15. The explanatory value of the examined patient socio-demographic and health characteristics was low, suggesting the need for exploring other patient-related determinants of care experiences. Our findings also suggest a care paradox: patients in greatest need of hospital care are least satisfied with the quality of the care they receive.

  20. Serum total antioxidant capacity in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Almira Hadžović-Džuvo

    2011-02-01

    Full Text Available Multiple sclerosis (MS is a chronic inflammatory disease of the central nervous system (CNS. It is characterized by loss of myelin, the fatty tissue that surrounds and protects nerve fibres allowing them to conduct electrical impulses. Recent data indicate that oxidative stress (OS plays a major role in the pathogenesis of multiple sclerosis (MS. The aim of this study was to estimate level of serum total antioxidative capacity in patients with multiple sclerosis. Our cross-sectional study included 33 patients with MS and 24 age and sex matched control subjects. All our patients had a Poser criteria for definite diagnostic categories of multiple sclerosis. Serum total antioxidant capacity (TAC was measured by quantitative colorimetric determination, using Total antioxidant Capacity-QuantiCromAntioxidant Assay Kit (BioAssay systems, USA; DTAC-100. Mean serum TAC in multiple sclerosis group of patients was 119.2 mM Trolox equivalents and was significantly lower (p<0.001 compared to the control group of subjects (167.1 mM Trolox equivalents. Our results showed that oxidative stress plays an important role in pathogenesis of multiple sclerosis. This finding, also, suggests the importance of antioxidants in diet and therapy of MS patients.

  1. Analyzing differences between patient and proxy on Patient Reported Outcomes in multiple sclerosis.

    Science.gov (United States)

    Sonder, Judith M; Holman, Rebecca; Knol, Dirk L; Bosma, Libertje V A E; Polman, Chris H; Uitdehaag, Bernard M J

    2013-11-15

    Proxy respondents, partners of multiple sclerosis (MS) patients, can provide valuable information on the MS patients' disease. In an earlier publication we found relatively good agreement on patient reported outcomes (PROs) measuring physical impact and functioning, but we found large differences on (neuro)psychological scales. We aim to identify patient and proxy related variables explaining differences between patients' and proxies' ratings on five PROs. We report on data from 175 MS patients and proxy respondents. Regression analyses were performed, using as dependent variable the mean differences on five scales: Physical and Psychological scale of the Multiple Sclerosis Impact Scale (MSIS-29), the Multiple Sclerosis Walking Scale (MSWS), Guy's Neurological Disability Scale (GNDS) and the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ). The independent variables were patient, proxy and disease related variables. Caregiver strain was significantly related to differences between patient and proxy scores for all five PROs. A higher level of patient anxiety on the HADS was linked to larger differences on all PROs except the GNDS. In addition, cognitive functioning, proxy depression, walking ability, proxy gender and MS related disability were contributing to the discrepancies. We found several patient and proxy factors that may contribute to discrepancies between patient and proxy scores on MS PROs. The most important factor is caregiver burden. © 2013 Elsevier B.V. All rights reserved.

  2. Analysis of the immune system of multiple myeloma patients achieving long-term disease control by multidimensional flow cytometry

    Science.gov (United States)

    Pessoa de Magalhães, Roberto J.; Vidriales, María-Belén; Paiva, Bruno; Fernandez-Gimenez, Carlos; García-Sanz, Ramón; Mateos, Maria-Victoria; Gutierrez, Norma C.; Lecrevisse, Quentin; Blanco, Juan F; Hernández, Jose; de las Heras, Natalia; Martinez-Lopez, Joaquin; Roig, Monica; Costa, Elaine Sobral; Ocio, Enrique M.; Perez-Andres, Martin; Maiolino, Angelo; Nucci, Marcio; De La Rubia, Javier; Lahuerta, Juan-Jose; San-Miguel, Jesús F.; Orfao, Alberto

    2013-01-01

    Multiple myeloma remains largely incurable. However, a few patients experience more than 10 years of relapse-free survival and can be considered as operationally cured. Interestingly, long-term disease control in multiple myeloma is not restricted to patients with a complete response, since some patients revert to having a profile of monoclonal gammopathy of undetermined significance. We compared the distribution of multiple compartments of lymphocytes and dendritic cells in the bone marrow and peripheral blood of multiple myeloma patients with long-term disease control (n=28), patients with newly diagnosed monoclonal gammopathy of undetermined significance (n=23), patients with symptomatic multiple myeloma (n=23), and age-matched healthy adults (n=10). Similarly to the patients with monoclonal gammopathy of undetermined significance and symptomatic multiple myeloma, patients with long-term disease control showed an expansion of cytotoxic CD8+ T cells and natural killer cells. However, the numbers of bone marrow T-regulatory cells were lower in patients with long-term disease control than in those with symptomatic multiple myeloma. It is noteworthy that B cells were depleted in patients with monoclonal gammopathy of undetermined significance and in those with symptomatic multiple myeloma, but recovered in both the bone marrow and peripheral blood of patients with long-term disease control, due to an increase in normal bone marrow B-cell precursors and plasma cells, as well as pre-germinal center peripheral blood B cells. The number of bone marrow dendritic cells and tissue macrophages differed significantly between patients with long-term disease control and those with symptomatic multiple myeloma, with a trend to cell count recovering in the former group of patients towards levels similar to those found in healthy adults. In summary, our results indicate that multiple myeloma patients with long-term disease control have a constellation of unique immune changes

  3. The risk of fracture in incident multiple sclerosis patients

    DEFF Research Database (Denmark)

    Bazelier, Marloes T; Bentzen, Joan; Vestergaard, Peter

    2012-01-01

    Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling.......Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling....

  4. The experience of transitioning from relapsing remitting to secondary progressive multiple sclerosis: views of patients and health professionals.

    Science.gov (United States)

    O'Loughlin, Emer; Hourihan, Susan; Chataway, Jeremy; Playford, E Diane; Riazi, Afsane

    2017-09-01

    The majority of people with multiple sclerosis (pwMS) initially present with discreet periods of relapses followed by partial remission of symptoms (RRMS). Over time, most pwMS transition to secondary progressive MS (SPMS), characterized by a gradual accumulation of disability. This study aimed to explore the experiences, coping and needs associated with transitioning from RRMS to SPMS. Data were collected via semi-structured interviews with nine pwMS and seven specialist MS health professionals (HPs). Thematic analysis was used to analyze the data. Four major themes were identified: "Is this really happening?"; "Becoming a reality"; "A life of struggle"; and "Brushing oneself off and moving on." Findings suggested a process of moving from uncertainty towards confirmation of one's diagnostic label. Being reclassified with SPMS served as a turning point for many, and was accompanied by a range of cognitive, emotional and behavioral responses. The value of adequate information and support surrounding the transition, and the potential benefit of education and support for health professionals in relation to the transition were indicated. Understanding pwMS' experiences of the transition is essential if clinicians are to provide pwMS with appropriate support during the transition. Implications for Rehabilitation The timing and delivery of preparatory education for patients about the transition to SPMS should be carefully considered. Sufficient information and follow-up support following the reclassification of SPMS is crucial but sometimes lacking. The importance of sensitive communication of the reclassification of SPMS was highlighted. MS Specialist health professionals may potentially benefit from training and support around communication of the reclassification of SPMS. Given the potential negative psychological impact of the transition, the psychological wellbeing of the patients during the transition to SPMS should be monitored and responded to appropriately.

  5. Multiplicity: An Explorative Interview Study on Personal Experiences of People with Multiple Selves.

    Science.gov (United States)

    Ribáry, Gergő; Lajtai, László; Demetrovics, Zsolt; Maraz, Aniko

    2017-01-01

    Background and aims: Personality psychology research relies on the notion that humans have a single self that is the result of the individual's thoughts, feelings, and behaviors that can be reliably described (i.e., through traits). People who identify themselves as "multiple" have a system of multiple or alternative, selves, that share the same physical body. This is the first study to explore the phenomenon of multiplicity by assessing the experiences of people who identify themselves as "multiple." Methods: First, an Internet forum search was performed using the terms "multiplicity" and "multiple system." Based on that search, people who identified themselves as multiple were contacted. Interviews were conducted by a consultant psychiatrist, which produced six case vignettes. Results: Multiplicity is discussed on Twitter, Tumblr, Google+ and several other personal websites, blogs, and forums maintained by multiples. According to the study's estimates, there are 200-300 individuals who participate in these forums and believe they are multiple. Based on the six interviews, it appears that multiples have several selves who are relatively independent of each other and constitute the personality's system. Each "resident person" or self, has their own unique behavioral pattern, which is triggered by different situations. However, multiples are a heterogeneous group in terms of their system organization, memory functions, and control over switching between selves. Conclusions: Multiplicity can be placed along a continuum between identity disturbance and dissociative identity disorder (DID), although most systems function relatively well in everyday life. Further research is needed to explore this phenomenon, especially in terms of the extent to which multiplicity can be regarded as a healthy way of coping.

  6. Impact of a comprehensive supportive care team on management of hopelessly ill patients with multiple organ failure.

    Science.gov (United States)

    Field, B E; Devich, L E; Carlson, R W

    1989-08-01

    We developed a supportive care team for hopelessly ill patients in an urban emergency/trauma hospital. The team includes a clinical nurse specialist and a faculty physician as well as a chaplain and social worker. The supportive care team provides an alternative to intensive care or conventional ward management of hopelessly ill patients and concentrates on the physical and psychosocial comfort needs of patients and their families. We describe our experience with 20 hopelessly ill patients with multiple organ failure vs a similar group treated before the development of the supportive care team. Although there was no difference in mortality (100 percent), the length of stay in the medical ICU for patients with multiple organ failure decreased by 12 days to 6 days. Additionally, there were 50 percent fewer therapeutic interventions provided by the supportive care team vs intensive care or conventional ward treatment of multiple organ failure patients. We describe the methods that the supportive care team uses in an attempt to meet the physical and psychosocial comfort needs of hopelessly ill multiple organ failure patients and their families. This multidisciplinary approach to the care of the hopelessly ill may have applications in other institutions facing the ethical, medical, and administrative challenges raised by these patients.

  7. An exploration of the lived experiences of individuals with relapsed multiple myeloma.

    LENUS (Irish Health Repository)

    Maher, K

    2012-02-01

    The experience of living with relapsed Multiple Myeloma (myeloma) for eight patients accessing treatment within a haematology unit in a large London hospital is explored in this study. Myeloma is recognised as incurable and is sometimes described as an \\'incurable chronic disease\\' with a main treatment option of chemotherapy. Hermeneutic phenomenology was the methodology used in conducting the study and data were collected through open-ended, unstructured interviews. Findings suggest that living with relapsed myeloma in the context of a chronic illness causes an ever-shifting perspective between illness and wellness consequently maintaining a state of uncertainty. The patients in this study placed importance on the emotional aspect of their experience. Hope, intuitive knowing and a fighting spirit were expressed as required positive elements that enabled living with relapsed myeloma. These assisted in maintaining normality, coping with bad news and adjusting to the illness. Pervading through the themes was the need to control uncertainty. Having strong support from significant others provided something to live for and the necessary social support required to promote a new orientation to life.

  8. A Spanish pillbox app for elderly patients taking multiple medications: randomized controlled trial.

    Science.gov (United States)

    Mira, José Joaquín; Navarro, Isabel; Botella, Federico; Borrás, Fernando; Nuño-Solinís, Roberto; Orozco, Domingo; Iglesias-Alonso, Fuencisla; Pérez-Pérez, Pastora; Lorenzo, Susana; Toro, Nuria

    2014-04-04

    Nonadherence and medication errors are common among patients with complex drug regimens. Apps for smartphones and tablets are effective for improving adherence, but they have not been tested in elderly patients with complex chronic conditions and who typically have less experience with this type of technology. The objective of this study was to design, implement, and evaluate a medication self-management app (called ALICE) for elderly patients taking multiple medications with the intention of improving adherence and safe medication use. A single-blind randomized controlled trial was conducted with a control and an experimental group (N=99) in Spain in 2013. The characteristics of ALICE were specified based on the suggestions of 3 nominal groups with a total of 23 patients and a focus group with 7 professionals. ALICE was designed for Android and iOS to allow for the personalization of prescriptions and medical advice, showing images of each of the medications (the packaging and the medication itself) together with alerts and multiple reminders for each alert. The randomly assigned patients in the control group received oral and written information on the safe use of their medications and the patients in the experimental group used ALICE for 3 months. Pre and post measures included rate of missed doses and medication errors reported by patients, scores from the 4-item Morisky Medication Adherence Scale (MMAS-4), level of independence, self-perceived health status, and biochemical test results. In the experimental group, data were collected on their previous experience with information and communication technologies, their rating of ALICE, and their perception of the level of independence they had achieved. The intergroup intervention effects were calculated by univariate linear models and ANOVA, with the pre to post intervention differences as the dependent variables. Data were obtained from 99 patients (48 and 51 in the control and experimental groups, respectively

  9. Myeloproliferative neoplasms in five multiple sclerosis patients

    DEFF Research Database (Denmark)

    Thorsteinsdottir, Sigrun; Bjerrum, Ole Weis

    2013-01-01

    The concurrence of myeloproliferative neoplasms (MPNs) and multiple sclerosis (MS) is unusual. We report five patients from a localized geographic area in Denmark with both MS and MPN; all the patients were diagnosed with MPNs in the years 2007-2012. We describe the patients' history and treatment...

  10. MR spectroscopy of cervical spinal cord in patients with multiple sclerosis

    International Nuclear Information System (INIS)

    Kendi, Ayse Tuba Karaguelle; Kendi, Mustafa; Tan, Funda Uysal; Tellioglu, Serdar; Huvaj, Sinef

    2004-01-01

    MR spectroscopy (MRS) of the brain in patients with multiple sclerosis has been well studied. However, in vivo MRS of the spinal cord in patients with MR spectroscopy has not been reported to our knowledge. We performed MRS of normal-appearing cervical spinal cords in multiple sclerosis patients and in healthy controls. N-acetyl aspartate was shown to be reduced within the cervical spinal cord of multiple sclerosis patients when compared with healthy controls. This finding supports axonal loss and damage within even normal-appearing spinal cords of multiple sclerosis patients. (orig.)

  11. Multiplicity: An Explorative Interview Study on Personal Experiences of People with Multiple Selves

    Directory of Open Access Journals (Sweden)

    Gergő Ribáry

    2017-06-01

    Full Text Available Background and aims: Personality psychology research relies on the notion that humans have a single self that is the result of the individual's thoughts, feelings, and behaviors that can be reliably described (i.e., through traits. People who identify themselves as “multiple” have a system of multiple or alternative, selves, that share the same physical body. This is the first study to explore the phenomenon of multiplicity by assessing the experiences of people who identify themselves as “multiple.”Methods: First, an Internet forum search was performed using the terms “multiplicity” and “multiple system.” Based on that search, people who identified themselves as multiple were contacted. Interviews were conducted by a consultant psychiatrist, which produced six case vignettes.Results: Multiplicity is discussed on Twitter, Tumblr, Google+ and several other personal websites, blogs, and forums maintained by multiples. According to the study's estimates, there are 200–300 individuals who participate in these forums and believe they are multiple. Based on the six interviews, it appears that multiples have several selves who are relatively independent of each other and constitute the personality's system. Each “resident person” or self, has their own unique behavioral pattern, which is triggered by different situations. However, multiples are a heterogeneous group in terms of their system organization, memory functions, and control over switching between selves.Conclusions: Multiplicity can be placed along a continuum between identity disturbance and dissociative identity disorder (DID, although most systems function relatively well in everyday life. Further research is needed to explore this phenomenon, especially in terms of the extent to which multiplicity can be regarded as a healthy way of coping.

  12. Patient perceptions of multiple sclerosis and its treatment

    Directory of Open Access Journals (Sweden)

    de Seze J, Borgel F, Brudon F

    2012-04-01

    Full Text Available Jérôme de Seze1, Florent Borgel2, Frédérique Brudon31Department of Neurology CHRU de Strasbourg, Strasbourg, 2Medical Center, Grenoble, 3Clinique du Tonkin, Villeurbanne, FranceBackground: In order to improve the treatment outcome in multiple sclerosis, it is important to document the factors that influence adherence to therapy. The purpose of this study was to determine patient perceptions and awareness of multiple sclerosis and its treatment, treatment adherence, and impact on quality of life and daily living.Methods: This was a cross-sectional observational study performed in France. Each participating neurologist included the first three patients with relapsing-remitting multiple sclerosis who consulted after the start of the study. Data on clinical features were collected from a physician questionnaire and on disease and treatment perception and on quality of life from a patient autoquestionnaire.Results: A total of 175 neurologists entered 202 patients in the study. The mean duration of disease was 8.0 ± 7.0 years, and immunomodulatory treatment had been administered for a mean duration of 3.0 ± 2.0 years. A total of 166 patients (82.2% were treated with interferon-ß preparations and 36 patients (17.8% with glatiramer acetate. Eighty-five patients (42.1% reported missing their injections from time to time and 36 patients (17.8% reported “drug holidays”. The most frequently given reason for nonadherence was forgetfulness (38.7% of cases. Eighty-six patients (42.6% and 70 patients (34.7% claimed to be well informed about their disease and treatment, respectively. Adherence was significantly higher in well informed patients (P = 0.035. The majority of patients (176 patients, 87.1% intended continuing their current treatment and 49.5% considered that their current treatment might reduce relapses. The most frequently reported side effect was muscle pain (124 patients, 61.4%.Conclusion: Patient understanding of treatment for disease

  13. Theoretical investigations of quantum correlations in NMR multiple-pulse spin-locking experiments

    Science.gov (United States)

    Gerasev, S. A.; Fedorova, A. V.; Fel'dman, E. B.; Kuznetsova, E. I.

    2018-04-01

    Quantum correlations are investigated theoretically in a two-spin system with the dipole-dipole interactions in the NMR multiple-pulse spin-locking experiments. We consider two schemes of the multiple-pulse spin-locking. The first scheme consists of π /2-pulses only and the delays between the pulses can differ. The second scheme contains φ-pulses (0Quantum discord is obtained for the first scheme of the multiple-pulse spin-locking experiment at different temperatures.

  14. First clinical experience with a multiple region of interest registration and correction method in radiotherapy of head-and-neck cancer patients

    International Nuclear Information System (INIS)

    Beek, Suzanne van; Kranen, Simon van; Mencarelli, Angelo; Remeijer, Peter; Rasch, Coen; Herk, Marcel van; Sonke, Jan-Jakob

    2010-01-01

    Purpose: To discuss the first clinical experience with a multiple region of interest (mROI) registration and correction method for high-precision radiotherapy of head-and-neck cancer patients. Materials and methods: 12-13 3D rectangular-shaped ROIs were automatically placed around bony structures on the planning CT scans (n = 50 patients) which were individually registered to subsequent CBCT scans. mROI registration was used to quantify global and local setup errors. The time required to perform the mROI registration was compared with that of a previously used single-ROI method. The number of scans with residual local setup error exceeding 5 mm/5 deg. (warnings) was scored together with the frequency ROIs exceeding these limits for three or more consecutive imaging fractions (systematic errors). Results: In 40% of the CBCT scans, one or more ROI-registrations exceeded the 5 mm/5 deg.. Most warnings were seen in ROI 'hyoid', 31% of the rotation warnings and 14% of the translation warnings. Systematic errors lead to 52 consults of the treating physician. The preparation and registration time was similar for both registration methods. Conclusions: The mROI registration method is easy to use with little extra workload, provides additional information on local setup errors, and helps to select patients for re-planning.

  15. Faith as a Resource in Patients with Multiple Sclerosis Is Associated with a Positive Interpretation of Illness and Experience of Gratitude/Awe

    Directory of Open Access Journals (Sweden)

    Arndt Büssing

    2013-01-01

    Full Text Available The aim of this cross-sectional anonymous survey with standardized questionnaires was to investigate which resources to cope were used by patients with multiple sclerosis (MS. We focussed on patients' conviction that their faith might be a strong hold in difficult times and on their engagement in different forms of spirituality. Consecutively 213 German patients (75% women; mean age 43 ± 11 years were enrolled. Fifty-five percent regarded themselves as neither religious nor spiritual (R−S−, while 31% describe themselves as religious. For 29%, faith was a strong hold in difficult times. This resource was neither related to patients' EDSS scores, and life affections, fatigue, negative mood states, life satisfaction nor to Positive attitudes. Instead it was moderately associated with a Reappraisal strategy (i.e., and positive interpretation of illness and experience of gratitude/awe. Compared to spiritual/religious patients, R−S− individuals had significantly (P<.0001 lower Reappraisal scores and lower engagement in specific forms of spiritual practices. The ability to reflect on what is essential in life, to appreciate and value life, and also the conviction that illness may have meaning and could be regarded as a chance for development was low in R−S− individuals which either may have no specific interest or are less willing to reflect these issues.

  16. Upper limits from counting experiments with multiple pipelines

    International Nuclear Information System (INIS)

    Sutton, Patrick J

    2009-01-01

    In counting experiments, one can set an upper limit on the rate of a Poisson process based on a count of the number of events observed due to the process. In some experiments, one makes several counts of the number of events, using different instruments, different event detection algorithms or observations over multiple time intervals. We demonstrate how to generalize the classical frequentist upper limit calculation to the case where multiple counts of events are made over one or more time intervals using several (not necessarily independent) procedures. We show how different choices of the rank ordering of possible outcomes in the space of counts correspond to applying different levels of significance to the various measurements. We propose an ordering that is matched to the sensitivity of the different measurement procedures and show that in typical cases it gives stronger upper limits than other choices. As an example, we show how this method can be applied to searches for gravitational-wave bursts, where multiple burst-detection algorithms analyse the same data set, and demonstrate how a single combined upper limit can be set on the gravitational-wave burst rate.

  17. Measuring Patient Preferences: An Overview of Methods with a Focus on Discrete Choice Experiments.

    Science.gov (United States)

    Hazlewood, Glen S

    2018-05-01

    There is increasing recognition of the importance of patient preferences and methodologies to measure them. In this article, methods to quantify patient preferences are reviewed, with a focus on discrete choice experiments. In a discrete choice experiment, patients are asked to choose between 2 or more treatments. The results can be used to quantify the relative importance of treatment outcomes and/or other considerations relevant to medical decision making. Conducting and interpreting a discrete choice experiment requires multiple steps and an understanding of the potential biases that can arise, which we review in this article with examples in rheumatic diseases. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Multiple myeloma and central nervous system involvement: experience of a Brazilian center

    Directory of Open Access Journals (Sweden)

    Ana Luiza Miranda Silva Dias

    2018-01-01

    Full Text Available Introduction: The estimated involvement of the central nervous system in patients with multiple myeloma is rare at about 1%. The infiltration can be identified at the time multiple myeloma is diagnosed or during its progression. However, it is more common in refractory disease or during relapse. Methods: This retrospective cohort study reviewed data from medical records of patients followed up at the Gammopathy Outpatient Clinic of Santa Casa de Misericórdia de São Paulo from January 2008 to December 2016. Results: Twenty patients were included, with a median follow-up of 33.5 months after central nervous system infiltration. The prevalence was 7%. The median age at diagnosis of multiple myeloma was 56.1 years, with 70% of participants being female. Sixteen patients had central nervous system infiltration at diagnosis of multiple myeloma. Seventeen patients had exclusive osteodural lesions and three had infiltrations of the leptomeninge, of which one had exclusive involvement and two had associated osteodural lesions. The median overall survival was 40.3 months after central nervous system involvement. The median overall survival in the group with central nervous system infiltration at relapse was 7.4 months. The patients with leptomeningeal involvement had a median overall survival of 5.8 months. Conclusion: Central nervous system infiltration is a rare condition, but it should be considered as a possibility in patients with multiple myeloma and neurological symptoms. The best treatment regimen for this condition remains unknown and, in most cases, the prognosis is unfavorable. Keywords: Central nervous system, Multiple myeloma, Radiotherapy, Chemotherapy, Prognosis

  19. Increased rate of treatment with antidepressants in patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Harhoff, Mette; Andersen, Per Kragh

    2008-01-01

    The prevalence of depression and anxiety is increased in patients with multiple sclerosis, but it has not been investigated whether these conditions are treated in clinical practice. The objective of this study was to investigate whether the rate of treatment with antidepressants is increased...... in patients with multiple sclerosis compared with patients with other chronic illnesses and compared with the general population. By linkage of nationwide case registers, all patients were identified, who had received a main diagnosis of multiple sclerosis or osteoarthritis at first admission or during...... outpatient contact in the period 1995-2000 in Denmark. Rates of subsequent purchase of antidepressants for these patients were calculated. In total, 417 patients with a main diagnosis of multiple sclerosis and 12 127 patients with a main diagnosis of osteoarthritis, at first discharge from hospital...

  20. The Experiences of Medical Marijuana Patients: A Scoping Review of the Qualitative Literature.

    Science.gov (United States)

    Ryan, Jennie; Sharts-Hopko, Nancy

    2017-06-01

    Medical marijuana is now legal in more than half of the United States but remains federally prohibited and classified as a schedule 1 drug. The chemical compounds in marijuana are known neuroprotectants; however, their clinical efficacy and safety have not been proven. Many healthcare providers remain unaware of the therapeutic potential of marijuana and its adverse effects. The conflicting laws and lack of guidance from healthcare professionals can lead to confusion and frustration for patients seeking this medication. Multiple factors contribute to the unique and varied experiences of medical marijuana patients. Because more individuals with neurological disorders seek therapeutic marijuana, it is important for healthcare professionals to understand their distinctive experiences. Qualitative research methodology is ideal to capture the thick descriptions of these experiences. This review examines the qualitative research exploring the experiences of medical marijuana patients and discusses common themes across all studies.

  1. Use of multiple patient simulators to enhance prioritizing and delegating skills for senior nursing students.

    Science.gov (United States)

    Kaplan, Barbara; Ura, Darla

    2010-07-01

    The student clinical experience is rich, yet challenges arise in providing experiences where leadership skills can be developed and used in nursing practice. To increase student confidence and enhance student ability to safely and effectively prioritize, delegate, and implement care for numerous patients, a simulation-based learning (SBL) experience was developed. The SBL experience involves multiple patient simulators, case study analysis, and a debriefing session. Ninety-seven senior nursing students participated in this program. Students reported through Likert surveys to either "agree" or "strongly agree" that the SBL was well organized (87%, n = 84), prompted realistic expectations (59%, n = 57), the scenarios were believable (73%, n = 71), case studies increased understanding (66%, n = 64), and that the SBL experience increased understanding of prioritizing and delegating care (69%, n = 67). Seventy-eight percent (n = 76) reported "more confidence in ability to work as a team" and 55% (n = 52) reported "more confidence in prioritizing and delegating care." Copyright 2010, SLACK Incorporated.

  2. Incidence of complications in dermatological surgery of melanoma and non-melanoma skin cancer in patients with multiple comorbidity and/or antiplatelet-anticoagulants. Five year experience in our Hospital.

    Science.gov (United States)

    Arguello-Guerra, Lilia; Vargas-Chandomid, Estefanía; Díaz-González, Jose Manuel; Méndez-Flores, Silvia; Ruelas-Villavicencio, Ana; Domínguez-Cherit, Judith

    2018-01-01

    Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8% . The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity. Copyright: © 2018 Permanyer.

  3. Musical identity of patients with multiple sclerosis.

    Science.gov (United States)

    Moreira, Shirlene Vianna; França, Cecília Cavalieri; Moreira, Marcos Aurélio; Lana-Peixoto, Marco Aurélio

    2009-03-01

    Musical autobiographies consist of a powerful therapeutic tool by which individuals define themselves. The use of this technique may help (re)construction personal identities and improve quality of life of patients with multiple sclerosis (MS). Eight adult patients on treatment at CIEM Multiple Sclerosis Investigation Center after selecting 10 to 15 pieces of music most significant in their lives were interviewed. The data collected were classified according to Even Rudd categories, which reveal how a person expresses his personal, social, temporal and transpersonal identities. We observed that recall of musical history makes MS patients get better perception both of their feelings and body awareness, as well as provide them with an alternative way to express themselves, activate and contextualize affective memories, and achieving a sense of life continuity in spite of the disease.

  4. Serum Homocysteine level in patients with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    F Ashtari

    2005-09-01

    Full Text Available Background: The etiology of multiple sclerosis (MS, a chronic demyelinative disease-is unknown. The damage of blood–brain barrier (BBB vasculature is a characteristic of MS and Homocystein (Hcy can damage BBB, then increase in total Hcy may be important in MS pathogenesis. The aim of this study was to compare the serum level of total Hcy in MS patients with control group. Methods: In a case control study, serum level of total Hcy measured in 35 MS patient and compared with 30 healthy matched controls. All patients had definitive MS according to Poser criteria, without history of myocardial infarction, stroke, neuropathy, transient ischemic attack, homocystinuria or renal failure. Results: The serum concentration of total homocystein was significantly higher in multiple sclerosis patients than healthy controls. The mean total Hcy level was 17.92± 6.9 mmol/lit in cases and 14.6±2.92 mmol/lit in controls (P=0.013. Conclusion: Serum total Homocystein may have a role in MS pathogenesis and reduction of it should be studied moreover. Key words: Multiple Sclerosis, Homocystein, Serum level

  5. Personality factors in recently diagnosed multiple sclerosis patients: a preliminary investigation with the NEO-FFI scale

    Directory of Open Access Journals (Sweden)

    Aline Braz de Lima

    2015-03-01

    Full Text Available This article describes some prevalent personality dimensions of recently diagnosed multiple sclerosis patients. A sample of 33 female recently diagnosed with relapsing-remitting multiple sclerosis (RRMS was assessed with the NEO-FFI personality scale. Beck depression (BDI and anxiety (BAI scales were also used. No significant levels of anxiety or depression were identified in this group. As for personality factors, conscientiousness was the most common factor found, whereas openness to experience was the least observed. Literature on the relationship between personality and MS is scarce and there are no Brazilian studies on this subject. Some personality traits might complicate or facilitate the experience of living with a chronic, disabling and uncertain neurological condition such as MS.

  6. Oroal manifestations in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Grajales González Hilda María

    2014-07-01

    Full Text Available Multiple sclerosis is a chronic autoimmune inflammatory disease of the central nervous system, characterized by the presence of acute focal inflammatory demyelination, axonal loss and gliosis. It affects predominantly in young adults between 20 and 40 years of age; it is infrequent in the pediatric age. A observational, retrospective and descriptive cohort research was conducted between May 1999 and January 2012 to assess demographic characteristics, and pathological manifestations in the oral cav- ity of children with this condition. Records of 17 patients, under 18 years of age, of either sex were included, who had been evaluated in the Department of Stomatology. Data recorded were age, sex, State of origin, oral and facial pathological features, focal cavity infections and ceod index. There were no patients with trigeminal neuralgia or facial paralysis; a 5.7% ceod index was identified. Most of the patients were under immunopressive treatment. A protocol for stomatological follow-up in patients with multiple sclerosis does not exist. The medical profession must be sensibilized to establish strategies for an integral follow-up in patients with this condition.

  7. Effects of Acupuncture on Gait of Patients with Multiple Sclerosis.

    Science.gov (United States)

    Criado, Maria Begoña; Santos, Maria João; Machado, Jorge; Gonçalves, Arminda Manuela; Greten, Henry Johannes

    2017-11-01

    Multiple sclerosis is considered a complex and heterogeneous disease. Approximately 85% of patients with multiple sclerosis indicate impaired gait as one of the major limitations in their daily life. Acupuncture studies found a reduction of spasticity and improvement of fatigue and imbalance in patients with multiple sclerosis, but there is a lack of studies regarding gait. We designed a study of acupuncture treatment, according to the Heidelberg model of Traditional Chinese Medicine (TCM), to investigate if acupuncture can be a useful therapeutic strategy in patients with gait impairment in multiple sclerosis of relapsing-remitting type. The sample consisted of 20 individuals with diagnosis of multiple sclerosis of relapsing-remitting type. Gait impairment was evaluated by the 25-foot walk test. The results showed differences in time to walk 25 feet following true acupuncture. In contrast, there was no difference in time to walk 25 feet following sham acupuncture. When using true acupuncture, 95% of cases showed an improvement in 25-foot walk test, compared with 45% when sham acupuncture was done. Our study protocol provides evidence that acupuncture treatment can be an attractive option for patients with multiple sclerosis, with gait impairment.

  8. Experience of gratitude, awe and beauty in life among patients with multiple sclerosis and psychiatric disorders

    DEFF Research Database (Denmark)

    Büssing, Arndt; Wirth, Anne Gritli; Reiser, Franz

    2014-01-01

    Background: Feelings of gratitude and awe facilitate perceptions and cognitions that go beyond the focus of illness and include positive aspects of one's personal and interpersonal reality, even in the face of disease. We intended to measure feelings of gratitude, awe, and experiences of beauty...... spiritual practices (SpREUK-P) and their relation to experiences of Gratitude, Awe and Beauty in Life and life satisfaction (BMLSS-10). In total, 461 individuals (41 +/- 13 years; 68% women) with multiple sclerosis (46%) and depressive (22%) or other psychiatric disorders (32%) participated. Results: Among...... participants, 23% never, 43% rarely, 24% often, and 10% frequently experienced Gratitude. In contrast, 41% never, 37% rarely, 17% often, and 6% frequently experienced Awe. Beauty in Life was never experienced by 8% of the sample, and 28% rarely, 46% often, and 18% frequently experienced it. Gratitude (F = 9...

  9. [Surgical treatment of Marfan syndrome; analysis of the patients required multiple surgical interventions].

    Science.gov (United States)

    Yamazaki, F; Shimamoto, M; Fujita, S; Nakai, M; Aoyama, A; Chen, F; Nakata, T; Yamada, T

    2002-07-01

    Without treatment, the life expectancy of patients with Marfan syndrome is reduced by the associated cardiovascular abnormalities. In this study, we reviewed our experience of the patients with Marfan syndrome who required multiple surgical interventions to identify the optimal treatment for these patients. Between January 1986 and December 2000, 44 patients with Marfan syndrome were operated on at Shizuoka City Hospital (SCH). Among them, 10 patients (22.7%) underwent multiple surgical interventions. There were 5 male and 5 female patients with a mean age of 40.6 +/- 16.1 years at the initial surgery. Only one patient was operated on at another hospital for his first, second, and third operations. His fourth operation was carried out at SCH. The remaining 9 patients underwent a total of 14 additional surgical procedures at SCH. Computed tomography (CT) scans were taken every 6 months postoperatively, and aortic diameter greater than 60 mm was considered as the indication for the additional surgery. There were no early death and one late death. The causes of additional surgery were enlargement of true aneurysm in 6, enlargement of residual dissection in 4, new dissection in 4, false aneurysm at the coronary anastomosis of Bentall procedure in 1. In 9 patients, both ascending and descending aorta were replaced. Among these 9 patients, only 3 patients underwent total arch replacement, and remaining 6 patients had their arch left in place with or without dissection. Our current strategy of the treatment of Marfan patients with acute type A dissection is total arch replacement with an elephant trunk at the initial emergent surgery.

  10. Causes of death in critically ill multiple sclerosis patients.

    Science.gov (United States)

    Karamyan, A; Brandtner, H; Grinzinger, S; Chroust, V; Bacher, C; Otto, F; Reisp, M; Hauer, L; Sellner, J

    2017-10-01

    Patients with multiple sclerosis (MS) experience higher mortality rates as compared to the general population. While the risk of intensive care unit (ICU) admission is also reported to be higher, little is known about causes of death CoD in critically ill MS patients. To study the causes of death (CoD) in the series of critically ill patients with MS verified by autopsy. We reviewed hospital electronic charts of MS patients treated at the neurological ICU of a tertiary care hospital between 2000 and 2015. We compared clinical and pathological CoD for those who were autopsied. Overall, 10 patients were identified (seven female; median age at death 65 years, range 27-80), and six of them were autopsied. The median MS duration prior to ICU admission was 27.5 years (range 1-50), and the median EDSS score at the time of ICU admission was 9 (range 5-9.5). The median length of ICU stay was 3 days (range 2-213). All the individuals in our series had experienced respiratory insufficiency during their ICU stay. The autopsy examination of brain tissue did not reveal evidences of MS lesions in one patient. In another patient, Lewy bodies were found on brain immunohistochemistry. Mortality in critically ill MS patients is largely driven by respiratory complications. Sporadic disparities between clinical and pathological findings can be expected. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Abundance of Stress, Anxiety and Depression in Multiple Sclerosis Patients

    Directory of Open Access Journals (Sweden)

    A. Dehghan

    2013-05-01

    Conclusion: The findings of this research revealed high stress, anxiety and depression in Multiple Sclerosis Patients that can jeopardize their health. Hence the providing appropriate education for coping and adapting with the symptoms in Multiple Sclerosis Patients seems to be necessary.

  12. The patient with multiple intestinal polyps.

    Science.gov (United States)

    Schulmann, Karsten; Pox, Christian; Tannapfel, Andrea; Schmiegel, Wolff

    2007-01-01

    The management of patients with multiple intestinal polyps may be difficult and greatly depends on the correct classification. Polyposis syndromes account for less than 1% of newly diagnosed colorectal cancers. In addition the risk for extracolonic cancer is increased in most syndromes. Here we report the case of a difficult patient with severe gastric polyposis and we present a review of polyposis syndromes such as classical and attenuated familial adenomatous polyposis (FAP), MYH-associated polyposis, Peutz-Jeghers syndrome, juvenile polyposis as well as rare polyposis syndromes. The most practical approach for the diagnostic workup in patients with newly diagnosed gastrointestinal polyposis is based on the histological typing of polyps. In addition, a detailed family history regarding cancer, polyps and congenital abnormalities should be obtained from every polyposis patient. Patients with multiple adenomas are most likely to suffer from FAP, AFAP or MAP. Of these, younger age and higher polyp count are most likely a diagnosis of typical FAP. Older age and fewer polyps favour a diagnosis of AFAP or MAP. Germline testing of the APC gene is suggested, and if negative, MYH gene testing should be done. In patients with hamartomas, extraintestinal features should be evaluated and reference histology should be initiated. In addition panintestinal imaging should be performed with EGD, colonoscopy and small bowel imaging (PE, CE, and MR) enteroclysis. For diagnostic and therapeutic problems a familial colorectal cancer center should be consulted. Using this algorithm, correct classification and adequate treatment should be possible for every polyposis patient.

  13. Multiple primary malignant neoplasms in breast cancer patients in Israel

    International Nuclear Information System (INIS)

    Schenker, J.G.; Levinsky, R.; Ohel, G.

    1984-01-01

    The data of an epidemiologic study of multiple primary malignant neoplasms in breast cancer patients in Israel are presented. During the 18-year period of the study 12,302 cases of breast carcinoma were diagnosed, and, of these, 984 patients (8%) had multiple primary malignant tumors. Forty-seven of these patients developed two multiple primary cancers. A significantly higher than expected incidence of second primary cancers occurred at the following five sites: the opposite breast, salivary glands, uterine corpus, ovary, and thyroid. Cancers of the stomach and gallbladder were fewer than expected. Treatment of the breast cancer by irradiation was associated with an increased risk of subsequent cancers of lung and hematopoietic system. The prognosis was mainly influenced by the site and malignancy of the second primary cancer. The incidence of multiple primary malignancies justifies a high level of alertness to this possibility in the follow-up of breast cancer patients

  14. Multiple myeloma and central nervous system involvement: experience of a Brazilian center.

    Science.gov (United States)

    Dias, Ana Luiza Miranda Silva; Higashi, Fabiana; Peres, Ana Lúcia M; Cury, Pricilla; Crusoé, Edvan de Queiroz; Hungria, Vânia Tietsche de Moraes

    The estimated involvement of the central nervous system in patients with multiple myeloma is rare at about 1%. The infiltration can be identified at the time multiple myeloma is diagnosed or during its progression. However, it is more common in refractory disease or during relapse. This retrospective cohort study reviewed data from medical records of patients followed up at the Gammopathy Outpatient Clinic of Santa Casa de Misericórdia de São Paulo from January 2008 to December 2016. Twenty patients were included, with a median follow-up of 33.5 months after central nervous system infiltration. The prevalence was 7%. The median age at diagnosis of multiple myeloma was 56.1 years, with 70% of participants being female. Sixteen patients had central nervous system infiltration at diagnosis of multiple myeloma. Seventeen patients had exclusive osteodural lesions and three had infiltrations of the leptomeninge, of which one had exclusive involvement and two had associated osteodural lesions. The median overall survival was 40.3 months after central nervous system involvement. The median overall survival in the group with central nervous system infiltration at relapse was 7.4 months. The patients with leptomeningeal involvement had a median overall survival of 5.8 months. Central nervous system infiltration is a rare condition, but it should be considered as a possibility in patients with multiple myeloma and neurological symptoms. The best treatment regimen for this condition remains unknown and, in most cases, the prognosis is unfavorable. Copyright © 2017. Published by Elsevier Editora Ltda.

  15. The management of multiple sclerosis in children: a European view

    DEFF Research Database (Denmark)

    Ghezzi, Angelo; Banwell, Brenda; Boyko, Alexey

    2010-01-01

    in the paediatric multiple sclerosis population has triggered the use of disease-modifying therapies that have been shown to reduce relapse rate, disease progression and cognitive decline in adult patients with multiple sclerosis. Hard evidence for the right treatment and its appropriate timing is scarce...... in the management of paediatric multiple sclerosis. One of the aims was to generate a common view on the management of paediatric multiple sclerosis patients. The result of this meeting is presented here to help standardize treatment and to support clinicians with less experience in this field.......About 3-5% of all patients with multiple sclerosis experience the onset of their disease under the age of 16. A significant proportion of paediatric multiple sclerosis patients develop significant cognitive disturbances and persistent physical disability. The high relapse rate and the morbidity...

  16. Holistic needs assessment in advanced, intensively treated multiple myeloma patients.

    Science.gov (United States)

    Boland, E G; Boland, J W; Ezaydi, Y; Greenfield, D M; Ahmedzai, S H; Snowden, J A

    2014-10-01

    It is recommended that patients with multiple myeloma should be assessed for unmet holistic needs at key times in their disease trajectory. The aim of this exploratory study was to characterise the holistic needs of advanced, intensively treated multiple myeloma using a structured assessment tool. Patients with multiple myeloma who had undergone a haematopoietic stem cell transplantation and subsequent treatment for at least one episode of progressive disease but were in stable plateau phase were included in the study. Patients' holistic needs were assessed using the self-reporting tool, Sheffield Profile for Assessment and Referral for Care (SPARC). Thirty-two patients with a median age of 60 years at assessment and a median of 5.5 years from diagnosis were recruited. Using the SPARC, half of the patients reported tiredness as 'quite a bit/very much,' while one third complained that daytime somnolence and insomnia were 'quite a bit/very much.' Forty-four percent of patients reported pain. One third of patients were bothered and distressed by the side effects from their treatment and were worried about long-term effects of their treatment. Thirty-one percent of patients felt that the effect of their condition had an impact on their sexual life, and 40 % were worried about the effect that their illness was having on their family or other people. This is the first study to use a self-reported holistic needs assessment tool in multiple myeloma. A multidimensional structured questionnaire like the SPARC could provide a useful first step in the effective delivery of supportive and palliative care for patients with multiple myeloma.

  17. Neuraxial anesthesia in patients with multiple sclerosis - a systematic review

    Directory of Open Access Journals (Sweden)

    Helmar Bornemann-Cimenti

    Full Text Available Abstract Background and objectives: Current guidelines for neuraxial analgesia in patients with multiple sclerosis are ambiguous and offer the clinician only a limited basis for decision making. This systematic review examines the number of cases in which multiple sclerosis has been exacerbated after central neuraxial analgesia in order to rationally evaluate the safety of these procedures. Methods: A systematic literature search with the keywords "anesthesia or analgesia" and "epidural, peridural, caudal, spinal, subarachnoid or intrathecal" in combination with "multiple sclerosis" was performed in the databases PubMed and Embase, looking for clinical data on the effect of central neuraxial analgesia on the course of multiple sclerosis. Results and conclusions: Over a period of 65 years, our search resulted in 37 reports with a total of 231 patients. In 10 patients multiple sclerosis was worsened and nine multiple sclerosis or neuromyelitis optica was first diagnosed in a timely context with central neuraxial analgesia. None of the cases showed a clear relation between cause and effect. Current clinical evidence does not support the theory that central neuraxial analgesia negatively affects the course of multiple sclerosis.

  18. Bone Health in Patients with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Vit Zikan

    2011-01-01

    Full Text Available Multiple sclerosis (MS is a gait disorder characterized by acute episodes of neurological defects leading to progressive disability. Patients with MS have multiple risk factors for osteoporotic fractures, such as progressive immobilization, long-term glucocorticoids (GCs treatment or vitamin D deficiency. The duration of motor disability appears to be a major contributor to the reduction of bone strength. The long term immobilization causes a marked imbalance between bone formation and resorption with depressed bone formation and a marked disruption of mechanosensory network of tightly connected osteocytes due to increase of osteocyte apoptosis. Patients with higher level of disability have also higher risk of falls that combined with a bone loss increases the frequency of bone fractures. There are currently no recommendations how to best prevent and treat osteoporosis in patients with MS. However, devastating effect of immobilization on the skeleton in patients with MS underscores the importance of adequate mechanical stimuli for maintaining the bone structure and its mechanical competence. The physical as well as pharmacological interventions which can counteract the bone remodeling imbalance, particularly osteocyte apoptosis, will be promising for prevention and treatment of osteoporosis in patients with MS.

  19. [Experience with high-dose immunosuppressive therapy followed by transplantation of autologous stem hematopoietic cells in patients with multiple sclerosis].

    Science.gov (United States)

    Rossiev, V A; Makarov, S V; Aleksandrova, I Ia; Dolgikh, G T; Lipshina, S R; Stukalova, T A; Trushina, O A; Fedorova, E Iu; Lipina, L N; Sivak, V F; Korenev, P P; Murashov, B F

    2002-01-01

    To assess efficiency of immunosuppressive therapy and subsequent autologous transplantation of stem blood cells (SBC) in patients with multiple sclerosis. The trial enrolled 23 patients (4 men and 19 women) with multiple sclerosis (MS) lasting for 3 to 12 years. The age of the patients ranged from 18 to 44 years. The index of the progression was above 1 in all the patients. A remitting, primary-progredient, secondary-progredient course was diagnosed in 3, 3 and 17 patients, respectively. Posttransplantation follow-up was 1 to 1.5 years. The degree of the neurological deficiency (0-6 scores) was estimated by the scale of functional systems damage. Lymphocyte subpopulations were evaluated by enzyme immunoassay according to expression of membrane antigens CD3, CD4, CD8, CD16, CD20, CD25, CD56, CD95 using monoclonal antibodies ICO (Biomedspectr), humoral immunity--by serum levels of IgA, IgM and IgG. SBC mobilization was conducted for 5 days by subcutaneous introduction of neipogen (Roche) in a dose 8.7-10 mcg/kg. Preparation of SBC was made on Haemonetics blood separator on mobilization day 4-5. Cryopreservation was carried out in programmed freezer (Cryomed) with 7% dimethylsulphoxide as a cryoprotector. Pretransplantation conditioning was conducted according to the schemes BEAM + antilymphocytic globulin (protocol N 1) and fludar + melfalan + ALG (protocol N 2). In posttransplantation period most of the patients achieved a fall in intensity of motor and coordination disorders. No recovery of cranial nerve function was observed. The protocols of pretransplantation preparation were compared by efficiency and organic toxicity. Indications to immunosuppressive therapy in MS patients were defined, pathogenetic validation of the immunosuppressive therapy was attempted.

  20. Organizational Processes and Patient Experiences in the Patient-centered Medical Home.

    Science.gov (United States)

    Aysola, Jaya; Schapira, Marilyn M; Huo, Hairong; Werner, Rachel M

    2018-06-01

    There is increasing emphasis on the use of patient-reported experience data to assess practice performance, particularly in the setting of patient-centered medical homes. Yet we lack understanding of what organizational processes relate to patient experiences. Examine associations between organizational processes practices adopt to become PCMH and patient experiences with care. We analyzed visit data from patients (n=8356) at adult primary care practices (n=22) in a large health system. We evaluated the associations between practice organizational processes and patient experience using generalized estimating equations (GEE) with an exchangeable correlation structure to account for patient clustering by practice in multivariate models, adjusting for several practice-level and patient-level characteristics. We evaluated if these associations varied by race/ethnicity, insurance type, and the degree of patient comorbidity MEASURES:: Predictors include overall PCMH adoption and adoption of six organizational processes: access and communications, patient tracking and registry, care management, test referral tracking, quality improvement and external coordination. Primary outcome was overall patient experience. In our full sample, overall PCMH adoption score was not significantly associated with patient experience outcomes. However, among subpopulations with higher comorbidities, the overall PCMH adoption score was positively associated with overall patient experience measures [0.2 (0.06, 0.4); P=0.006]. Differences by race/ethnicity and insurance type in associations between specific organizational processes and patient experience were noted. Although some organizational processes relate to patients' experiences with care irrespective of the background of the patient, further efforts are needed to align practice efforts with patient experience.

  1. Measuring medicine-related experiences from the patient perspective: a systematic review.

    Science.gov (United States)

    Katusiime, Barbra; Corlett, Sarah; Reeve, Joanne; Krska, Janet

    2016-01-01

    There is an increasing drive to measure and so improve patients' experiences and outcomes of health care. This also applies to medicines, given their ubiquity as health care interventions. Patients' experiences of using medicines vary, and instruments which measure these are seen as an essential component to improve care. We aimed to identify generic measures of patients' experiences of using prescription medicines and to examine their properties and suitability for use in research or practice. Multiple electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycARTICLES, CINHAL Plus, PROQOLID ® , and Google Scholar. We identified, critically appraised, and summarized generic questionnaires assessing one or more aspects of the medicine use experience among adult patients using prescription medicines for chronic conditions, and the process of questionnaire development, degree of patient involvement, and/or validation processes. Fifteen questionnaires were included. Of these, nine measures were multidimensional, covering various aspects of medicine use. Six instruments covered only a single domain, assessing a specific facet of using medicines. Domains covered were the following: effectiveness; convenience, practicalities, and/or managing medicines; information, knowledge, and/or understanding; side effects; relationships and/or communication with health professionals; impact on daily living and/or social life; general satisfaction; attitudes; beliefs, concerns, and/or perceptions; medical follow-up and/or adherence-related issues; treatment- and/or medicine-related burden, perceived control, or autonomy; self-confidence about medicine use; availability and accessibility; and medicine-related quality of life. None of the identified questionnaires covered all domains. Instruments varied in the extent of patient involvement in both their development and validation. There is a scarcity of psychometrically sound, comprehensive, and generic measures of experiences

  2. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel

    2015-01-01

    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how patie......, intermediate care patients felt hindered in doing so by continuous monitoring of vital signs. RELEVANCE TO CLINICAL PRACTICE: Intermediate care may increase patient perceptions of quality and safety of care.......AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating...

  3. Measuring the patient experience.

    Science.gov (United States)

    Lees, Carolyn

    2011-01-01

    This paper examines the complex issues of measuring the patient experience and evaluating the quality of health care. It discusses the use of surveys, patient stories and narrative methods of data collection in an attempt to define quality and how it should be measured. A recent Department of Health (DH) document insists that patients will be at the heart of decision making in the NHS by having greater control in informing strategic commissioning decisions (DH 2010c). The government aims to improve patient experience, enabling patients to rate services according to the quality of care they receive. This will be carried out using information generated by patients. This paper discusses the advantages and disadvantages of using surveys in gathering patient satisfaction data. It considers the value of surveys in measuring quality of care and appraises their usefulness in strengthening patients' collective voice. The paper investigates the use of another source of feedback - it examines the design of qualitative data collection methods as a means of gaining feedback from service users in encouraging providers of health care to be more responsive to their needs. Too often, patients are expected to fit the services, rather than services meeting the patients' needs. The most effective way of exploring and representing the patient's experience is by using a mixed-method approach. In other words, an integrated approach with the use of surveys and more narrative methods, such as patient stories, will effectively define quality and how it should be measured, ensuring that the focus is always on what matters most to patients.

  4. [Effect of preventive treatment on cognitive performance in patients with multiple sclerosis].

    Science.gov (United States)

    Shorobura, Maria S

    2018-01-01

    Introduction: cognitive, emotional and psychopathological changes play a significant role in the clinical picture of multiple sclerosis and influence the effectiveness of drug therapy, working capacity, quality of life, and the process of rehabilitation of patients with multiple sclerosis. The aim: investigate the changes in cognitive function in patients with multiple sclerosis, such as information processing speed and working memory of patients before and after treatment with immunomodulating drug. Materials and methods:33 patients examined reliably diagnosed with multiple sclerosis who were treated with preventive examinations and treatment from 2012 to 2016. For all patients with multiple sclerosis had clinical-neurological examination (neurological status using the EDSS scale) and the cognitive status was evaluated using the PASAT auditory test. Patient screening was performed before, during and after the therapy. Statistical analysis of the results was performed in the system Statistica 8.0. We used Student's t-test (t), Mann-Whitney test (Z). Person evaluated the correlation coefficients and Spearman (r, R), Wilcoxon criterion (T), Chi-square (X²). Results: The age of patients with multiple sclerosis affects the growth and EDSS scale score decrease PASAT to treatment. Duration of illness affects the EDSS scale score and performance PASAT. Indicators PASAT not significantly decreased throughout the treatment. Conclusions: glatiramer acetate has a positive effect on cognitive function, information processing speed and working memory patients with multiple sclerosis, which is one of the important components of the therapeutic effect of this drug.

  5. Neural correlates of alerting and orienting impairment in multiple sclerosis patients.

    Science.gov (United States)

    Vázquez-Marrufo, Manuel; Galvao-Carmona, Alejandro; González-Rosa, Javier J; Hidalgo-Muñoz, Antonio R; Borges, Mónica; Ruiz-Peña, Juan Luis; Izquierdo, Guillermo

    2014-01-01

    A considerable percentage of multiple sclerosis patients have attentional impairment, but understanding its neurophysiological basis remains a challenge. The Attention Network Test allows 3 attentional networks to be studied. Previous behavioural studies using this test have shown that the alerting network is impaired in multiple sclerosis. The aim of this study was to identify neurophysiological indexes of the attention impairment in relapsing-remitting multiple sclerosis patients using this test. After general slowing had been removed in patients group to isolate the effects of each condition, some behavioral differences between them were obtained. About Contingent Negative Variation, a statistically significant decrement were found in the amplitude for Central and Spatial Cue Conditions for patient group (pmultiple sclerosis. P1 and N1 delayed latencies are evidence of the demyelination process that causes impairment in the first steps of the visual sensory processing. Lastly, P3 amplitude shows a general decrease for the pathological group probably indexing a more central impairment. These results suggest that the Attention Network Test give evidence of multiple levels of attention impairment, which could help in the assessment and treatment of relapsing-remitting multiple sclerosis patients.

  6. Lenalidomide at the dose of 25 mg every other day in patients affected by multiple myeloma and renal failure: a real-life experience.

    Science.gov (United States)

    Cerchione, Claudio; Nappi, Davide; Pareto, Anna E; Romano, Alessandra; Martinelli, Vincenzo; Picardi, Marco; Pane, Fabrizio; Catalano, Lucio

    2018-04-01

    Renal impairment (RI) is a relevant complication of patients affected by multiple myeloma (MM); it can be present in up to 30-35% of newly diagnosed MM and is linked to a poor outcome. However, early recognition and early treatment with novel agents can overcome the negative impact of RI and even reverse kidney damage in most cases. Lenalidomide, available as an oral compound, is an immunomodulatory drug with both antiproliferative and immunomodulatory activity that is largely used in the management of MM. Dose reduction is mandatory in RI; however, there is no theoretical assumption against the possibility that protracting the time of full standard doses can be equally effective and tolerated by patients requiring reduced doses. In this report, we describe our retrospective experience, in 18 patients, with the administration of lenalidomide 25 mg every other day for patients with MM and RI. The overall response ratio was 66.5%. More than half (61.1%) of the patients had a renal response. The median progression-free survival was 8 months (range: 3-18 months). No serious adverse event occurred during treatment, and it was never necessary to disrupt or delay treatment for toxicity. These preliminary observations point to a significant therapeutic effect of lenalidomide, at the dose of 25 mg every other day for 21 days, with logistic and economic advantages. However, these results should be validated by controlled studies involving larger numbers of patients.

  7. Factors affecting dignity of patients with multiple sclerosis.

    Science.gov (United States)

    Sharifi, Simin; Borhani, Fariba; Abbaszadeh, Abbas

    2016-12-01

    MS is one of the most common chronic diseases of the nervous system. Apart from disease progression, other complications such as unemployment, separation and divorce could potentially threat patients' dignity. Most of the previous studies have been done of maintaining patients' dignity in interaction with healthcare team, but studies on affecting factors of dignity in chronic patients in the society and in interaction with usual people are scarce. We aimed to investigate factors affecting dignity of Iranian patients with MS in daily living and in interaction of them with the society. In this qualitative study, 13 patients with multiple sclerosis were chosen by purposive sampling and semi-structured interviews were conducted until data saturation. The study was done in Tehran, the capital city of Iran. Factors affecting dignity were classified as 'personal factors' and 'social factors'. Personal factors consist of the following subcategories: patients' communication with self, patients' knowledge, patients' values and beliefs and patients' resources. Social factors include others' communication with patients, social knowledge, social values and beliefs and social resources. Multiple personal and social factors interfere in perceived patient dignity. In fact, interaction between personal and social factors can be influential in final perceived dignity. By focusing on whole aspects of the patients' lives, we can identify dignity-promoting or dignity-threatening factors and help patients maintain their dignity by taking appropriate measures for moderating threatening factors and improving dignity enhancing ones. © 2016 Nordic College of Caring Science.

  8. Computer simulation of FT-NMR multiple pulse experiment

    Science.gov (United States)

    Allouche, A.; Pouzard, G.

    1989-04-01

    Using the product operator formalism in its real form, SIMULDENS expands the density matrix of a scalar coupled nuclear spin system and simulates analytically a large variety of FT-NMR multiple pulse experiments. The observable transverse magnetizations are stored and can be combined to represent signal accumulation. The programming language is VAX PASCAL, but a MacIntosh Turbo Pascal Version is also available.

  9. Assessment level of anxiety and depression in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Kusnetsova D.E.

    2012-06-01

    Full Text Available

    In patients with multiple sclerosis observed polymorphism of the emergency psychiatric disorders with a wide range of psychopathological phenomena — from neurotic and personality disorders to psychotic states and epileptiform syndrome. However, the problems of mental health problems in people with MS for a long time little attention was paid. The aim of our study was to analyze the level of anxiety and depression severity in patients with multiple sclerosis. According to this objective have been identifed objectives of the study: to determine the level of depression and anxiety in MS patients according to sex, age, course, duration of disease. For our work was selected group of patients with documented diagnosis of multiple sclerosis, Charles Poser criteria, consisting of 79 persons, with a disease duration of more than 2 years. We used a specially designed questionnaire, which included a table to assess complaints, anamnesis, the neurological status of the patient, and standard questionnaires (test anxiety, Taylor Depression Scale Research psychoneurology them. Spondylitis, the index of overall psychological well-being. The study found that mood disorders such as anxiety, depression, often occurs in patients with multiple sclerosis. However, they are expressed in groups of patients receiving and not receiving DMD, in many ways. Thus, it should be recommended  Vat practical neurologists in the treatment of multiple sclerosis patients to pay attention to whether or not they have a certain range of mental disorders, and above all, anxious-depressive syndrome, which is in need of medical and non-pharmacological correction.

  10. Vorinostat in combination with lenalidomide and dexamethasone in patients with relapsed or refractory multiple myeloma

    International Nuclear Information System (INIS)

    Siegel, D S; Richardson, P; Dimopoulos, M; Moreau, P; Mitsiades, C; Weber, D; Houp, J; Gause, C; Vuocolo, S; Eid, J; Graef, T; Anderson, K C

    2014-01-01

    The addition of vorinostat to lenalidomide/dexamethasone represents a novel combination therapy in multiple myeloma (MM), informed by laboratory studies suggesting synergy. This was a phase I, multicenter, open-label, non-randomized, dose-escalating study in patients with relapsed or relapsed and refractory MM. Clinical evaluation, electrocardiogram, laboratory studies and adverse events were obtained and assessed. The maximum-tolerated dose was not reached owing to a non-occurrence of two dose-limiting toxicities per six patients tested at any of the dosing levels. Patients tolerated the highest dose tested (Level 5) and this was considered the maximum administered dose: at 400 mg vorinostat on days 1–7 and 15–21, 25 mg lenalidomide on days 1–21 and 40 mg dexamethasone on days 1, 8, 15 and 22, per 28-day cycle. Drug-related adverse events were reported in 90% of patients serious adverse experiences were reported in 45% of the patients and 22% of all patients had adverse experiences considered, possibly related to study drug by the investigators. A confirmed partial response or better was reported for 14/30 patients (47%) evaluable for efficacy, including 31% of patients previously treated with lenalidomide. Vorinostat in combination with lenalidomide and dexamethasone proved tolerable with appropriate supportive care, with encouraging activity observed

  11. Multiple plastic biliary stent placement in the management of large and multiple choledochal stones: single center experience and review of the literature.

    Science.gov (United States)

    Bektaş, Hasan; Gürbulak, Bünyamin; Şahin, Zeynep Deniz; Düzköylü, Yiğit; Çolak, Şükrü; Gürbulak, Esin Kabul; Güneş, Mehmet Emin; Çakar, Ekrem

    2017-09-01

    Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is the first step treatment modality of choledocholithiasis. In spite of an extended sphincterotomy, 10-15% of complex choledochal stones (larger than 15 mm and/or more than 3 stones) cannot be removed and recurrent ERCP procedures may be needed. To evaluate the role and efficiency of multiple biliary stent application in the treatment of large and multiple choledochal stones. Patients with complex choledochal stones and patients with inadequate choledochal clearance during ERCP were included in the study. The study group was divided into 2 groups as the placement of single (n = 27 patients) or multiple stents (n = 58 patients). After a mean time interval of 21 days (10-28), the ERCP procedure was tried for the second time and a stent was placed in case of recurrence. Successful biliary drainage was provided in both groups. The decrease in the longitudinal or transverse size of the stones after stent placement was found to be statistically significant in both groups (p = 0.001). Cholestatic enzymes (alkaline phosphatase (ALP), γ-glutamyltransferase (GGT)) and bilirubin levels decreased significantly in both groups following stenting (p = 0.001). Additionally, multiple stents functioned as a bridge starting from the first ERCP to full clearance in patients with large and multiple stones which could not be removed at once and saved them from the possible morbidities of an invasive operation. Endoscopic multiple biliary stent placement should be preferred in the treatment of patients with complex choledochal stones and high rates of co-morbidity, as a safe alternative to surgery.

  12. Sudden multiple fractures in a patient with sarcoidosis in multiple organs.

    Science.gov (United States)

    Sada, Mitsuru; Saraya, Takeshi; Ishii, Haruyuki; Goto, Hajime

    2014-04-07

    A 30-year-old man who incidentally fractured his right olecranon and other multiple phalanges was admitted to our hospital. He had a 2-year history of uveitis and bilateral hilar lymphadenopathy (BHL), and pulmonary sarcoidosis was diagnosed from transbronchial lung biopsy. Right elbow arthrodesis was performed, and biopsied specimens showed non-caseating epithelioid cell granuloma, suggesting osseous sarcoidosis. He was discharged uneventfully without further treatment, but BHL had progressed with the appearance of lung parenchymal lesions 3 months later. At that time, involvement of other organs was also noted on Gallium-67 scintigraphy, showing accumulations in BHL, axillary and inguinal lymph nodes, enlarged liver and spleen and subcutaneous areas. After initiation of steroid therapy, multiple organ involvement improved, and no further bone involvement has been recognised to date. Osseous sarcoidosis complicated by bone fracture is an extremely rare presentation, but should be considered in patients with sarcoidosis, especially when multiple organs are involved.

  13. Computer simulation of FT-NMR multiple pulse experiment

    International Nuclear Information System (INIS)

    Allouche, A.; Pouzard, G.

    1989-01-01

    Using the product operator formalism in its real form, SIMULDENS expands the density matrix of a scalar coupled nuclear spin system and simulates analytically a large variety of FT-NMR multiple pulse experiments. The observable transverse magnetizations are stored and can be combined to represent signal accumulation. The programming language is VAX PASCAL, but a MacIntosh Turbo Pascal Version is also available. (orig.)

  14. Conventional chemotherapy and long-term survival in multiple myeloma patients

    International Nuclear Information System (INIS)

    Kraj, M; Poglod, R.; Sokolowska, U.; Kruk, B.; Maj, S.

    2010-01-01

    Objectives. The study was especially focused on the estimation of real frequency of long-term survivals in patients with multiple myeloma and finding common clinical and laboratory features present in long-term surviving patients as possible good prognostic factors. Material and methods. The survey was carried out on 600 multiple myeloma patients diagnosed before the year 2000 and treated with conventional chemotherapy in the Institute of Hematology and Transfusion Medicine in Warsaw in the years 1962-2009. All patients who had fulfilled the requirement of more than seven years of survival from the diagnosis and beginning of treatment for myeloma were included into the study group. Results. Out of 600 studied patients with multiple myeloma 88 (14.7%) survived over 7 years including 45 (7.5%) over 10 years, 11 (1.8 %) over 15 years and 7 (1.1%) over 20 years from the disease diagnosis and beginning of antitumor treatment. Patients with long survival were younger (median age 55 years) at the time of diagnosis than the whole studied group and had normal serum creatinine, calcium and beta2-microglobulin levels. Sixty eight percent of these patients had stage I or II clinical progression, 60% presented with IgG monoclonal protein and 58% with osteolysis. Treatment with melphalan only was given to 18 patients, 30 were treated with melphalan, followed by vincristine, cyclophosphamide, BCNU, doxorubicin and prednisone or dexamethasone. Polychemotherapy was given from the time of the diagnosis to 16 patients, 15 received radiotherapy or 60C o irradiation besides chemotherapy and 9 received new agents: thalidomide, bortezomib, lenalidomide. In 66% of the evaluated cases response to treatment was good and in another 34% stabilization of the proliferative process was achieved. The mean duration of treatment till the achievement of partial response was 10 months, range: 2 - 89 months. The mean duration of good therapeutic response was 70 months. Twelve patients are alive and

  15. Rhabdomyolysis following interferon-beta treatment in a patient with multiple sclerosis

    DEFF Research Database (Denmark)

    Dalbjerg, Sara Maria; Tsakiri, Anna; Fredriksen, Jette Lautrup

    2016-01-01

    Background Multiple sclerosis is an inflammatory disease of the central nervous system for which there is currently no cure. Interferon-beta-1-alpha is worldwide one of the most widely used treatments in multiple sclerosis. To our knowledge there is one previous reported case of rhabdomyolysis...... associated with Interferon-beta treatment. Case presentation We describe a 30 year old man with relapsing remitting multiple sclerosis who developed rhabdomyolysis and increased creatine kinase following Interferon-beta-1-alpha therapy. After the medication was discontinued, the patient rapidly improved...... Interferon-beta-1-alpha therapy in patients with multiple sclerosis....

  16. Hypercoagulable states in patients with multiple myeloma can affect the thalidomide-associated venous thromboembolism.

    Science.gov (United States)

    Talamo, Giampaolo P; Ibrahim, Sulfi; Claxton, David; Tricot, Guido J; Fink, Louis M; Zangari, Maurizio

    2009-07-01

    The therapeutic use of thalidomide in patients with multiple myeloma is often complicated by the development of venous thromboembolism. The objective of the present study was to identify hypercoagulable states associated with development of venous thromboembolism in thalidomide-treated multiple myeloma patients. We screened 49 consecutive multiple myeloma patients treated with thalidomide at baseline for hypercoagulability. With a median follow-up of 11 months, 10 of 49 multiple myeloma patients developed a thrombotic episode. Laboratory assays revealed an underlying abnormality in nine of the 10 patients; hypercoagulable screenings were normal in 36 of the 39 patients who did not develop venous thromboembolism (P < 0.0001). Our retrospective study results suggest that the multiple myeloma patients with thromboembolic complications during treatment with thalidomide have a frequent concomitant underlying thrombophilic state.

  17. Medical home characteristics and the pediatric patient experience.

    Science.gov (United States)

    Burnet, Deborah; Gunter, Kathryn E; Nocon, Robert S; Gao, Yue; Jin, Janel; Fairchild, Paige; Chin, Marshall H

    2014-11-01

    The patient-centered medical home (PCMH) has roots in pediatrics, yet we know little about the experience of pediatric patients in PCMH settings. To examine the association between clinic PCMH characteristics and pediatric patient experience as reported by parents. We assessed the cross-sectional correlation between clinic PCMH characteristics and pediatric patient experience in 24 clinics randomly selected from the Safety Net Medical Home Initiative, a 5-state PCMH demonstration project. PCMH characteristics were measured with surveys of randomly selected providers and staff; surveys generated 0 (worst) to 100 (best) scores for 5 subscales, and a total score. Patient experience was measured through surveying parents of pediatric patients. Questions from the Consumer Assessment of Healthcare Providers and Systems-Clinician and Group instrument produced 4 patient experience measures: timeliness, physician communication, staff helpfulness, and overall rating. To investigate the relationship between PCMH characteristics and patient experience, we used generalized estimating equations with an exchangeable correlation structure. We included 440 parents and 214 providers and staff in the analysis. Total PCMH score was not associated with parents' assessment of patient experience; however, PCMH subscales were associated with patient experience in different directions. In particular, quality improvement activities undertaken by clinics were strongly associated with positive ratings of patient experience, whereas patient care management activities were associated with more negative reports of patient experience. Future work should bolster features of the PCMH that work well for patients while investigating which PCMH features negatively impact patient experience, to yield a better patient experience overall.

  18. Comparing Normal and Multiple Sclerotic Patients Short Term Memory

    Directory of Open Access Journals (Sweden)

    Mahboubeh Parsaeian

    2006-07-01

    Full Text Available Objective: Multiple sclerosis (MS is a disease of the central nervous system. The main pattern of neuropsychological impairment in M.S. patients characterized with deficits of attention and memory. Memory problem are known to occur in approximately 50% to 60% of people with M.S. The purpose of the present study is to asses memory function in M.S. patients. Materials & Methods: 40 M.S. patients (30 patients suffering from as relapsing – remitting and 10 patients are chronic progressive M.S. assessed using Luria – Nebraska memory scale. Results: All of multiple sclerosis patients (without sever depresive state evaluated by BDI exhibited significant impairments in all of memory veriable (verbal , non - verbal , delayed and whole memory performance as compared with control groups (normal subjects. Difference of memory performance between the patients with two type of M.S. were not significant. Furthermore no significant relation was found between memory loss and MRI lesions.  Conclusion: This study is guidedas such one can lead to a better understanding of memory deficits in M.S. patients. In addition, specific rehabilitation strategies can be planed on the patterns of memory impairment in M.S. patients.

  19. Perspectives from the Patient and the Healthcare Professional in Multiple Sclerosis: Social Media and Participatory Medicine.

    Science.gov (United States)

    Kantor, Daniel; Bright, Jeremy R; Burtchell, Jeri

    2018-06-01

    When faced with a diagnosis of multiple sclerosis (MS), patients often turn to the Internet and social media to find support groups, read about the experiences of other people affected by MS and seek their advice, and research their condition and treatment options to discuss with their healthcare professionals (HCPs). Here, we examine the use of social media and the Internet among patients with MS, considering its impact on patient empowerment and patient participation in treatment decision-making and MS research. These themes are exemplified with first-hand experiences of the patient author. We also explore the impact of the Internet and social media on the management of patients from the perspective of HCPs, including new opportunities for HCPs to engage in participatory medicine and to improve communication with and among patients. We consider both the benefits afforded to and the potential pitfalls faced by HCPs when interacting with their patients via these routes, and discuss potential concerns around privacy and confidentiality in the use of the Internet and social media in the clinical context. Communication online is driving the evolution of the patient-HCP relationship, and is empowering patients to participate more actively in the decision-making process relating to the provision of their health care. Funding Novartis Pharmaceuticals Corporation.

  20. Neural correlates of alerting and orienting impairment in multiple sclerosis patients.

    Directory of Open Access Journals (Sweden)

    Manuel Vázquez-Marrufo

    Full Text Available BACKGROUND: A considerable percentage of multiple sclerosis patients have attentional impairment, but understanding its neurophysiological basis remains a challenge. The Attention Network Test allows 3 attentional networks to be studied. Previous behavioural studies using this test have shown that the alerting network is impaired in multiple sclerosis. The aim of this study was to identify neurophysiological indexes of the attention impairment in relapsing-remitting multiple sclerosis patients using this test. RESULTS: After general slowing had been removed in patients group to isolate the effects of each condition, some behavioral differences between them were obtained. About Contingent Negative Variation, a statistically significant decrement were found in the amplitude for Central and Spatial Cue Conditions for patient group (p<0.05. ANOVAs showed for the patient group a significant latency delay for P1 and N1 components (p<0.05 and a decrease of P3 amplitude for congruent and incongruent stimuli (p<0.01. With regard to correlation analysis, PASAT-3s and SDMT showed significant correlations with behavioral measures of the Attention Network Test (p<0.01 and an ERP parameter (CNV amplitude. CONCLUSIONS: Behavioral data are highly correlated with the neuropsychological scores and show that the alerting and orienting mechanisms in the patient group were impaired. Reduced amplitude for the Contingent Negative Variation in the patient group suggests that this component could be a physiological marker related to the alerting and orienting impairment in relapsing-remitting multiple sclerosis. P1 and N1 delayed latencies are evidence of the demyelination process that causes impairment in the first steps of the visual sensory processing. Lastly, P3 amplitude shows a general decrease for the pathological group probably indexing a more central impairment. These results suggest that the Attention Network Test give evidence of multiple levels of attention

  1. Serum galectin-1 in patients with multiple myeloma

    DEFF Research Database (Denmark)

    Andersen, Morten Nørgaard; Ludvigsen, Maja; Abildgaard, Niels

    2017-01-01

    with worse disease state or poor outcome. Gal-1 can be secreted from cells by an unknown mechanism, and levels in blood samples were associated with high tumor burden and worse disease state in cHL and CLL patients. However, serum levels of Gal-1 have never been investigated in patients with multiple myeloma...

  2. Understanding and meeting injection device needs in multiple sclerosis: a survey of patient attitudes and practices

    Directory of Open Access Journals (Sweden)

    Russell S

    2011-03-01

    Full Text Available Elisabetta Verdun di Cantogno1, Susan Russell2, Tom Snow21Global Clinical Development Unit, Merck Serono S.A. – Geneva, Switzerland; 2Global Marketing, Merck Serono S.A. – Geneva, SwitzerlandBackground: All established disease-modifying drugs for multiple sclerosis require parenteral administration, which can cause difficulties for some patients, sometimes leading to suboptimal adherence. A new electronic autoinjection device has been designed to address these issues.Methods: Patients with relapsing multiple sclerosis currently receiving subcutaneous or intramuscular interferon beta-1a, interferon beta-1b, or glatiramer acetate completed an online questionnaire (July 4–25, 2008 that surveyed current injection practices, experiences with current injection methods, and impressions and appeal of the new device.Results: In total, 422 patients completed the survey, of whom 44% used autoinjectors, 43% prefilled syringes, and 13% syringes and vials; overall, 66% currently self-injected. Physical and psychological barriers to self-injection included difficulty with injections, needle phobia, and concerns over correct injection technique. Only 40% of respondents were “very satisfied” with their current injection method. The new electronic autoinjector was rated as “very appealing” by 65% of patients. The benefits of the new device included the ability to customize injection settings and to review dosing history.Conclusion: New technologies may help patients overcome physical and psychological barriers to self-injection. The combination of a reliable and flexible autoinjection device with dose-monitoring technology may improve communication between health care professionals and patients, and improve treatment adherence.Keywords: adherence, autoinjection, subcutaneous interferon beta-1a, multiple sclerosis 

  3. Slow or swift, your patients' experience won't drift: absence of correlation between physician productivity and the patient experience.

    Science.gov (United States)

    Lenz, Kasia; McRae, Andrew; Wang, Dongmei; Higgins, Benjamin; Innes, Grant; Cook, Timothy; Lang, Eddy

    2017-09-01

    Absract OBJECTIVES: To evaluate the relationship between Emergency Physician (EP) productivity and patient satisfaction with Emergency Department (ED) care. This retrospective observational study linked administrative and patient experience databases to measure correlations between the patient experience and EP productivity. The study was performed across three Calgary EDs (from June 2010 to July 2013). Patients>16 years old with completed Health Quality Council of Alberta (HQCA) ED Patient Experience Surveys were included. EP productivity was measured at the individual physician level and defined as the average number of patients seen per hour. The association between physician productivity and patient experience scores from six composite domains of the HQCA ED Patient Experience Survey were examined using Pearson correlation coefficients, linear regression modelling, and a path analysis. We correlated 3,794 patient experience surveys with productivity data for 130 EPs. Very weak non-significant negative correlations existed between productivity and survey composites: "Staff Care and Communication" (r=-0.057, p=0.521), "Discharge Communication" (r=-0.144, p=0.102), and "Respect" (r=-0.027, p=0.760). Very weak, non-significant positive correlations existed between productivity and the composite domains: "Medication Communication" (r=0.003, p=0.974) and "Pain management" (r=0.020, p=0.824). A univariate general linear model yielded no statistically significant correlations between EP productivity and patient experience, and the path analysis failed to show a relationship between the variables. We found no correlation between EP productivity and the patient experience.

  4. Multiple aetiologies of secondary hypertension in one patient

    OpenAIRE

    Golan, Eliezer; Nabriski, Danny; Sharabi, Yehonatan; Werner, Miryam; Griton, Yigal; Moshkovich, Evgeny; Korzets, Ze?ev

    2008-01-01

    Apart from seeking target organ damage, the investigation of hypertension is primarily aimed at finding a treatable cause of the hypertension. The finding of one such cause is usually construed as being the sole culprit responsible for the patient's elevated blood pressure. The existence of multiple aetiologies of secondary hypertension in one patient is infrequent. In this report, we describe such a patient in whom secondary hypertension due to Cushing's disease, renovascular and finally bar...

  5. Safe and tolerable one-hour pamidronate infusion for multiple myeloma patients

    Directory of Open Access Journals (Sweden)

    Dimitrios Chantzichristos

    2008-09-01

    Full Text Available Dimitrios Chantzichristos, Andréasson Björn, Johansson PeterDepartment of Internal Medicine, Uddevalla Hospital, Uddevalla, SwedenBackground: Once a month, patients with multiple myeloma received an infusion of bisphosphonates, principally to reduce osteoclastic bone resorption. Recommended infusion time for pamidronate is 2 hours in the US and 4 hours in Europe because of its potential nephrotoxicity. From 2003, a 90 mg infusion of pamidronate was provided over 1 hour to patients with no pre-existing renal impairment, in the Daily Care Unit at Uddevalla Hospital.Method: Retrospective analysis of the renal deterioration, serum calcium, and adverse effects in patients with multiple myeloma treated with 1-hour pamidronate 90 mg infusion from January 2003 to April 2007.Results: Seventy-nine patients provided valuable data. A total number of 846 infusions were given and the median number of infusion to each patient was 11. Significant creatinine elevation was seen in 7 patients (8.9%, after 19 infusions (2.2%. Renal deterioration occurred in 5 of these 7 patients, which was related to progress of the myeloma or opportunistic infections. Prevalence of infusion-related events was 0.8% and the mean total S-Ca was 0.05 mmol/L lower than the baseline.Conclusion: Few events of renal deterioration, hypocalcemia, or other adverse effects resulted from a 1-hour pamidronate 90 mg infusion for multiple myeloma patients with no pre-existing renal impairment.Keywords: bisphosphonates, pamidronate, multiple myeloma, infusion time

  6. Effects of physiotherapy treatment for urinary incontinence in patient with multiple sclerosis.

    Science.gov (United States)

    Pereira, Carla Maria de Abreu; Castiglione, Mariane; Kasawara, Karina Tamy

    2017-07-01

    [Purpose] The aim of the study was to evaluate the benefits of physical therapy for urinary incontinence in patients with multiple sclerosis and to verify the impact of urinary incontinence on the patient's quality of life. [Subject and Methods] A case study of a 55-year-old female patient diagnosed with multiple sclerosis and mixed urinary incontinence was conducted. Physical therapy sessions were conducted once a week, in total 15 sessions, making use of targeted functional electrical vaginal stimulation, along with active exercises for the pelvic floor muscles and electrical stimulation of the posterior tibial nerve, behavioral rehabilitation and exercise at home. [Results] After 15 physical therapy sessions, a patient diagnosed with multiple sclerosis and mixed urinary incontinence showed continued satisfactory results after five months. She showed better quality of life, higher strength of pelvic floor muscle and reduced urinary frequency without nocturia and enuresis. [Conclusion] The physical therapy protocol in this patient with multiple sclerosis and mixed urinary incontinence showed satisfactory results reducing urinary incontinence symptomatology and improving the patient's quality of life.

  7. Risks of multiple sclerosis in relatives of patients in Flanders, Belgium

    NARCIS (Netherlands)

    Carton, H; Vlietinck, R; Debruyne, J; DeKeyser, J; DHooghe, MB; Loos, R; Medaer, R; Truyen, L; Yee, IML; Sadovnick, AD

    Objectives - To calculate age adjusted risks for multiple sclerosis in relatives of Flemish patients with multiple sclerosis. Methods - Lifetime risks were calculated using the maximum likelihood approach. Results - Vital information was obtained on 674 probands with multiple sclerosis in Flanders

  8. Patient Experiences with the Preoperative Assessment Clinic (PEPAC): validation of an instrument to measure patient experiences

    NARCIS (Netherlands)

    Edward, G. M.; Lemaire, L. C.; Preckel, B.; Oort, F. J.; Bucx, M. J. L.; Hollmann, M. W.; de Haes, J. C. J. M.

    2007-01-01

    Background. Presently, no comprehensive and validated questionnaire to measure patient experiences of the preoperative assessment clinic (PAC) is available. We developed and validated the Patient Experiences with the Preoperative Assessment Clinic (PEPAC) questionnaire, which can be used for

  9. X-irradiation of thyroid during therapy of patients with multiple sclerosis

    International Nuclear Information System (INIS)

    Agte, B.S.; Efimova, A.S.; Kalmykova, T.N.; Bajkova, V.P.

    1985-01-01

    X-radiation of 27 patients with thyroid at acute therapeutically resistant, progradient form of multiple sclerosis has been applied. Indistinct therapeutic effect attributed to depression of auto-aggressive allergic processes in cerebrospinal formations is noted in 20 patients after one or two courses of radiotherapy. The method can be used in complex therapy of progradient forms of multiple sclerosis

  10. Is impaired cerebral vasoreactivity an early marker of cognitive decline in multiple sclerosis patients?

    Science.gov (United States)

    Metzger, Aude; Le Bars, Emmanuelle; Deverdun, Jeremy; Molino, François; Maréchal, Bénédicte; Picot, Marie-Christine; Ayrignac, Xavier; Carra, Clarisse; Bauchet, Luc; Krainik, Alexandre; Labauge, Pierre; Menjot de Champfleur, Nicolas

    2018-03-01

    The link between cerebral vasoreactivity and cognitive status in multiple sclerosis remains unclear. The aim of the present study was to investigate a potential decrease of cerebral vasoreactivity in multiple sclerosis patients and correlate it with cognitive status. Thirty-three patients with multiple sclerosis (nine progressive and 24 remitting forms, median age: 39 years, 12 males) and 22 controls underwent MRI with a hypercapnic challenge to assess cerebral vasoreactivity and a neuropsychological assessment. Cerebral vasoreactivity, measured as the cerebral blood flow percent increase normalised by end-tidal carbon dioxide variation, was assessed globally and by regions of interest using the blood oxygen level-dependent technique. Non-parametric statistics tests were used to assess differences between groups, and associations were estimated using linear models. Cerebral vasoreactivity was lower in patients with cognitive impairment than in cognitively normal patients (p=0.004) and was associated with education level in patients (R 2 = 0.35; p = 0.047). There was no decrease in cerebral vasoreactivity between patients and controls. Cognitive impairment in multiple sclerosis may be mediated through decreased cerebral vasoreactivity. Cerebral vasoreactivity could therefore be considered as a marker of cognitive decline in multiple sclerosis. • Cerebral vasoreactivity does not differ between multiple sclerosis patients and controls. • Cerebral vasoreactivity measure is linked to cognitive impairment in multiple sclerosis. • Cerebral vasoreactivity is linked to level of education in multiple sclerosis.

  11. Multiple thymoma in a patient with myasthenia gravis: case report

    International Nuclear Information System (INIS)

    Ko, Eun Sook; Jeon, Kyung Nyeo; Bae, Kyung Soo; Yoo, Jin Jong; Kang, Duk Sik

    2004-01-01

    A thymoma often occurs in patients with myasthenia gravis, but the development of multiple thymoma is very rare. The authors report the radiologic and pathologic findings of multiple invasive thymoma in a 59-year-old male with myasthenia gravis

  12. Multiple thymoma in a patient with myasthenia gravis: case report

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Eun Sook; Jeon, Kyung Nyeo; Bae, Kyung Soo; Yoo, Jin Jong [College of Medicine, Gyeongsang National Univ., Jinju (Korea, Republic of); Kang, Duk Sik [College of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    2004-02-01

    A thymoma often occurs in patients with myasthenia gravis, but the development of multiple thymoma is very rare. The authors report the radiologic and pathologic findings of multiple invasive thymoma in a 59-year-old male with myasthenia gravis.

  13. Prevalence of benign tumors among patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Aryan Rafiee Zadeh

    2015-10-01

    Full Text Available Multiple sclerosis (MS, an inflammatory autoimmune disease, affects almost 1% of world’s population in which myelin sheaths of neurons are targeted by immune cells. Association of different factors and diseases with MS provides new insights into possible pathogenesis and treatment for this disease. In this regard, we investigated the association of benign tumors with MS disease by studying total Isfehan multiple sclerosis (TIMS records for MS patients registered in Isfahan Multiple Sclerosis Society (IMSS who had developed any kind of benign tumors whether before MS diagnosis or after it. This study was performed in Isfahan province, third large province of Iran, with 4,815,863 populations located 1590 meters above sea level between latitudes 30 and 34 degrees north of the equator, and longitude 49-55 east. Among 4950 registered patients, 28 patients were discovered to have three types of benign tumors; pituitary adenoma in 22, meningioma in 5 and lipoma in 1 patient. The incidence rate of developing pituitary adenoma and meningioma were higher than in general population (OR 95%CI: 1.110; range: 0.731-1.685 and 1.035; range: 0.431-2.487 respectively but these findings were not statistically significant (p= 0.624 for pituitary adenoma and p= 0.939 for meningioma. But the incidence rate for lipoma was lower among MS patients (OR 95%CI: 0.020; range: 0.003-0.143 which was statistically significant (p <0.001.

  14. The influence of multiple oppressions on women of color's experiences with insidious trauma.

    Science.gov (United States)

    Watson, Laurel B; DeBlaere, Cirleen; Langrehr, Kimberly J; Zelaya, David G; Flores, Mirella J

    2016-11-01

    In this study, we examined the relations between multiple forms of oppressive experiences (i.e., racism, sexism, and sexual objectification) and trauma symptoms among Women of Color (WOC). In addition, self-esteem was explored as a partial mediating variable in these links, and ethnic identity strength was proposed to buffer the negative relationship between multiple forms of oppression and self-esteem, and the positive relationship between oppressive experiences and trauma symptoms. Results suggested that self-esteem partially mediated the positive relationship between racist experiences and trauma symptoms, such that racism was related to lower self-esteem, which was then related to more trauma symptoms. Sexism and sexual objectification were directly linked with trauma symptoms. Moreover, average and high levels of ethnic identity strength buffered the positive link between racism and trauma symptoms. Consistent with an additive intersectionality framework, results demonstrate the importance of attending to multiple forms of oppression as they relate to trauma symptoms among WOC. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  15. Adult Patients' Experiences of Nursing Care Dependence.

    Science.gov (United States)

    Piredda, Michela; Matarese, Maria; Mastroianni, Chiara; D'Angelo, Daniela; Hammer, Marilyn J; De Marinis, Maria Grazia

    2015-09-01

    Care dependence can be associated with suffering and humiliation. Nurses' awareness of patients' perception of care dependence is crucial to enable them in helping the dependent persons. This study aimed to describe adult patients' experience of nursing care dependence. A metasynthesis was conducted to integrate qualitative findings from 18 studies published through December 2014 on adult patients' experiences of care dependency. Procedures included the Johanna Briggs Institute approach for data extraction, quality appraisal, and integration of findings. The experience of dependence revealed the concept of the embodied person, particularly in relation to care of the physical body. The relationship between the individual and nurses within the context of care had a major impact for dependent patients. When the care relation was perceived as positive, the experience led to the development of the person in finding new balances in life, but when it was perceived as negative, it increased patient' suffering. Care dependence is manifested mostly as bodily dependence and is consistent with its relational nature. The nurse-patient relationship is important to the dependent patients' experience. A greater understanding of patients' experiences of dependence is crucial to enable nurses in improving care and decreasing patient suffering. © 2015 Sigma Theta Tau International.

  16. Physical Telerehabilitation in Patients with Multiple Sclerosis with Significant Mobility Impairment

    Science.gov (United States)

    2017-10-01

    Award Number: W81XWH-16-1-0704 TITLE: Physical Telerehabilitation in Patients with Multiple Sclerosis with Significant Mobility Impairment...including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing ...29 Sep 2017 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Physical Telerehabilitation in Patients with Multiple Sclerosis with Significant Mobility

  17. Nursing students' experience of patient's death

    OpenAIRE

    Rulíková, Klára

    2016-01-01

    Reflections on student nurse's experience with death of a patient during their studies were collected in form of questionnaires. Theory and practice were compared and research conducted into the needs of students, who experienced patient's death during their studies. Research concluded with recommendation for widening the nursing course programme and adding opportunities for students to share their feelings and experiences after their patients death. Key terms: death, dying patient, study, te...

  18. Differences between Proxy and Patient Assessments of Cancer Care Experiences and Quality Ratings.

    Science.gov (United States)

    Roydhouse, Jessica K; Gutman, Roee; Keating, Nancy L; Mor, Vincent; Wilson, Ira B

    2018-04-01

    To assess the impact of proxy survey responses on cancer care experience reports and quality ratings. Secondary analysis of data from Cancer Care Outcomes Research and Surveillance (CanCORS). Recruitment occurred from 2003 to 2005. The study was a cross-sectional observational study. The respondents were patients with incident colorectal or lung cancer or their proxies. Analyses used linear regression models with an independent variable for proxy versus patient responses as well as study site and clinical covariates. The outcomes were experiences with medical care, nursing care, care coordination, and care quality rating. Multiple imputation was used for missing data. Among 6,471 respondents, 1,011 (16 percent) were proxies. The proportion of proxy respondents varied from 6 percent to 28 percent across study sites. Adjusted proxy scores were modestly higher for medical care experiences (+1.28 points [95 percent CI:+ 0.05 to +2.51]), but lower for nursing care (-2.81 [95 percent CI: -4.11 to -1.50]) and care coordination experiences (-2.98 [95 percent CI: -4.15 to -1.81]). There were no significant differences between adjusted patient and proxy ratings of quality. Proxy responses have small but statistically significant differences from patient responses. However, if ratings of care are used for financial incentives, such differences could be exaggerated across practices or areas if proxy use varies. © Health Research and Educational Trust.

  19. Effects of physiotherapy treatment for urinary incontinence in patient with multiple sclerosis

    OpenAIRE

    Pereira, Carla Maria de Abreu; Castiglione, Mariane; Kasawara, Karina Tamy

    2017-01-01

    [Purpose] The aim of the study was to evaluate the benefits of physical therapy for urinary incontinence in patients with multiple sclerosis and to verify the impact of urinary incontinence on the patient?s quality of life. [Subject and Methods] A case study of a 55-year-old female patient diagnosed with multiple sclerosis and mixed urinary incontinence was conducted. Physical therapy sessions were conducted once a week, in total 15 sessions, making use of targeted functional electrical vagin...

  20. Patient Experience: A Critical Indicator of Healthcare Performance.

    Science.gov (United States)

    Guler, Pamela H

    2017-01-01

    Patient experience has become a critical differentiator for healthcare organizations, and it will only grow in importance as transparency and consumerism dominate the healthcare landscape. Creating and sustaining a consistently exceptional experience that promotes patient engagement and the best outcomes is far more than just "satisfying" patients, going well beyond amenities that may be provided.Perception of care experience is often shaped by methods we use to address the biopsychosocial needs of patients. Building relationships and communicating well with our patients and families are primary approaches. In a complex healthcare situation, patients may not fully understand or remember the highly clinical nature of treatment. However, they always remember how we made them feel, how we communicated with them as a team, and what interactions they experienced while in our care.Patients who are fully informed and feel connected to their caregivers are often less anxious than those who are disengaged. Informed and engaged patients are enabled to participate in their healthcare. Organizations that focus on developing an accountable culture-one that inspires caregivers to communicate in a way that connects to patients' mind, body, and spirit while leveraging standard, evidence-based patient experience practices-find that patients' perception of care, or "the patient experience," is vastly improved.Adventist Health System has embarked on a journey to patient experience excellence with a commitment to whole-person care and standard patient experience practice across the system. Recognized with several national awards, we continue to strengthen our approach toward bringing all of our campuses and patient settings to sustained high-level performance. We have found that a combination of strong, accountable leadership; a focus on employee culture; engagement of physicians; standardized patient experience practices and education; and meaningful use of patient feedback are top

  1. Effects of Patient-centered Medical Home Transformation on Child Patient Experience.

    Science.gov (United States)

    Harder, Valerie S; Krulewitz, Julianne; Jones, Craig; Wasserman, Richard C; Shaw, Judith S

    2016-01-01

    Patient experience, 1 of 3 aims for improving health care, is rarely included in studies of patient-centered medical home (PCMH) transformation. This study examines the association between patient experience and National Committee on Quality Assurance (NCQA) PCMH transformation. This was a cross-sectional study of parent-reported child patient experience from PCMH and non-PCMH practices. It used randomly sampled experience surveys completed by 2599 patients at 29 pediatric and family medicine PCMH (n = 21) and non-PCMH (n = 8) practices in Vermont from 2011 to 2013. Patient experiences related to child development and prevention were assessed using the Consumer Assessment of Health care Providers and Systems (CAHPS). A 10-point increase in NCQA score at PCMH practices is associated with a 3.1% higher CAHPS child prevention score (P = .004). Among pediatric practices, PCMH recognition is associated with 7.7% (P child development and prevention composite scores, respectively. Among family medicine practices, PCMH recognition is associated with 7.4% (P = .001) and 11.0% (P child development and prevention composite scores, respectively. Our results suggest that PCMH recognition may improve child patient experience at pediatric practices and worsen experience at family medicine practices. These findings warrant further investigation into the differential influence of NCQA PCMH transformation on family medicine and pediatric practices. © Copyright 2016 by the American Board of Family Medicine.

  2. Measuring medicine-related experiences from the patient perspective: a systematic review

    Directory of Open Access Journals (Sweden)

    Katusiime B

    2016-10-01

    Full Text Available Barbra Katusiime,1 Sarah Corlett,1 Joanne Reeve,2 Janet Krska1 1Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Maritime, Kent, UK; 2Warwick Medical School, University of Warwick, Coventry, UK Background: There is an increasing drive to measure and so improve patients’ experiences and outcomes of health care. This also applies to medicines, given their ubiquity as health care interventions. Patients’ experiences of using medicines vary, and instruments which measure these are seen as an essential component to improve care. We aimed to identify generic measures of patients’ experiences of using prescription medicines and to examine their properties and suitability for use in research or practice. Methods: Multiple electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycARTICLES, CINHAL Plus, PROQOLID®, and Google Scholar. We identified, critically appraised, and summarized generic questionnaires assessing one or more aspects of the medicine use experience among adult patients using prescription medicines for chronic conditions, and the process of questionnaire development, degree of patient involvement, and/or validation processes. Results: Fifteen questionnaires were included. Of these, nine measures were multidimensional, covering various aspects of medicine use. Six instruments covered only a single domain, assessing a specific facet of using medicines. Domains covered were the following: effectiveness; convenience, practicalities, and/or managing medicines; information, knowledge, and/or understanding; side effects; relationships and/or communication with health professionals; impact on daily living and/or social life; general satisfaction; attitudes; beliefs, concerns, and/or perceptions; medical follow-up and/or adherence-related issues; treatment- and/or medicine-related burden, perceived control, or autonomy; self-confidence about medicine use; availability and accessibility; and medicine

  3. The management of multiple sclerosis in children: a European view

    DEFF Research Database (Denmark)

    Ghezzi, Angelo; Banwell, Brenda; Boyko, Alexey

    2010-01-01

    About 3-5% of all patients with multiple sclerosis experience the onset of their disease under the age of 16. A significant proportion of paediatric multiple sclerosis patients develop significant cognitive disturbances and persistent physical disability. The high relapse rate and the morbidity i...

  4. Assessing the patient's mammogram experience.

    Science.gov (United States)

    Dodendorf, Diane M; Deogun, Gurvinder K; Rodie, Amy Risch; Pol, Louis G

    2004-01-01

    This study overviews an operational blueprint that diagrams the activities and interactions of all participants in a typical screening mammography appointment in a large medical center. The blueprint is constructed from multiple sources of data collected from mammography patients, service providers in the radiology department, and medical records. The benefits from using patient perspectives, the insights gained from the blueprint development process, and the value of the resulting screening mammography appointment blueprint are included.

  5. Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care.

    Science.gov (United States)

    Elmore, Natasha; Burt, Jenni; Abel, Gary; Maratos, Frances A; Montague, Jane; Campbell, John; Roland, Martin

    2016-12-01

    Longer consultations in primary care have been linked with better quality of care and improved health-related outcomes. However, there is little evidence of any potential association between consultation length and patient experience. To examine the relationship between consultation length and patient-reported communication, trust and confidence in the doctor, and overall satisfaction. Analysis of 440 videorecorded consultations and associated patient experience questionnaires from 13 primary care practices in England. Patients attending a face-to-face consultation with participating GPs consented to having their consultations videoed and completed a questionnaire. Consultation length was calculated from the videorecording. Linear regression (adjusting for patient and doctor demographics) was used to investigate associations between patient experience (overall communication, trust and confidence, and overall satisfaction) and consultation length. There was no evidence that consultation length was associated with any of the three measures of patient experience (P >0.3 for all). Adjusted changes on a 0-100 scale per additional minute of consultation were: communication score 0.02 (95% confidence interval [CI] = -0.20 to 0.25), trust and confidence in the doctor 0.07 (95% CI = -0.27 to 0.41), and satisfaction -0.14 (95% CI = -0.46 to 0.18). The authors found no association between patient experience measures of communication and consultation length, and patients may sometimes report good experiences from very short consultations. However, longer consultations may be required to achieve clinical effectiveness and patient safety: aspects also important for achieving high quality of care. Future research should continue to study the benefits of longer consultations, particularly for patients with complex multiple conditions. © British Journal of General Practice 2016.

  6. Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

    OpenAIRE

    Park, Hyun Oh; Kang, Dong Hoon; Moon, Seong Ho; Yang, Jun Ho; Kim, Sung Hwan; Byun, Joung Hun

    2017-01-01

    Background: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and De...

  7. Understanding and meeting injection device needs in multiple sclerosis: a survey of patient attitudes and practices

    Science.gov (United States)

    Verdun di Cantogno, Elisabetta; Russell, Susan; Snow, Tom

    2011-01-01

    Background: All established disease-modifying drugs for multiple sclerosis require parenteral administration, which can cause difficulties for some patients, sometimes leading to suboptimal adherence. A new electronic autoinjection device has been designed to address these issues. Methods: Patients with relapsing multiple sclerosis currently receiving subcutaneous or intramuscular interferon beta-1a, interferon beta-1b, or glatiramer acetate completed an online questionnaire (July 4–25, 2008) that surveyed current injection practices, experiences with current injection methods, and impressions and appeal of the new device. Results: In total, 422 patients completed the survey, of whom 44% used autoinjectors, 43% prefilled syringes, and 13% syringes and vials; overall, 66% currently self-injected. Physical and psychological barriers to self-injection included difficulty with injections, needle phobia, and concerns over correct injection technique. Only 40% of respondents were “very satisfied” with their current injection method. The new electronic autoinjector was rated as “very appealing” by 65% of patients. The benefits of the new device included the ability to customize injection settings and to review dosing history. Conclusion: New technologies may help patients overcome physical and psychological barriers to self-injection. The combination of a reliable and flexible autoinjection device with dose-monitoring technology may improve communication between health care professionals and patients, and improve treatment adherence. PMID:21573048

  8. Orthognathic Surgery in a Patient with Multiple Sclerosis.

    Science.gov (United States)

    Al-Bazie, Saleh A

    2015-06-01

    The aim of this paper was to report a case of orthognathic surgery successfully done in a patient with multiple sclerosis. Multiple sclerosis (MS) is a chronic, progressive inflammatory disorder of the central nervous system affecting young adults, characterized by lymphocytic infiltration of the brain and spinal cord leading to demyelination and focal axonal damage. Clinically, MS patients present with reversible neurological dysfunction in the early stages, which progresses to irreversible neurological disability and deficit. Oral manifestations of MS include facial numbness or pain, neuralgias, facial paralysis, dysarthria and dysphagia. While dental treatment is not contraindicated in MS patients, it is, however, limited to preventive and supportive dental care. A 23-year-old Saudi male patient with a diagnosis of MS since 2008 reported to the oral and maxillo-facial surgery (OMFS) department for correction of dentofacial deformity. The patient was under follow-up with the neurology department and was being treated with interferon beta-1a. Following consent from the neurologist and the patient, a Lefort 1 segmental osteotomy was done under general anesthesia. The patient was stable throughout the surgical procedure and during the postoperative period. The patient was discharged upon complete surgical recovery and no acute exacerbations of MS were reported during the perioperative period. Based on our observations, orthognathic and maxillofacial surgical procedures can be safely carried out in patients with MS, provided a strict perioperative prophylactic regimen for stress reduction and prevention of acute attacks of MS is adhered to. Due to the stressful nature of dental treatment and oral and maxillofacial surgical procedures, acute exacerbations of MS are very much likely. Hence, it is imperative that dental and oral surgical practitioners are aware of the manifestations of MS and are able to manage such patients with suitable treatment modifications.

  9. User participation is a family matter: A multiple case study of the experiences of older, hospitalised people and their relatives.

    Science.gov (United States)

    Nyborg, Ingrid; Danbolt, Lars J; Kirkevold, Marit

    2017-12-01

    The purpose of this multiple case study was to compare and contrast older people's and their relatives' experiences of participation in decision-making processes regarding the planning of everyday life after discharge from hospital. Internationally, patient involvement in health services is established to benefit patient health and to improve quality of the services. The literature shows that at hospital discharge, older people would benefit from better communication and more active participation of relatives in the discharge planning. Little research has been carried out on the experiences of patients and relatives as a family in this context, and even less has investigated their participation. This study used a qualitative design with a comparative multicase approach. Participants were recruited from two hospitals in Norway using a purposive sampling strategy. Semi-structured interviews were conducted with five patients and with six of their relatives. Three patterns of experiences were identified: contradicting experiences; consistent experiences of nonpreferred participation; similar, but separate experiences of user participation. User participation in the planning of everyday life following discharge appeared to be random and limited for both patients and their relatives, and conflicting for the families as a whole. The decision-making processes seemed to be limited to the hospital context and did not include the broader context of everyday life following discharge. The results underscore the importance of taking a family perspective when caring for older people. Family meetings might be a useful tool to ensure systematic assessment and integration of the perspectives of both older people and their family in the planning of follow-up care. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

  10. Exploring change in a group-based psychological intervention for multiple sclerosis patients.

    Science.gov (United States)

    Borghi, Martina; Bonino, Silvia; Graziano, Federica; Calandri, Emanuela

    2018-07-01

    The study is focused on a group-based cognitive behavioral intervention aimed at promoting the quality of life and psychological well-being of multiple sclerosis patients. The study investigates how the group intervention promoted change among participants and fostered their adjustment to the illness. The intervention involved six groups of patients (a total of 41 patients) and included four consecutive sessions and a 6-month follow-up. To explore change, verbatim transcripts of the intervention sessions were analyzed using a mixed-methods content analysis with qualitative data combined with descriptive statistics. The categories of resistance and openness to change were used to describe the process of change. Resistance and openness to change coexisted during the intervention. Only in the first session did resistance prevail over openness to change; thereafter, openness to change gradually increased and stabilized over time, and openness to change was then always stronger than resistance. The study builds on previous research on the effectiveness of group-based psychological interventions for multiple sclerosis patients and gives methodological and clinical suggestions to health care professionals working with multiple sclerosis patients. Implications for rehabilitation The study suggests that a group-based cognitive behavioral intervention for multiple sclerosis patients focused on the promotion of identity redefinition, a sense of coherence and self-efficacy in dealing with multiple sclerosis fosters the process of change and may be effective in promoting patients' adjustment to their illness. Health care professionals leading group-based psychological interventions for multiple sclerosis patients should be aware that resistance and openness to change coexist in the process of change. The study suggests that the duration of the intervention is a crucial factor: a minimum of three sessions appears to be necessary for group participants to develop greater openness

  11. Initial Clinical Experience in Multiple Myeloma Staging by Means of Whole-Body Resonance Techniques

    International Nuclear Information System (INIS)

    Gallego, J. I.; Concepcion, L.; Alonso, S.; Sanchez, B.; Manzi, F.

    2003-01-01

    To develop a magnetic resonance (MR) exploratory technique equivalent to serial bone X-ray, and to compare their precision in the staging of multiple myeloma (MM) patients. Multiple acquisition T1-weights TSE and STIR sequences in the coronal plane were performed. Ten healthy volunteers and 11 multiple myeloma diagnosed patients were included. The visualization of bony structures was particularly noted,with special attention given to those which would normally be included in a serial bone X-ray. In the case of the patients, a comparison was made between diagnostic capacities of the MR sequences. MR highlighters significantly more (p<0.05) bony elements than did the serial bone X-ray. This was greatly due to a sequential displacement of the scanner bed, allowing for field-of-views which were minimally from head to third proximal of the leg. Magnetic resonance detected a significantly higher number (p<0.05) of lesions. It was, in turn, capable of revealing greater lesion extensions, even to the point of implying staging classification changes in 18% of the patients. The utilization of whole-body MR techniques in multiple myeloma patients is feasible and clinically beneficial. MR is both more sensitive and more specific than serial bone X-ray for evaluation of bony lesions in MM. It is currently serving as a valid alternative in a growing numbers of patients. (Author) 10 refs

  12. Charged particle multiplicity distributions in e+e--annihilation processes in the LEP experiments

    International Nuclear Information System (INIS)

    Shlyapnikov, P.V.

    1992-01-01

    Results of studies of the charged particle multiplicity distributions in the process of e + e - -annihilation into hadrons obtained in experiments at LEP accelerator in CERN are reviewed. Universality in energy dependence of the average charged particle multiplicity in e + e - and p ± p collisions, evidence for KNO-scaling in e + e - data, structure in multiplicity distribution and its relation to the jet structure of events, average particle multiplicities or quark and gluon jets, 'clan' picture and other topics are discussed. 73 refs.; 20 figs.; 3 tabs

  13. Unexpected Multiple Organ Infarctions in a Poisoned Patient

    Directory of Open Access Journals (Sweden)

    Sung-Wook Park

    2015-08-01

    Full Text Available Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE. However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.

  14. Turning challenges into design principles: Telemonitoring systems for patients with multiple chronic conditions.

    Science.gov (United States)

    Sultan, Mehwish; Kuluski, Kerry; McIsaac, Warren J; Cafazzo, Joseph A; Seto, Emily

    2018-01-01

    People with multiple chronic conditions often struggle with managing their health. The purpose of this research was to identify specific challenges of patients with multiple chronic conditions and to use the findings to form design principles for a telemonitoring system tailored for these patients. Semi-structured interviews with 15 patients with multiple chronic conditions and 10 clinicians were conducted to gain an understanding of their needs and preferences for a smartphone-based telemonitoring system. The interviews were analyzed using a conventional content analysis technique, resulting in six themes. Design principles developed from the themes included that the system must be modular to accommodate various combinations of conditions, reinforce a routine, consolidate record keeping, as well as provide actionable feedback to the patients. Designing an application for multiple chronic conditions is complex due to variability in patient conditions, and therefore, design principles developed in this study can help with future innovations aimed to help manage this population.

  15. Application of laser radiation and magnetostimulation in therapy of patients with multiple sclerosis.

    Science.gov (United States)

    Kubsik, Anna; Klimkiewicz, Robert; Janczewska, Katarzyna; Klimkiewicz, Paulina; Jankowska, Agnieszka; Woldańska-Okońska, Marta

    2016-01-01

    Multiple sclerosis is one of the most common neurological disorders. It is a chronic inflammatory demyelinating disease of the CNS, whose etiology is not fully understood. Application of new rehabilitation methods are essential to improve functional status. The material studied consisted of 120 patients of both sexes (82 women and 38 men) aged 21-81 years. The study involved patients with a diagnosis of multiple sclerosis. The aim of the study was to evaluate the effect of laser radiation and other therapies on the functional status of patients with multiple sclerosis. Patients were randomly divided into four treatment groups. The evaluation was performed three times - before the start of rehabilitation, immediately after rehabilitation (21 days of treatment) and subsequent control - 30 days after the patients leave the clinic. The following tests were performed for all patients to assess functional status: Expanded Disability Status Scale (EDSS) of Kurtzke and Barthel Index. Results of all testing procedures show that the treatment methods are improving the functional status of patients with multiple sclerosis, with the significant advantage of the synergistic action of laser and magneto stimulation. The combination of laser and magneto stimulation significantly confirmed beneficial effect on quality of life. The results of these studies present new scientific value and are improved compared to program of rehabilitation of patients with multiple sclerosis by laser radiation which was previously used. This study showed that synergic action of laser radiation and magneto stimulation has a beneficial effect on improving functional status, and thus improves the quality of life of patients with multiple sclerosis. The effects of all methods of rehabilitation are persisted after cessation of treatment applications, with a particular advantage of the synergistic action of laser radiation and magneto stimulation, which indicates the possibility to elicitation in these

  16. The experiences of individuals with Multiple Sclerosis in the Western ...

    African Journals Online (AJOL)

    Background: Multiple Sclerosis (MS) is a debilitating and degenerative lifelong neurological disease that seems to be growing increasingly more prevalent in South Africa. Objectives: The aim of this qualitative study was to explore the personal experiences of individuals with MS in the South African context. The focus of this ...

  17. Diagnostic radiology on multiple injured patients: interdisciplinary management

    International Nuclear Information System (INIS)

    Linsenmaier, U.; Pfeifer, K.J.; Kanz, K.G.; Mutschler, W.

    2001-01-01

    The presence of a radiologist within the admitting area of an emergency department and his capability as a member of the trauma team have a major impact on the role of diagnostic radiology in trauma care. The knowledge of clinical decision criteria, algorithms, and standards of patient care are essential for the acceptance within a trauma team. We present an interdisciplinary management concept of diagnostic radiology for trauma patients, which comprises basic diagnosis, organ diagnosis, radiological ABC, and algorithms of early clinical care. It is the result of a prospective study comprising over 2000 documented multiple injured patients. The radiologist on a trauma team should support trauma surgery and anesthesia in diagnostic and clinical work-up. The radiological ABC provides a structured approach for diagnostic imaging in all steps of the early clinical care of the multiple injured patient. Radiological ABC requires a reevaluation in cases of equivocal findings or difficulties in the clinical course. Direct communication of radiological findings with the trauma team enables quick clinical decisions. In addition, the radiologist can priority-oriented influence the therapy by using interventional procedures. The clinical radiologist is an active member of the interdisciplinary trauma team, not only providing diagnostic imaging but also participating in clinical decisions. (orig.) [de

  18. Differential diagnosis of Mendelian and mitochondrial disorders in patients with suspected multiple sclerosis

    Science.gov (United States)

    Katz Sand, Ilana B.; Honce, Justin M.; Lublin, Fred D.

    2015-01-01

    Several single gene disorders share clinical and radiologic characteristics with multiple sclerosis and have the potential to be overlooked in the differential diagnostic evaluation of both adult and paediatric patients with multiple sclerosis. This group includes lysosomal storage disorders, various mitochondrial diseases, other neurometabolic disorders, and several other miscellaneous disorders. Recognition of a single-gene disorder as causal for a patient’s ‘multiple sclerosis-like’ phenotype is critically important for accurate direction of patient management, and evokes broader genetic counselling implications for affected families. Here we review single gene disorders that have the potential to mimic multiple sclerosis, provide an overview of clinical and investigational characteristics of each disorder, and present guidelines for when clinicians should suspect an underlying heritable disorder that requires diagnostic confirmation in a patient with a definite or probable diagnosis of multiple sclerosis. PMID:25636970

  19. Association of copeptin and cortisol in newly diagnosed multiple sclerosis patients.

    Science.gov (United States)

    Baranowska-Bik, Agnieszka; Kochanowski, Jan; Uchman, Dorota; Litwiniuk, Anna; Kalisz, Malgorzata; Martynska, Lidia; Wolinska-Witort, Ewa; Baranowska, Boguslawa; Bik, Wojciech

    2015-05-15

    Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. Obesity may increase the risk of developing MS. The aim of this study was to evaluate copeptin and cortisol plasma levels in newly diagnosed untreated MS patients and to determine whether copeptin and cortisol are related to the patients' clinical statuses. We report that copeptin and cortisol were higher in overweight/obese MS patients. Positive correlations were observed between the two parameters. We conclude that alterations of copeptin and cortisol levels in multiple sclerosis patients may be related to adiposity. An increase in cortisol may also be associated with copeptin secretion. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Feasibility of a multiple-choice mini mental state examination for chronically critically ill patients.

    Science.gov (United States)

    Miguélez, Marta; Merlani, Paolo; Gigon, Fabienne; Verdon, Mélanie; Annoni, Jean-Marie; Ricou, Bara

    2014-08-01

    Following treatment in an ICU, up to 70% of chronically critically ill patients present neurocognitive impairment that can have negative effects on their quality of life, daily activities, and return to work. The Mini Mental State Examination is a simple, widely used tool for neurocognitive assessment. Although of interest when evaluating ICU patients, the current version is restricted to patients who are able to speak. This study aimed to evaluate the feasibility of a visual, multiple-choice Mini Mental State Examination for ICU patients who are unable to speak. The multiple-choice Mini Mental State Examination and the standard Mini Mental State Examination were compared across three different speaking populations. The interrater and intrarater reliabilities of the multiple-choice Mini Mental State Examination were tested on both intubated and tracheostomized ICU patients. Mixed 36-bed ICU and neuropsychology department in a university hospital. Twenty-six healthy volunteers, 20 neurological patients, 46 ICU patients able to speak, and 30 intubated or tracheostomized ICU patients. None. Multiple-choice Mini Mental State Examination results correlated satisfactorily with standard Mini Mental State Examination results in all three speaking groups: healthy volunteers: intraclass correlation coefficient = 0.43 (95% CI, -0.18 to 0.62); neurology patients: 0.90 (95% CI, 0.82-0.95); and ICU patients able to speak: 0.86 (95% CI, 0.70-0.92). The interrater and intrarater reliabilities were good (0.95 [0.87-0.98] and 0.94 [0.31-0.99], respectively). In all populations, a Bland-Altman analysis showed systematically higher scores using the multiple-choice Mini Mental State Examination. Administration of the multiple-choice Mini Mental State Examination to ICU patients was straightforward and produced exploitable results comparable to those of the standard Mini Mental State Examination. It should be of interest for the assessment and monitoring of the neurocognitive

  1. Maternity experiences of mothers with multiple disadvantages in England: A qualitative study.

    Science.gov (United States)

    McLeish, Jenny; Redshaw, Maggie

    2018-06-14

    Disadvantaged mothers and their babies are at increased risk of poor perinatal outcomes and have less positive experiences of maternity care. To explore the maternity care experiences of mothers with multiple disadvantages. A qualitative descriptive study based on semi-structured interviews with 40 mothers with multiple disadvantages, using thematic analysis. Four themes emerged: 'A confusing and frightening time', 'Longing to be respected as an individual', 'The importance of choice and control', and 'Needing trust to feel safe'. Mothers brought feelings of powerlessness and low self-esteem to their encounters with maternity professionals, which could be significantly worsened by disrespectful care. They needed support to navigate the complex maternity system. Positive experiences were much more likely where the mother had received continuity of care from a specialist midwife or small team. Mothers with multiple disadvantages value being treated as an individual, making informed choices, and feeling safe, but they may lack the confidence to ask questions or challenge disrespectful treatment. Training and supervision should enable maternity professionals to understand how confusing maternity care can be to very disadvantaged mothers. It should emphasise the need to provide accessible and empowering information and guidance to enable all mothers to make choices and understand the system. Leaders of maternity services need to do more to challenge negative staff attitudes and ensure that that all mothers are treated at all times with kindness, respect and dignity. Specialist midwives can deliver a high quality service to mothers experiencing multiple disadvantages. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. The LBL multiple beam experiments

    International Nuclear Information System (INIS)

    Fessenden, T.J.; Keefe, D.; Kim, C.; Meuth, H.; Warwick, A.

    1987-01-01

    The multiple-beam induction linac approach to a heavy ion driver for inertial confinement fusion features continuous current amplification along the accelerator and a minimum of beam manipulations from source to pellet. Current amplification and bunch length control require careful shaping of the accelerating voltages. MBE-4 is designed as a four-beam induction linac that models much of the accelerator physics of the electrostatically focused section of a significantly longer induction accelerator. Four space-charge-dominated Cs + beams, initially about one meter in length at a current of 13 mA, are focused by electrostatic quadrupoles and accelerated in parallel from 200 to nearly 600 keV. The energy will reach approximately one MeV when the accelerator is complete. Experiments have proceeded in parallel with the construction of the apparatus which began in FY 85 and is now more than half complete. The results show a current amplification, so far, by a factor of 2.8 in good agreement with the longitudinal acceleration calculations. 9 refs

  3. Multiple tracing experiments in unsaturated fractured clayey till

    DEFF Research Database (Denmark)

    Mortensen, Annette Pia; Jensen, Karsten Høgh; Nilsson, B.

    2004-01-01

    control of the water balance in the block. Experiments at three different steady-state flow rates were performed. Multiple tracers with different diffusion coefficients were applied in each experiment to evaluate the influence of diffusive exchange between fractures and the matrix. The tracers included...... a fast peak was followed by a long tailing period. At flow rates, two of the applied tracers revealed a double peak breakthrough curve, whereas the tracer with the lowest molecular diffusion coefficient showed only one peak. The separation of the tracers was hypothesized to be influenced by extensive...... two halogen anions ( Cl- and Br-), two fluorobenzoic acids (FBA) ( 2,3-DFBA and 2,6-DFBA), two fluorescent dyes (uranine and sulforhodamine B), and one colloidal tracer (0.5-mum mlatex particles). At high flow rates, the obtained tracer breakthrough showed a traditional asymmetrical behavior where...

  4. The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers.

    Science.gov (United States)

    Ancker, Jessica S; Witteman, Holly O; Hafeez, Baria; Provencher, Thierry; Van de Graaf, Mary; Wei, Esther

    2015-06-04

    A critical problem for patients with chronic conditions who see multiple health care providers is incomplete or inaccurate information, which can contribute to lack of care coordination, low quality of care, and medical errors. As part of a larger project on applications of consumer health information technology (HIT) and barriers to its use, we conducted a semistructured interview study with patients with multiple chronic conditions (MCC) with the objective of exploring their role in managing their personal health information. Semistructured interviews were conducted with patients and providers. Patients were eligible if they had multiple chronic conditions and were in regular care with one of two medical organizations in New York City; health care providers were eligible if they had experience caring for patients with multiple chronic conditions. Analysis was conducted from a grounded theory perspective, and recruitment was concluded when saturation was achieved. A total of 22 patients and 7 providers were interviewed; patients had an average of 3.5 (SD 1.5) chronic conditions and reported having regular relationships with an average of 5 providers. Four major themes arose: (1) Responsibility for managing medical information: some patients perceived information management and sharing as the responsibility of health care providers; others—particularly those who had had bad experiences in the past—took primary responsibility for information sharing; (2) What information should be shared: although privacy concerns did influence some patients' perceptions of sharing of medical data, decisions about what to share were also heavily influenced by their understanding of health and disease and by the degree to which they understood the health care system; (3) Methods and tools varied: those patients who did take an active role in managing their records used a variety of electronic tools, paper tools, and memory; and (4) Information management as invisible work

  5. Correlation between white matter damage and gray matter lesions in multiple sclerosis patients

    Directory of Open Access Journals (Sweden)

    Xue-mei Han

    2017-01-01

    Full Text Available We observed the characteristics of white matter fibers and gray matter in multiple sclerosis patients, to identify changes in diffusion tensor imaging fractional anisotropy values following white matter fiber injury. We analyzed the correlation between fractional anisotropy values and changes in whole-brain gray matter volume. The participants included 20 patients with relapsing-remitting multiple sclerosis and 20 healthy volunteers as controls. All subjects underwent head magnetic resonance imaging and diffusion tensor imaging. Our results revealed that fractional anisotropy values decreased and gray matter volumes were reduced in the genu and splenium of corpus callosum, left anterior thalamic radiation, hippocampus, uncinate fasciculus, right corticospinal tract, bilateral cingulate gyri, and inferior longitudinal fasciculus in multiple sclerosis patients. Gray matter volumes were significantly different between the two groups in the right frontal lobe (superior frontal, middle frontal, precentral, and orbital gyri, right parietal lobe (postcentral and inferior parietal gyri, right temporal lobe (caudate nucleus, right occipital lobe (middle occipital gyrus, right insula, right parahippocampal gyrus, and left cingulate gyrus. The voxel sizes of atrophic gray matter positively correlated with fractional anisotropy values in white matter association fibers in the patient group. These findings suggest that white matter fiber bundles are extensively injured in multiple sclerosis patients. The main areas of gray matter atrophy in multiple sclerosis are the frontal lobe, parietal lobe, caudate nucleus, parahippocampal gyrus, and cingulate gyrus. Gray matter atrophy is strongly associated with white matter injury in multiple sclerosis patients, particularly with injury to association fibers.

  6. Measuring Patients' Experience of Rehabilitation Services Across the Care Continuum. Part II: Key Dimensions.

    Science.gov (United States)

    McMurray, Josephine; McNeil, Heather; Lafortune, Claire; Black, Samantha; Prorok, Jeanette; Stolee, Paul

    2016-01-01

    To identify key dimensions of patients' experience across the rehabilitative care system and to recommend a framework to develop survey items that measure the rehabilitative care experience. Data were sourced from a literature review that searched MEDLINE (PubMed), CINAHL (Ebsco), and PsycINFO (APA PsycNET) databases from 2004 to 2014, the reference lists of the final accepted articles, and hand searches of relevant journals. Four reviewers performed the screening process on 2472 articles; 33 were included for analysis. Interrater reliability was confirmed through 2 rounds of title review and 1 round of abstract review, with an average κ score of .69. The final sample of 33 accepted articles was imported into a qualitative data analysis software application. Multiple levels of coding and a constant comparative methodology generated 6 themes. There were 502 discreet survey questions measuring patient experience that were categorized using the following dimensions: rehabilitative care ecosystem, client and informal caregiver engagement, patient and health care provider relation, pain and functional status, group and individual identity, and open ended. The most common survey questions examine the care delivery ecosystem (37%), the engagement of clients and their informal caregivers (24.9%), and the quality of relations between providers and patients (21.7%). Examination of patient's functional status and management of pain yielded (15.3%) of the instruments' questions. Currently available instruments and questions that measure patients' experience in rehabilitative care are unable to assess the performance of rehabilitative delivery systems that aspire to integrate care across the continuum. However, question panels derived from our 6 key themes may measure the key concepts that define rehabilitative care and facilitate measurement of patient experience at the system level. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc

  7. The Relationship between Personality Traits and Life Expectancy in Patients with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Leila Zaghari

    2012-04-01

    Full Text Available Objectives: Multiple Sclerosis is an incurable and chronic disease of the central nervous system. The main purpose of this survey is to compare the character types and life expectancy of patients suffering from M. S as compared with normal people. This survey was conducted using the Persian translation of NEO-FFI (NEO-Five Factor Inventory and Herth Life Expectancy. Methods:Thirty nine people suffering from multiple sclerosis, who were hospitalized in anursing home, were chosen. As a control group there were 39 healthy people who had no background of physical or mental diseases. These people were selected from educational centre scientific and the personnel of Islamic Azad University, Science and Research Campus. Healthy people were matched to control group according, to sex, gender, marital status and education. Results: To analyze the data, T tests were used. The results of the survey show that people suffering from multiple sclerosis were significantly different from healthy people in three factors, neuroticism, extraversion and openness. For life expectancy there was no significant difference between the two groups. Discussion: Peopleaffected by Multiple Sclerosis achieve higher marks levels of the function of neuroticism compared with the healthy people. They are also agreeableness in a lower state, due to the function of openness to experience compared with the safe ones and in a lower state compared with the healthy persons.

  8. Researching the experience of kidney cancer patients.

    Science.gov (United States)

    Taylor, K

    2002-09-01

    The author's personal experience as a kidney cancer patient, researcher and founder of a kidney cancer support group forms the basis for consideration of the challenges involved in researching patients' experiences. The researcher needs to understand the variability of those experiences in both clinical and psychological-emotional terms, and in relation to the personal, familial and social contexts of the patient. It is also essential to define the purpose of the research and to show how an understanding of personal experiences of cancer can be used to enhance the quality of care for cancer patients. The research encounter with a patient is also in some respects a therapeutic encounter requiring a considerable degree of sensitivity on the part of the researcher. The person-centred approach of Carl Rogers is of value in supporting such an encounter.

  9. Renal failure in patients with multiple myeloma.

    Science.gov (United States)

    Almueilo, Samir H

    2015-01-01

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

  10. Cumulative radiation dose of multiple trauma patients during their hospitalization

    International Nuclear Information System (INIS)

    Wang Zhikang; Sun Jianzhong; Zhao Zudan

    2012-01-01

    Objective: To study the cumulative radiation dose of multiple trauma patients during their hospitalization and to analyze the dose influence factors. Methods: The DLP for CT and DR were retrospectively collected from the patients during June, 2009 and April, 2011 at a university affiliated hospital. The cumulative radiation doses were calculated by summing typical effective doses of the anatomic regions scanned. Results: The cumulative radiation doses of 113 patients were collected. The maximum,minimum and the mean values of cumulative effective doses were 153.3, 16.48 mSv and (52.3 ± 26.6) mSv. Conclusions: Multiple trauma patients have high cumulative radiation exposure. Therefore, the management of cumulative radiation doses should be enhanced. To establish the individualized radiation exposure archives will be helpful for the clinicians and technicians to make decision whether to image again and how to select the imaging parameters. (authors)

  11. Statin Induced Myopathy a Patient with Multiple Systemic Diseases

    Directory of Open Access Journals (Sweden)

    Özgül Uçar

    2011-04-01

    Full Text Available Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins are the most successful class of drugs for the treatment of hypercholesterolaemia and dyslipidaemia. However, the popular profile of statins in terms of efficacy has been maligned by theiradverse effects. Statin induced myopathy, which can be seen at any time during the course of therapy, is a clinically important cause of statin intolerance and discontinuation. When a patient with multiple systemic diseases who use numerous medications represent with myalgia and muscle cramps, statin induced myopathy may not be remembered at first. We present a patient with multiple systemic diseases, alcohol and morphine abuse in whom myopathy developed. After exclusion of other etiologies, we concluded that myopathy was related to statin therapy.

  12. Is impaired cerebral vasoreactivity an early marker of cognitive decline in multiple sclerosis patients?

    International Nuclear Information System (INIS)

    Metzger, Aude; Le Bars, Emmanuelle; Deverdun, Jeremy; Molino, Francois; Marechal, Benedicte; Picot, Marie-Christine; Ayrignac, Xavier; Carra, Clarisse; Labauge, Pierre; Bauchet, Luc; Krainik, Alexandre; Menjot de Champfleur, Nicolas

    2018-01-01

    The link between cerebral vasoreactivity and cognitive status in multiple sclerosis remains unclear. The aim of the present study was to investigate a potential decrease of cerebral vasoreactivity in multiple sclerosis patients and correlate it with cognitive status. Thirty-three patients with multiple sclerosis (nine progressive and 24 remitting forms, median age: 39 years, 12 males) and 22 controls underwent MRI with a hypercapnic challenge to assess cerebral vasoreactivity and a neuropsychological assessment. Cerebral vasoreactivity, measured as the cerebral blood flow percent increase normalised by end-tidal carbon dioxide variation, was assessed globally and by regions of interest using the blood oxygen level-dependent technique. Non-parametric statistics tests were used to assess differences between groups, and associations were estimated using linear models. Cerebral vasoreactivity was lower in patients with cognitive impairment than in cognitively normal patients (p=0.004) and was associated with education level in patients (R 2 = 0.35; p = 0.047). There was no decrease in cerebral vasoreactivity between patients and controls. Cognitive impairment in multiple sclerosis may be mediated through decreased cerebral vasoreactivity. Cerebral vasoreactivity could therefore be considered as a marker of cognitive decline in multiple sclerosis. (orig.)

  13. Is impaired cerebral vasoreactivity an early marker of cognitive decline in multiple sclerosis patients?

    Energy Technology Data Exchange (ETDEWEB)

    Metzger, Aude [University Hospital Center, Department of Neurology, Montpellier (France); University Hospital Center, Department of Neurology, Memory Ressource and Research Center, Montpellier (France); Le Bars, Emmanuelle; Deverdun, Jeremy [Centre Hospitalier Regional Universitaire de Montpellier, Departement de Neuroradiologie, Hopital Gui de Chauliac, Montpellier (France); Centre Hospitalier Regional Universitaire de Montpellier, Institut d' Imagerie Fonctionnelle Humaine (I2FH), Hopital Gui de Chauliac, Montpellier (France); Universite de Montpellier, Laboratoire Charles Coulomb, CNRS UMR 5221, Montpellier (France); Molino, Francois [Universite de Montpellier, Laboratoire Charles Coulomb, CNRS UMR 5221, Montpellier (France); Universite de Montpellier, Institut de Genomique Fonctionnelle, CNRS UMR 5203, INSERM U661, Montpellier (France); Marechal, Benedicte [Siemens Healthcare, Advanced Clinical Imaging Technology, Lausanne (Switzerland); CHUV, Department of Radiology, Lausanne (Switzerland); LTS5, EPFL, Lausanne (Switzerland); Picot, Marie-Christine [Centre Hospitalier Regional Universitaire de Montpellier, Departement de Biostatistiques, Montpellier (France); Ayrignac, Xavier; Carra, Clarisse; Labauge, Pierre [University Hospital Center, Department of Neurology, Montpellier (France); Bauchet, Luc [Centre Hospitalier Regional Universitaire de Montpellier, Departement de Neurochirurgie, Hopital Gui de Chauliac, Montpellier (France); Hopital Saint Eloi, Institut de Neurosciences de Montpellier, INSERM U1051, Montpellier (France); Krainik, Alexandre [University Hospital of Grenoble, MR Unit CS 10217, Grenoble (France); Menjot de Champfleur, Nicolas [Centre Hospitalier Regional Universitaire de Montpellier, Departement de Neuroradiologie, Hopital Gui de Chauliac, Montpellier (France); Centre Hospitalier Regional Universitaire de Montpellier, Institut d' Imagerie Fonctionnelle Humaine (I2FH), Hopital Gui de Chauliac, Montpellier (France); Universite de Montpellier, Laboratoire Charles Coulomb, CNRS UMR 5221, Montpellier (France); Centre Hospitalier Universitaire Caremeau, Departement d' Imagerie Medicale, Nimes (France)

    2018-03-15

    The link between cerebral vasoreactivity and cognitive status in multiple sclerosis remains unclear. The aim of the present study was to investigate a potential decrease of cerebral vasoreactivity in multiple sclerosis patients and correlate it with cognitive status. Thirty-three patients with multiple sclerosis (nine progressive and 24 remitting forms, median age: 39 years, 12 males) and 22 controls underwent MRI with a hypercapnic challenge to assess cerebral vasoreactivity and a neuropsychological assessment. Cerebral vasoreactivity, measured as the cerebral blood flow percent increase normalised by end-tidal carbon dioxide variation, was assessed globally and by regions of interest using the blood oxygen level-dependent technique. Non-parametric statistics tests were used to assess differences between groups, and associations were estimated using linear models. Cerebral vasoreactivity was lower in patients with cognitive impairment than in cognitively normal patients (p=0.004) and was associated with education level in patients (R{sup 2} = 0.35; p = 0.047). There was no decrease in cerebral vasoreactivity between patients and controls. Cognitive impairment in multiple sclerosis may be mediated through decreased cerebral vasoreactivity. Cerebral vasoreactivity could therefore be considered as a marker of cognitive decline in multiple sclerosis. (orig.)

  14. Further experience with radiotherapy by multiple daily sessions

    Energy Technology Data Exchange (ETDEWEB)

    Svoboda, V H.J. [Saint Mary' s Hospital, Portsmouth (UK). Dept. of Radiotherapy and Oncology

    1978-05-01

    Since 1972 over 100 patients have been treated by frequent daily sessions of radiotherapy with a short overall time. Cobalt 60 teletherapy and 250 kV X-ray beams have been used with radical or palliative dosage. The tolerance to these regimes of the skin, breast, chest wall, neck, lung and pelvis is discussed and the tumour responses described. Radiotherapy by multiple daily sessions is clinically possible and often an advantage. Its therapeutic ratio is not inferior to comparable regimes using longer intervals.

  15. Managing treatment fatigue in patients with multiple sclerosis on long-term therapy: the role of multiple sclerosis nurses

    Directory of Open Access Journals (Sweden)

    Crawford A

    2014-08-01

    Full Text Available Ann Crawford, Sally Jewell,* Holly Mara, Laura McCatty, Regina Pelfrey The Lash Group; Frisco, TX, USA *Sally Jewell is now retired Abstract: This article discusses the many ways that nurses can address the factors that lead to treatment fatigue in patients with multiple sclerosis (MS on long-term disease-modifying therapy, ultimately helping to preserve the patient’s health and quality of life. Patients with MS on long-term therapy may suffer from treatment fatigue and poor adherence due to a variety of different factors, including difficulties with injections, anxiety/depression, financial problems, and inaccurate beliefs about the MS disease process. Because MS nurses have regular interactions with patients, they are ideally situated to help patients cope with these and other factors that may limit adherence. Keywords: multiple sclerosis, disease-modifying therapy, injection, nurse

  16. Multiple primary malignant neoplasms in patients treated with definitive chemoradiotherapy for esophageal cancer

    International Nuclear Information System (INIS)

    Yamashita, Keishi; Muto, Manabu; Ohtsu, Atsushi; Mera, Kiyomi; Doi, Toshihiko; Sano, Yasushi; Yoshida, Shigeaki

    2003-01-01

    We reviewed our clinical experiences of chemoradiotherapy (CRT) for esophageal cancer (EC) in 44 patients with multiple primary malignant neoplasms. Among them, 34 were accompanied with synchronous tumors, 8 were accompanied with antecedent tumors and 8 with subsequent tumors. The sites of primary malignant neoplasms were as follows; stomach 24 (43.6%), head and neck 17 (30.9%), colon and rectum 4 (7.3%). Among the 19 patients with synchronous cancer in the stomach, 6 patients underwent gastrectomy or endoscopic mucosal resection before CRT, and the others received definitive CRT as initial treatment. While 5 patients were alive without recurrence of EC and gastric cancer, more than half of the patients died of EC. Among 11 patients with head and neck cancer (HNC), 9 patients underwent surgery for HNC before CRT, because the clinical stages of the HNC was more progressive than that of EC. Only 3 patients achieved complete cure of both EC and HNC. The number of patients who developed subsequent tumors after CRT for EC was too small for us to draw definitive conclusions from our discussion, so further long-term follow-up and analysis based on large-scale surveys are required. Although CRT has become one of the standard treatments for EC, there is no treatment strategy for patients with both EC and other malignant primary neoplasms. Our results suggest that we should consider the curability of EC by CRT when we treat such patients. (author)

  17. Pleasure Experience and Emotion Expression in Patients with Schizophrenia

    Science.gov (United States)

    CHU, Min-yi; LI, Xu; LV, Qin-yu; Yl, Zheng-hui; CHEUNG, Eric F. C.; CHAN, Raymond C. K.

    2017-01-01

    Background Impairments in emotional experience and expression have been observed in patients with schizophrenia. However, most previous studies have been limited to either emotional experience (especially anhedonia) or expression. Few studies have examined both the experience and expression of emotion in schizophrenia patients at the same time. Aims The present study aimed to examine pleasure experience and emotion expression in patients with schizophrenia. In particular, we specifically examined the relationship between emotion impairments (both pleasure experience and expression) and negative symptoms. Methods One hundred and fifty patients completed the Temporal Experience of Pleasure Scale and Emotional Expressivity Scale. Results Schizophrenia patients exhibited deficits in experiencing pleasure, but showed intact reported emotion expression. Patients with prominent negative symptoms showed reduced anticipatory pleasure, especially in abstract anticipatory pleasure. Conclusion The present findings suggest that patients with schizophrenia have deficits in pleasure experience, while their abilities to express emotion appear intact. Such deficits are more severe in patients with prominent negative symptoms. PMID:29276350

  18. Intraosseous Atypical Chondroid Tumor or Chondrosarcoma Grade 1 in Patients with Multiple Osteochondromas

    NARCIS (Netherlands)

    Goud, Annemarie L.; Wuyts, Wim; Bessems, Johannes; Bramer, Jos; van der Woude, Henk Jan; Ham, John

    2015-01-01

    Background: The autosomal dominant condition multiple osteochondromas, formerly called multiple hereditary exostoses, is associated with a risk of malignant progression of osteochondroma into secondary peripheral chondrosarcoma. Most patients with multiple osteochondromas have exostosin-1 or

  19. Leisure time activities of Iranian patients with multiple sclerosis: a qualitative study.

    Science.gov (United States)

    Hosseini, Seyed Mohammad Sadegh; Asgari, Ali; Rassafiani, Mehdi; Yazdani, Farzaneh; Mazdeh, Mehrdokht

    2016-01-01

    Leisure time is one of the most important aspects of life, especially for people with chronic diseases. The concept and types of leisure have frequently been evaluated in different socio-cultural populations. The aim of this study was to identify the nature of leisure activities among a sample of Iranian patients with multiple sclerosis (MS) and classify the identified types of activities in the context of Iranian culture. In this qualitative study, semi-structured interview was applied to gather data from 34 MS patients that were selected through purposive sampling. The interviews were continued up to the point of saturation. Content analysis was used to explore experiences of the interviewees regarding their leisure activities. Six categories of leisure activities were extracted for the studied patients with MS i.e.physical, social, individual, art/cultural, educational and spiritual/religious. The results represented the range and heterogeneity of leisure activities amongst the MS patients. Considering participation in spiritual/religious and social activities as leisure time undertaking might reflect cultural diversity in the perception and use of time for recreation. For mental health promotion purposes, paying special attention to the types of activities that people of different socio-cultural background choose for their refreshment could help health care providers in giving tailored advice for patients with MS and other chronic debilitating disease.

  20. Leisure time activities of Iranian patients with multiple sclerosis: a qualitative study

    Science.gov (United States)

    Hosseini, Seyed Mohammad Sadegh; Asgari, Ali; Rassafiani, Mehdi; Yazdani, Farzaneh; Mazdeh, Mehrdokht

    2016-01-01

    Background: Leisure time is one of the most important aspects of life, especially for people with chronic diseases. The concept and types of leisure have frequently been evaluated in different socio-cultural populations. The aim of this study was to identify the nature of leisure activities among a sample of Iranian patients with multiple sclerosis (MS) and classify the identified types of activities in the context of Iranian culture. Methods: In this qualitative study, semi-structured interview was applied to gather data from 34 MS patients that were selected through purposive sampling. The interviews were continued up to the point of saturation. Content analysis was used to explore experiences of the interviewees regarding their leisure activities. Results: Six categories of leisure activities were extracted for the studied patients with MS i.e.physical, social, individual, art/cultural, educational and spiritual/religious. Conclusion: The results represented the range and heterogeneity of leisure activities amongst the MS patients. Considering participation in spiritual/religious and social activities as leisure time undertaking might reflect cultural diversity in the perception and use of time for recreation. For mental health promotion purposes, paying special attention to the types of activities that people of different socio-cultural background choose for their refreshment could help health care providers in giving tailored advice for patients with MS and other chronic debilitating disease. PMID:27123437

  1. Air MEDEVAC in case of multiple casualties – The experience of civilian-military cooperation in RoAF

    Directory of Open Access Journals (Sweden)

    Dragoș C. Tudose

    2016-07-01

    Full Text Available Introduction: Starting September 2010 in Romania was created the Military Emergency Medical Service (SMMU by the Ministry of National Defense, which has as main mission to provide first aid and save the lives of military personnel during military operations using special equipped MEDEAVC aircraft. Nationwide exist the national emergency system which operates thru 112- SMURD acting in support of the civilian population. In case of accidents with multiple victims the experience has shown the need for collaboration between the two systems, in order to save lives. In the last 5 years there has been an increasing Airlift missions (MEDEVAC with multiple victims executed by joint civil-military medical teams using military aircraft. Material and methods. This paper provides a review of the most important aspects of particularities, advantages and disadvantages of this type of medical transport using the MEDEVAC missions based study carried out by the Air Force in recent years. Results and conclusions. Performing these tasks presents challenges to mission planning, use of medical equipment and procedures, command-control system, exercise programs jointly joint medical teams and, of course, managing a large number of patients in flight. The large number of patients transported safely and in the shortest time, regardless of weather conditions recommends this type of medical intervention. Given the Romanian military presence in various theaters and that NATO strategic medical evacuation is a national responsibility, the capacity of air transport in case multiple casualties is a priority.

  2. Multiple sclerosis-associated retrovirus, Epstein-Barr virus, and vitamin D status in patients with relapsing remitting multiple sclerosis.

    Science.gov (United States)

    Mostafa, Aliehossadat; Jalilvand, Somayeh; Shoja, Zabihollah; Nejati, Ahmad; Shahmahmoodi, Shohreh; Sahraian, Mohammad Ali; Marashi, Sayed Mahdi

    2017-07-01

    The relationship between infections and autoimmune diseases is complex and there are several reports highlighting the role of human endogenous retroviruses (HERVs) in these patients. The levels of multiple sclerosis-associated retrovirus (MSRV)-type DNA of Env gene was measured in peripheral blood mononuclear cells from 52 patients with relapsing-remitting multiple sclerosis (RRMS) and 40 healthy controls using specific quantitative PCR (qPCR) analysis. Furthermore, we analyzed the status of HERV-W/MSRV in these patients with regards to both EBV (DNA load and anti-EBNA1 IgG antibody) and vitamin D concentration. MSRV DNA copy number were significantly higher in RRMS patients than healthy controls (P < 0.0001). Interestingly, an inverse correlation was found between MSRV DNA copy number and serum vitamin D concentration (P < 0.01), but not for EBV load or anti-EBNA-1 IgG antibody. © 2017 Wiley Periodicals, Inc.

  3. Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

    Directory of Open Access Journals (Sweden)

    Hyun Oh Park

    2017-10-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU. This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results: Forty-six patients (45.5% had at least 1 episode of VAP, 10 (21.7% of whom died in the ICU. Of the 55 (54.5% patients who did not have pneumonia, 9 (16.4% died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029. Conclusion: Severe pulmonary contusion (pulmonary lung contusion score 6–12 is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

  4. Improved patient-reported health impact of multiple sclerosis

    DEFF Research Database (Denmark)

    Macdonell, Richard; Nagels, Guy; Laplaud, David-Axel

    2016-01-01

    BACKGROUND: Multiple sclerosis (MS) is a debilitating disease that negatively impacts patients' lives. OBJECTIVE: ENABLE assessed the effect of long-term prolonged-release (PR) fampridine (dalfampridine extended release in the United States) treatment on patient-perceived health impact in patients...... with MS with walking impairment. METHODS: ENABLE was a 48-week, open-label, Phase 4 study of PR-fampridine 10 mg twice daily. Patients who showed any improvement in Timed 25-Foot Walk walking speed at weeks 2 and 4 and any improvement in 12-item MS Walking Scale score at week 4 remained on treatment....... The primary endpoint was change from baseline in 36-Item Short-Form Health Survey (SF-36) physical component summary (PCS) score. RESULTS: At week 4, 707/901 (78.5%) patients met the criteria to remain on treatment. Patients on treatment demonstrated significant and clinically meaningful improvements in SF-36...

  5. Multiple Pyogenic Abscess of the Hybrid Mice on the Course of Radiation Experiment

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Heon; Shin, Sei One; Kim, Myung Se; Choi, Won Hee; Kim, Seung Hoon [Yeungnam University College of Medicine, Daegu (Korea, Republic of)

    1985-12-15

    Even though the mechanism and the nature of radiation induced pneumonitis, esophagitis and gastroenteritis were detailed by many authors, complicated secondary infection is still serious problem, sometimes fatal, even today. We experience a case of multiple pyogenic abscess in subcutaneous tissue of the back and both kidneys which could not differentiate from multiple metastatic sarcoma grossly, and report with review of literatures, lab. findings.

  6. Insomnia patients' help-seeking experiences.

    Science.gov (United States)

    Cheung, Janet M Y; Bartlett, Delwyn J; Armour, Carol L; Glozier, Nicholas; Saini, Bandana

    2014-03-04

    Timely access to appropriate treatment is important for optimizing insomnia management. To date, little is known about insomnia patients' treatment experiences or how they access and engage with the available health care resources. This study sought to capture the help-seeking experiences and behavioral patterns of patients with insomnia who are seeking or receiving specialist care. A purposive sample of 26 insomnia patients from specialist sleep and mental health clinics located in metropolitan New South Wales, Australia was recruited. Participants completed a brief questionnaire, followed by an in-depth, semi-structured interview. Interviews were digitally recorded, transcribed verbatim, and analyzed using framework analysis. Three key themes emerged from the data: patients' sleep beliefs, treatment beliefs, and accessing specialized care. The findings show that daytime symptoms arising from insomnia serve as important illness cues for patients to seek medical help. In addition, participants' treatment pathways highlight factors that prevent the widespread use of cognitive behavioral therapy for insomnia (CBT-I), including limited awareness about CBT-I, tentative referral mechanisms, limited service providers, and the high cost of CBT-I.

  7. Evaluating Functional Decline in Patients with Multiple Sclerosis

    Science.gov (United States)

    Rosenblum, Sara; Weiss, Patrice L.

    2010-01-01

    Multiple Sclerosis (MS) is a disease with a wide-ranging impact on functional status. The aim of the study was to examine the added value of simultaneously evaluating fatigue, personal ADL and handwriting performance as indicators for functional decline among patients with MS. Participants were 50 outpatients with MS and 26 matched healthy…

  8. Mapping patients' experiences after stroke onto a patient-focused intervention framework.

    Science.gov (United States)

    Donnellan, C; Martins, A; Conlon, A; Coughlan, T; O'Neill, D; Collins, D R

    2013-03-01

    Stroke patients' involvement in the rehabilitation process including decision making has made significant advances clinically over the past two decades. However, development of patient-focused interventions in stroke rehabilitation is a relatively under developed area of research. The aim of this study was to interpret the explanations that patients gave of their experience after stroke and how these may validate an already established patient-focused intervention framework - the Quest for quality and improved performance (QQUIP) (2006) that includes seven quality improvement goals. A random purposive sample of eight stroke patients was interviewed between 3 and 6 months following discharge. Patients' reports of their experience after stroke were obtained using in-dept semi-structured interviews and analysed using Qualitative Content Analysis. Explanations given by patients included both positive and negative reports of the stroke experience. Regardless of consequences as a result of physical, psychological and social impairments, there were other life style disruptions that were reported by all patients such as taking new medication and adverse effects of these, experiencing increasing fatigue, difficulties with social activities and situations and having to make changes in health behaviours and lifestyle. Some of the core themes that emerged reflected the aims of QQUIP improvement goals that include improving health literacy, clinical decision-making, self-care, patient safety, access to health advice, care experience and service development. Further recommendations based on the findings from this study would be to consider using the QQUIP framework for developing intervention studies in stroke rehabilitation care that are person-centred. This framework provides a template that is equipped to address some of the main concerns that people have following the experience of stroke and also focuses on improving quality of care.

  9. Early infections in patients undergoing high-dose treatment with stem cell support: a comparison of patients with non-Hodgkin lymphoma and multiple myeloma

    DEFF Research Database (Denmark)

    Gang, A O; Arpi, M.; Gang, U.J.O.

    2010-01-01

    . The population included non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) patients. No patients received prophylactic antibacterial treatment. Results: Pathogens were isolated from 44% of all patients. MM patients more frequently had multiple pathogens in blood cultures (38% versus 25%). Transplantation...

  10. Comorbidity in US patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Edwards NC

    2018-02-01

    Full Text Available Natalie C Edwards,1 Michael Munsell,2 Joseph Menzin,2 Amy L Phillips3 1Health Services Consulting Corporation (NCE, Boxborough, MA, USA; 2Boston Health Economics, Inc., Waltham, MA, USA; 3EMD Serono, Inc., Rockland, MA, USA Objective: To assess the trends in the prevalence of comorbidities in US patients with multiple sclerosis (MS, and the association of demographic characteristics with the presence of comorbidities. Study design: A retrospective analysis was conducted from a sample of 5 million patients from the IMS Health Real World Data Adjudicated Claims – US database.Methods: Comorbidity in patients with MS was assessed by year (2006–2014, and logistic regression models evaluated the association of age, sex, and region with select comorbidities.Results: The most common comorbidities from 2006 to 2014 were hyperlipidemia and hypertension (25.9%–29.7% of patients within an individual year, followed by gastrointestinal disease (18.4%–21.2% of patients and thyroid disease (12.9%–17.1% of patients. The proportion with a claim for hyperlipidemia increased from 2006 to 2009, was stable from 2009 to 2011, and then declined from 2011 to 2014. The proportion with a claim for hypertension generally increased from 2006 to 2013, then declined from 2013 to 2014. The proportion with a claim for gastrointestinal disease, thyroid disease, and anxiety generally increased from 2006 to 2014. Claims for comorbidities were statistically significantly more likely among older age groups (p<0.05, with the exception of anxiety and alcohol abuse, which were statistically significantly less likely among older age groups. Claims for gastrointestinal disease (OR=0.75, thyroid disease (OR=0.36, chronic lung disease (OR=0.76, arthritis (OR=0.71, anxiety (OR=0.63, and depression (OR=0.69 were statistically significantly less likely among males versus females (all p<0.05. Claims for hyperlipidemia (OR=1.39, hypertension (OR=1.25, diabetes (OR=1.31, and alcohol

  11. Use of neuromuscular electrostimulation in the treatment of dysphagia in patients with multiple sclerosis

    NARCIS (Netherlands)

    Bogaardt, Hans; van Dam, Danielle; Wever, Nienke M.; Bruggeman, Caroline E.; Koops, Johan; Fokkens, Wytske J.

    2009-01-01

    OBJECTIVES: We explored the possible effects of neuromuscular electrostimulation on the swallowing function of patients with multiple sclerosis and swallowing problems. METHODS: Twenty-five patients (average age, 53.1 years; SD, 9.8 years) with multiple sclerosis and swallowing problems were treated

  12. Creating the ideal patient experience.

    Science.gov (United States)

    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.

  13. MR imaging of multiple sclerosis in patients with negative cerebrospinal fluid

    International Nuclear Information System (INIS)

    Dooms, G.C.; Mathurin, P.; Cornelis, G.; Laterre, E.C.; Demeure, R.

    1986-01-01

    A prospective study was performed to assess the value of MR imaging for detecting demyelinating disease of the brain in 50 patients with clinically suspected multiple sclerosis but negative cerebrospinal fluid (CSF). The MR imaging examinations were performed with a superconducting magnet (Philips Gyroscan S15) operating at 0.5T. A multisection, double spin-echo technique was used in all cases (TR = 2,100 msec, TE = 50 and 100 msec). No abnormality was demonstrated in eight patients. In the others, lesions were usually located in the periventricular white matter (rounded masses and/or high signal intensity bands along the lateral ventricles), the brain stem and thalami (12 patients), and the cerebellum (6 patients). In conclusion, MR imaging appears to be an exquisite imaging modality for confirmation of clinically suspected multiple sclerosis in patients with negative CSF. However, it must include examination of the spinal cord when the brain examination is negative

  14. Multiple Intelligences, Motivations and Learning Experience Regarding Video-Assisted Subjects in a Rural University

    Science.gov (United States)

    Hajhashemi, Karim; Caltabiano, Nerina; Anderson, Neil; Tabibzadeh, Seyed Asadollah

    2018-01-01

    This study investigates multiple intelligences in relation to online video experiences, age, gender, and mode of learning from a rural Australian university. The inter-relationships between learners' different intelligences and their motivations and learning experience with the supplementary online videos utilised in their subjects are…

  15. Parathyroid mitogenic activity in plasma from patients with familial multiple endocrine neoplasia type 1

    International Nuclear Information System (INIS)

    Brandi, M.L.; Aurbach, G.D.; Fitzpatrick, L.A.; Quarto, R.; Spiegel, A.M.; Bliziotes, M.M.; Norton, J.A.; Doppman, J.L.; Marx, S.J.

    1986-01-01

    Hyperplasia of the parathyroid glands is a central feature of familial multiple endocrine neoplasia type 1. We used cultured bovine parathyroid cells to test for mitogenic activity in plasma from patients with this disorder. Normal plasma stimulated [ 3 H]thymidine incorporation, on the average, to the same extent as it was stimulated in a plasma-free control culture. This contrasted with the results of the tests with plasma from patients with familial multiple endocrine neoplasia type 1, in which parathyroid mitogenic activity increased 2400 percent over the control value (P less than 0.001). Plasma from these patients also stimulated the proliferation of bovine parathyroid cells in culture, whereas plasma from normal subjects inhibited it. Parathyroid mitogenic activity in plasma from the patients with familial multiple endocrine neoplasia type 1 was greater than that in plasma from patients with various other disorders, including sporadic primary hyperparathyroidism (with adenoma, hyperplasia, or cancer of the parathyroid), sporadic primary hypergastrinemia, sporadic pituitary tumor, familial hypocalciuric hypercalcemia, and multiple endocrine neoplasia type 2 (P less than 0.05). Parathyroid mitogenic activity in the plasma of patients with familial multiple endocrine neoplasia type 1 persisted for up to four years after total parathyroidectomy. The plasma also had far more mitogenic activity in cultures of parathyroid cells than did optimal concentrations of known growth factors or of any parathyroid secretagogue. This mitogenic activity had an apparent molecular weight of 50,000 to 55,000. We conclude that primary hyperparathyroidism in familial multiple endocrine neoplasia type 1 may have a humoral cause

  16. Color blindness among multiple sclerosis patients in Isfahan.

    Science.gov (United States)

    Shaygannejad, Vahid; Golabchi, Khodayar; Dehghani, Alireza; Ashtari, Fereshteh; Haghighi, Sepehr; Mirzendehdel, Mahsa; Ghasemi, Majid

    2012-03-01

    Multiple sclerosis (MS) is a disease of young and middle aged individuals with a demyelinative axonal damage nature in central nervous system that causes various signs and symptoms. As color vision needs normal function of optic nerve and macula, it is proposed that MS can alter it via influencing optic nerve. In this survey, we evaluated color vision abnormalities and its relationship with history of optic neuritis and abnormal visual evoked potentials (VEPs) among MS patients. The case group was included of clinically definitive MS patients and the same number of normal population was enrolled as the control group. Color vision of all the participants was evaluated by Ishihara test and then visual evoked potential (VEPs) and history of optic neuritis (ON) was assessed among them. Then, frequency of color blindness was compared between the case and the control group. Finally, color blinded patients were compared to those with the history of ON and abnormal VEPs. 63 MS patients and the same number of normal populations were enrolled in this study. 12 patients had color blindness based on the Ishihara test; only 3 of them were among the control group, which showed a significant different between the two groups (P = 0.013). There was a significant relationship between the color blindness and abnormal VEP (R = 0.53, P = 0.023) but not for the color blindness and ON (P = 0.67). This study demonstrates a significant correlation between color blindness and multiple sclerosis including ones with abnormal prolonged VEP latencies. Therefore, in individuals with acquired color vision impairment, an evaluation for potentially serious underlying diseases like MS is essential.

  17. Color blindness among multiple sclerosis patients in Isfahan

    Directory of Open Access Journals (Sweden)

    Vahid Shaygannejad

    2012-01-01

    Full Text Available Background: Multiple sclerosis (MS is a disease of young and middle aged individuals with a demyelinative axonal damage nature in central nervous system that causes various signs and symptoms. As color vision needs normal function of optic nerve and macula, it is proposed that MS can alter it via influencing optic nerve. In this survey, we evaluated color vision abnormalities and its relationship with history of optic neuritis and abnormal visual evoked potentials (VEPs among MS patients. Materials and Methods: The case group was included of clinically definitive MS patients and the same number of normal population was enrolled as the control group. Color vision of all the participants was evaluated by Ishihara test and then visual evoked potential (VEPs and history of optic neuritis (ON was assessed among them. Then, frequency of color blindness was compared between the case and the control group. Finally, color blinded patients were compared to those with the history of ON and abnormal VEPs. Results: 63 MS patients and the same number of normal populations were enrolled in this study. 12 patients had color blindness based on the Ishihara test; only 3 of them were among the control group, which showed a significant different between the two groups (P = 0.013. There was a significant relationship between the color blindness and abnormal VEP (R = 0.53, P = 0.023 but not for the color blindness and ON (P = 0.67. Conclusions: This study demonstrates a significant correlation between color blindness and multiple sclerosis including ones with abnormal prolonged VEP latencies. Therefore, in individuals with acquired color vision impairment, an evaluation for potentially serious underlying diseases like MS is essential.

  18. Genetic and infectious profiles of Japanese multiple sclerosis patients.

    Directory of Open Access Journals (Sweden)

    Satoshi Yoshimura

    Full Text Available BACKGROUND: Nationwide surveys conducted in Japan over the past thirty years have revealed a four-fold increase in the estimated number of multiple sclerosis (MS patients, a decrease in the age at onset, and successive increases in patients with conventional MS, which shows an involvement of multiple sites in the central nervous system, including the cerebrum and cerebellum. We aimed to clarify whether genetic and infectious backgrounds correlate to distinct disease phenotypes of MS in Japanese patients. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed HLA-DRB1 and -DPB1 alleles, and IgG antibodies specific for Helicobacter pylori, Chlamydia pneumoniae, varicella zoster virus, and Epstein-Barr virus nuclear antigen (EBNA in 145 MS patients and 367 healthy controls (HCs. Frequencies of DRB1*0405 and DPB1*0301 were significantly higher, and DRB1*0901 and DPB1*0401 significantly lower, in MS patients as compared with HCs. MS patients with DRB1*0405 had a significantly earlier age of onset and lower Progression Index than patients without this allele. The proportion and absolute number of patients with DRB1*0405 successively increased with advancing year of birth. In MS patients without DRB1*0405, the frequency of the DRB1*1501 allele was significantly higher, while the DRB1*0901 allele was significantly lower, compared with HCs. Furthermore, DRB1*0405-negative MS patients were significantly more likely to be positive for EBNA antibodies compared with HCs. CONCLUSIONS: Our study suggests that MS patients harboring DRB1*0405, a genetic risk factor for MS in the Japanese population, have a younger age at onset and a relatively benign disease course, while DRB1*0405-negative MS patients have features similar to Western-type MS in terms of association with Epstein-Barr virus infection and DRB1*1501. The recent increase of MS in young Japanese people may be caused, in part, by an increase in DRB1*0405-positive MS patients.

  19. Correlation between fatigue and self-esteem in patients with multiple sclerosis

    OpenAIRE

    Fragoso,Yára Dadalti; Silva,Érika Oliveira da; Finkelsztejn,Alessandro

    2009-01-01

    OBJECTIVE: To assess the possible association of fatigue with self-esteem in multiple sclerosis (MS) patients. METHOD: Thirty patients were prospectively assessed. None of them presented moderate or severe depression or anxiety and their degree of disability was low (EDSS

  20. Seizure characteristics in multiple sclerosis patients

    Directory of Open Access Journals (Sweden)

    Vahid Shaygannejad

    2013-01-01

    Full Text Available Background: To evaluate seizure characteristic among multiple sclerosis patients with coexistent seizure activity compared to control group. Materials and Methods : This study is a cross-sectional study which was conducted by reviewing the clinical records of patients with definite diagnosis of MS according to McDonald′s criteria from March 2007 to June 2011, who referred to the MS clinic of the university. Results : A total of 920 patients with a diagnosis of MS were identified, among whom 29 patients (3.15% with seizure activity (case due to MS with the mean age of 32.6 ± 6.23 years were analyzed. Also, fifty MS patients without any seizure occurrence with the mean age of 33.7 ± 7.4 years were used as our control group. In case group, seizure was general tonic clonic in 23 patients (79.3%, complex partial in four (13.8%, and simple partial in two (5.9%. The 26 available interictal EEGs in MS patients showed abnormal EEG pattern in 22 (84.6% of them, including focal epileptic form discharge or focal slowing in 10 (38.5%, generalized discharge (spike-wave, polyspike, or general paroxysmal fast activity in 10 (38.5%, and general slowing activity in 10 record (38.5%. MRI reviews of the 26 available brain MRIs showed subcortical white mater lesions in 22 (84.6% of patients with seizure. All MRIs were performed within one month after the first seizure episode. Amongst 48 available MRIs in our control group, 91.7% (44 cases showed periventricular lesions and in 8.3% (4 cases subcortical white matter lesions were reported. Conclusion : The result of this study demonstrated the higher rate of subcortical whit matter lesion in MS patients with seizure occurrence compared to control group.

  1. Multiple victimization experiences of urban elementary school students: associations with psychosocial functioning and academic performance.

    Science.gov (United States)

    Holt, Melissa K; Finkelhor, David; Kantor, Glenda Kaufman

    2007-05-01

    This study explored the victimization experiences of urban elementary school students to determine whether subsets of youth emerged with similar victimization profiles (e.g., no victimization, multiple types of victimization). It also evaluated whether multiple victimization was associated with greater psychological distress and lower academic performance. Participants were 689 fifth grade students from an urban, ethnically diverse school district in the Northeast. Youth completed self-report measures in school about bullying victimization, victimization in the home and community, and psychosocial functioning. Cluster analysis suggested the existence of three distinct youth profiles: those with minimal victimization, those victimized primarily by their peers, and those with multiple types of victimizations. As hypothesized, youth with multiple victimizations experienced more psychological distress and earned lower grades than their peers. Findings highlight the heterogeneity of youth victimization experiences and their relations to functioning, and have implications for treatment planning among practitioners working with youth.

  2. Prognostic index to identify patients who may not benefit from whole brain radiotherapy for multiple brain metastases from lung cancer

    International Nuclear Information System (INIS)

    Sundaresan, P.; Yeghiaian, R.; Gebski, V.

    2010-01-01

    Full text: Palliative whole brain radiotherapy (WBRT) is often recommended in the management of multiple brain metastases. Allowing for WBRT waiting time, duration of the WBRT course and time to clinical response, it may take 6 weeks from the point of initial assessment for a benefit from WBRT to manifest. Patients who die within 6 weeks ('early death') may not benefit from WBRT and may instead experience a decline in quality of life. This study aimed to develop a prognostic index (PI) that identifies the subset of patients with lung cancer with multiple brain metastases who may not benefit from WBRT because of'early death'. The medical records of patients with lung cancer who had WBRT recommended for multiple brain metastases over a 10-year period were retrospectively reviewed. Patients were classified as either having died within 6 weeks or having lived beyond 6 weeks. Potential prognostic indicators were evaluated for correlation with 'early death'. A PI was constructed by modelling the survival classification to determine the contribution of these factors towards shortened survival. Of the 275 patients recommended WBRT, 64 (23.22%) died within 6 weeks. The main prognostic factor predicting early death was Eastern Cooperative Oncology Group (ECOG) status >2. Patients with a high PI score (>13) were at higher risk of'early death'. Twenty-three per cent of patients died prior to benefit from WBRT. ECOG status was the most predictive for 'early death'. Other factors may also contribute towards a poor outcome. With further refinement and validation, the PI could be a valuable clinical decision tool.

  3. Assessment of patients with multiple sclerosis according to tests of the Multiple Sclerosis Functional Composite

    Directory of Open Access Journals (Sweden)

    Anelise Ineu Figueiredo

    Full Text Available Abstract Introduction: The Multiple Sclerosis Functional Composite (MSFC is a scale that evaluates the functional and cognitive aspects of patients with multiple sclerosis (MS. Objective: To compare the performance of individuals with the relapsing-remitting form of MS (RRMS with a group of healthy subjects using the MSFC. Methods: Twenty subjects were investigated in this study, consisting of 10 patients with clinical diagnosis of RRMS and 10 controls with similar gender and age to the group with the disease. The three tests that comprise the MSFC were used for the evaluation of gait, upper limb motor function and cognition (memory and processing speed. Student's t-test was used to assess data with normal distribution and data with skewed distribution were evaluated using the Mann-Whitney test. Results: The results showed that the patients with RRMS took longer to perform the locomotion test (6.91 ± 2.35 compared to the control group (5.16 ± 1.28. The MS group (22.06 ± 5.44 also showed greater difficulty in performing a task with the dominant upper limb compared to the healthy subjects (17.79 ± 2.96. No statistically significant difference was found between the groups in the performance of cognitive tasks (p = .65. Conclusion: The use of the MSFC tests proved valuable for measuring possible motor and cognitive impairments in patients with RRMS. Thus, it is suggested that this scale is adopted in clinical practice, improving therapies for the treatment of MS patients and thereby providing them a better quality of life.

  4. Factors affecting bone mineral density in multiple sclerosis patients

    Science.gov (United States)

    Ayatollahi, Azin; Mohajeri-Tehrani, Mohammad Reza

    2013-01-01

    Background Multiple sclerosis (MS) is a demyelinating disease which can cause many disabilities for the patient. Recent data suggests that MS patients have higher risk for osteoporosis. This study was performed to investigate if the osteoporosis prevalence is higher in MS patients and to determine the possible factors affecting bone mineral density (BMD). Methods 51 definite relapsing-remitting MS patients according to McDonald's criteria (45 females, 6 males aged between 20 and 50 years) participated in this study. The control group included 407 females aged from 20 to 49 years; they were healthy and had no history of the diseases affecting bone metabolism. Femoral and lumbar BMD were measured by Dual Energy X-ray Absorptiometry (DXA). The disability of MS patients was evaluated by Expanded Disability Status Scale (EDSS). The patient's quality of life was evaluated by the validated Persian version of multiple sclerosis impact scale (MSIS-29). Results Patients’ mean age was 36 ± 3.3 years and their mean disease duration was 8.7 ± 1.7 years. The mean EDSS score and the mean body mass index (BMI) of the patients were 3 ± 0.9 and 23.5 ± 2.3 kg/m2, respectively. 29% of the patients had never been treated by ß-interferon and 6% of them had not received glucocorticoids (GCs) pulses since their MS had been diagnosed. 26% of the patients had a history of fracture.18% of our patients were osteoporotic and 43% of them were osteopenic. Femoral BMD was significantly lower among MS patients than age matched controls (P < 0.001), but lumbar BMD showed no difference. There was no correlation between administration of GCs pulses, interferon and BMD; however, we found a significant correlation between EDSS score, quality of life (QoL), disease duration and BMD of both site. Conclusion As a result of this study, bone loss inevitably occurs in MS patients. The major factor of BMD loss is immobility. Osteoporosis should be managed as part of MS patients’ treatment protocols

  5. Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy

    DEFF Research Database (Denmark)

    Coles, Alasdair J; Twyman, Cary L; Arnold, Douglas L

    2012-01-01

    The anti-CD52 monoclonal antibody alemtuzumab reduces disease activity in previously untreated patients with relapsing-remitting multiple sclerosis. We aimed to assess efficacy and safety of alemtuzumab compared with interferon beta 1a in patients who have relapsed despite first-line treatment....

  6. Patients' experiences of intensive care diaries

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Bagger, Christine

    2010-01-01

    The aim of the study was to explore patients' experiences and perceptions of receiving intensive care diaries. A focus group and intensive care diaries for four former ICU patients were analysed to understand what works and what needs further development for patients who receive a diary. The stud......-ICU patients to gradually construct or reconstruct their own illness narrative, which is pieced together by their fragmented memory, the diary, the pictures, the hospital chart and the accounts from family and friends.......The aim of the study was to explore patients' experiences and perceptions of receiving intensive care diaries. A focus group and intensive care diaries for four former ICU patients were analysed to understand what works and what needs further development for patients who receive a diary. The study...... that the diary alone provided incomplete information and reading the diary did not necessarily bring back memories, but helped complete their story. The patients needed to know what they had gone through in ICU and wished to share their story with their family. We conclude that diaries might help post...

  7. Cognitive status in patients with multiple sclerosis in Lanzarote

    Directory of Open Access Journals (Sweden)

    Pérez-Martín MY

    2016-06-01

    Full Text Available María Yaiza Pérez-Martín,1 Pablo Eguia-del Río,2 Montserrat González-Platas,1 Alejandro Jiménez-Sosa31Service of Neurology, Complejo Hospitalario Universitario de Canarias, La Laguna, 2Service of Neurology, Doctor José Molina Orosa Hospital, Arrecife, Lanzarote, 3Unit of Research, Complejo Hospitalario Universitario de Canarias, La Laguna, SpainObjectives: Cognitive impairment is a common feature in multiple sclerosis affecting ~43%–72% of patients, which involves cognitive functions such as memory, processing speed, attention, and executive function. The aim of this study was to describe the extent and pattern of the involvement of cognitive impairment and psychological status in all patients with multiple sclerosis on a small Spanish island.Patients and methods: In all, 70 patients and 56 healthy controls were included in the study between February 2013 and May 2013. All participants were assessed using the Brief Repeatable Battery of Neuropsychological Test. The patients also completed instruments to evaluate the presence of fatigue, perceived cognitive dysfunction, and symptoms of anxiety and depression. All procedures were performed in a single session.Results: Cognitive impairment, defined as a score <1.5 standard deviation on two subtests of the battery, was present in 35% of the participants. The most frequently affected domain was working memory, followed by verbal memory and processing speed. Disease duration showed a moderate correlation with visuospatial memory and processing speed. The Expanded Disability Status Scale score correlated with verbal and processing speed. Verbal memory was correlated with depression symptoms and fatigue.Conclusion: Cognitive impairment was present in 35% of the study population. The most affected domains were working memory and verbal memory. Working memory and verbal fluency deficit are independent factors of disease evolution. Cognitive decline is related to clinical variables and

  8. Prevalence and clinical outcomes of patients with multiple potential causes of syncope

    NARCIS (Netherlands)

    Chen, Lin Y.; Gersh, Bernard J.; Hodge, David O.; Wieling, Wouter; Hammill, Stephen C.; Shen, Win-Kuang

    2003-01-01

    Objective: To determine the prevalence, predictors, and prognosis of patients with multiple potential causes of syncope. Patients and Methods: This is a retrospective cohort study with prospective follow-up of consecutive patients with syncope of uncertain cause who were referred to the

  9. Vicarious experience affects patients' treatment preferences for depression.

    Directory of Open Access Journals (Sweden)

    Seth A Berkowitz

    Full Text Available Depression is common in primary care but often under-treated. Personal experiences with depression can affect adherence to therapy, but the effect of vicarious experience is unstudied. We sought to evaluate the association between a patient's vicarious experiences with depression (those of friends or family and treatment preferences for depressive symptoms.We sampled 1054 English and/or Spanish speaking adult subjects from July through December 2008, randomly selected from the 2008 California Behavioral Risk Factor Survey System, regarding depressive symptoms and treatment preferences. We then constructed a unidimensional scale using item analysis that reflects attitudes about antidepressant pharmacotherapy. This became the dependent variable in linear regression analyses to examine the association between vicarious experiences and treatment preferences for depressive symptoms.Our sample was 68% female, 91% white, and 13% Hispanic. Age ranged from 18-94 years. Mean PHQ-9 score was 4.3; 14.5% of respondents had a PHQ-9 score >9.0, consistent with active depressive symptoms. Analyses controlling for current depression symptoms and socio-demographic factors found that in patients both with (coefficient 1.08, p = 0.03 and without (coefficient 0.77, p = 0.03 a personal history of depression, having a vicarious experience (family and friend, respectively with depression is associated with a more favorable attitude towards antidepressant medications.Patients with vicarious experiences of depression express more acceptance of pharmacotherapy. Conversely, patients lacking vicarious experiences of depression have more negative attitudes towards antidepressants. When discussing treatment with patients, clinicians should inquire about vicarious experiences of depression. This information may identify patients at greater risk for non-adherence and lead to more tailored patient-specific education about treatment.

  10. Second-site prosthetic joint infection in patients with multiple prosthetic joints.

    Science.gov (United States)

    Clesham, Kevin; Hughes, Andrew J; O' hEireamhoin, Sven; Fleming, Catherine; Murphy, Colin G

    2018-04-10

    Prosthetic joint infections (PJIs) are among the most serious complications in arthroplasty. A second-site PJI in patients with multiple prosthetic joints increases morbidity, with many requiring further revision procedures. We aimed to establish why some patients with multiple joints develop second-site infections. Our institution's arthroplasty database was reviewed from 2004 to 2017. All PJIs were identified, and all patients with more than one prosthetic joint in situ were included. We recorded risk factors, causative organisms, number of procedures and length of stay. Forty-four patients meeting the criteria were identified. Four patients (9.1%) developed second-site infection. Eight patients (18.2%) developed re-infection of the primary PJI. Positive MRSA carrier status and PJI of a total knee replacement were associated with an increased risk of a second episode of infection. Patients who developed further infection had more frequent admission and longer lengths of stay than isolated PJIs. Higher morbidity and use of hospital resources are associated with this cohort of patients. PJIs in total knee replacements and positive MRSA status are associated with higher rates of second infection. Identifying this vulnerable cohort of patients at an early stage is critical to ensure measures are taken to reduce the risks of further infection.

  11. Risk of Multiple Sclerosis in Patients with Psoriasis

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Mallbris, Lotus; Gislason, Gunnar Hilmar

    2016-01-01

    Psoriasis and multiple sclerosis (MS) are inflammatory disorders with similarities in genetic risk variants and inflammatory pathways. Limited evidence is available on the relationship between the two diseases. We therefore investigated the risk of incident (new-onset) MS in patients with mild...

  12. Investigating patients' experiences: methodological usefulness of interpretive interactionism.

    Science.gov (United States)

    Tower, Marion; Rowe, Jennifer; Wallis, Marianne

    2012-01-01

    To demonstrate the methodological usefulness of interpretive interactionism by applying it to the example of a study investigating healthcare experiences of women affected by domestic violence. Understanding patients' experiences of health, illness and health care is important to nurses. For many years, biomedical discourse has prevailed in healthcare language and research, and has influenced healthcare responses. Contemporary nursing scholarship can be developed by engaging with new ways of understanding therapeutic interactions with patients. Research that uses qualitative methods of inquiry is an important paradigm for nurses who seek to explain and understand or describe experiences rather than predict outcomes. Interpretive interactionism is an interpretive form of inquiry for conducting studies of social or personal problems that have healthcare policy implications. It puts the patient at the centre of the research process and makes visible the experiences of patients as they interact with the healthcare and social systems that surround them. Interpretive interactionism draws on concepts of symbolic interactionism, phenomenology and hermeneutics. Interpretive interactionism is a patient-centred methodology that provides an alternative way of understanding patients' experiences. It can contribute to policy and practice development by drawing on the perspectives and experiences of patients, who are central to the research process. It also allows research findings to be situated in and linked to healthcare policy, professional ethics and organisational approaches to care. Interpretive interactionism has methodological utility because it can contribute to policy and practice development by drawing on the perspectives and experiences of patients who are central to the research process. Interpretive interactionism allows research findings to be situated in and linked to health policy, professional ethics and organisational approaches to caring.

  13. How Patients Experience Antral Irrigation

    Directory of Open Access Journals (Sweden)

    Karin Blomgren

    2015-01-01

    Full Text Available Background Antral irrigation earlier had an important role in the diagnosis and treatment of rhinosinusitis. Nowadays, it is often considered too unpleasant. However, the experience of patients of this procedure has been very seldom evaluated. Nor has the effect on pain in rhinosinusitis been evaluated. The aim of this study was to evaluate patients’ experience of discomfort and pain during antral irrigation. We also assessed facial pain caused by rhinosinusitis before the procedure and pain soon after the procedure. Methods Doctors and 121 patients completed their questionnaires independently after antral irrigation in a university clinic, in a private hospital, and at a communal health center. Results Patients experienced mild pain during antral irrigation (mean and median visual analog scale score: <3. Their experience of pain during antral irrigation was closely comparable to pain during dental calculus scaling. Facial pain assessed before antral irrigation decreased quickly after the procedure. Conclusions Antral irrigation was well tolerated as an outpatient procedure. The procedure seems to relieve facial pain caused by the disease quickly. The role of antral irrigation in the treatment of acute rhinosinusitis will need further investigation.

  14. Search for specific biomarkers of IFNβ bioactivity in patients with multiple sclerosis.

    Directory of Open Access Journals (Sweden)

    Sunny Malhotra

    Full Text Available Myxovirus A (MxA, a protein encoded by the MX1 gene with antiviral activity, has proven to be a sensitive measure of IFNβ bioactivity in multiple sclerosis (MS. However, the use of MxA as a biomarker of IFNβ bioactivity has been criticized for the lack of evidence of its role on disease pathogenesis and the clinical response to IFNβ. Here, we aimed to identify specific biomarkers of IFNβ bioactivity in order to compare their gene expression induction by type I IFNs with the MxA, and to investigate their potential role in MS pathogenesis. Gene expression microarrays were performed in PBMC from MS patients who developed neutralizing antibodies (NAB to IFNβ at 12 and/or 24 months of treatment and patients who remained NAB negative. Nine genes followed patterns in gene expression over time similar to the MX1, which was considered the gold standard gene, and were selected for further experiments: IFI6, IFI27, IFI44L, IFIT1, HERC5, LY6E, RSAD2, SIGLEC1, and USP18. In vitro experiments in PBMC from healthy controls revealed specific induction of selected biomarkers by IFNβ but not IFNγ, and several markers, in particular USP18 and HERC5, were shown to be significantly induced at lower IFNβ concentrations and more selective than the MX1 as biomarkers of IFNβ bioactivity. In addition, USP18 expression was deficient in MS patients compared with healthy controls (p = 0.0004. We propose specific biomarkers that may be considered in addition to the MxA to evaluate IFNβ bioactivity, and to further explore their implication in MS pathogenesis.

  15. Patient experience and hospital profitability: Is there a link?

    Science.gov (United States)

    Richter, Jason P; Muhlestein, David B

    Patient experience has had a direct financial impact on hospitals since value-based purchasing was instituted by the Centers for Medicare & Medicaid Services in 2013 as a method to reward or punish hospitals based on performance on various measures, including patient experience. Although other industries have shown an indirect impact of customer experience on overall profitability, that link has not been well established in the health care industry. Return-to-provider rate and perceptions of health quality have been associated with profitability in the health care industry. Our aims were to assess whether, independent of a direct financial impact, a more positive patient experience is associated with increased profitability and whether a more negative patient experience is associated with decreased profitability. We used a sample of 19,792 observations from 3767 hospitals over the 6-year period 2007-2012. The data were sourced from Centers for Medicare & Medicaid Services and Hospital Consumer Assessment of Healthcare Providers and Systems. Using generalized estimating equations to account for repeated measures, we fit four separate models for three dependent variables: net patient revenue, net income, and operating margin. Each model included one of the following independent variables of interest: percentage of patients who definitely recommend the hospital, percentage of patients who definitely would not recommend the hospital, percentage of patients who rated the hospital 9 or 10, and percentage of patients who rated the hospital 6 or lower. We identified that a positive patient experience is associated with increased profitability and a negative patient experience is even more strongly associated with decreased profitability. Management should have greater justification for incurring costs associated with bolstering patient experience programs. Improvements in training, technology, and staffing can be justified as a way to improve not only quality but now

  16. Risk of vertebral compression fractures in multiple myeloma patients

    OpenAIRE

    Anitha, D.; Thomas, Baum; Jan, Kirschke S.; Subburaj, Karupppasamy

    2017-01-01

    Abstract The purpose of this study was to develop and validate a finite element (FE) model to predict vertebral bone strength in vitro using multidetector computed tomography (MDCT) images in multiple myeloma (MM) patients, to serve as a complementing tool to assess fracture risk. In addition, it also aims to differentiate MM patients with and without vertebral compression fractures (VCFs) by performing FE analysis on vertebra segments (T1?L5) obtained from in vivo routine MDCT imaging scans....

  17. Survival of patients with multiple sclerosis in Denmark

    DEFF Research Database (Denmark)

    Brønnum-Hansen, Henrik; Koch-Henriksen, Nils; Hyllested, K

    1994-01-01

    We estimated survival probability and excess death rates for patients with MS on the basis of data from the Danish Multiple Sclerosis Registry, which includes virtually all patients diagnosed with MS in Denmark (population, five million) since 1948. We reviewed and reclassified all case records...... in women (versus 46 years). The median survival time from diagnosis was 22 years in men (versus 37 years) and 28 years in women (versus 42 years). The excess death rate between onset and follow-up (observed deaths per 1,000 person-years minus the expected number of deaths in a matched general population...

  18. Anaesthetic management of a patient with multiple system atrophy ...

    African Journals Online (AJOL)

    Multiple system atrophy (MSA) is a rare adult-onset neurodegenerative disease. Symptoms vary from autonomic dysfunction to Parkinsonism and cerebellar ataxia, in any combination. MSA affects many organ systems with many possible complications and makes perioperative management of a patient with this condition ...

  19. Measuring the frailty index of multiple myeloma cancer patients

    DEFF Research Database (Denmark)

    Corradini, Andrea; Bøgelund Hansen, Martin; Savic, Toma

    2016-01-01

    We report on a responsive web-based application that we have been developing for the cancer hospital in Vejle, Denmark. The application administers and handles systematic frailty scoring of patients with multiple myeloma and helps doctors make a more efficient and effective treatment choice. The ...

  20. Low leucocyte myeloperoxidase activity in patients with multiple sclerosis

    NARCIS (Netherlands)

    Ramsaransing, G; Teelken, A; Prokopenko, VM; Arutjunyan, AV; De Keyser, J

    The gene for myeloperoxidase (MPO) has been implicated in multiple sclerosis (MS). By measuring H2O2 dependent oxidation of 3,3'5,5'-tetramethylbenzidine with spectrophotometry the authors investigated MPO activity in peripheral blood leucocytes from 42 patients with MS (12 with secondary

  1. Evaluation of prevalence of headache in Multiple Sclerosis patients before & after the disease

    Directory of Open Access Journals (Sweden)

    H. Mozhdehipanah

    2017-08-01

    Full Text Available Background: Multiple Sclerosis disease is a chronic disease of nervous system which causes different symptoms. Although headache is not a major symptom of this disease, but a lot of patients suffer from it. To specify the prevalence of headache and its’ types has an important role in diagnose, treatment and improvement the quality of patients’ life. Objective: Our goal of this study was to determine the prevalence of headache in multiple sclerosis patients, before and after the diagnosis of this disease. Methods: This cross-sectional descriptive epidemiologic study was performed on 150 multiple sclerosis patients referred to the neurology clinic of Qazvin in 2015. Data were recorded by history taking & physical examination the existence of headache before the MS diagnosis and at the time of study was evaluated by the patients’ data. Findings: Among participants, prevalence of headache before the MS diagnosis was 40%, which increased to 64% after that (P<0.001. The most common type of headache, before and after the affection was tension headache, which formed 58.3% and 70.8% of all headaches, respectively. The average rate of headache in the group with headache, before and after the diagnosis of MS was 5.8 and 5.76 days in month, which calculated 2.32 and 3.68 days in month in all patients, respectively. Conclusion: Prevalence of headache increases in multiple sclerosis patients. Patients suffer from headache almost 13% of their life days.

  2. Application and analysis of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumor: initial experience.

    Science.gov (United States)

    Zhu, Jundong; Jiang, Fan; Li, Pu; Shao, Pengfei; Liang, Chao; Xu, Aiming; Miao, Chenkui; Qin, Chao; Wang, Zengjun; Yin, Changjun

    2017-09-11

    To explore the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for the patients with multiple renal tumor of who have solitary kidney or contralateral kidney insufficiency. Nine patients who have undergone retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping between October 2010 and January 2017 were retrospectively analyzed. Clinical materials and parameters during and after the operation were summarized. Nineteen tumors were resected in nine patients and the operations were all successful. The operation time ranged from 100 to 180 min (125 min); clamping time of segmental renal artery was 10 ~ 30 min (23 min); the amount of blood loss during the operation was 120 ~ 330 ml (190 ml); hospital stay after the operation is 3 ~ 6d (5d). There was no complication during the perioperative period, and the pathology diagnosis after the surgery showed that there were 13 renal clear cell carcinomas, two papillary carcinoma and four perivascular epithelioid cell tumors with negative margins from the 19 tumors. All patients were followed up for 3 ~ 60 months, and no local recurrence or metastasis was detected. At 3-month post-operation follow-up, the mean serum creatinine was 148.6 ± 28.1 μmol/L (p = 0.107), an increase of 3.0 μmol/L from preoperative baseline. For the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency, retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping was feasible and safe, which minimized the warm ischemia injury to the kidney and preserved the renal function effectively.

  3. Patients' Experiences with and Attitudes towards a Diabetes Patient Web Portal

    NARCIS (Netherlands)

    Ronda, Maaike C. M.; Dijkhorst-Oei, Lioe-Ting; Rutten, Guy E. H. M.

    2015-01-01

    Objective A diabetes patient web portal allows patients to access their personal health record and may improve diabetes outcomes; however, patients' adoption is slow. We aimed to get insight into patients' experiences with a web portal to understand how the portal is being used, how patients

  4. Measuring Patient Experiences: Is It Meaningful and Actionable?

    Science.gov (United States)

    Wong, Sabrina T; Johnston, Sharon; Burge, Fred; McGrail, Kim; Hogg, William

    2017-10-01

    Performance measurement must be meaningful to those being asked to contribute data and to the clinicians who are collecting the information. It must be actionable if performance measurement and reporting is to influence health system transformation. To date, measuring patient experiences in all parts of the healthcare system in Canada lags behind other countries. More attention needs to be paid to capturing patients with complex intersecting health and social problems that result from inequitable distribution of wealth and/or underlying structural inequities related to systemic issues such as racism and discrimination, colonialism and patriarchy. Efforts to better capture the experiences of patients who do not regularly access care and who speak English or French as a second language are also needed. Before investing heavily into collecting patient experience data as part of a performance measurement system the following ought to be considered: (1) ensuring value for and buy-in from clinicians who are being asked to collect the data and/or act on the results; (2) investment in the infrastructure to administer iterative, cost-effective patient/family experience data collection, analysis and reporting (e.g., automated software tools) and (3) incorporating practice support (e.g., facilitation) and health system opportunities to integrate the findings from patient experience surveys into policy and practice. Investment into the infrastructure of measuring, reporting and engaging clinicians in improving practice is needed for patient/caregiver experiences to be acted upon. © 2017 Longwoods Publishing.

  5. Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions.

    Science.gov (United States)

    Brenk-Franz, Katja; Strauß, Bernhard; Tiesler, Fabian; Fleischhauer, Christian; Schneider, Nico; Gensichen, Jochen

    2017-06-01

    The conceptual model of attachment theory has been applied to understand the predispositions of patients in medical care and the patient-provider relationship. In patients with chronic conditions insecure attachment was connected to poorer self-management. The patient-provider relationship is associated with a range of health related outcomes and self-management skills. We determined whether the quality of the patient-provider relationship mediates the link between adult attachment and self-management among primary care patients with multiple chronic diseases. 209 patients with a minimum of three chronic diseases (including type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 from eight general practices were included in the APRICARE cohort study. Adult attachment was measured via self-report (ECR-RD), self-management skills by the FERUS and the patient-provider relationship by the PRA-D. The health status and chronicity were assessed by the GP. Multiple mediation analyses were used to examine whether aspects of the patient-provider relationship (communication, information, affectivity) are a mediators of associations between adult attachment and self-management. The analysis revealed that the quality of the patient-provider relationship mediated the effect of attachment on self-management in patients with multiple chronic conditions. Particularly the quality of communication and information over the course of treatment has a significant mediating influence. A personalized, attachment-related approach that promotes active patient-provider communication and gives information about the treatment to the patient may improve self-management skills in patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Dorsal Column Degeneration after Bortezomib Therapy in a Patient with Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Tatsuro Joh

    2009-10-01

    Full Text Available We present here a case of dorsal column degeneration in a female patient with multiple myeloma following exposure to bortezomib. Two days after intravenous administration of a first course of bortezomib 1 mg/m2, the patient developed rapidly-progressive numbness, pain and muscle weakness in the bilateral upper and lower limbs. Following gancyclovir treatment of subsequent cytomegalovirus viremia, the patient went on to receive a course of EPOCH (etoposide 50 mg/m2/day on days 1–4, vincristine 0.4 mg/m2/day on days 1–4, doxorubicin 10 mg/m2/day on days 1–4, cyclophosphamide 750 mg/m2/day on day 6, and prednisolone 60 mg/m2/day on days 1–6. Shortly thereafter, the patient developed bilateral Aspergillus pneumonia. Despite treatment with appropriate antifungal agents, the patient died from respiratory failure due to bilateral diffuse alveolar damage of the lungs and without recovery of severe sensory and motor neuropathy prior to her death. Post mortem examination revealed spongy degeneration of the dorsal column from the medulla oblongata to the cervical spinal cord. Bortezomib-associated peripheral neuropathy in patients with multiple myeloma has been commonly reported but appears to resolve in a majority of these patients after dose reduction or discontinuation. We believe this to be the first report of spinal cord abnormalities in a patient with multiple myeloma treated with bortezomib. Further investigation is required to ascertain the exact mechanism of this central neurotoxic effect and to identify appropriate neuroprotective strategies.

  7. Patients' experiences and care needs during the diagnostic phase of an Integrated Brain Cancer Pathway

    DEFF Research Database (Denmark)

    Vedelø, Tina Wang; Sørensen, Jens Christian Hedemann; Delmar, Charlotte

    2018-01-01

    of brain cancer, not knowing what to expect and participants' perceptions of the relationship with the health care providers. The analysis revealed that participants were in risk of having unmet information needs and that contextual factors seemed to cause fragmented care that led to feelings...... that the shock of the diagnosis, combined with the multiple symptoms, affect patients' ability to understand information and express needs of care and support. Unmet needs have been reported within this group of patients, however, the experiences and care needs of patients going through the diagnostic phase...... of a standardised Integrated Brain Cancer Pathway have not previously been explored. DESIGN: A Case Study design was used to provide detailed information of the complex needs of patients being diagnosed with a malignant brain tumour. METHODS: Research interviews and direct participant observation of four patients...

  8. Streptococcus anginosus endocarditis and multiple liver abscesses in a splenectomised patient.

    Science.gov (United States)

    Finn, Talya; Schattner, Ami; Dubin, Ina; Cohen, Regev

    2018-04-27

    An unusual case of infective endocarditis and concurrent multiple liver abscesses both caused by Streptococcus anginosus in a splenectomised patient is reported. The microorganism is a very rare cause of endocarditis and its presentation with multiple liver abscesses is highly unusual. It was initially misdiagnosed as Streptococcus sanguinis and issues relating to the different clinical presentations of S. anginosus including the rare cases of endocarditis, the role of the patient's splenectomy and problems that may contribute to its potential laboratory misidentifications are discussed. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Relationship between contrast sensitivity test and disease severity in multiple sclerosis patients.

    Science.gov (United States)

    Soler García, A; González Gómez, A; Figueroa-Ortiz, L C; García-Ben, A; García-Campos, J

    2014-09-01

    To assess the importance of the Pelli-Robson contrast sensitivity test in multiple sclerosis patients according to the Expanded Disability Status Scale (EDSS). A total of 62 patients with multiple sclerosis were included in a retrospective study. Patients were enrolled from the Neurology Department to Neuroophthalmology at Virgen de la Victoria Hospital. Patients were classified into 3 groups according to EDSS: group A) lower than 1.5, group B) between 1.5 and 3.5 and group C) greater than 3.5. Visual acuity and monocular and binocular contrast sensitivity were performed with Snellen and Pelli-Robson tests respectively. Twelve disease-free control participants were also recruited. Correlations between parameter changes were analyzed. The mean duration of the disease was 81.54±35.32 months. Monocular and binocular Pelli-Robson mean values in the control group were 1.82±0.10 and 1.93±0.43 respectively, and 1.61±0.29 and 1.83±0.19 in multiple sclerosis patients. There were statistically significant differences in the monocular analysis for a level of significance P<.05. Mean monocular and binocular Pelli-Robson values in relation to gravity level were, in group A: 1.66±0.24 and 1.90±0.98, group B: 1.64±0.21 and 1.82±0.16, and group C: 1.47±0.45 and 1.73±0.32 respectively. Group differences were statistically significant in both tests: P=.05 and P=.027. Monocular and binocular contrast discrimination analyzed using the Pelli-Robson test was found to be significantly lower when the severity level, according EDSS, increases in multiple sclerosis patients. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  10. Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores

    International Nuclear Information System (INIS)

    Gupta, Nakul; Patel, Anish; Ensor, Joe; Ahrar, Kamran; Ahrar, Judy; Tam, Alda; Odisio, Bruno; Huang, Stephen; Murthy, Ravi; Mahvash, Armeen; Avritscher, Rony; McRae, Stephen; Sabir, Sharjeel; Wallace, Michael; Matin, Surena; Gupta, Sanjay

    2017-01-01

    PurposeTo describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.Materials and MethodsThe medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.ResultsTwenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.ConclusionA majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.

  11. Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, Nakul [Houston Methodist Hospital (United States); Patel, Anish [The University of Texas Southwestern Medical Center (United States); Ensor, Joe [Houston Methodist Research Institute, The Houston Methodist Cancer Center (United States); Ahrar, Kamran; Ahrar, Judy; Tam, Alda; Odisio, Bruno; Huang, Stephen; Murthy, Ravi; Mahvash, Armeen; Avritscher, Rony; McRae, Stephen; Sabir, Sharjeel; Wallace, Michael [The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology (United States); Matin, Surena [The University of Texas MD Anderson Cancer Center, Department of Urology (United States); Gupta, Sanjay, E-mail: sgupta@mdanderson.org [The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology (United States)

    2017-02-15

    PurposeTo describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.Materials and MethodsThe medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.ResultsTwenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.ConclusionA majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.

  12. Health-related quality of life in Iranian patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Pakpour, Amir H.; Yekaninejad, Mir Saeed; Mohammadi, Nastaran Keshavarz

    2009-01-01

    Background and purpose: This study aimed to evaluate aspects of health-related quality of life (HRQoL) of patients with multiple sclerosis (MS) who live in Tehran and to compare data with evaluations of both the general population and MS patients in other countries Material and methods: One hundr...

  13. Health-related quality of life in Iranian patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Pakpour, Amir H.; Yekaninejad, Mir Saeed; Mohammadi, Nastaran Keshavarz

    2010-01-01

    BACKGROUND AND PURPOSE: This study aimed to evaluate aspects of health-related quality of life (HRQoL) of patients with multiple sclerosis (MS) who live in Tehran and to compare data with evaluations of both the general population and MS patients in other countries. MATERIAL AND METHODS: One hund...

  14. Cognitive-Behavioral Classifications of Chronic Pain in Patients with Multiple Sclerosis

    Science.gov (United States)

    Khan, Fary; Pallant, Julie F.; Amatya, Bhasker; Young, Kevin; Gibson, Steven

    2011-01-01

    The aim of this study was to replicate, in patients with multiple sclerosis (MS), the three-cluster cognitive-behavioral classification proposed by Turk and Rudy. Sixty-two patients attending a tertiary MS rehabilitation center completed the Pain Impact Rating questionnaire measuring activity interference, pain intensity, social support, and…

  15. Multiple Pregnancies in CKD Patients: An Explosive Mix

    Science.gov (United States)

    Arduino, Silvana; Attini, Rossella; Parisi, Silvia; Fassio, Federica; Biolcati, Marlisa; Pagano, Arianna; Bossotti, Carlotta; Vasario, Elena; Borgarello, Valentina; Daidola, Germana; Ferraresi, Martina; Gaglioti, Pietro; Todros, Tullia

    2013-01-01

    Summary Background and objectives CKD and multiple pregnancies bear important risks for pregnancy outcomes. The aim of the study was to define the risk for adverse pregnancy-related outcomes in multiple pregnancies in CKD patients in comparison with a control group of “low-risk” multiple pregnancies. Design, setting, participants, & measurements The study was performed in the Maternal Hospital of the University of Turin, Italy. Of 314 pregnancies referred in CKD (2000–2011), 20 were multiple (15 twin deliveries). Control groups consisted of 379 low-risk multiple pregnancies (314 twin deliveries) and 19 (15 twin deliveries) cases with hypertension-collagen diseases. Baseline data and outcomes were compared by univariate and logistic regression analyses. Results The prevalence of multiple pregnancies was relatively high in the CKD population (6.4%); all referred cases were in early CKD stages (I-II); both creatinine (0.68 to 0.79 mg/dl; P=0.010) and proteinuria (0.81 to 3.42 g/d; P=0.041) significantly increased from referral to delivery. No significant difference in demographic data at baseline was found between cases and low-risk controls. CKD was associated with higher risk of adverse pregnancy outcomes versus low-risk twin pregnancies. Statistical significance was reached for preterm delivery (<34 weeks: 60% vs 26.4%; P=0.005; <32 weeks: 53.3% vs 12.7%; P<0.001), small for gestational age babies (28.6% vs 8.1%; P<0.001), need for Neonatal Intensive Care Unit (60% vs 12.7%; P<0.001), weight discordance between twins (40% vs 17.8%; P=0.032), and neonatal and perinatal mortality (6.6% vs 0.8%; P=0.032). Conclusion This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages. PMID:23124785

  16. Creating the ideal patient experience

    Science.gov (United States)

    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

  17. Perioperative management of patient with alkaptonuria and associated multiple comorbidities

    Directory of Open Access Journals (Sweden)

    Ravindra Pandey

    2011-01-01

    Full Text Available Alkaptonuria is a rare inherited genetic disorder of tyrosine metabolism characterized by a triad of homogentisic aciduria, ochronosis, and arthritis. The most common clinical manifestations of ochronosis involve the musculoskeletal, respiratory, airway, cardiovascular, genitourinary, cutaneous, and ocular systems. We report the perioperative anesthetic management of a 56-year-old alkaptonuric patient, with multiple comorbidities scheduled, for revision total hip replacement. A review of her medical history revealed alkaptonuria, hypothyroidism, rheumatoid arthritis, hypertension, diabetes mellitus, and Pott′s spine with disc prolapse. We want to highlight the need of thorough preoperative evaluation in patients of alkaptonuria, as it is associated with multiple comorbidities. The systemic involvement should determine the anesthetic plan. Caution should be exercised during positioning to prevent injury to the joints and the spine.

  18. Quality of life assessment in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Kisić-Tepavčević Darija

    2009-01-01

    Full Text Available Background/Aim. Multiple sclerosis (MS is a chronic inflammatory disease of central nervous system. The main physiopatological feature of MS is demyelination. Multiple sclerosis is one of three most common causes of severe disability in youngest people. In patients with MS, apart from complete psychophysical status and objective neurologic status, a subjective perception of symptoms and signs, known as quality of life, must be considered, too. The aim of this study was to estimate a health related quality of life (HRQoL in patients with multiple sclerosis (MS and to investigate the correlations between scores of HRQoL and selected demographic and clinical parameters. Methods. A cross-sectional study was performed in patients meeting following inclusion criteria: MS diagnosis (McDonald's criteria, age 18-60 years, the Expanded Disability Status Scale (EDSS < 8, and written informed consent. Exclusion criteria were exacerbation of MS in the last month, any preexisting major chronic illness and/or psychiatric disorders and antidepressive and/or corticosteroid therapy in the last month. The quality of life was measured by a disease specific instrument, MSQoL-54 (The Multiple Sclerosis Quality of Life. The neurological impairment was assessed using the Expended Disability Status Scale (EDSS and Mini Mental Scale (MMS. The presence and severity of depression was estimated by the Hamilton Depression Rating Scale (HDRS. The presence and severity of fatigue was assessed by the Fatigue Severity Scale (FSS. Statistical analysis included descriptive statistics and correlation analysis. Results. The higher HRQoL score was registered for mental health (56.3 ± 19.5 than for physical one(51.3 ± 17.9, which means that physical disability had more important influence on quality of life deterioration comparing to mental health. The highest values of HRQoL were observed in domains of Cognitive Functioning (77.4 ± 22.5 and Pain (75.7 ± 25.5. The lowest scores of

  19. MRI findings in patients with multiple lacunar infarcts manifesting hyperactive-type delirium

    International Nuclear Information System (INIS)

    Arahata, Yutaka; Motegi, Yoshimasa; Furuse, Masahiro; Watanabe, Masaki; Takahashi, Akira.

    1994-01-01

    MRI studies were carried out on 69 patients with multiple lacunar infarcts: 32 had hyperactive-type delirium and the other 37 were non-delirious controls. Between the two groups, there were no statistically significant differences in mean age and sex distribution. In the corona radiata and basal ganglia, the number of infarcts did not differ between the two groups. However, the extent of thalamic infarcts and periventricular hyperintensity (PVH), the maximal width of the third ventricle and Evans' ratio among the delirious patients were significantly larger than those in the controls. In conclusion, thalamic lesions and diffuse advanced PVH may have an intimate correlation in the development of hyperactive-type delirium in patients with multiple lacunar infarcts. (author)

  20. MRI findings in patients with multiple lacunar infarcts manifesting hyperactive-type delirium

    Energy Technology Data Exchange (ETDEWEB)

    Arahata, Yutaka; Motegi, Yoshimasa; Furuse, Masahiro (Nakatsugawa Municipal General Hospital, Gifu (Japan)); Watanabe, Masaki; Takahashi, Akira

    1994-04-01

    MRI studies were carried out on 69 patients with multiple lacunar infarcts: 32 had hyperactive-type delirium and the other 37 were non-delirious controls. Between the two groups, there were no statistically significant differences in mean age and sex distribution. In the corona radiata and basal ganglia, the number of infarcts did not differ between the two groups. However, the extent of thalamic infarcts and periventricular hyperintensity (PVH), the maximal width of the third ventricle and Evans' ratio among the delirious patients were significantly larger than those in the controls. In conclusion, thalamic lesions and diffuse advanced PVH may have an intimate correlation in the development of hyperactive-type delirium in patients with multiple lacunar infarcts. (author).

  1. Time while waiting: patients' experiences of scheduled surgery.

    Science.gov (United States)

    Carr, Tracey; Teucher, Ulrich C; Casson, Alan G

    2014-12-01

    Research on patients' experiences of wait time for scheduled surgery has centered predominantly on the relative tolerability of perceived wait time and impacts on quality of life. We explored patients' experiences of time while waiting for three types of surgery with varied wait times--hip or knee replacement, shoulder surgery, and cardiac surgery. Thirty-two patients were recruited by their surgeons. We asked participants about their perceptions of time while waiting in two separate interviews. Using interpretative phenomenological analysis (IPA), we discovered connections between participant suffering, meaningfulness of time, and agency over the waiting period and the lived duration of time experience. Our findings reveal that chronological duration is not necessarily the most relevant consideration in determining the quality of waiting experience. Those findings helped us create a conceptual framework for lived wait time. We suggest that clinicians and policy makers consider the complexity of wait time experience to enhance preoperative patient care. © The Author(s) 2014.

  2. Radiography and bone scintigraphy in bone marrow transplant multiple myeloma patients

    International Nuclear Information System (INIS)

    Aagren, B.; Aspelin, P.

    1997-01-01

    Purpose: To compare conventional radiography and bone scintigraphy in relation to clinical outcome in bone marrow transplant multiple myeloma patients. Material and Methods: A total of 70 radiographies and 70 bone scintigraphies were compared in 35 patients. Results: The skull, the extremities, the iliac and public bones were better assessed with radiography. For new vertebral lesions and for lesions in the ribs and sternum, bone scintigraphy proved superior. For the sacrum, the methods were equal. When bone scintigraphy was used as a complement to radiography, 4% more pathological sites were found. No patient had both a normal radiography and a pathological bone scintigraphy, but 5 patients had both a normal bone scintigraphy and a pathological radiography. The results of the radiological examinations did not always correlate with the clinician's grading of the patient's disease. The radiological examinations had no prognostic value for the 7 patients examined on several occasions. Conclusion: The ability of conventional radiography and bone scintigraphy to disclose myeloma lesions varies, depending on location and size of the lesions. Radiography should remain the primary examination modality also for bone marrow transplant multiple myeloma patients. Bone scintigraphy can severe as a complement for investigating unexplained pain, e.g. caused by lesions in vertebrae or ribs. (orig.)

  3. Workflow Management for Multiple Sclerosis Patients: IT and Organization

    NARCIS (Netherlands)

    Michel-Verkerke, Margreet B.; Michel-Verkerke, M.B.; Schuring, R.W.; Spil, Antonius A.M.; Sprague, R.H.

    2004-01-01

    Patients with Multiple Sclerosis (MS) visit various healthcare providers during the course of their disease. It was suggested that IT might help to orchestrate their care provision. We have applied the USE IT-tool to get insight in the relevant problems, solutions and constraints of the MS-care and

  4. Triple-orifice valve repair in severe Barlow disease with multiple-jet mitral regurgitation: report of mid-term experience.

    Science.gov (United States)

    Fucci, Carlo; Faggiano, Pompilio; Nardi, Matilde; D'Aloia, Antonio; Coletti, Giuseppe; De Cicco, Giuseppe; Latini, Leonardo; Vizzardi, Enrico; Lorusso, Roberto

    2013-09-10

    Barlow disease represents a surgical challenge for mitral valve repair (MR) in the presence of mitral insufficiency (MI) with multiple regurgitant jets. We hereby present our mid-term experience using a modified edge-to-edge technique to address this peculiar MI. From March 2003 till December 2010, 25 consecutive patients (mean age 54 ± 7 years, 14 males) affected by severe Barlow disease with multiple regurgitant jets were submitted to MR. Preoperative transesophageal echo (TEE) in all the cases showed at least 2 regurgitant jets, involving one or both leaflets in more than one segment. In all the patients, a triple orifice valve (TOV) repair with annuloplasty was performed. Intra-operative TEE and postoperative transthoracic echocardiography (TTE) were carried out to evaluate results of the TOV repair. There was no in-hospital death and one late death (non-cardiac related). At intra-operative TEE, the three orifices showed a mean total valve area of 2.9 ± 0.1cm(2) (range 2.5-3.3 cm(2)) with no residual regurgitation (2 cases of trivial MI) and no sign of valve stenosis (mean transvalvular gradient 4.6 ± 1.5 mmHg). At follow up (mean 38 ± 22 months), TTE showed favourable MR and no recurrence of significant MI (6 cases of trivial and 1 of mild MI). Stress TTE was performed in 5 cases showing persistent effective valve function (2 cases of trivial MI at peak exercise). All the patients showed significant NYHA functional class improvement. This report indicates that the TOV technique is effective in correcting complex Barlow mitral valves with multiple jets. Further studies are required to confirm long-term applicability and durability in more numerous clinical cases. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  5. Rhabdomyolysis following interferon-beta treatment in a patient with multiple sclerosis - A case report.

    Science.gov (United States)

    Dalbjerg, Sara Maria; Tsakiri, Anna; Frederiksen, Jette Lautrup

    2016-07-01

    Multiple sclerosis is an inflammatory disease of the central nervous system for which there is currently no cure. Interferon-beta-1-alpha is worldwide one of the most widely used treatments in multiple sclerosis. To our knowledge there is one previous reported case of rhabdomyolysis associated with Interferon-beta treatment. We describe a 30 year old man with relapsing remitting multiple sclerosis who developed rhabdomyolysis and increased creatine kinase following Interferon-beta-1-alpha therapy. After the medication was discontinued, the patient rapidly improved. Clinicians should be aware of the possibility of rhabdomyolysis occurring during Interferon-beta-1-alpha therapy. In cases where patients complain of severe myalgia, and in particular if weakness is reported, creatine kinase activity should be measured to prevent irreversible rhabdomyolysis during Interferon-beta-1-alpha therapy in patients with multiple sclerosis. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Investigating the effect of multiple layers of insulation with a bubble wrap experiment

    Science.gov (United States)

    Eggers, Dolores; Ruiz, Michael J.

    2018-03-01

    We provide a fun, inexpensive laboratory experiment for students to investigate the effects of multiple layers of insulation and observe diminishing values for additional layers using bubble wrap. This experiment provides an opportunity for students to learn about heat transfer through conduction using readily available materials. A water-ice pack is placed on top of five layers of bubble wrap. The temperature is taken between each layer periodically for at least 15 min. Students determine asymptotic temperatures for varying layers. This experiment also suggests a real world application.

  7. Depressive Symptoms in Bariatric Surgery Patients with Multiple Sclerosis.

    Science.gov (United States)

    Fisher, Carolyn J; Heinberg, Leslie J; Lapin, Brittany; Aminian, Ali; Sullivan, Amy B

    2018-04-01

    Bariatric surgery has been shown to be a safe and effective intervention for patients with comorbid obesity and multiple sclerosis (MS); however, this sub-population may be at heightened risk for pre- and postoperative depressive symptoms. This current exploratory study aims to describe the prevalence and nature of depressive symptoms in a sample of patients with MS who undergo bariatric surgery. Medical records were retrospectively reviewed to identify patients who received bariatric surgery and had a diagnosis of MS (n = 31) and a control sample of non-surgical MS patients with severe obesity (n = 828). Longitudinal outcome measures included the Patient Health Questionnaire-9 (PHQ-9) and Multiple Sclerosis Performance Scale (MSPS). There were no significant differences in PHQ-9 total and item scores between groups at baseline. PHQ-9 scores significantly improved at years 1 (p bariatric surgery when compared to non-surgical controls. Higher BMI (p = 0.03) and worse overall quality of life (p bariatric group. When compared to controls, the bariatric group demonstrated improved MSPS scores on a trend level 1 year post-surgery (p = 0.08). Consistent with the literature on more general bariatric surgery populations, current findings highlight the possible early benefits of bariatric surgery for reducing depressive symptoms in this population when compared to controls. Importantly, results should be viewed as preliminary and additional research is needed to examine bariatric surgery and associations with depressive symptoms and performance in the MS population.

  8. [Qualitative research on pain experiences of adult burn patients].

    Science.gov (United States)

    Li, L; Pan, Q; Xu, L; Lin, R Q; Dai, J X; Chen, Z H

    2018-03-20

    Objective: To explore the pain experiences of adult burn patients so as to lay foundation for practical analgesic measures. Methods: Using phenomenological method in qualitative research, semi-structured interviews were conducted on 12 adult burn patients hospitalized in our burn units from May to November 2015, aiming at pain experiences from immediately after burns to 3 to 7 months after being discharged from hospital. Then the Colaizzi's analysis method was applied to analyze, induce, and refine themes of interview data. Results: After analysis, pain experiences of adult burn patients were generalized into 6 themes: deep pain experiences, heavy psychological burden, limited daily life, poor assessment and treatment of pain, different attributions of pain, and different ways of coping of pain. Conclusions: Burn pain brings harm to the patients' physiology, mentality, and daily life. Nevertheless, pain processing modes of medical staff and patients themselves are the key factors affecting patients' pain experiences. Therefore, according to the deficiency of current situation of pain management, the targeted analgesic intervention measures should be carried out from the perspectives of medical staff and patients.

  9. Patient preferences for Interferon-beta in Iran: A discrete choice experiment.

    Directory of Open Access Journals (Sweden)

    Farimah Rahimi

    Full Text Available Multiple sclerosis is a chronic, progressive, and common disease affecting the central nervous system in young adults. Interferon-beta is one of the most widely used medicines to reduce the disease progression. Given the variety of drugs in this category, we aimed to identify the preferences of patients for IFN-β that play an important role in policymaking in this area. Discrete choice experiment method was used in the present study to identify and prioritize those attributes that are of interest to MS patients and increases the utility of the use of IFN-β in their treatment. Questionnaires were given to 358 patients in Isfahan-Iran, who were asked to choose between the two treatment choices in each scenario. The results of the logit model showed that the changes in the efficacy lead to the most changes in the patient utility. Changes in side effects and ease of injection have been placed in the next rankings. Considering the drug attributes considered more desirable by patients can lead to greater medication adherence and possibly better treatment outcomes. Also, pharmaceutical companies, the health ministry, the Food and Drug Administration, insurance organizations, and neurologists can benefit from this information in production and importation, policymaking, and prescription.

  10. The boarding experience from the patient perspective: the wait.

    Science.gov (United States)

    Liu, Shan; Milne, Leslie; Yun, Brian; Walsh, Kathleen

    2015-11-01

    We sought to better understand the experience of being a boarder patient. We conducted a qualitative study between March and August 2012 to examine the experience of boarding in an urban, teaching hospital emergency department (ED). We included boarder patients and selected patients based on a convenience sample. Interviews were semistructured, consisting of eight main open-ended questions. Interviews were transcribed; codes were generated and then organised into categorises and subsequently into one theme. We concluded analysis when we achieved thematic saturation. Our institutional review board approved this study. Our final sample included 18 patients. The average age was 62.3 years. Patients characterised waiting as central to their experience as a boarder patient. One patient stated, "Well if you have to wait for a bed you have to wait for a bed, it's terrible." Three categories exemplified this waiting experience: (1) there was often lack of communication; (2) patients experienced frustration during this waiting period; and yet (3) patients often differentiated the experience of waiting from the care they were receiving. Being a boarder patient was characterised as a waiting experience associated with poor communication and frustration. However, patients may still differentiate their feelings towards the wait from those towards the medical care they are receiving. Our data add more reason to eradicate the practice of ED boarding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Multiple neoplasms among cervical cancer patients in the material of the lower Silesian cancer registry.

    Science.gov (United States)

    Izmajłowicz, Barbara; Kornafel, Jan; Błaszczyk, Jerzy

    2014-01-01

    According to the definition by the International Agency for Research on Cancer (IARC), primary multiple neoplasms are two or more neoplasms of different histopathological build in one organ, or two or more tumors occurring in one patient, regardless of the time of their occurrence (synchronic - up to 6 months, metachronous - after 6 months), coming from an organ or a tissue and not being an infiltration from another neoplasm, a relapse or a metastasis. It was the aim of the study to analyze the frequency of the occurrence of multiple neoplasms among patients suffering from uterine cervix cancer, with a special interest in coexistent neoplasms, the time of their occurrence and total 5-year survivals. The data from the Lower Silesian Cancer Registry concerning the years 1984-2009 formed the material of the present study. 5.3% of all cervix neoplasms occurred as multiple cancers. Cervix neoplasms were 13.4% of multiple neoplasms. On average, cervical cancer occurred as a subsequent cancer in 6 patients yearly (60.7% of the occurrences of cervical cancer were in the period of 5 years following treatment for the first neoplasm). 5-year survival in patients suffering from primarily multiple cervix neoplasms constituted 57% and was convergent with the results for all patients suffering from cervical cancer. Cervical cancer as the first neoplasm occurred in 287 patients, on average in 11 patients annually. In the period of the first 5 years after the treatment of cervical cancer, there were 42.8% occurrences of other cancers. Cervical neoplasms most frequently coexisted with cancers of the breast, lung and large intestine. The frequency of the occurrence of multiple neoplasm among cervical cancer patients is increasing. Most frequently they coexist with other tobacco-related neoplasms, those related to HPV infections and with secondary post-radiation neoplasms. These facts should be taken into consideration during post-treatment observation and when directing diagnostic

  12. Anesthetic management of a patient with multiple sclerosis - case report

    Directory of Open Access Journals (Sweden)

    Eduardo Barbin Zuccolotto

    Full Text Available Abstract Background and objectives: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. Case report: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. Conclusion: The use of neuromuscular blockers (depolarizing and non-depolarizing is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.

  13. Burden of a multiple sclerosis relapse: the patient's perspective.

    Science.gov (United States)

    Oleen-Burkey, Merrikay; Castelli-Haley, Jane; Lage, Maureen J; Johnson, Kenneth P

    2012-01-01

    Relapses are a common feature of relapsing-remitting multiple sclerosis (RRMS) and increasing severity has been shown to be associated with higher healthcare costs, and to result in transient increases in disability. Increasing disability likely impacts work and leisure productivity, and lowers quality of life. The objective of this study was to characterize from the patient's perspective the impact of a multiple sclerosis (MS) relapse in terms of the economic cost, work and leisure productivity, functional ability, and health-related quality of life (HR-QOL), for a sample of patients with RRMS in the US treated with immunomodulatory agents. A cross-sectional, web-based, self-report survey was conducted among members of MSWatch.com, a patient support website now known as Copaxone.com. Qualified respondents in the US had been diagnosed with RRMS and were using an immunomodulatory agent. The survey captured costs of RRMS with questions about healthcare resource utilization, use of community services, and purchased alterations and assistive items related to MS. The Work and Leisure Impairment instrument and the EQ-5D were used to measure productivity losses and HR-QOL (health utility), respectively. The Goodin MS neurological impairment questionnaire was used to measure functional disability; questions were added about relapses in the past year. Of 711 qualified respondents, 67% reported having at least one relapse during the last year, with a mean of 2.2 ± 2.3 relapses/year. Respondents who experienced at least one relapse had significantly higher mean annual direct and indirect costs compared with those who did not experience a relapse ($US38 458 vs $US28 669; p = 0.0004) [year 2009 values]. Direct health-related costs accounted for the majority of the increased cost ($US5201; 53%) and were mainly due to increases in hospitalizations, medications, and ambulatory care. Indirect costs, including informal care and productivity loss, accounted for the

  14. Coronaviruses in brain tissue from patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Dessau, R B; Lisby, G; Frederiksen, J L

    2001-01-01

    Brain tissue from 25 patients with clinically definite multiple sclerosis (MS) and as controls brain tissue from 36 patients without neurological disease was tested for the presence of human coronaviral RNA. Four PCR assays with primers specific for N-protein of human coronavirus strain 229E...... and three PCR assays with primers specific for the nucleocapsid protein of human coronavirus strain OC43 were performed. Sporadic positive PCR assays were observed in both patients and controls in some of the PCR assays. However, these results were not reproducible and there was no difference...... in the proportion of positive signals from the MS patients compared to controls. Evidence for a chronic infection with the human coronaviruses strain 229E or OC43 in brain tissue from patients with MS or controls has not been found in this study....

  15. "You Get Reminded You're a Sick Person": Personal Data Tracking and Patients With Multiple Chronic Conditions.

    Science.gov (United States)

    Ancker, Jessica S; Witteman, Holly O; Hafeez, Baria; Provencher, Thierry; Van de Graaf, Mary; Wei, Esther

    2015-08-19

    Consumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as "quantified self" advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population. Our aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data? We used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached. Interviews were conducted with 22 patients and 7 health care providers. The patients had an average of 3.5 chronic conditions, including type 2 diabetes, heart disease, chronic pain, and depression, and had regular relationships with an average of 5 providers. Four major themes arose from the interviews: (1) tracking this data feels like work for many patients, (2) personal medical data for individuals with chronic conditions are not simply objective facts, but instead provoke strong positive and negative emotions, value judgments, and diverse interpretations, (3) patients track for different purposes, ranging from sense-making to self-management to reporting to the doctor, and (4

  16. Linezolid desensitization for a patient with multiple medication hypersensitivity reactions.

    Science.gov (United States)

    Bagwell, Autumn D; Stollings, Joanna L; White, Katie D; Fadugba, Olajumoke O; Choi, Jane J

    2013-01-01

    To describe a case in which a linezolid desensitization protocol was successfully used for a polymicrobial surgical wound infection in a patient with multiple drug hypersensitivity reactions. A 24-year-old woman with vocal cord dysfunction requiring tracheostomy was admitted for a surgical wound infection following a tracheostomy fistula closure procedure. The patient reported multiple antibiotic allergies including penicillins (rash), sulfonamides (rash), vancomycin (anaphylaxis), azithromycin (rash), cephalosporins (anaphylaxis), levofloxacin (unspecified), clindamycin (unspecified), and carbapenems (unspecified). Gram stain of the purulent wound drainage demonstrated mixed gram-negative and gram-positive flora, and bacterial cultures were overgrown with Proteus mirabilis, which precluded identification of other pathogens. Following failed test doses of linezolid, tigecycline, and daptomycin, all of which resulted in hypersensitivity reactions, a 16-step linezolid desensitization protocol was developed and successfully implemented without adverse reactions. The patient completed a 2-week course of antibiotic therapy that included linezolid upon finishing the desensitization protocol. Linezolid is useful in treating complicated and uncomplicated skin and soft tissue infections caused by gram-positive bacteria. With precautions, including premedication, a monitored nursing unit, and immediate availability of an emergency anaphylaxis kit, drug desensitization allows patients the ability to safely use medications to which they may have an immediate hypersensitivity reaction. Minimal data exist on linezolid desensitization protocols. Linezolid desensitization can be a viable option in patients requiring antimicrobial therapy for complicated gram-positive skin infections.

  17. Retinal periphlebitis in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Stamenković Miroslav

    2011-01-01

    Full Text Available Background/Aim. Multiple sclerosis (MS is an immunemediated disorder of the central nervous system (CNS, characterized by inflammation, demyelination and axonal loss. Retinal periphlebitis (RP is often present in MS patients with similar evolution and histopathological changes as MS lesions. The aim of this study was to analyze the presence of RP in MS patients during different clinical phases, and its connection with impairment of blood-brain barrier. Methods. The study included 45 patients (26 females and 19 males with MS. Their average age was 33.2 ± 8.1 years. There were 28 patients with relapsing-remitting (RR form, 7 with primary progresive (PP and 10 with secondary progressive (SP form of MS. There were 27 patients in the relapse and 18 patients in the remission phase. The average MS duration was 7.48 ± 1.3 years. Ophthalmological, neurological and MRI examination were performed in all the patients, as well as cerebrospinal fluid sampling. Albumin ratio and IgG index were calculated in all the patients. Results. There were 9 patients with RP, and 36 without it. MS duration was significantly longer in the RP group. RP was much more common in the progressive form and was not present in the remission phase of MS. Albumin ratio values were increased in the group with RP. IgG index and IgG synthesis according to Tourtellotte formula, were statistically higher in the group of patients with RP. The values of visual evoked potentials (VEP's latency were significantly higher in the group of patients with RP. Conclusion. The presence of RP is a reliable indicator of MS activity and might be considered as a parameter for monitoring the disease activity and effects of the treatment.

  18. Cognitive status in patients with multiple sclerosis in Lanzarote.

    Science.gov (United States)

    Pérez-Martín, María Yaiza; Eguia-Del Río, Pablo; González-Platas, Montserrat; Jiménez-Sosa, Alejandro

    2016-01-01

    Cognitive impairment is a common feature in multiple sclerosis affecting ~43%-72% of patients, which involves cognitive functions such as memory, processing speed, attention, and executive function. The aim of this study was to describe the extent and pattern of the involvement of cognitive impairment and psychological status in all patients with multiple sclerosis on a small Spanish island. In all, 70 patients and 56 healthy controls were included in the study between February 2013 and May 2013. All participants were assessed using the Brief Repeatable Battery of Neuropsychological Test. The patients also completed instruments to evaluate the presence of fatigue, perceived cognitive dysfunction, and symptoms of anxiety and depression. All procedures were performed in a single session. Cognitive impairment, defined as a score <1.5 standard deviation on two subtests of the battery, was present in 35% of the participants. The most frequently affected domain was working memory, followed by verbal memory and processing speed. Disease duration showed a moderate correlation with visuospatial memory and processing speed. The Expanded Disability Status Scale score correlated with verbal and processing speed. Verbal memory was correlated with depression symptoms and fatigue. Cognitive impairment was present in 35% of the study population. The most affected domains were working memory and verbal memory. Working memory and verbal fluency deficit are independent factors of disease evolution. Cognitive decline is related to clinical variables and psychological measures such as fatigue or depression but not to anxiety.

  19. Multiple scattering and attenuation corrections in Deep Inelastic Neutron Scattering experiments

    International Nuclear Information System (INIS)

    Dawidowski, J; Blostein, J J; Granada, J R

    2006-01-01

    Multiple scattering and attenuation corrections in Deep Inelastic Neutron Scattering experiments are analyzed. The theoretical basis of the method is stated, and a Monte Carlo procedure to perform the calculation is presented. The results are compared with experimental data. The importance of the accuracy in the description of the experimental parameters is tested, and the implications of the present results on the data analysis procedures is examined

  20. [Neuropsychology of mildly disabled patients with relapsing-remitting multiple sclerosis].

    Science.gov (United States)

    Santiago Rolanía, Olga; Guàrdia Olmos, Joan; Arbizu Urdiain, Txomin

    2006-02-01

    Previous papers have mainly demonstrated the presence of cognitive impairment in patients with multiple sclerosis (MS), these changes have been traditionally associated with the later stages of the disease. In the current study, a comprehensive neuropsychological battery was administered to 216 relapsing-remitting MS patients with mild clinical disability (EDSSreproduction visual memory; and long term verbal memory of texts, and information processing speed. We also observed greeter incidence of depressive symptoms in patients. And a little relation of the cognitive deficits with the clinical variables in these phase of the disease.

  1. Different cognitive profiles of Brazilian patients with relapsing-remitting and primary progressive multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Dóra-Neide Rodrigues

    2011-08-01

    Full Text Available Cognitive impairment is a symptom of multiple sclerosis (MS. Different clinical forms of multiple sclerosis have different cognitive profiles, according to findings of previous studies which used extensive batteries of neuropsychological tests. OBJECTIVE: To investigate cognitive profiles of Brazilian patients with relapsing-remitting multiple sclerosis (RRMS and primary progressive multiple sclerosis (PPMS by using a brief battery of neuropsychological tests. METHOD: Sixty-six patients, within 18-65 of age and 3-18 years of education, were paired with healthy control subjects, regarding gender, age, and education level. RESULTS: On Symbol Digit Modalities Test and Hooper Visual Organization Test, cognition was affected in 50% in RRMS and 69% in PPMS. Fluency of "F" was impaired in 24% of RRMS and 81% of PPMS. Immediate recall was affected in 32% of RRMS and in 63% of PPMS; whereas late recall, in 46% of relapsing-remitting and in 69% of primary progressive. CONCLUSION: Cognitive profiles of relapsing-remitting and primary progressive patients are different

  2. Cognitive reserve and patient-reported outcomes in multiple sclerosis.

    Science.gov (United States)

    Schwartz, Carolyn E; Snook, Erin; Quaranto, Brian; Benedict, Ralph H B; Vollmer, Timothy

    2013-01-01

    Adaptation and compensation in the face of changing pathology may be better understood by considering the concept of cognitive reserve, which may protect against disability in multiple sclerosis (MS). The present work investigates the relationship between cognitive reserve and demographic characteristics, health behaviors, and patient-reported outcomes (PROs). Cross-sectional data (n=1142) were drawn from the North American Research Committee on MS (NARCOMS) Registry, from whom additional survey data were collected. Cognitive reserve was measured using the Stern and Sole-Padulles measures, the O*NET occupational classification system, and the Godin Leisure-Time Exercise Questionnaire. PROs were assessed using generic (SF -12v2, Perceived Deficits Questionnaire, Ryff Psychological Well-Being, Diener Satisfaction with Life Scale) and disease-specific (Patient-Determined Disease Steps, Performance Scales) measures. Psychometric analysis created unidimensional cognitive reserve subscales. Regression models examined relationships between cognitive reserve, demographic characteristics, and PROs. The cognitive reserve measures assessed distinct but related constructs. Individuals with high cognitive reserve were more likely to report lower levels of perceived disability and perceived cognitive deficits, and higher levels of physical health, mental health, and well-being. Both active and passive reserve are associated with better outcomes, independent of demographic factors, and these associations apply to both generic and disease-specific outcomes. This expanded measurement of cognitive reserve captures both the passive and active aspects of the construct, and there is a consistent and substantial relationship with PROs. Individuals with high passive and/or active reserve are healthier and experience higher levels of well-being.

  3. Nursing Practice in Primary Care and Patients' Experience of Care.

    Science.gov (United States)

    Borgès Da Silva, Roxane; Brault, Isabelle; Pineault, Raynald; Chouinard, Maud-Christine; Prud'homme, Alexandre; D'Amour, Danielle

    2018-01-01

    Nurses are identified as a key provider in the management of patients in primary care. The objective of this study was to evaluate patients' experience of care in primary care as it pertained to the nursing role. The aim was to test the hypothesis that, in primary health care organizations (PHCOs) where patients are systematically followed by a nurse, and where nursing competencies are therefore optimally used, patients' experience of care is better. Based on a cross-sectional analysis combining organizational and experience of care surveys, we built 2 groups of PHCOs. The first group of PHCOs reported having a nurse who systematically followed patients. The second group had a nurse who performed a variety of activities but did not systematically follow patients. Five indicators of care were constructed based on patient questionnaires. Bivariate and multivariate linear mixed models with random intercepts and with patients nested within were used to analyze the experience of care indicators in both groups. Bivariate analyses revealed a better patient experience of care in PHCOs where a nurse systematically followed patients than in those where a nurse performed other activities. In multivariate analyses that included adjustment variables related to PHCOs and patients, the accessibility indicator was found to be higher. Results indicated that systematic follow-up of patients by nurses improved patients' experience of care in terms of accessibility. Using nurses' scope of practice to its full potential is a promising avenue for enhancing both patients' experience of care and health services efficiency.

  4. Older patients' experiences during care transition

    Directory of Open Access Journals (Sweden)

    Rustad EC

    2016-05-01

    Full Text Available Else Cathrine Rustad,1–4 Bodil Furnes,1 Berit Seiger Cronfalk,2,5,6 Elin Dysvik1 1Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway; 2Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway; 3Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Haugesund, Norway; 4Department of Clinical Medicine, Helse Fonna Local Health Authority, Haugesund, Norway; 5Palliative Research Center, Ersta Sköndal University College, Stockholm, Sweden; 6Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Background: A fragmented health care system leads to an increased demand for continuity of care across health care levels. Research indicates age-related differences during care transition, with the oldest patients having experiences and needs that differ from those of other patients. To meet the older patients’ needs and preferences during care transition, professionals must understand their experiences.Objective: The purpose of the study was to explore how patients ≥80 years of age experienced the care transition from hospital to municipal health care services.Methods: The study has a descriptive, explorative design, using semistructured interviews. Fourteen patients aged ≥80 participated in the study. Qualitative content analysis was used to describe the individuals’ experiences during care transition.Results: Two complementary themes emerged during the analysis: “Participation depends on being invited to plan the care transition” and “Managing continuity of care represents a complex and challenging process”.Discussion: Lack of participation, insufficient information, and vague responsibilities among staff during care transition seemed to limit the continuity of care. The patients are the vulnerable part of the care transition process, although they possess important

  5. Non-inflammatory causes of emergency consultation in patients with multiple sclerosis.

    Science.gov (United States)

    Rodríguez de Antonio, L A; García Castañón, I; Aguilar-Amat Prior, M J; Puertas, I; González Suárez, I; Oreja Guevara, C

    2018-05-26

    To describe non-relapse-related emergency consultations of patients with multiple sclerosis (MS): causes, difficulties in the diagnosis, clinical characteristics, and treatments administered. We performed a retrospective study of patients who attended a multiple sclerosis day hospital due to suspected relapse and received an alternative diagnosis, over a 2-year period. Demographic data, clinical characteristics, final diagnosis, and treatments administered were evaluated. Patients who were initially diagnosed with pseudo-relapse and ultimately diagnosed with true relapse were evaluated specifically. As an exploratory analysis, patients who consulted with non-inflammatory causes were compared with a randomly selected cohort of patients with true relapses who attended the centre in the same period. The study included 50 patients (33 were women; mean age 41.4±11.7years). Four patients (8%) were initially diagnosed with pseudo-relapse and later diagnosed as having a true relapse. Fever and vertigo were the main confounding factors. The non-inflammatory causes of emergency consultation were: neurological, 43.5% (20 patients); infectious, 15.2% (7); psychiatric, 10.9% (5); vertigo, 8.6% (4); trauma, 10.9% (5); and miscellaneous, 10.9% (5). MS-related symptoms constituted the most frequent cause of non-inflammatory emergency consultations. Close follow-up of relapse and pseudo-relapse is necessary to detect incorrect initial diagnoses, avoid unnecessary treatments, and relieve patients' symptoms. Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Sexual Dysfunction and Incidence of Depression in Multiple Sclerosis Patients

    Science.gov (United States)

    Zavoreo, Iris; Gržinčić, Tihana; Preksavec, Marina; Madžar, Tomislav; Bašić Kes, Vanja

    2016-09-01

    Multiple sclerosis (MS) is one of the most common diseases of the central nervous system and usually occurs at the age when people would be expected to be in the prime of their sexual lives. In everyday practice, sexual dysfunction is underestimated because clinicians mostly concentrate on the classic neurologic deficits and often overlook symptoms that can seriously affect the quality of life. Our study included 98 patients (42 men and 56 women, mean age 35±12 years) with relapse from our MS register, with established diagnosis of relapsing remitting multiple sclerosis according to McDonald criteria. Patients completed the questionnaires (Sexual Satisfaction Scale, SSS and Beck Depression Scale BDS), and underwent neurological assessment (Expanded Disability Status Scale, EDSS). All patients were in the group with EDSS 2 to 4 points (mobile patients). There was no statistically significant difference in BDS and SSS values according to EDSS score. Correlation coefficients were calculated (BDS and SSS) for men (p=0.42) and women (p=0.44), yielding positive correlation. There was no statistically significant difference in BDS and SSS values according to gender, disease duration or immunomodulatory therapy. In our group of patients, despite low EDSS score (fully ambulatory without aid, self sufficient patients) we found positive correlation between sexual dysfunction and depression, showing that even in such patients the quality of life can be decreased. In conclusion, sexual dysfunction and depression are mostly under-recognized by neurologists because they are not part of routine testing; therefore, some additional questionnaires should be used in the evaluation in MS patients, even those with low EDSS score, in order to improve their quality of life.

  7. [GP medication prioritisation in older patients with multiple comorbidities recently discharged from hospital: a case-based bottom-up approach].

    Science.gov (United States)

    Herrmann, M L H; von Waldegg, G H; Kip, M; Lehmann, B; Andrusch, S; Straub, H; Robra, B-P

    2015-01-01

    After the hospital discharge of older patients with multiple morbidities, GPs are often faced with the task of prioritising the patients' drug regimens so as to reduce the risk of overmedication. How do GPs prioritise such medications in multimorbid elderly patients at the transition between inpatient and home care? The experience by the GPs is documented in typical case vignettes. 44 GPs in Sachsen-Anhalt were recruited--they were engaged in focus group discussions and interviewed using semi-standardised questionnaires. Typical case vignettes were developed, relevant to the everyday care that elderly patients would typically receive from their GPs with respect to their drug optimisation. According to the results of the focus groups, the following issues affect GPs' decisions: drug and patient safety, their own competence in the health system, patient health literacy, evidence base, communication between secondary and primary care (and their respective influences on each other). When considering individual cases, patient safety, patient wishes, and quality of life were central. This is demonstrated by the drug dispositions of one exemplary case vignette. GPs do prioritise drug regimens with rational criteria. Initial problem delineation, process documentation and the design of a transferable product are interlinking steps in the development of case vignettes. Care issues of drug therapy in elderly patients with multiple morbidities should be investigated further with larger representative samples in order to clarify whether the criteria used here are applied contextually or consistently. Embedding case vignettes into further education concepts is also likely to be useful. © Georg Thieme Verlag KG Stuttgart · New York.

  8. What do multiple sclerosis patients and their caregivers perceive as unmet needs?

    OpenAIRE

    Lorefice, Lorena; Mura, Gioia; Coni, Giulia; Fenu, Giuseppe; Sardu, Claudia; Frau, Jessica; Coghe, Giancarlo; Melis, Marta; Marrosu, Maria Giovanna; Cocco, Eleonora

    2013-01-01

    Background Multiple sclerosis (MS) has a major impact on the physical, psychological and social life of patients and their families. The aim of this study was to evaluate the different perceptions of patients and caregivers about management of MS, particularly about the same items, to gather information to ameliorate the care of patients. Methods We evaluated what MS patients and caregivers perceive as unmet needs and compared patients? opinions with caregivers? opinions using a multidimensio...

  9. Shaping the Future of Patient Experience Measurement in Canadian Healthcare.

    Science.gov (United States)

    Sutherland, Jason M

    2017-10-01

    Patients' experiences with healthcare providers can be tumultuous and stressful. Focusing on what matters, the experience of care is important to improving patients' quality of life. In this issue's lead article, Kuluski and colleagues (2017) propose moving beyond setting-based patient experience measures. In doing so, the authors emphasize the importance of caregivers and the communities in which patients live in improving patients' and caregivers' care experiences. To achieve these aims, however, the authors demand a higher level of reflexivity from provinces' healthcare funders and providers. © 2017 Longwoods Publishing.

  10. Increased osteopontin plasma levels in multiple sclerosis patients correlate with bone-specific markers

    NARCIS (Netherlands)

    Vogt, M.H.J.; ten Kate, J.; Drent, R.J.M.; Polman, C.H.; Hupperts, R.

    2010-01-01

    The pro-inflammatory cytokine osteopontin has been found to be highly expressed in multiple sclerosis lesions and plasma levels are increased during relapses in relapse-onset multiple sclerosis patients. The objective was to determine the relationship between osteopontin plasma and cerebrospinal

  11. THE EXPERIENCE OF TREATMENT OF MULTIPLE BASALIOMA IN GORLIN-GOLTZ SYNDROME

    Directory of Open Access Journals (Sweden)

    E. I. Tret'yakova

    2016-01-01

    Full Text Available Aim: To assess clinical efficacy of the treatment options for multiple basalioma in patients with Gorlin-Goltz syndrome. Materials and methods: We retrospectively analyzed the results of various treatments in 23  patients with the Gorlin-Goltz syndrome for the time period of 25  years. Four treatment groups were formed depending on the treatment method. In the group 1, 18 patients were cryodestructed, with elimination of 158  superficial and ulcer basaliomas T₁N₀M₀, T₂N₀M₀, T₃N₀M₀. In the group 2, 5  patients received photodynamic therapy, with removal of 78 superficial, nodular and ulcer basaliomas T₁N₀M₀, T₂N₀M₀, T₃N₀M₀. In the group 3, 3  patients were administered laser-induced thermic therapy with removal of 16  superficial basaliomas T₁N₀M₀. In the group 4, 5 patients received topical chemotherapy with Mardil Selen, with removal of 18  superficial and ulcer basaliomas T₁N₀M₀. As radiation sources for photodynamic and laser-induced thermic therapy we used laser equipment with copper vaporization and adjusted wave length Metalaz 1  and semiconductor infrared laser LAMI. The photodynamic therapy was administered with photosensitizers Photohem and Radachlorin. The results of treatment and relapse-free periods were assessed annually in all patients up to 5  years after treatment. Results: After cryodestruction, 83.3%  of patients with Gorlin-Goltz syndrome were cured (153  basaliomas and additional 16.7%  improved. Relapses during the time period from one to three years were observed in 16.7% of patients. Nine (9 basaliomas relapsed. After photodynamic therapy, 80%  of patients (73  basaliomas were cured and 20%  improved. Relapses from 1  to 3  years were observed in 20% of patients (2 basaliomas. After laser-induced thermic therapy 100%  of patients (16  basaliomas were cured, and relapses from 1  to 2  years were registered in 33%  of patients (4 basaliomas. After

  12. The Use of Mobile Health Applications to Improve Patient Experience: Cross-Sectional Study in Chinese Public Hospitals.

    Science.gov (United States)

    Lu, Chuntao; Hu, Yinhuan; Xie, Jinzhu; Fu, Qiang; Leigh, Isabella; Governor, Samuel; Wang, Guanping

    2018-05-23

    The proliferation of mobile health apps has greatly changed the way society accesses the health care industry. However, despite the widespread use of mobile health apps by patients in China, there has been little research that evaluates the effect of mobile health apps on patient experience during hospital visits. The purpose of our study was to examine whether the use of mobile health apps improves patient experience and to find out the difference in patient experience between users and nonusers and the characteristics associated with the users of these apps. We used the Chinese Outpatient Experience Questionnaire to survey patient experience. A sample of 300 outpatients was randomly selected from 3 comprehensive public hospitals (3 tertiary hospitals) in Hubei province, China. Each hospital randomly selected 50 respondents from mobile health app users and 50 from nonusers. A chi-square test was employed to compare the different categorical characteristics between mobile health app users and nonusers. A t test was used to test the significance in continuous variables between user scores and nonuser scores. Multiple linear regression was conducted to determine whether the use of mobile health apps during hospital visits was associated with patient experience. The users and nonusers differed in age (χ 2 2 =12.2, P=.002), education (χ 2 3 =9.3, P=.03), living place (χ 2 1 =7.7, P=.006), and the need for specialists (χ 2 4 =11.0, P=.03). Compared with nonusers, mobile health app users in China were younger, better educated, living in urban areas, and had higher demands for specialists. In addition, mobile health app users gave significantly higher scores than nonusers in total patient experience scores (t 298 =3.919, Pmobile health apps during hospital visits influenced patient experience (t 289 =3.143, P=.002). After controlling for other factors, it was shown that the use of mobile health apps increased the outpatient experience scores by 17.7%. Additional

  13. Helical tomotherapy. Experiences of the first 150 patients in Heidelberg

    Energy Technology Data Exchange (ETDEWEB)

    Sterzing, F.; Schubert, K.; Sroka-Perez, G.; Kalz, J.; Debus, J.; Herfarth, K. [Dept. of Radiation Oncology, Univ. of Heidelberg (Germany)

    2008-01-15

    Background and purpose: helical tomotherapy was introduced into clinical routine at the Department of Radiation Oncology, University Hospital of Heidelberg, Germany, in July 2006. This report is intended to describe the experience with the first 150 patients treated with helical tomotherapy. Patient selection, time effort, handling of daily image guidance with megavoltage (MV) CT, and quality of radiation plans shall be assessed. Patients and methods: between July 2006 and May 2007, 150 patients were treated with helical tomotherapy in the University Hospital of Heidelberg. Mean age was 60 years with a minimum of 30 years and a maximum of 85 years. 79 of these patients received radiotherapy as a part of multimodal treatment pre- or postoperatively, 17 patients received treatment as a combined radiochemotherapy. 76% were treated with curative intent. Radiotherapy sites were central nervous system (n = 7), head and neck (n = 28), thoracic (n = 37), abdominal (n = 58) and skeletal system (n = 20). Most common tumor entities were prostate cancer (n = 28), breast cancer (n = 17), gastrointestinal tumors (n = 19), pharyngeal carcinoma (n = 14), lymphoma (n = 13), metastatic disease (bone n = 14, liver n = 6, lung n = 4, lymph node n = 2), sarcoma (n = 8), malignant pleural mesothelioma (n = 5), ovarian cancer treated with whole abdominal irradiation (n = 4), lung cancer (n = 3), skin malignancies (n = 3), chordoma (n = 2), meningioma (n = 2), one ependymoma and one medulloblastoma treated with craniospinal axis irradiation (n = 2), and others (n = 4). Nine patients were treated with single-fraction radiosurgery, nine with image-guided spinal reirradiation, and twelve patients were treated at multiple targets simultaneously. A pretreatment MV-CT scan was performed in 98.2% of the 3,026 fractions applied. After matching with the kilovoltage planning CT, corrections for translations and rotation around longitudinal axis (roll) were done. Results: mean time on table was 24

  14. The patient experience of intensive care

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Bergbom, Ingegerd; Lindahl, Berit

    2015-01-01

    : Nordic intensive care units. PARTICIPANTS: Patients in Nordic intensive care units. METHODS: We performed a literature search of qualitative studies of the patient experience of intensive care based on Nordic publications in 2000-2013. We searched the following databases: PubMed, CINAHL, Scopus, and Psyc...

  15. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review.

    Science.gov (United States)

    Snowdon, David A; Leggat, Sandra G; Taylor, Nicholas F

    2017-11-28

    To ensure quality of care delivery clinical supervision has been implemented in health services. While clinical supervision of health professionals has been shown to improve patient safety, its effect on other dimensions of quality of care is unknown. The purpose of this systematic review is to determine whether clinical supervision of health professionals improves effectiveness of care and patient experience. Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of each study was rated using the Medical Education Research Study Quality Instrument. Data were extracted on effectiveness of care (process of care and patient health outcomes) and patient experience. Seventeen studies across multiple health professions (medical (n = 4), nursing (n = 7), allied health (n = 2) and combination of nursing, medical and/or allied health (n = 4)) met the inclusion criteria. The clinical heterogeneity of the included studies precluded meta-analysis. Twelve of 14 studies investigating 38,483 episodes of care found that clinical supervision improved the process of care. This effect was most predominant in cardiopulmonary resuscitation and African health settings. Three of six studies investigating 1756 patients found that clinical supervision improved patient health outcomes, namely neurological recovery post cardiopulmonary resuscitation (n = 1) and psychological symptom severity (n = 2). None of three studies investigating 1856 patients found that clinical supervision had an effect on patient experience. Clinical supervision of health professionals is associated with effectiveness of care. The review found significant improvement in the process of care that may improve compliance with processes that are associated with enhanced patient health

  16. Factors affecting experiences of intensive care patients in Turkey: patient outcomes in critical care setting.

    Science.gov (United States)

    Demir, Yurdanur; Korhan, Esra Akin; Eser, Ismet; Khorshid, Leyla

    2013-07-01

    To determine the factors affecting a patient's intensive care experience. The descriptive study was conducted at an intensive care unit in the Aegean Region of Turkey, and comprised 158 patients who spent at least 48 hours at the unit between June and November 2009. A questionnaire form and the Intensive Care Experience Scale were used as data collection tools. SPSS 11.5 was used for statistical analysis of the data. Of the total, 86 (54.4%) patients related to the surgical unit, while 72 (45.5%) spent time at the intensive care unit. Most of the subjects (n=113; 71.5%) reported that they constantly experienced pain during hospitalisation. Patients receiving mechanical ventilation support and patients reporting no pain had significantly higher scores on the intensive care experience scale. Patients who reported pain remembered their experiences less than those having no pain. Interventions are needed to make the experiences of patients in intensive care more positive.

  17. High-dose erythropoietin in patients with progressive multiple sclerosis

    DEFF Research Database (Denmark)

    Schreiber, Karen; Magyari, Melinda; Sellebjerg, Finn

    2017-01-01

    BACKGROUND: Erythropoietin (EPO) is a part of an endogenous neuroprotective system in the brain and may address pathophysiological mechanisms in progressive multiple sclerosis (MS). OBJECTIVE: To evaluate a treatment effect of EPO on progressive MS. METHODS: This was a single-center, randomized......, double-blind, placebo-controlled phase 2 trial, in which 52 patients with secondary or primary progressive MS were allocated to treatment with recombinant EPO (48,000 IU) or placebo, administered intravenously 17 times during 24 weeks. Patients had an Expanded Disability Status Score (EDSS) from 4 to 6......: This study provides class II evidence that treatment with high-dose EPO is not an effective treatment in patients with moderately advanced progressive MS....

  18. Natalizumab treatment for multiple sclerosis: updated recommendations for patient selection and monitoring

    DEFF Research Database (Denmark)

    Kappos, Ludwig; Bates, David; Edan, Gilles

    2011-01-01

    Natalizumab, a highly specific α4-integrin antagonist, is approved for treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). It is generally recommended for individuals who have not responded to a currently available first-line disease-modifying therapy or who have very......, based on additional long-term follow-up of clinical studies and post-marketing observations, including appropriate patient selection and management recommendations.......Natalizumab, a highly specific α4-integrin antagonist, is approved for treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). It is generally recommended for individuals who have not responded to a currently available first-line disease-modifying therapy or who have very...... active disease. The expected benefits of natalizumab treatment have to be weighed against risks, especially the rare but serious adverse event of progressive multifocal leukoencephalopathy. In this Review, we revisit and update previous recommendations on natalizumab for treatment of patients with RRMS...

  19. Intern as Patient: A Patient Experience Simulation to Cultivate Empathy in Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Sara W. Nelson

    2017-12-01

    Full Text Available Introduction Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM interns as a way to teach empathy and conscientious patient care. Methods We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. Results We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience. Conclusion Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents’ actual clinical care is warranted.

  20. Spontaneous acute subdural hematoma in a patient with multiple myeloma

    Directory of Open Access Journals (Sweden)

    Abrar Ahad Wani

    2012-01-01

    Full Text Available Acute spontaneous subdural hematoma in a patient of multiple myeloma receiving chemotherapy is an unknown event, needing an urgent neurosurgical management. We report this patient who presented with progressive neurological deterioration and a low platelet count. She was successfully managed by craniotomy and evacuation of subdural hematoma with intraoperative transfusion of platelets. The acute spontaneous subdural hematoma in her was probably related to the bleeding diathesis due to thrombocytopenia associated with chemotherapy.

  1. Reactivation of BK polyomavirus in patients with multiple sclerosis receiving natalizumab therapy.

    LENUS (Irish Health Repository)

    Lonergan, Roisin M

    2012-02-01

    Natalizumab therapy in multiple sclerosis has been associated with JC polyomavirus-induced progressive multifocal leucoencephalopathy. We hypothesized that natalizumab may also lead to reactivation of BK, a related human polyomavirus capable of causing morbidity in immunosuppressed groups. Patients with relapsing remitting multiple sclerosis treated with natalizumab were prospectively monitored for reactivation of BK virus in blood and urine samples, and for evidence of associated renal dysfunction. In this cohort, JC and BK DNA in blood and urine; cytomegalovirus (CMV) DNA in blood and urine; CD4 and CD8 T-lymphocyte counts and ratios in peripheral blood; and renal function were monitored at regular intervals. BK subtyping and noncoding control region sequencing was performed on samples demonstrating reactivation. Prior to commencement of natalizumab therapy, 3 of 36 patients with multiple sclerosis (8.3%) had BK viruria and BK reactivation occurred in 12 of 54 patients (22.2%). BK viruria was transient in 7, continuous in 2 patients, and persistent viruria was associated with transient viremia. Concomitant JC and CMV viral loads were undetectable. CD4:CD8 ratios fluctuated, but absolute CD4 counts did not fall below normal limits. In four of seven patients with BK virus reactivation, transient reductions in CD4 counts were observed at onset of BK viruria: these resolved in three of four patients on resuppression of BK replication. No renal dysfunction was observed in the cohort. BK virus reactivation can occur during natalizumab therapy; however, the significance in the absence of renal dysfunction is unclear. We propose regular monitoring for BK reactivation or at least for evidence of renal dysfunction in patients receiving natalizumab.

  2. Palliative radiotherapy for multiple myeloma

    International Nuclear Information System (INIS)

    Furusawa, Mitsuhiro; Baba, Yuji; Murakami, Ryuji; Yokoyama, Toshimi; Nishimura, Ryuichi; Uozumi, Hideaki; Takada, Chitose; Takahashi, Mutsumasa

    1995-01-01

    This study reviews the experience of palliative radiotherapy to patients with multiple myeloma to define the optimal dose for pain relief. The records of 31 patients (66 sites) with multiple myeloma irradiated for palliation at Kumamoto University hospital between 1985 and 1994 were reviewed. Total dose ranged from 8 to 50 Gy, with a mean of 32.2 Gy. Symptoms included pain (78.1%), neurological abnormalities (28.1%), and palpable masses (34.3%). Symptomatic remission was obtained in 45 of 46 evaluable sites (97.8%). Complete remission of symptoms were obtained in 28.3%, and partial remission in 69.6%. According to fraction size, there was no significant difference between 3-5 Gy and 1.8-2 Gy. The incidence of complete remission increased when a total dose of more than 20 Gy was given. When the quality of life is considered, hypofractionation was recommended for the palliative radiation therapy of multiple myeloma. (author)

  3. The risk of venous thromboembolism in patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Peeters, P J H L; Bazelier, M T; Uitdehaag, B M J

    2014-01-01

    BACKGROUND: In patients with multiple sclerosis (MS), disability and autoinflammatory processes may result in an increased risk of venous thromboembolism (VTE) OBJECTIVE: To evaluate the risk of VTE associated with MS. METHODS: We conducted an observational-cohort study within the Clinical Practice...

  4. [Multiple sclerosis management system 3D. Moving from documentation towards management of patients].

    Science.gov (United States)

    Schultheiss, T; Kempcke, R; Kratzsch, F; Eulitz, M; Pette, M; Reichmann, H; Ziemssen, T

    2012-04-01

    The increasing therapeutic options for relapsing-remitting multiple sclerosis require a specific treatment and risk management to recognize the individual response as well as potential side effects. To switch from pure MS documentation to MS management by implementing a new multiple sclerosis management and documentation tool may be of importance. This article presents the novel computer-based patient management system "multiple sclerosis management system 3D" (MSDS 3D). MSDS 3D allows documentation and visualization of visit schedules and mandatory examinations via defined study modules by integration of data input from patients, attending physicians and MS nurses. It provides forms for the documentation of patient visits as well as clinical and diagnostic findings. Information is collected via interactive touch screens. A specific module which is part of MSDS 3D's current version allows the monthly monitoring of patients under treatment with natalizumab. A checklist covering clinical signs of progressive multifocal leukoencephalopathy (PML) and a detailed questionnaire about the handling of natalizumab in practice have additionally been added. The MS patient management system MSDS 3D has successfully been implemented and is currently being evaluated in a multi-centre setting. Advanced assessment of patient data may allow improvements in clinical practice and research work. The addition of a checklist and a questionnaire into the natalizumab module may support the recognition of PML during its early, treatable course.

  5. The expression of p53 protein in patients with multiple myeloma

    Directory of Open Access Journals (Sweden)

    Marković Olivera

    2007-01-01

    Full Text Available Introduction: Although mutations of p53 are one of the most often acquired genetic changes in malignant tumors, these mutations are rare events in patients with newly diagnosed multiple myeloma (MM. Moreover, there are a few literature data about clinical significance of p53 overexpression in multiple myeloma. Objective The aim of our study was to evaluate the clinical significance of p53 immunoexpression in multiple myeloma. Method A total of 58 patients with newly diagnosed MM (26 females and 32 males, mean age 62 years were enrolled in the study. The diagnosis of MM was made according to criteria of Chronic Leukemia-Myeloma Task Force. Clinical staging was done according to Durie and Salmon classification (4 patients had disease stage I, 15 patients stage II and 39 patients stage III. The histological grade and histological stage were determined according to predominant plasma cell morphology and volume of myeloma infiltration, respectively. Standard immunohistochemical analysis with p53 antibody in B5-fixed and paraffin- embedded bone marrow specimens was used to evaluate the expression of p53 in myeloma cells. The specimens were considered positive when ≥5% of plasma cells exhibited clear nuclear positivity. Results Out of 58 patients, p53 expression was detected in 9 (15.52%. No significant correlation was found between p53 expression and clinical stage (I+II vs. III, Я2-microglobulin level (≤6 mg/L vs. >6mg/L, histological grade (I vs. II+III, histological stage (<20% vs. 21-50% vs. >50% and the extent of osteolytic lesions (≤3 vs. >3 lesions. Median survival of patients with p53 immunoreactivity in =>5% of plasma cells was 10 months, whilst median survival of patients with p53 immunoreactivity in <5% of plasma cells was 36 months. However, such difference was not significant (p=0.2. Conclusion The frequency of p53 immunoexpression in our group of newly diagnosed MM was relatively low. Although p53 immunoexpression was not

  6. How general practitioners perceive and assess self-care in patients with multiple chronic conditions

    DEFF Research Database (Denmark)

    Kristensen, Mads Aage Toft; Hølge-Hazelton, Bibi; Waldorff, Frans Boch

    2017-01-01

    Background: It is not known how general practitioners (GPs) perceive the concept of self-care and how they assess self-care ability in patients with multiple chronic conditions. As a part of the strategy to improve the care of people living with chronic conditions, disease management programs...... in Denmark require GPs and other health care workers to assess and support patients' self-care ability. The aim of the present study was to explore GPs' perceptions and assessment of self-care ability in patients with multiple chronic conditions who have difficulty following a given treatment. Methods...

  7. Patient Experience: The New Heart of Healthcare Leadership.

    Science.gov (United States)

    Wolf, Jason A

    2017-01-01

    In a healthcare world in which consumerism is no longer a question and value has claimed its place at center stage, leaders are called to think differently about how they operate and manage their organizations. Priorities are curving in new directions with shifts in policy, direction of dollars, and evolution of practice. At the center of this transition is an opportunity for healthcare leaders to recognize that patient experience is the new heart of healthcare leadership.To address quality, safety, service, cost, and population health outcomes, leaders must rethink how they understand and engage in experience efforts overall. An intentional and clear strategic line of sight and purpose are required, including how patient experience is defined, the core concepts it comprises and is influenced by, and the outcomes it ultimately helps achieve. The challenge for leaders is to reconceive how this maximum potential can be achieved as compared with how experience has been traditionally managed through tactical efforts.Quick lists of effective tactics are relatively easy to come by, and leaders are already aware of many, if not most, of them. So why do so many organizations applying these tactics today struggle to maintain the results they seek? The reason is that tactics are only as useful as the framework in which they are applied and as robust as the foundation on which they are implemented. The intent of this article is to stir a dialogue on how to reframe the issue of patient experience.In reframing a collective view about what patient experience is, the way leaders choose to address it must change. This adjustment requires balancing the work of defining patient experience with the strategic intent behind what organizations ultimately aim to achieve. In changing the conversation on patient experience, we move it from an idea that lurks at the edges of healthcare, or that stands as just one of many strategic pillars, to the central call to action for healthcare

  8. What is known about the patient's experience of medical tourism? A scoping review

    Science.gov (United States)

    2010-01-01

    Background Medical tourism is understood as travel abroad with the intention of obtaining non-emergency medical services. This practice is the subject of increasing interest, but little is known about its scope. Methods A comprehensive scoping review of published academic articles, media sources, and grey literature reports was performed to answer the question: what is known about the patient's experience of medical tourism? The review was accomplished in three steps: (1) identifying the question and relevant literature; (2) selecting the literature; (3) charting, collating, and summarizing the information. Overall themes were identified from this process. Results 291 sources were identified for review from the databases searched, the majority of which were media pieces (n = 176). A further 57 sources were included for review after hand searching reference lists. Of the 348 sources that were gathered, 216 were ultimately included in this scoping review. Only a small minority of sources reported on empirical studies that involved the collection of primary data (n = 5). The four themes identified via the review were: (1) decision-making (e.g., push and pull factors that operate to shape patients' decisions); (2) motivations (e.g., procedure-, cost-, and travel-based factors motivating patients to seek care abroad); (3) risks (e.g., health and travel risks); and (4) first-hand accounts (e.g., patients' experiential accounts of having gone abroad for medical care). These themes represent the most discussed issues about the patient's experience of medical tourism in the English-language academic, media, and grey literatures. Conclusions This review demonstrates the need for additional research on numerous issues, including: (1) understanding how multiple information sources are consulted and evaluated by patients before deciding upon medical tourism; (2) examining how patients understand the risks of care abroad; (3) gathering patients' prospective and retrospective

  9. Patient experience with mupirocin or povidone-iodine nasal decolonization.

    Science.gov (United States)

    Maslow, Jed; Hutzler, Lorraine; Cuff, Germaine; Rosenberg, Andrew; Phillips, Michael; Bosco, Joseph

    2014-06-01

    Led by the federal government, the payers of health care are enacting policies designed to base provider reimbursement on the quality of care they render. This study evaluated and compared patient experiences and satisfaction with nasal decolonization with either nasal povidone-iodine (PI) or nasal mupirocin ointment (MO). A total of 1903 patients were randomized to undergo preoperative nasal decolonization with either nasal MO or PI solution. All randomized patients were also given 2% chlorhexidine gluconate topical wipes. Patients were interviewed prior to discharge to assess adverse events and patient experience with their assigned preoperative antiseptic protocol. Of the 1903 randomized patients, 1679 (88.1%) were interviewed prior to discharge. Of patients receiving PI, 3.4% reported an unpleasant or very unpleasant experience, compared with 38.8% of those using nasal MO (P.05). Being recruited as an active participant in surgical site infection prevention was a positive experience for 87.2% of MO patients and 86.3% of PI patients (P=.652). Those assigned to receive PI solution preoperatively reported significantly fewer adverse events than the nasal MO group (P<.01). Preoperative nasal decolonization with either nasal PI or MO was considered somewhat or very helpful by more than two-thirds of patients. Copyright 2014, SLACK Incorporated.

  10. Microbiology of Peritonitis in Peritoneal Dialysis Patients with Multiple Episodes

    Science.gov (United States)

    Nessim, Sharon J.; Nisenbaum, Rosane; Bargman, Joanne M.; Jassal, Sarbjit V.

    2012-01-01

    ♦ Background: Peritoneal dialysis (PD)–associated peritonitis clusters within patients. Patient factors contribute to peritonitis risk, but there is also entrapment of organisms within the biofilm that forms on PD catheters. It is hypothesized that this biofilm may prevent complete eradication of organisms, predisposing to multiple infections with the same organism. ♦ Methods: Using data collected in the Canadian multicenter Baxter POET (Peritonitis, Organism, Exit sites, Tunnel infections) database from 1996 to 2005, we studied incident PD patients with 2 or more peritonitis episodes. We determined the proportion of patients with 2 or more episodes caused by the same organism. In addition, using a multivariate logistic regression model, we tested whether prior peritonitis with a given organism predicted the occurrence of a subsequent episode with the same organism. ♦ Results: During their time on PD, 558 patients experienced 2 or more peritonitis episodes. Of those 558 patients, 181 (32%) had at least 2 episodes with the same organism. The organism most commonly causing repeat infection was coagulase-negative Staphylococcus (CNS), accounting for 65.7% of cases. Compared with peritonitis caused by other organisms, a first CNS peritonitis episode was associated with an increased risk of subsequent CNS peritonitis within 1 year (odds ratio: 2.1; 95% confidence interval: 1.5 to 2.8; p peritonitis, 48% of repeat episodes occurred within 6 months of the earlier episode. ♦ Conclusions: In contrast to previous data, we did not find a high proportion of patients with multiple peritonitis episodes caused by the same organism. Coagulase-negative Staphylococcus was the organism most likely to cause peritonitis more than once in a given patient, and a prior CNS peritonitis was associated with an increased risk of CNS peritonitis within the subsequent year. PMID:22215659

  11. Phonological Fluency Strategy of Switching Differentiates Relapsing-Remitting and Secondary Progressive Multiple Sclerosis Patients

    OpenAIRE

    Messinis, L.; Kosmidis, M. H.; Vlahou, C.; Malegiannaki, A. C.; Gatzounis, G.; Dimisianos, N.; Karra, A.; Kiosseoglou, G.; Gourzis, P.; Papathanasopoulos, P.

    2013-01-01

    The strategies used to perform a verbal fluency task appear to be reflective of cognitive abilities necessary for successful daily functioning. In the present study, we explored potential differences in verbal fluency strategies (switching and clustering) used to maximize word production by patients with relapsing-remitting multiple sclerosis (RRMS) versus patients with secondary progressive multiple sclerosis (SPMS). We further assessed impairment rates and potential differences in the sensi...

  12. Life Experience of Patients With Unilateral Vocal Fold Paralysis.

    Science.gov (United States)

    Francis, David O; Sherman, Ariel E; Hovis, Kristen L; Bonnet, Kemberlee; Schlundt, David; Garrett, C Gaelyn; Davies, Louise

    2018-05-01

    Clinicians and patients benefit when they have a clear understanding of how medical conditions influence patients' life experiences. Patients' perspectives on life with unilateral vocal fold paralysis have not been well described. To promote patient-centered care by characterizing the patient experiences of living with unilateral vocal fold paralysis. This study used mixed methods: surveys using the voice and dysphagia handicap indexes (VHI and DHI) and semistructured interviews with adults with unilateral vocal cord paralysis recruited from a tertiary voice center. Recorded interviews were transcribed, coded using a hierarchical coding system, and analyzed using an iterative inductive-deductive approach. Symptom domains of the patient experience. In 36 patients (26 [72%] were female, and the median age and interquartile range [IQR] were 63 years [48-68 years]; median interview duration, 42 minutes), median VHI and DHI scores were 96 (IQR, 77-108) and 55.5 (IQR, 35-89) at the time of interviews, respectively. Frustration, isolation, fear, and altered self-identity were primary themes permeating patients' experiences. Frustrations related to limitations in communication, employment, and the medical system. Sources of fear included a loss of control, fear of further dysfunction or permanent disability, concern for health consequences (eg, aspiration pneumonia), and/or an inability to call for help in emergency situations. These experiences were modified by the following factors: resilience, self-efficacy, perceived sense of control, and social support systems. Effects of unilateral vocal fold paralysis extend beyond impaired voice and other somatic symptoms. Awareness of the extent to which these patients experience frustration, isolation, fear, and altered self-identity is important. A patient-centered approach to optimizing unilateral vocal fold paralysis treatment is enhanced by an understanding of both the physical dimension of this condition and how patients

  13. Genome-Wide Screening of Cytogenetic Abnormalities in Multiple Myeloma Patients Using Array-CGH Technique: A Czech Multicenter Experience

    Directory of Open Access Journals (Sweden)

    Jan Smetana

    2014-01-01

    Full Text Available Characteristic recurrent copy number aberrations (CNAs play a key role in multiple myeloma (MM pathogenesis and have important prognostic significance for MM patients. Array-based comparative genomic hybridization (aCGH provides a powerful tool for genome-wide classification of CNAs and thus should be implemented into MM routine diagnostics. We demonstrate the possibility of effective utilization of oligonucleotide-based aCGH in 91 MM patients. Chromosomal aberrations associated with effect on the prognosis of MM were initially evaluated by I-FISH and were found in 93.4% (85/91. Incidence of hyperdiploidy was 49.5% (45/91; del(13(q14 was detected in 57.1% (52/91; gain(1(q21 occurred in 58.2% (53/91; del(17(p13 was observed in 15.4% (14/91; and t(4;14(p16;q32 was found in 18.6% (16/86. Genome-wide screening using Agilent 44K aCGH microarrays revealed copy number alterations in 100% (91/91. Most common deletions were found at 13q (58.9%, 1p (39.6%, and 8p (31.1%, whereas gain of whole 1q was the most often duplicated region (50.6%. Furthermore, frequent homozygous deletions of genes playing important role in myeloma biology such as TRAF3, BIRC1/BIRC2, RB1, or CDKN2C were observed. Taken together, we demonstrated the utilization of aCGH technique in clinical diagnostics as powerful tool for identification of unbalanced genomic abnormalities with prognostic significance for MM patients.

  14. CHANGES IN TUMOR NECROSIS FACTOR ALFA DURING TREATMENT OF PATIENTS WITH MULTIPLE SCLEROSIS BY TRANSIMMUNIZATION METHOD

    Directory of Open Access Journals (Sweden)

    A. V. Kil'dyushevskiy

    2016-01-01

    Full Text Available Background: Despite the availability of a  large number of treatments for multiple sclerosis with various targets, these treatments are not always effective. According to the literature, experimental studies have shown a  significant decrease in tumor necrosis factor alfa (TNF-α with the use of extracorporeal photochemotherapy. Aim: To assess changes in TNF-α in patients with multiple sclerosis during treatment with transimmunization. Materials and methods: The study recruited 13 adult patients with multiple sclerosis. Serum TNF-α was measured by immunochemiluminescence analysis (IMMULITE 1000, Siemens. The patients were treated by transimmunization, i.e. a  modified photopheresis. Two hours before the procedure, Ammifurin (8-methoxypsoralene was administered to all the patients, then their mononuclear cells were isolated under PBSC protocol with Haemonetics MCS+ cell separator. Thereafter, mononuclear cells were irradiated with ultraviolet for 90  minutes and incubated for 20 hours at 37 °С. The next day the cells were re-infused to the patients. The procedure was performed 2  times per week for 6  months, then once per 4  months. Results: Before transimmunization, mean TNF-α level in adult patients with multiple sclerosis was 9.958±0.812  pg/mL (normal, below 8.1 pg/mL. After transimmunization, its level was 6.992±0.367  pg/mL (р<0.05. Conclusion: Ultraviolet irradiation of peripheral blood monocytes with their subsequent incubation (transimmunization led to a 30% decrease of serum TNF-α in patients with multiple sclerosis. This indicates a suppressive effect of transimmunization on TNF-α. Hence, in patients with multiple sclerosis transimmunization exerts an anti-inflammatory effect.

  15. The subjective experience of patients who received electroconvulsive therapy.

    Science.gov (United States)

    Koopowitz, Leslie Frank; Chur-Hansen, Anna; Reid, Sally; Blashki, Miriam

    2003-02-01

    Despite the vast amount of scientific literature available on electroconvulsive therapy (ECT), there is little qualitative focus upon the patients' subjective experience of this procedure. Using an exploratory descriptive methodology, this study aims to provide a more unique insight into what certain patients actually think of ECT. Semistructured interviews were conducted to explore eight patients' opinions and experiences of ECT. Interviews were subjected to analysis by a five-step framework approach that identified prominent themes in relation to five broad questions and in conjunction with issues raised by the subjects themselves. Eleven major themes were identified. Four of these were chosen for discussion, not only as the most prevalent themes (in terms of how frequently they were mentioned by the subjects), but also as the most striking (in regards to the intensity of emotions evoked, or their influence on their perception of ECT as a future treatment option). The four themes are fear of ECT, attribution of cognitive decline and memory loss to ECT, positive ECT experiences, and patients' suggestions. Using such a qualitative approach, the depth of the information obtained has revealed new perspectives on how patients perceive the experience of ECT. Fears reported by patients present an opportunity to address specific areas of the procedure that generate the most angst. These were closely associated with recommendations that many patients proposed throughout the interviews. Patients' perceptions of the cognitive effects of ECT do not necessarily correspond with those commonly reported in the literature on ECT. Positive experiences with ECT were more complex than simply its efficacy. There is a need for future research in order to explore and address patients' experiences of ECT.

  16. Multiple arterial grafts in coronary artery bypass grafting, Sohag University Hospital's initial experience

    Directory of Open Access Journals (Sweden)

    A.A.A. Elsayed

    2017-12-01

    Conclusions: Using multiple arterial grafts did not add a significant risk or time to the classic CABG. With accumulating evidence about better patency rate in arterial grafts, MAR is recommended especially in younger patients undergoing CABG.

  17. Healthcare resource use and costs associated with chronic kidney disease in US private insurance patients with multiple myeloma.

    Science.gov (United States)

    Bhowmik, Debajyoti; Song, Xue; Intorcia, Michele; Kent, Shia T; Shi, Nianwen

    2018-01-01

    Objectives Within a median 1.2 years after patients have an initial diagnosis with multiple myeloma, up to 61% were diagnosed with renal impairment and 50% were diagnosed with chronic kidney disease. This study estimated economic burden associated with chronic kidney disease in multiple myeloma patients in the US. Methods In this retrospective cohort study, patients ≥18 years old with ≥1 inpatient or ≥ 2 outpatient multiple myeloma diagnoses between 1 January 2008 and 31 March 2015 were identified from MarketScan® Commercial and Medicare Supplemental Databases. Chronic kidney disease patients had ≥1 diagnosis of chronic kidney disease Stages 1-5 (first chronic kidney disease diagnosis date = index date) on or after the first multiple myeloma diagnosis, and were propensity score matched 1:1 to multiple myeloma patients without chronic kidney disease, end-stage renal disease, dialysis, or other type of chronically impaired renal function. All patients had ≥six-month continuous enrollment prior to index date and were followed for ≥one month from index date until the earliest of inpatient death, end of continuous enrollment, or end of the study period (30 September 2015). The per-patient per-year healthcare resource utilization and costs were measured during follow-up. Costs were total reimbursed amount in 2016 US dollars. Results A total of 2541 multiple myeloma patients with chronic kidney disease stages 1-5 and 2541 matched controls met the study criteria and were respectively 69.3 and 69.6 years, 54.5% and 55.3% men, and had 572.2 and 533.4 mean days of follow up. Compared to controls, chronic kidney disease patients had significantly (all P chronic kidney disease, end-stage renal disease, or dialysis had $78,455 ( P chronic kidney disease in patients with multiple myeloma was estimated to be between $34,754 and $78,455 per-patient per-year. Given its substantial clinical and economic impact, preservation of renal function is important in

  18. A Strategic Framework for Improving the Patient Experience in Hospitals.

    Science.gov (United States)

    Birkelien, Natalie L

    Hospitals are taking new approaches to satisfy consumers and deliver on customer expectations by enhancing their patients' comprehensive experience. The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey and value-based purchasing initiatives have tied reimbursement to patient satisfaction scores, bringing patient perspectives on care to the forefront of hospitals' strategic priorities. This essay reviews the patient experience literature and argues that hospitals should adopt an expanded approach beyond HCAHPS measures to enhance the patient experience. Such an approach allows providers to deliver quality outcomes that satisfy patients' wants and needs.

  19. Patients' experiences of coping with Idiopathic Pulmonary Fibrosis and their recommendations for its clinical management.

    Science.gov (United States)

    Senanayake, Sameera; Harrison, Kim; Lewis, Michael; McNarry, Melitta; Hudson, Joanne

    2018-01-01

    Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive and life-limiting condition. From a healthcare perspective it is vital to establish effective methods of improving the quality of remaining life in these patients. This requires a detailed understanding of the multiple impacts of an IPF diagnosis on the individual. We sought to understand how patients coped with their initial diagnosis, how they live with the disease day-to-day, and their experiences and opinions of the professional support they receive. A patient-centred approach was used to explore the social, psychological and physical impacts of IPF. Semi-structured interviews were conducted by an experienced academic. Interview questions were written by the researchers but guided by informal conversations with patients and clinicians. An inductive thematic approach was used to analyse the data, allowing us to identify common themes in the patients' experiences. Of fifty invited participants, ten took part in the study (aged 53-81 years; 9 male). Inductive analysis of interviews identified seven second-order themes and eleven first-order themes, represented by two General Dimensions: 'Patient experience with the condition' and 'Patient-led recommendations for practice'. The key message on 'coping' in these patients was that acceptance of their condition led to a sense of optimism. Participants reported using appraisal-focused coping strategies to change their perspectives (thinking positively) and emotion-focused strategies to overcome depression (the main opportunity for emotional expression being an IPF support group). The support group also facilitated problem-focused coping: individuals exchanged knowledge and experience and gave one another tips on how to live with their condition. Health professionals should provide patients with information that focuses on living with IPF, encouraging them to make lifestyle changes and adaptations to improve quality of life. Family members should receive

  20. Clinical utility and patient consideration in the use of lenalidomide for multiple myeloma in Chinese patients

    Directory of Open Access Journals (Sweden)

    Wang J

    2015-06-01

    Full Text Available Jing Wang, Hongfeng Guo, Xin Zhou Department of Hematology, Wuxi People’s Hospital, Nanjing Medical University, Wuxi, People’s Republic of China Abstract: Multiple myeloma (MM is an incurable hematologic malignancy caused by the autonomous growth of malignant plasma cells. In the last decade, the introduction of novel targeted agents such as thalidomide, bortezomib, and lenalidomide has dramatically improved the clinical outcome of MM patients in both the frontline and recurrent settings. Lenalidomide is a synthetic derivative of thalidomide, which has been shown to significantly improve overall survival, time to progression, and overall response rates in patients with MM. The China Food and Drug Administration approved the use of lenalidomide in patients with MM in 2013. In a Phase II trial, lenalidomide plus low-dose dexamethasone was associated with a high response rate and acceptable safety profile in heavily pretreated Chinese patients with relapsed/refractory MM, including those with renal impairment and IgD subtype. However, lenalidomide will remain as a second-line antimyeloma drug in the near future because of its high price and the policy of health insurance reimbursement in People’s Republic of China. In this review, we summarize the clinical utility and patient considerations in the use of lenalidomide for MM in Chinese patients. Further studies with larger sample sizes are required to investigate the better quality, longer duration, and more clinically meaningful outcomes of lenalidomide in the treatment of MM in Chinese patients. Keywords: lenalidomide, multiple myeloma, clinical efficacy, Chinese patients

  1. [Operating Room Nurses' Experiences of Securing for Patient Safety].

    Science.gov (United States)

    Park, Kwang Ok; Kim, Jong Kyung; Kim, Myoung Sook

    2015-10-01

    This study was done to evaluate the experience of securing patient safety in hospital operating rooms. Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

  2. Oxidative Stress is Increased in Serum from Mexican Patients with Relapsing-Remitting Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Genaro Gabriel Ortiz

    2009-01-01

    Full Text Available Objective: To determine the oxidative stress markers in serum from patients with relapsing-remitting multiple sclerosis. Methods: Blood samples from healthy controls and 22 patients 15 women (7 aged from 20 to 30 and 8 were > 40 years old and 7 men (5 aged from 20 to 30 and 2 were > 40 years old fulfilling the McDonald Criteria and classified as having Relapsing-Remitting Multiple Sclerosis accordingly with Lublin were collected for oxidative stress markers quantification. Results: Nitric oxide metabolites (nitrates/nitrites, lipid peroxidation products (malondialdehyde plus 4-hidroxialkenals, and glutathione peroxidase activity were significantly increased in serum of subjects with relapsing-remitting multiple sclerosis in comparison with that of healthy controls. These data support the hypothesis that multiple sclerosis is a component closely linked to oxidative stress.

  3. SIMULTANEOUS DISC HERNIATION IN PATIENTS WITH MULTIPLE SCLEROSIS

    Directory of Open Access Journals (Sweden)

    Kalina V. Drenska

    2013-04-01

    Full Text Available Background: Multiple sclerosis (MS is a chronic autoimmune, inflammatory demyelinating disease of the central nervous system. Commonly, MS patients present with accompanying degenerative vertebral disc diseases. Simultaneous disc herniations situated in the cervical or lumbosacral spine can mimic the clinical symptoms of MS and worsen patients’ quality of life.Objective: to investigate the incidence rate and clinical impact of accompanying disc herniations in patients with MS.Material and methods: Our study covered 330 patients (220 females and 110 males, mean age 40.5±12.4 years with clinically definite MS, according to McDonald’s criteria. Comprehensive neurological examinations, EDSS (Expanded Disability Status Scale assessments, and MRI neuroimaging were carried out. Statistical data processing was performed by using the method of variation analysis.Results: Relapsing-remitting MS (RRMS was diagnosed in 280 patients while 50 patients presented with secondary progressive MS (SPMS. Disc herniation was found in 64 (19.4% of our patients. Cervical disc pathology was detected in 38 patients (11.5% of the cases and lumbosacral - in 26 (7.9% of the cases. EDSS scores ranged from 2.5 to 5.5. EDSS evaluation showed statistically significantly worse scores in MS patients with disc herniation comorbidity (p<0, 05.Conclusion: Our own data confirm the assumption that MS patients often present with accompanying degenerative disc pathology. We suggest that comorbidity of disc herniation and MS exert an additional unfavorable effect on patient’s disability and individual quality of life.

  4. Morganella morganii Pericarditis in a Patient with Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Takafumi Nakao

    2013-01-01

    Full Text Available Purulent pericarditis caused by Morganella morganii is extremely rare. We report herein a case of a 61-year-old man who presented with chest pain and dyspnea fourteen days after chemotherapy for multiple myeloma. Echocardiogram and computed tomography revealed a massive pericardial effusion and associated cardiac tamponade. Pericardiocentesis was performed. Pericardial fluid was found to be purulent, and Morganella morganii was isolated from the fluid. The patient was successfully treated with antibiotic therapy and surgical drainage of the fluid. Morganella morganii should be considered a possible pathogen when immunocompromised patients develop purulent pericarditis.

  5. Multiple primary tumors in patients with uterine cancer

    International Nuclear Information System (INIS)

    Velikova, N.; Parvanova, V.; Dimitrova, N.

    2013-01-01

    Full text: Introduction: The aging population and improved medical care lead to increased likelihood for patients experienced a tumor to develop at least one more in the course of his life. The aim of the study was to analyze the clinical and biological characteristics and survival of patients with primary tumor multiplicity in which a tumor is cancer of the uterine body. Materials and Methods: For the period 1997-2007, in the department of radiotherapy were treated 191 women with carcinoma of the uterine body (in a group of moderate and high risk) with invasion of the myometrium more than one third. Patients ranged in age from 36 to 77 (average age 59.9) and were followed until 31.03.2013 with an average follow-up period 126 months. Postoperatively, all were carried intravaginal brachytherapy with high dose rate 3x5 Gy once a week, followed by percutaneous radiotherapy 22x2 Gy daily to the area of the pelvic lymph nodes. Data to diagnose combined tumors were obtained from the National Cancer Registry. Survival analysis was made by the method of Kaplan - Meier with Lograng test. Results: In 26 (13.6 %) of the analyzed patients a tumor multiplicity is find in 22 (84,6%) tumors are two in 3 (11.5 %)- three , and in 1 (3.8%) - four . A detailed analysis of 14 (53.8%) patients whose cancer of the uterine body is the first tumor and is followed by another. The distribution of the tumor according to the second location is: breast cancer 5 (35.7%) skin malignant melanoma without 4 (28.5%) of the column 3 (21.4 %) of stomach 1 (7.1%) , MALT lymphoma, 1 (7.1% ) . Evaluate and compare the 5 - and 10-year overall survival of patients whose cancer of the uterine body only, and those who are diagnosed with a malignant tumor following - in those without a second tumor is 85.3% and 81.4 %, and in the presence of such a - 78, 6% and 69.3% respectively. Conclusion: The matched tumors are the most common among the so-called hormone dependent cancers such as breast cancer, uterine

  6. Dynamic activity of NF-κB in multiple trauma patients and protective effects of ulinastain

    Directory of Open Access Journals (Sweden)

    LI Jun

    2012-02-01

    Full Text Available 【Abstract】Objective: To investigate the dynamic activity of NF-κB at the early stage of injury in multiple trauma patients and the protective effects of ulinastain. Methods: From January 2008 to May 2010, patients with multiple traumas admitted to our emergency department were enrolled in this study. Their age varied from 20-55 years. All enrolled patients were assigned randomly into control group (26 cases of multiple injury without ulinastain treatment, ulinastain group (25 cases of multiple injury with ulinastain treatment, and mild injury group (20 cases for basic control. The inclusion criteria for mild injury group were AIS-2005≤3, single wound, previously healthy inhospital patients without the history of surgical intervention. In addition to routine treatment, patients in ulinastain group were intravenously injected 200 000 IU of ulinastain dissolved in 100 ml of normal saline within 12 hours after injury and subsequently injected at the interval of every 8 hours for 7 days. NF-κB activity in monocytes and the level of TNF? IL-1, IL? in serum on admission (day 0, day 1, 2, 3, 4, and 7 were measured. Data were compared and analyzed between different groups. Results: NF-κB activity in monocytes and TNF? IL-1 and IL? of these patients reached peak levels at 24 hour after trauma, with gradual decrease to normal at 72 hour after trauma. NF-κB activity and levels of TNF? IL-1 and IL? were lower in ulinastain group than control one, without any significant difference between the two groups. The mean duration for systemic inflammatory response syndrome and multiple organ dysfunction syndrome was 7 d?.1 d and 10 d?.5 d in ulinastain group and control group respectively, and showed a significant difference. Conclusions: NF-κB activity in monocytes and the levels of inflammatory cytokines in multiply injured patients increased transiently at the early stage of trauma. Ulinastain may shorten the duration of systemic inflammatory

  7. Living with uncertainty and hope: A qualitative study exploring parents' experiences of living with childhood multiple sclerosis.

    Science.gov (United States)

    Hinton, Denise; Kirk, Susan

    2017-06-01

    Background There is growing recognition that multiple sclerosis is a possible, albeit uncommon, diagnosis in childhood. However, very little is known about the experiences of families living with childhood multiple sclerosis and this is the first study to explore this in depth. Objective Our objective was to explore the experiences of parents of children with multiple sclerosis. Methods Qualitative in-depth interviews with 31 parents using a grounded theory approach were conducted. Parents were sampled and recruited via health service and voluntary sector organisations in the United Kingdom. Results Parents' accounts of life with childhood multiple sclerosis were dominated by feelings of uncertainty associated with four sources; diagnostic uncertainty, daily uncertainty, interaction uncertainty and future uncertainty. Parents attempted to manage these uncertainties using specific strategies, which could in turn create further uncertainties about their child's illness. However, over time, ongoing uncertainty appeared to give parents hope for their child's future with multiple sclerosis. Conclusion Illness-related uncertainties appear to play a role in generating hope among parents of a child with multiple sclerosis. However, this may lead parents to avoid sources of information and support that threatens their fragile optimism. Professionals need to be sensitive to the role hope plays in supporting parental coping with childhood multiple sclerosis.

  8. Investigating the use of patient involvement and patient experience in quality improvement in Norway

    DEFF Research Database (Denmark)

    Wiig, Siri; Storm, Marianne; Aase, Karina

    2013-01-01

    -fold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve...... the quality of care they provide. METHODS: This multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews and non-participant observation of key meetings and shadowing of staff at the meso and micro levels in two purposively...... in hospitals. The expectations span from systematic collection of patients' and family members' experiences for the purpose of improving service quality through establishing patient-oriented arenas for ongoing collaboration with staff to the support of individual involvement in decision making. However...

  9. Hopelessness, Depression and Life Satisfaction Among The Patients With Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Güler Duru Aşiret

    2014-03-01

    Full Text Available OBJECTIVE: This study was carried out to determine the level of hopelessness, depression, and life satisfaction among patients with multiple sclerosis. METHODS: 65 patients with multiple sclerosis, treated at the neurology clinic of a university hospital, were included in this study. In this descriptive study, a data collection form developed by the researchers, the Beck Depression Scale, and the Beck Hopelessness and Life Satisfaction Scale were used. RESULTS: Almost half (43.1% of the patients exhibited severe depressive symptoms. Patients’ hopelessness and life satisfaction levels were moderate. The scores on depression and life satisfaction scales were correlated negatively. While patients’ traits including female gender, low economic level, difficulties in walking, and fatigue were associated with reduced life satisfaction; variables such as having a child, low economic and education levels, experiencing incontinence, and fatigue were related to a higher level of depressive symptoms. CONCLUSION: The majority of patients were depressed; life satisfaction and hopelessness levels were moderate. Linear regression analysis revealed that education and emotional problems determined 42% of the depression score; and economic level and emotional problems identified 32% of the life satisfaction score

  10. Comparison of Masking Level Difference in Patients with Multiple Sclerosis and Healthy Control Group

    Directory of Open Access Journals (Sweden)

    Soghrat Faghihzadeh

    2012-03-01

    Full Text Available Background and Aim: Multiple sclerosis (MS is a neurological disorder that involves central nervous system. Studies have showed that multiple sclerosis affects behavioral central auditory tests, such as masking release or masking level difference (MLD. The purpose of this study is to compare the masking level difference between multiple sclerosis patients and normal subjects.Methods: This cross sectional and non-interventional study was conducted on 32 multiple sclerosis patients aged between 20-50 years and 32 controls matched for age and gender in Faculty of Rehabilitation, Tehran University of Medical Sciences. masking level difference test was performed on each subject.Results: The mean masking level difference in the two groups was significantly different (p<0.01 however, gender did not prove to play a role in this difference.Conclusion: As part of the multiple sclerosis diagnosis panel, masking level difference test is an efficient modality for evaluation of hearing impairment and monitoring of rehabilitation progress.

  11. [The results of a randomized open multicenter comparative study on the tolerability and safety of gilenya (fingolimod) in patients with remitting multiple sclerosis].

    Science.gov (United States)

    Popova, E V; Boyko, A N; Boyko, O V

    2015-01-01

    At the present time, disease modifying drugs (DMD) for treatment of patients with multiple sclerosis are used to reduce the risk of exacerbations and, consequently, slowing the progression of disability in accordance to treatment standards. However, the application of the first line of this therapy is not always successful. In these situations, patients receive second-line DMD. Fingolimod is one of the second-line drugs in Russia. To gain experience in using fingolimod in routine neurological practice, we have conducted a post-marketing research - GIMN.

  12. Poor sleep quality in patients with multiple sclerosis : gender differences

    NARCIS (Netherlands)

    Vitkova, Marianna; Rosenberger, Jaroslav; Gdovinova, Zuzana; Szilasiova, Jarmila; Mikula, Pavol; Groothoff, Johan W.; Reijneveld, Sijmen A.; van Dijk, Jitse P.

    2016-01-01

    Objectives Most of the psychological and physical factors associated with poor sleep quality in patients with multiple sclerosis (MS) have a different prevalence in women and men, but whether or not these factors contribute differently to sleep quality in women and men with MS remains unclear. The

  13. Experiences of cancer patients in a patient navigation program: a qualitative systematic review.

    Science.gov (United States)

    Tan, Clarice Hwee Hoon; Wilson, Sally; McConigley, Ruth

    2015-03-12

    A patient navigation program is a model of care which entails trained personnel providing individualized and assistive care to adult oncology patients to help the patients overcome barriers. A further aim of the program is to achieve continuity of care as patients experience the complex healthcare system. Patient navigation is a new model of care in many institutions, and as such the experiences of patients in the patient navigation program remains inconclusive. The review seeks to understand the experiences of adult patients in patient navigation programs and how patient navigators impact the challenges patients encounter in the cancer care continuum. Participants of interest were adult cancer patients more than 18 years of age who are receiving or have received cancer care and are in a patient navigation program or had been in a hospital patient navigation program. Types of intervention(s)/phenomena of interest: The phenomenon of interest was the experiences of adult cancer patients who used patient navigation programs in hospital including how patient navigators impact on the challenges patients encounter in the cancer care continuum. Types of studies: This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, action research and exploratory studies. The review includes patient navigation programs within a hospital setting. Types of outcome: The review sought to understand the experiences of patients with cancer in patient navigation programs in the hospital. A three-step search strategy was used. An initial search to identify keywords was undertaken in PubMed and Science Direct followed by an expanded search using all identified keywords and index terms specific to each included database. The reference lists of included papers were then searched for any other relevant studies. Each paper was assessed independently by two reviewers for methodological quality using the Joanna

  14. Designing an Electronic Patient Management System for Multiple Sclerosis: Building a Next Generation Multiple Sclerosis Documentation System.

    Science.gov (United States)

    Kern, Raimar; Haase, Rocco; Eisele, Judith Christina; Thomas, Katja; Ziemssen, Tjalf

    2016-01-08

    Technologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients and their physicians as well as among health care professionals. Today, every part of the treatment process from diagnosis, treatment selection, and application to patient education and long-term care may be enhanced by a quality-assured implementation of health information technology (HIT) that also takes data security standards and concerns into account. In order to increase the level of effectively realized benefits of eHealth services, a user-driven needs assessment should ensure the inclusion of health care professional perspectives into the process of technology development as we did in the development process of the Multiple Sclerosis Documentation System 3D. After analyzing the use of information technology by patients suffering from multiple sclerosis, we focused on the needs of neurological health care professionals and their handling of health information technology. Therefore, we researched the status quo of eHealth adoption in neurological practices and clinics as well as health care professional opinions about potential benefits and requirements of eHealth services in the field of multiple sclerosis. We conducted a paper-and-pencil-based mail survey in 2013 by sending our questionnaire to 600 randomly chosen neurological practices in Germany. The questionnaire consisted of 24 items covering characteristics of participating neurological practices (4 items), the current use of network technology and the Internet in such neurological practices (5 items), physicians' attitudes toward the general and MS-related usefulness of eHealth systems (8 items) and toward the clinical documentation via electronic health records (4 items), and physicians' knowledge about the Multiple Sclerosis Documentation System (3 items). From 600 mailed surveys, 74 completed surveys were returned

  15. Infections in patients with multiple sclerosis: Implications for disease-modifying therapy.

    Science.gov (United States)

    Celius, E G

    2017-11-01

    Patients with multiple sclerosis have an increased risk of infections compared to the general population. The increased risk has been described for decades and is not alone attributed to the use of disease-modifying drugs, but secondary to the disability. The introduction of more potent immunomodulatory drugs may cause an additional challenge, and depending on the mechanism of action, a treatment-induced increased risk of bacterial, viral, fungal or parasitic infections is observed. The choice of treatment in the individual patient with infections and multiple sclerosis must be guided by the drugs' specific mechanism of action, the drug-specific risk of infection and comorbidities. Increased monitoring and follow-up through treatment registries is warranted to increase our understanding and thereby improve management. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Long-Term Survival in a Patient with Multiple Brain Metastases from Small-Cell Lung Cancer Treated with Gamma Knife Radiosurgery on Four Occasions: A Case Report

    Science.gov (United States)

    Elaimy, Ameer L.; Thumma, Sudheer R.; Lamm, Andrew F.; Mackay, Alexander R.; Lamoreaux, Wayne T.; Fairbanks, Robert K.; Demakas, John J.; Cooke, Barton S.; Lee, Christopher M.

    2012-01-01

    Brain metastases are the most common cancerous neoplasm in the brain. The treatment of these lesions is challenging and often includes a multimodality management approach with whole-brain radiation therapy, stereotactic radiosurgery, and neurosurgery options. Although advances in biomedical imaging technologies and the treatment of extracranial cancer have led to the overall increase in the survival of brain metastases patients, the finding that select patients survive several years remains puzzling. For this reason, we present the case of a 70-year-old patient who was diagnosed with multiple brain metastases from small-cell lung cancer five years ago and is currently alive following treatment with chemotherapy for the primary cancer and whole-brain radiation therapy and Gamma Knife radiosurgery on four separate occasions for the neurological cancer. Since the diagnosis of brain metastases five years ago, the patient's primary cancer has remained controlled. Furthermore, multiple repeat GKRS procedures provided this patient with high levels of local tumor control, which in combination with a stable primary cancer led to an extended period of survival and a highly functional life. Further analysis and clinical research will be valuable in assessing the durability of multiple GKRS for brain metastases patients who experience long-term survival. PMID:23091748

  17. [Bacterial brain abscess--experiences with 67 patients].

    Science.gov (United States)

    Berlit, P; Fedel, C; Tornow, K; Schmiedek, P

    1996-08-01

    Sixty-seven patients with brain abscess were managed over 19 years (1975-1993). Our series had a 2.5 to 1 male predominance; the age distribution was from 3 days to 81 years. The underlying conditions of hematogenic brain abscesses (n = 33; 49%) included lung infections (n = 16), heart disease (n = 4), sepsis (n = 10), and other foci (n = 3). Otolaryngologic infections led to the abscess in 10 cases; there were 9 traumatic abscesses. The causes remained unknown in 15 cases. There were 47 solitary abscesses (70%) and 20 multiple abscesses. The most frequent presenting signs and symptoms were neurologic deficits (n = 17), disturbances of consciousness (n = 14), seizures (n = 6), and headaches, meningism and vomiting (n = 13). Causative organisms were isolated in 39 cases (58%) and included staphylococci (n = 6), streptococci (n = 6), enterobacteriae (n = 2), and anaerobic pathogens (n = 9). The most reliable laboratory sign of inflammation was an elevated ESR (52/59 patients). With the advent of computed tomography, burr hole aspiration of the abscess with or without drainage was possible in 30 cases; the mortality in this subgroup was 9%. All 4 patients with surgical excision in the pre CT-era died. The mortality of patients treated with antibiotics only was 62% (18/29). Overall mortality was 37% (25/67), including 5 cases with post mortem-diagnosis of brain abscess. Good recovery was achieved in 29/42 survivors. Predictors of a poor outcome were the patient's age, the level of consciousness, multiple abscesses, polybacterial cultures, and a hematogenic etiology, but not the size of the abscess.

  18. Objectives and configuration of the Multiple Pulse Propagation Experiment

    International Nuclear Information System (INIS)

    Orzechowski, T.J.; Caporaso, G.J.; Chamber, F.W.; Chong, Y.P.; Deadrick, F.J.; Guethlein, G.; Fawley, W.M.; Renbarger, V.L.; Rogers, D. Jr.; Weir, J.T.; Eckstrom, D.; Stalder, K.; Hubbard, R.; Lee, P.

    1990-01-01

    The Multiple Pulse Propagation Experiment (MPPE) was designed to determine the hose stability properties of an intense relativistic electron beam in a beam generated density channel and to investigate range extension with increasing pulse number in the burst. This experiment used a 10-MeV electron beam generated by the Advanced Test Accelerator (ATA). The electron beam current was expected to be at least 6-kA with an equilibrium radius of 0.5 cm (RMS) in the gas. This last constraint implied an unnormalized, RMS beam emittance of 20 mrad-cm. In order to achieve beam stability against hose, each electron beam pulse had to be tailored in emittance in order to phase mix damp the instability. The initial offsets of the beam were to be kept small in order to prevent a large saturated amplitude. Numerical simulations determined the initial criteria for the emittance profile and initial beam displacements. In order to demonstrate a final density depression of 25% of ambient pressure, at least five pulses with interpulse separation of 1- to 2-ms were specified

  19. Associations Between Physician Empathy, Physician Characteristics, and Standardized Measures of Patient Experience.

    Science.gov (United States)

    Chaitoff, Alexander; Sun, Bob; Windover, Amy; Bokar, Daniel; Featherall, Joseph; Rothberg, Michael B; Misra-Hebert, Anita D

    2017-10-01

    To identify correlates of physician empathy and determine whether physician empathy is related to standardized measures of patient experience. Demographic, professional, and empathy data were collected during 2013-2015 from Cleveland Clinic Health System physicians prior to participation in mandatory communication skills training. Empathy was assessed using the Jefferson Scale of Empathy. Data were also collected for seven measures (six provider communication items and overall provider rating) from the visit-specific and 12-month Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) surveys. Associations between empathy and provider characteristics were assessed by linear regression, ANOVA, or a nonparametric equivalent. Significant predictors were included in a multivariable linear regression model. Correlations between empathy and CG-CAHPS scores were assessed using Spearman rank correlation coefficients. In bivariable analysis (n = 847 physicians), female sex (P empathy scores. In multivariable analysis, female sex (P empathy scores. Of the seven CG-CAHPS measures, scores on five for the 583 physicians with visit-specific data and on three for the 277 physicians with 12-month data were positively correlated with empathy. Specialty and sex were independently associated with physician empathy. Empathy was correlated with higher scores on multiple CG-CAHPS items, suggesting improving physician empathy might play a role in improving patient experience.

  20. Value of stereotactic radiosurgery in patients with multiple brain metastases

    International Nuclear Information System (INIS)

    Chen Jie; Lin Zhiguo; Li Qingguo; Shen Hong

    2002-01-01

    Objective: To analyze the prognostic factors and evaluate the effect of stereotactic radiosurgery for patients with multiple brain metastases. Methods: Comparison was made in 53 such patients treated by stereotactic radiosurgery plus radiotherapy and 53 treated by radiotherapy alone. Patients were matched-paired according to the following criteria: age, Karnofsky performance scale (KPS) before treatment, extent of systemic cancer and number of brain metastasis. Forty patients had stereotactic radiosurgery, 13 patients stereotactic fractionated radiosurgery. In the stereotactic radiosurgery group, the patients were given a mean marginal dose of 20 Gy. Methods of stereotactic fractionated radiosurgery was 4-12 Gy per fraction , twice a week to a total dose of 15-30 Gy. Whole brain radiotherapy was given immediately after stereotactic radiosurgery. For patients treated by radiotherapy alone, the entire brain was treated by 30-40 Gy in 3-4 weeks. Results: The median survival was 11.6 months in stereotactic radiosurgery plus radiotherapy and 6.7 months in radiotherapy alone. The one year survival rate and one year local control rate were 44.3%, 17.1% and 50.9%, 13. 2%. Those with KPS increased after treatment gave 1-year survivals of 69.8% and 30.2%, respectively. The validity rates in CT or MRI three months after treatment were 82.0% and 55.0%. The difference in the two groups was found to be statistically significant (P < 0.01). 23.3% of death in the stereotactic radiosurgery plus radiotherapy group was due to brain metastasis vs 51.0% in the radiotherapy alone group (P < 0.05). Complication of the two groups was similar. Conclusion: Stereotactic radiosurgery plus radiotherapy is superior to radiotherapy alone for multiple brain metastases in improving the local control and ultimate outcome

  1. Visualizing desirable patient healthcare experiences.

    Science.gov (United States)

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

    2010-01-01

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

  2. The application of microcatheter superselective catheterization in interventional chemoembolization for multiple hepatocarcinomas: an initial experience in 34 cases

    International Nuclear Information System (INIS)

    Xu Xiaolu; Chen Yongqiang; Wang Qing

    2012-01-01

    Objective: To assess the clinical value of superselective catheterization by using microcatheter in interventional chemoembolization for multiple hepatocarcinomas. Methods: A total of 68 patients with multiple hepatocarcinomas were enrolled in this study. The clinical data were retrospectively analyzed. Superselective catheterization by using a microcatheter was carried out in 34 cases (study group) and superselective catheterization by using a 4-5 F common catheter was performed in 34 cases (control group). The hepatic dysfunctions and the survival rate at 0.5, 1, 2 years were compared between the two groups. Results: The liver function of the patients in study group was much better than that of the patients in control group (P<0.05), and the survival time of the patients in study group was much longer than that of the patients in control group (P<0.05). Conclusion: For the treatment of multiple hepatocarcinomas, interventional chemoembolization by using microcatheter superselective catheterization technique is technically simple and clinically effective with high success rate and fewer complications. (authors)

  3. Experiences of dental care: what do patients value?

    Directory of Open Access Journals (Sweden)

    Sbaraini Alexandra

    2012-06-01

    Full Text Available Abstract Background Dentistry in Australia combines business and health care service, that is, the majority of patients pay money for tangible dental procedures such as fluoride applications, dental radiographs, dental fillings, crowns, and dentures among others. There is evidence that patients question dentists’ behaviours and attitudes during a dental visit when those highly technical procedures are performed. However, little is known about how patients’ experience dental care as a whole. This paper illustrates the findings from a qualitative study recently undertaken in general dental practice in Australia. It focuses on patients’ experiences of dental care, particularly on the relationship between patients and dentists during the provision of preventive care and advice in general dental practices. Methods Seventeen patients were interviewed. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation. Results Patients described their experiences when visiting dental practices with and without a structured preventive approach in place, together with the historical, biological, financial, psychosocial and habitual dimensions of their experience. Potential barriers that could hinder preventive activities as well as facilitators for prevention were also described. The offer of preventive dental care and advice was an amazing revelation for this group of patients as they realized that dentists could practice dentistry without having to “drill and fill” their teeth. All patients, regardless of the practice they came from or their level of clinical risk of developing dental caries, valued having a caring dentist who respected them and listened to their concerns without “blaming” them for their oral health status. These patients complied with and supported the preventive care options because they were being “treated as a person not as a patient” by their dentists. Patients valued dentists who made

  4. Practical experience of monitoring patient dose

    Energy Technology Data Exchange (ETDEWEB)

    McDonnell, C.; Shrimpton, P. (National Radiological Protection Board, Chilton (United Kingdom)); O' Mahoney, M. (National Radiological Protection Board, Leeds (United Kingdom)); Foster, J. (Nuffield Hospitals, Surbiton (United Kingdom))

    1994-05-01

    NRPB recommends the use of reference dose levels for diagnostic medical exposures as an aid to patient dose reduction, but is this approach effective This article describes the broadly encouraging experiences of one large group of hospitals in carrying out measurements of entrance surface dose on patients undergoing some common types of x-ray examination. (author).

  5. Upper Gastrointestinal Bleeding from Gastric Amyloidosis in a Patient with Smoldering Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Mihajlo Gjeorgjievski

    2015-01-01

    Full Text Available Amyloidosis is a common complication of patients with monoclonal gammopathy of undetermined significance (MGUS, smoldering multiple myeloma (SMM, and multiple myeloma (MM. This proteinaceous material can be deposited intercellularly in any organ system, including the gastrointestinal (GI tract. In the GI tract, amyloidosis affects the duodenum most commonly, followed by the stomach and colorectum. Gastric amyloidosis causes symptoms of nausea, vomiting, early satiety, abdominal pain, and GI bleeding. A case of upper GI bleeding from gastric amyloidosis is presented in a patient with SMM. Esophagogastroduodenoscopy (EGD revealed a gastric mass. Endoscopic biopsies revealed amyloid deposition in the lamina propria, consistent with gastric amyloidosis. Liquid chromatography tandem mass spectrometry performed on peptides extracted from Congo red-positive microdissected areas of paraffin-embedded stomach specimens revealed a peptide profile consistent with AL- (lambda- type amyloidosis. Based on this and multiple other case reports, we recommend that patients with GI bleeding and MGUS, SMM, or MM undergo EGD and pathologic examination of endoscopic biopsies of identified lesions using Congo red stains for amyloidosis for early diagnosis and treatment.

  6. Clinical Characteristics of Multiple Colorectal Adenoma Patients Without Germline APC or MYH Mutations

    NARCIS (Netherlands)

    Tieu, Alan H; Edelstein, Daniel; Axilbund, Jennifer; Romans, Katharine E; Brosens, Lodewijk; Wiley, Elizabeth; Hylind, Linda; Giardiello, Francis M

    BACKGROUND: Patients with multiple colorectal adenomas (MCRA) without genetic cause are increasingly being diagnosed. The characteristics and natural history of this condition are not well studied. MATERIALS AND METHODS: Twenty-seven patients with MCRA, with cumulatively 10 to 99 colorectal adenomas

  7. Safety and Efficacy of Fingolimod in Treatment-Naïve Multiple Sclerosis Patients

    Directory of Open Access Journals (Sweden)

    James J. Marriott

    2011-01-01

    Full Text Available Fingolimod was recently approved for use in the United States after two phase III trials confirmed its effectiveness in reducing disease activity in relapsing-remitting multiple sclerosis. These positive results, coupled with the important fact that this is the first oral disease-modifying therapy, has lead to considerable enthusiasm amongst physicians and patients. However, fingolimod is associated with rare but serious adverse events. In addition, unlike conventional disease-modifying therapies, cardiopulmonary, ophthalmological and dermatological safety monitoring unfamiliar to both neurologists and patients is required before and during treatment. This paper will discuss these issues from the perspective of using fingolimod as a first-line disease-modifying therapy in treatment-Naïve relapsing-remitting multiple sclerosis patients

  8. The representation of patient experience and satisfaction in physician rating sites. A criteria-based analysis of English- and German-language sites

    Directory of Open Access Journals (Sweden)

    Strech Daniel

    2010-12-01

    Full Text Available Abstract Background Information on patient experience and satisfaction with individual physicians could play an important role for performance measures, improved health care and health literacy. Physician rating sites (PRSs bear the potential to be a widely available source for this kind of information. However, patient experience and satisfaction are complex constructs operationalized by multiple dimensions. The way in which PRSs allow users to express and rate patient experience and satisfaction could likely influence the image of doctors in society and the self-understanding of both doctors and patients. This study examines the extent to which PRSs currently represent the constructs of patient experience and satisfaction. Methods First, a systematic review of research instruments for measuring patient experience and satisfaction was conducted. The content of these instruments was analyzed qualitatively to create a comprehensive set of dimensions for patient experience and patient satisfaction. Second, PRSs were searched for systematically in English-language and German-language search engines of Google and Yahoo. Finally, we classified every structured question asked by the different PRS using the set of dimensions of patient experience and satisfaction. Results The qualitative content analysis of the measurement instruments produced 13 dimensions of patient experience and satisfaction. We identified a total of 21 PRSs. No PRSs represented all 13 dimensions of patient satisfaction and experience with its structured questions. The 3 most trafficked English-language PRS represent between 5 and 6 dimensions and the 3 most trafficked German language PRSs between 8 and 11 dimensions The dimensions for patient experience and satisfaction most frequently represented in PRSs included diversely operationalized ones such as professional competence and doctor-patient relationship/support. However, other less complex but nevertheless important dimensions

  9. Perceived benefits and barriers to exercise for recently treated patients with multiple myeloma: a qualitative study.

    Science.gov (United States)

    Craike, Melinda J; Hose, Kaye; Courneya, Kerry S; Harrison, Simon J; Livingston, Patricia M

    2013-07-01

    Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM. This was a qualitative study that used a grounded theory approach. Semi-structured interviews were conducted in Victoria, Australia by telephone from December 2011-February 2012 with patients who had been treated for MM within the preceding 2-12 months. Interviews were transcribed and analysed using the constant comparison coding method to reduce the data to themes. Gender differences and differences between treatment groups were explored. Twenty-four interviews were completed. The sample comprised 13 females (54%), with a mean age of 62 years (SD = 8.8). Sixteen (67%) participants had received an autologous stem cell transplant (ASCT). All participants currently engaged in a range of light to moderate intensity physical activity; walking and gardening were the most common activities. Recovery from the symptoms of MM and side effects of therapy, psychological benefits, social factors and enjoyment were important benefits of physical activity. Barriers to physical activity predominately related to the symptoms of MM and side effects of therapy, including pain, fatigue, and fear of infection. Low self- motivation was also a barrier. Women participated in a more diverse range of physical activities than men and there were gender differences in preferred type of physical activity. Women were more likely to report psychological and social benefits; whereas men reported physical activity as a way to keep busy and self-motivation was a barrier. Patients treated with an ASCT more often reported affective benefits of participation in physical activity and fatigue as a barrier. Patients

  10. Clinical experiences with cannabinoids in spasticity management in multiple sclerosis.

    Science.gov (United States)

    Lorente Fernández, L; Monte Boquet, E; Pérez-Miralles, F; Gil Gómez, I; Escutia Roig, M; Boscá Blasco, I; Poveda Andrés, J L; Casanova-Estruch, B

    2014-06-01

    Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS. Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression. Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1). THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  11. How general practitioners perceive and assess self-care in patients with multiple chronic conditions: a qualitative study.

    Science.gov (United States)

    Kristensen, Mads Aage Toft; Hølge-Hazelton, Bibi; Waldorff, Frans Boch; Guassora, Ann Dorrit

    2017-12-22

    It is not known how general practitioners (GPs) perceive the concept of self-care and how they assess self-care ability in patients with multiple chronic conditions. As a part of the strategy to improve the care of people living with chronic conditions, disease management programs in Denmark require GPs and other health care workers to assess and support patients' self-care ability. The aim of the present study was to explore GPs' perceptions and assessment of self-care ability in patients with multiple chronic conditions who have difficulty following a given treatment. A qualitative study conducted through in-depth, semi-structured interviews with a purposive sample of 12 GPs in rural areas of Denmark with economically disadvantaged populations. The interviews involved 36 complex patient cases selected by the GPs themselves. Our analysis followed the principles of systematic text condensation. Most GPs in our study had a health-related perception of self-care, but some had a broader perception encompassing the situational context of the patient's life. The GPs' assessments of patients' self-care ability were based on information from the ongoing and often long-term relationships with the patients. GPs identified four major factors that influenced patients' self-care ability, which accumulated and fluctuated over time: multimorbidity, cognitive resources, material resources, and the patients' social contexts. The GPs in this study had dual perceptions of self-care, related to both the chronic health conditions and to the broader situational contexts of their patients' lives. GPs' assessments of self-care ability depended largely on their experiences from the doctor-patient relationship, and they emphasized that the factors affecting self-care ability were highly dynamic over the patient's lifetime. However, these findings might be resisted by the Danish disease management programs, which tend to have a static and more narrow, health-related view of patient self

  12. Multiple co morbid conditions in patient with Mast Cell Activation Syndrome

    Science.gov (United States)

    2017-10-26

    conditions in patient \\\\·ith Mast Cell Activation Syndron1e Sb. GRANT NUMBER Sc. PROGRAM.ELEMENT NUMBER 6. AUTHOR(S) Sd. PROJECT NUMBER Maj Sofia...13. SUPPLEMENTARY NOTES 14. ABSTRACT Multiple co-n1orhid conditions in patient \\Vith Mast Cell Activation Syndrotne Sofia M. Szari.MD. and James...Defense. !NTR()D{JCT!ON: Mast cell activation disorders {MCAD) have been associated \\Vilh Connective Tissue Disorders (CTD) and orthostatic

  13. MR brain scanning in patients with vasculitis: Differentiation from multiple sclerosis

    International Nuclear Information System (INIS)

    Miller, D.H.; Ormerod, I.E.C.; Du Boulay, E.P.G.H.; Rudge, P.; McDonald, W.I.; Gibson, A.

    1987-01-01

    We performed MR (magnetic resonance) brain imaging on 24 patients with a systemic vasculitis. MRI proved to be a sensitive method for detecting brain lesions (clinically silent or manifest) in these patients. The most frequent abnormalities were periventricular lesions seen in 12 cases. Such changes are not specific for vascular disease, and are often seen in multiple sclerosis. However, additional changes were commonly seen which suggested the correct diagnosis. (orig.)

  14. Trichomonal sinusitis in an adolescent patient with multiple trauma.

    Science.gov (United States)

    Oud, Lavi

    2009-03-01

    Trichomonal disease typically involves the genital and occasionally respiratory tracts. Although exposure of the upper respiratory tract to infected genital secretions is not uncommon with contemporary sexual practices, trichomonal sinus disease has been rarely described. The present report describes the case of a healthy 17-year-old male admitted to an intensive care unit following multiple trauma, who developed purulent sinusitis on the 4th day of hospitalization. Numerous trichomonads were noted on microscopic examination of sinus aspirate. Further investigation revealed orofacial sexual exposure of the patient to a partner with trichomoniasis. The patient's sinusitis resolved following a course of parenteral metronidazole-containing antibiotics.

  15. Prevalence of Diabetes Type 1 in Patients Suffered From Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Dayer

    2016-04-01

    Full Text Available Background Because IL2RA is considered a predisposing factor in the incidence of both type I diabetes and multiple sclerosis (MS, and considering that both are autoimmune diseases, some studies suggest a correlation between type I diabetes and MS. Objectives The aim of this study was to examine the prevalence of type I diabetes among people with MS. Patients and Methods The study subjects comprised 100 patients with MS from the Khuzestan multiple sclerosis center at rehabilitation school of Jundishapur University of Medical Sciences, whose diagnosis of MS had been confirmed by a specialist, and were not being treated with steroids. Subjects were selected from patients younger than 30 years old. After filling out an application form, 5 mL fasting venous blood and 5 mL after 2 hours were taken. The blood glucose level was measured with a kit (Zist Shimi using the enzymatic method. Results The mean age of the participants was 24.28 years. The rate of type I diabetes was equal to 4% of the total sample, while 18% of all patients had impaired fasting glucose. Conclusions Given the high level of impaired fasting glucose among patients in this study, it is likely that MS provides the basis for the incidence of glucose metabolism disorders. To prove this, further studies with larger sample sizes are required.

  16. Multiple condensation induced water hammer events, experiments and theoretical investigations

    International Nuclear Information System (INIS)

    Barna, Imre Ferenc; Ezsoel, Gyoergy

    2011-01-01

    We investigate steam condensation induced water hammer (CIWH) phenomena and present experimental and theoretical results. Some of the experiments were performed in the PMK-2 facility, which is a full-pressure thermalhydraulic model of the nuclear power plant of VVER-440/312 type and located in the Atomic Energy Research Institute Budapest, Hungary. Other experiments were done in the ROSA facility in Japan. On the theoretical side CIWH is studied and analyzed with the WAHA3 model based on two-phase flow six first-order partial differential equations that present one dimensional, surface averaged mass, momentum and energy balances. A second order accurate high-resolution shockcapturing numerical scheme was applied with different kind of limiters in the numerical calculations. The applied two-fluid model shows some similarities to RELAP5 which is widely used in the nuclear industry to simulate nuclear power plant accidents. New features are the existence of multiple, independent CIWH pressure peaks both in experiments and in simulations. Experimentally measured and theoretically calculated CIWH pressure peaks are in qualitative agreement. However, the computational results are very sensitive against flow velocity. (orig.)

  17. Fatigue Perceived by Multiple Sclerosis Patients Is Associated With Muscle Fatigue

    NARCIS (Netherlands)

    Steens, Anneke; de Vries, Astrid; Hemmen, Jolien; Heersema, Thea; Heerings, Marco; Maurits, Natasha; Zijdewind, Inge

    Background. Fatigue is a debilitating symptom in multiple sclerosis (MS). Previous studies showed no association between fatigue as perceived by the patient and physiological measures of fatigability. Objective. The authors investigated associations between perceived fatigue and measures of

  18. Conventional and Molecular Cytogenetic Analyses in Turkish Patients with Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Beyhan Durak Aras

    2012-06-01

    Full Text Available OBJECTIVE: Multiple myeloma (MM is characterized by the accumulation and proliferation of malignant plasma cells, secreting monoclonal immunoglobulins and genetic abnormalities in MM have implications for disease progression and survival. In the present study, we investigated the frequency of chromosomal abnormalities (CA in Turkish patients with MM, using interphase FISH and CC and evaluated the relationship between the rearrangements detected, prognosis and stage of disease. METHODS: We performed conventional cytogenetic and FISH studies in 50 patients to detect chromosome anomalies associated with MM. FISH probes were used to detect 13q14, 13q34, 17p13 deletions, IGH rearrangements, and monosomy and/or trisomy of chromosomes 5, 9, and 15. RESULTS: CC studies could be performed in 32 of 50 cases and five patients (15.6% showed chromosomal aberrations while 27 (84.3% had normal karyotypes. By FISH, eighteen percent (9/50 of cases were found to be normal for all parameters evaluated. Eighty-two percent (41/50 of the patients were positive for at least one abnormality. Chromosome 13 anomalies were detected in 54% (27/50 of cases. The second most common aberration observed is chromosome 15 aberrations (50%. CONCLUSION: Median survival rate was shorter in patients with one of the abnormalities including chromosome 13 aberrations, IGH rearrangements or P53 deletions. Chromosome 15 aberrations were significantly higher in patients with stage III disease (p=0.02. We conclude that FISH studies should be performed in conjunction with conventional cytogenetic analysis for prognosis in multiple myeloma patients.

  19. Self-reported everyday memory and depression in patients with multiple sclerosis.

    Science.gov (United States)

    Bruce, Jared M; Arnett, Peter A

    2004-04-01

    Depression and memory difficulties are among the most common complaints voiced by patients with multiple sclerosis (MS). Nevertheless, little is known about how depression might affect patients' perceptions of their memory difficulties. The present investigation was designed to explore this issue. Results supported a model that integrates aspects of Beck's theory of depression and the concept of depressive realism. Consistent with the depressive realism literature, nondepressed MS patients significantly overestimated their everyday memory compared with their actual performance on verbal memory and attention/concentration indices, whereas moderately depressed patients' everyday memory ratings mirrored their actual neuropsychological performance. Supporting Beck's negative cognitive schema notion, mildly depressed patients significantly overestimated their memory difficulties. Implications for the treatment of memory problems among MS patients are discussed.

  20. Insulin resistance in drug naive patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Kostić Smiljana

    2017-01-01

    Full Text Available Background/Aim. Due to the fact that there is a relatively small number of data related to systemic insulin abnormalities in the multiple sclerosis (MS, the main objective of our study was to determine whether a dysbalance of glucose and insulin metabolism exist in patients with natural course of MS. Our hypothesis was that the metabolic disorder that characterizes state of the insulin resistance (IR and reduced insulin sensitivity (IS in untreated patients with MS could play a role in disease progression and degree of functional disability. Methods. The study included 31 patients with relapsing-remitting (RR MS and 14 healthy controls from the same geographic area matched by age, ethnicity and number of smokers. The glucose tolerance, IS, and IR were examined using an oral glucose tolerance test (OGTT and using basal plasma glucose and insulin levels. The functional disability and disease progression were evaluated by the Expanded Disability Status Scale (EDSS and Multiple Sclerosis Severity Score (MSSS. Results. The MS patients tolerated glucose equally well as the healthy controls. Basal concentrations of insulin were significantly higher in the MS group (p < 0.05, as well as insulin plasma level 30 min after oral glucose load (p < 0.01. The patients with MS had significantly higher values of homeostasis model assessment indexes of IR (HOMA-IR (p = 0.027; p = 0.028. The percentage of IS (HOMA2 %S and whole body IS index (ISI Matsuda showed significantly lower values in the MS patients than in the controls (p = 0.005; p = 0.001. The insulinogenic index in the first 30 min of OGTT was significantly higher in MS patients (p = 0.005. The measures of functional disability and MS progression did not correlate significantly with the investigated parameters of IR and IS indexes. Conclusion. This study demonstrates for the first time the existence of hyperinsulinemia, reduced insulin sensitivity and normal glucose tolerance that indicate the initial

  1. [Intensive care treatment of traumatic brain injury in multiple trauma patients : Decision making for complex pathophysiology].

    Science.gov (United States)

    Trimmel, H; Herzer, G; Schöchl, H; Voelckel, W G

    2017-09-01

    Traumatic brain injury (TBI) and hemorrhagic shock due to uncontrolled bleeding are the major causes of death after severe trauma. Mortality rates are threefold higher in patients suffering from multiple injuries and additionally TBI. Factors known to impair outcome after TBI, namely hypotension, hypoxia, hypercapnia, acidosis, coagulopathy and hypothermia are aggravated by the extent and severity of extracerebral injuries. The mainstays of TBI intensive care may be, at least temporarily, contradictory to the trauma care concept for multiple trauma patients. In particular, achieving normotension in uncontrolled bleeding situations, maintenance of normocapnia in traumatic lung injury and thromboembolic prophylaxis are prone to discussion. Due to an ongoing uncertainty about the definition of normotensive blood pressure values, a cerebral perfusion pressure-guided cardiovascular management is of key importance. In contrast, there is no doubt that early goal directed coagulation management improves outcome in patients with TBI and multiple trauma. The timing of subsequent surgical interventions must be based on the development of TBI pathology; therefore, intensive care of multiple trauma patients with TBI requires an ongoing and close cooperation between intensivists and trauma surgeons in order to individualize patient care.

  2. Dealing with death: medical students' experiences with patient loss.

    Science.gov (United States)

    Pessagno, Regina; Foote, Carrie E; Aponte, Robert

    This article explores medical students' experiences and coping strategies when confronting patient loss in their 3rd and 4th years of their programs. Much of the literature on the impact of patient losses focuses on physicians. This article joins a handful of works aimed at how medical students experience and cope with patient loss. In-depth interviews with 20 medical students provided rich descriptions of their varying experiences coping with death. Consistent with previous work, students experience substantial emotional stress coping with patient deaths, though some were more difficult to bear than others, such as when the dying patient was a child or when treatment errors could have contributed to deaths. Common coping mechanisms included talking through their emotions, thrusting themselves into continuing their rounds, crying, participating in infant death rituals, and turning to religion. When deaths occurred, senior personnel who exhibited empathy toward the deceased and tolerance toward the students' emotional responses were lauded and made the process easier. Also emotionally daunting, in many instances, was dealing with the families of dying patients. Most of the students did not view death as a failure, contrary to much earlier literature, except in instances in which human error or decision making may have played a part in causing the death of a patient.

  3. Depersonalisation and schizophrenia: Comparative study of initial and multiple episodes of schizophrenia.

    Science.gov (United States)

    Luque-Luque, Rogelio; Chauca-Chauca, Geli Marie; Alonso-Lobato, Pablo; Jaen-Moreno, M Jose

    2016-01-01

    The phenomena of depersonalisation/derealisation have classically been associated with the initial phases of psychosis, and it is assumed that they would precede (even by years) the onset of clinical psychosis, being much more common in the prodromal and acute phases of the illness. The aims of the present study are to analyse the differences in depersonalisation/derealisation between patients with initial and multiple episodes and the factors that could influence this. A descriptive, controlled and cross-sectional study of 48 patients diagnosed with paranoid schizophrenia (20 with an initial episode and 28 with multiple episodes). These patients were assessed using scales such as the Cambridge Depersonalization Scale, the Positive and Negative Symptom Scale, and the Dissociative Experiences Scale. Participants with initial episodes score higher on both the Cambridge Depersonalisation Scale, and the subscale of the Dissociative Experiences Scale that evaluates such experiences. There were no associations between these types of experience and the positive symptoms subscale of the Positive and Negative Symptom Scale. Depersonalisation/derealisation experiences appear with greater frequency, duration and intensity in patients in the early stages of the illnesses, gradually decreasing as they become chronic. Copyright © 2016 SEP y SEPB. Published by Elsevier España. All rights reserved.

  4. Ketamine Therapy for Treatment-resistant Depression in a Patient with Multiple Sclerosis: A Case Report.

    Science.gov (United States)

    Messer, Michael M; Haller, Irina V

    2017-01-01

    Objective: Depression is a common condition among patients with multiple sclerosis and often becomes resistant to oral antidepressants. We report a patient with multiple sclerosis who developed severe treatment-resistant depression and who was successfully treated with intravenous ketamine over the period of two years. Methods: Ketamine treatment protocol included an initial series of six treatments administered every other day, followed by a maintenance schedule. Ketamine was administered intravenously at 0.5mg/kg of ideal body weight over 40 minutes. Depression symptoms were measured using Beck Depression Index. Results: The patient's Beck Depression Index score prior to initiating ketamine treatment was 38, corresponding to severe depression. Response to treatment, defined as 50-percent reduction in Beck Depression Index score, was observed after five treatments. For this patient, the maintenance schedule ranged from a weekly treatment to one treatment every three weeks. During the two-year observation period, this patient was able to maintain a stable non-depressed mood and had no worsening of her MS symptoms. Conclusion: Ketamine may be an alternative treatment for resistant depression and may have a special use in patients with multiple sclerosis.

  5. [Virological and immunological indices in patients with multiple sclerosis].

    Science.gov (United States)

    Agafonov, A P; Kameneva, S N; Agafonova, O A; Neverov, A A; Ignat'ev, G M

    2004-01-01

    The level of specific antibodies to viruses of measles, parotitis, type-6 herpes, Epstein-Barr, tick-borne encephalitis and Borrelia burgdorferi as well as presence of genetic samples and antigens of the above infectious antigens were studied in patients with multiple sclerosis (MS). The cytokines Th1 and Th2 parameters were investigated in blood serum of patients at different MS stages. The titer of antibodies to measles virus was noted to be increasing in MS patients with age and disease aggravation. The level of antibodies to any of the studied infectious agents, except for the type-6 herpes virus, was not dynamically changing for as long as 9 months. The viral genetic samples (measles RNA) were detected just once in 2 patients; the detection time coincided in both cases with MS aggravation. The cytokines dynamics failed to correlate with MS aggravation or exacerbation while the total index of all studied cytokines was decreased. A high MMPw 9 content in blood serum correlated with MS exacerbation in 1 patient.

  6. Mitoxantrone in the treatment of multiple sclerosis: a single-center experience

    Directory of Open Access Journals (Sweden)

    Özlem Taşkapılıoğlu

    2012-06-01

    Full Text Available OBJECTIVE: To investigate the secondary progressive multiple sclerosis (SPMS patients treated with mitoxantrone (MIT and discuss the effectiveness and side effects of MIT. METHODS: We retrospectively investigated 48 SPMS patients who completed or were still receiving MIT treatment. Expanded Disability Status Scale (EDSS scores of the patients were determined who had detailed examination before the treatment. Complete blood count, urine examination, chest x-ray, kidney and liver function tests, transthoracic echocardiography were performed at initiation and during follow-up and 10 mg/m2 MIT was administered every three months. The data were assessed in order to determine the effectiveness and side effects. RESULTS: A total of 48 patients, 34 women and 14 men, had an age of 42 (26-55 years at the initiation of MIT treatment. The duration of the treatment was 12 (3-30 months. The median EDSS scores were 6 (4-8 before the treatment and 6 (4-9 after the treatment. EDSS scores improved in 6 patients, deteriorated in 12 patients and 30 patients remained with stable EDSS scores during the treatment. Seventeen patients had no side effects however 31 patients developed side effects. CONCLUSION: On the basis of this study, which is a clinical assessment of the effectiveness and side effects of MIT, we conclude that MIT can limit disability in SPMS patients and it is useful in treating SPMS patients due to favorable risk-benefit ratio

  7. Track reconstruction for the Mu3e experiment based on a novel Multiple Scattering fit

    Directory of Open Access Journals (Sweden)

    Kozlinskiy Alexandr

    2017-01-01

    Full Text Available The Mu3e experiment is designed to search for the lepton flavor violating decay μ+ → e+e+e−. The aim of the experiment is to reach a branching ratio sensitivity of 10−16. In a first phase the experiment will be performed at an existing beam line at the Paul-Scherrer Institute (Switzerland providing 108 muons per second, which will allow to reach a sensitivity of 2 · 10−15. The muons with a momentum of about 28 MeV/c are stopped and decay at rest on a target. The decay products (positrons and electrons with energies below 53MeV are measured by a tracking detector consisting of two double layers of 50 μm thin silicon pixel sensors. The high granularity of the pixel detector with a pixel size of 80 μm × 80 μm allows for a precise track reconstruction in the high multiplicity environment of the Mu3e experiment, reaching 100 tracks per reconstruction frame of 50 ns in the final phase of the experiment. To deal with such high rates and combinatorics, the Mu3e track reconstruction uses a novel fit algorithm that in the simplest case takes into account only the multiple scattering, which allows for a fast online tracking on a GPU based filter farm. An implementation of the 3-dimensional multiple scattering fit based on hit triplets is described. The extension of the fit that takes into account energy losses and pixel size is used for offline track reconstruction. The algorithm and performance of the offline track reconstruction based on a full Geant4 simulation of the Mu3e detector are presented.

  8. Personalized therapy in multiple myeloma according to patient age and vulnerability

    DEFF Research Database (Denmark)

    Palumbo, Antonio; Bringhen, Sara; Ludwig, Heinz

    2011-01-01

    Most patients with newly diagnosed multiple myeloma (MM) are aged > 65 years with 30% aged > 75 years. Many elderly patients are also vulnerable because of comorbidities that complicate the management of MM. The prevalence of MM is expected to rise over time because of an aging population. Most...... elderly patients with MM are ineligible for autologous transplantation, and the standard treatment has, until recently, been melphalan plus prednisone. The introduction of novel agents, such as thalidomide, bortezomib, and lenalidomide, has improved outcomes; however, elderly patients with MM are more......, occurrence of serious nonhematologic adverse events during treatment should be carefully taken into account to adjust doses and optimize outcomes....

  9. Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

    Directory of Open Access Journals (Sweden)

    Sthela Maria Murad-Regadas

    2012-06-01

    Full Text Available CONTEXT: Management of patients with obstructed defecation syndrome is still controversial. OBJECTIVE: To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. METHODS: The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33% patients with significant improvement of symptoms through clinical management only. Group II: 14 (14% with improvement through clinical treatment plus biofeedback. Group III: 55 (53% referred to surgery due to treatment failure. RESULTS: Group I: 20 (59% patients had grade-II rectocele, 14 (41% grade-III. Obstructed defecation syndrome was associated with intussusception (41%, mucosal prolapse (41%, anismus (29%, enterocele (9% or 2 dysfunctions (23%. The average constipation score decreased significantly from 11 to 5. Group II: 11 (79% grade-II rectocele, 3 (21% grade-III, associated with intussusception (7%, mucosal prolapse (43%, anismus (71% or 2 dysfunctions (29%. There was significant decrease in constipation score from 13 to 6. Group III: 8 (15% grade-II rectocele, 47 (85% grade-III, associated with intussusception (42%, mucosal prolapse (40% or 2 dysfunctions (32%. The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31% patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. CONCLUSIONS: Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in

  10. Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome.

    Science.gov (United States)

    Murad-Regadas, Sthela Maria; Regadas, Francisco Sergio P; Rodrigues, Lusmar Veras; Fernandes, Graziela Olivia da Silva; Buchen, Guilherme; Kenmoti, Viviane T

    2012-01-01

    Management of patients with obstructed defecation syndrome is still controversial. To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure. Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associated with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation

  11. Early infections in patients undergoing high-dose treatment with stem cell support: a comparison of patients with non-Hodgkin lymphoma and multiple myeloma

    DEFF Research Database (Denmark)

    Gang, A O; Arpi, M.; Gang, U.J.O.

    2010-01-01

    Background: Infections are life-threatening complications in patients undergoing high-dose chemotherapy with stem cell support (HDT). Knowledge of the infectious pathogens is essential to make a safe outpatient setting. Methods: We conducted a retrospective study of 208 patients treated with HDT...... related mortality was similar between the groups. Conclusion: The frequency of isolated pathogens, positive blood cultures, and the diversity of pathogens were higher in MM patients as compared to NHL patients. However, this did not translate into higher transplantation-related mortality, probably because....... The population included non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) patients. No patients received prophylactic antibacterial treatment. Results: Pathogens were isolated from 44% of all patients. MM patients more frequently had multiple pathogens in blood cultures (38% versus 25%). Transplantation...

  12. Germline large genomic alterations on 7q in patients with multiple primary cancers

    DEFF Research Database (Denmark)

    Villacis, Rolando A R; Basso, Tatiane R; Canto, Luisa M

    2017-01-01

    Patients with multiple primary cancers (MPCs) are suspected to have a hereditary cancer syndrome. However, only a small proportion may be explained by mutations in high-penetrance genes. We investigate two unrelated MPC patients that met Hereditary Breast and Ovaria Cancer criteria, both presenti...

  13. Nurses' experience of caring for inmate patients.

    Science.gov (United States)

    Weiskopf, Constance S

    2005-02-01

    The aim of this paper is to report the findings of a study of the experience of caring for prisoners through examining the everyday experience of nurses' delivering health care to inmate patients in a correctional setting. Prisons are most often viewed as places for punishment, while the goals of health and healing, and prevention of diseases in correctional facilities are often neglected. Nurses who deliver health care to prisoners are challenged to do so in a caring relationship that will facilitate their health and healing. The literature on the nature of prison nursing indicates that delivering health care to inmates must be carefully balanced against the need for security, and is affected by factors such as custody staff values, staff education, nursing management, and organizational practices. In-depth interviews were carried out with nine Registered Nurses who had been employed in a variety of correctional institutions throughout their careers, and analysed thematically using Colaizzi's phenomenological method. Findings. Nurses' caring was experienced as an attempt to negotiate the boundaries between the cultures of custody and caring. Facing complex challenges and a number of limitations on the nurse-patient relationship, nurses strived to find a way to care for their inmate patients. Environmental risk meant that caution and vigilance were essential and these nurses demonstrated courage and persevered for the sake of their inmate patients. The findings make clear the challenging and frustrating experience of nurses' caring for inmate patients in restrictive settings. As a result, there are implications for nursing practice, education, and research to assure the best possible health outcomes for inmate patients, the integrity of caring nursing practice, and the safety of both nurses and patients.

  14. Efficacy of Bisphosphonates for the Treatment of Osteoporosis in Patients with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    İlke Coşkun Benlidayı

    2015-08-01

    Full Text Available Objective: The aim of this study was to evaluate the effectiveness of bisphosphonates in osteoporotic patients with multiple sclerosis. Materials and Methods: Patients with multiple sclerosis, who were started on treatment with a diagnosis of osteoporosis, at the Department of Physical Medicine and Rehabilitation, Faculty of Medicine Çukurova University, between January 2011 and January 2014, were included in this study. Patients were allocated into control (calcium-vitamin D alone and active treatment (calcium-vitamin D and bisphosphonate groups according to their medications. Response to the 12-month treatment in terms of bone mineral density (BMD values and biological marker levels were evaluated, both within and between groups. Results: The study group consisted of 29 patients (14 controls and 15 active treatment. Evaluation performed within each group revealed no significant difference between baseline and post-treatment values of BMD and biological markers in controls. However, regarding the active treatment group, a significant increase in L1-L4 T-score and 25(OHD was detected. When delta values were taken into account, comparison between groups revealed no significant difference in terms of BMD and biological marker levels. Conclusion: The effect of calcium-vitamin D alone on BMD and biologic markers was similar to that of calcium-vitamin D and bisphosphonate combination, in multiple sclerosis patients with osteoporosis. However, prospective, randomized, controlled studies are required on this issue. (Turkish Journal of Osteoporosis 2015;21: 53-7

  15. Autologous Graft versus Host Disease: An Emerging Complication in Patients with Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Anu Batra

    2014-01-01

    Full Text Available Autologous graft versus host disease (autoGVHD is a rare transplant complication with significant morbidity and mortality. It has been hypothesized that patients with multiple myeloma might be predisposed to autoGVHD through dysregulation of the immune response resulting from either their disease, the immunomodulatory agents (IMiDs used to treat it, or transplant conditioning regimen. Hematopoietic progenitor cell (HPC products were available from 8 multiple myeloma patients with biopsy-proven autoGVHD, 16 matched multiple myeloma patients who did not develop autoGVHD, and 7 healthy research donors. The data on number of transplants prior to developing autoGVHD, mobilization regimens, exposure to proteasome inhibitors, use of IMiDs, and class I human leukocyte antigen types (HLA A and B were collected. The HPC products were analyzed by flow cytometry for expression of CD3, CD4, CD8, CD25, CD56, and FoxP3. CD3+ cell number was significantly lower in autoGVHD patients compared to unaffected controls (P=0.047. On subset analysis of CD3+ cells, CD8+ cells (but not CD4+ cells were found to be significantly lower in patients with autoGVHD (P=0.038. HLA-B55 expression was significantly associated with development of autoGVHD (P=0.032. Lower percentages of CD3+ and CD8+ T-cells and HLA-B55 expression may be predisposing factors for developing autoGVHD in myeloma.

  16. Percutaneous vertebroplasty under local anaesthesia: feasibility regarding patients' experience

    International Nuclear Information System (INIS)

    Bonnard, Eric; Foti, Pauline; Amoretti, Nicolas; Kastler, Adrian

    2017-01-01

    Evaluate patients' intraoperative experience of percutaneous vertebroplasty (PV) performed without general anaesthesia in order to assess the feasibility of local anaesthesia and simple analgesic medication as pain control protocol. Ninety-five patients who underwent single-site PV were consecutively included in the study between 2011 and 2013. Each procedure was achieved under local anaesthesia and perfusion of paracetamol, tramadol and dolasetron, with combined CT and fluoroscopy guidance. Numeric pain scale (NPS) was collected before, during and after intervention. After intervention, patients were asked to evaluate their experience as ''very bad'', ''bad'', ''fair'', ''good'' or ''very good'', independently of the pain. Indications for vertebroplasty were osteopenic fractures (78 %), aggressive angiomas (13 %) and somatic tumours (9 %). In 76 % of cases, patients' experience was described as ''very good'' (44 %) or ''good'' (32 %), whereas 19 % described it as ''fair'' and 5 % as ''very bad''. Mean operative NPS was 5.5. After intervention, NPS was significantly lower with a decrease of 4.5 points. No differences were found according to the localization, type of lesion, age or sex either in terms of experience or NPS. Percutaneous vertebroplasty is feasible under local anaesthesia alone, with a very good or good experience in 76 % of the patients. (orig.)

  17. How to Conduct Clinical Qualitative Research on the Patient's Experience

    Science.gov (United States)

    Chenail, Ronald J.

    2011-01-01

    From a perspective of patient-centered healthcare, exploring patients' (a) preconceptions, (b) treatment experiences, (c) quality of life, (d) satisfaction, (e) illness understandings, and (f) design are all critical components in improving primary health care and research. Utilizing qualitative approaches to discover patients' experiences can…

  18. Multiple Sclerosis Patients with Markedly Low Intrathecal Antibody Response in Sri Lanka

    Directory of Open Access Journals (Sweden)

    S. M. K. Gamage

    2018-01-01

    Full Text Available Multiple sclerosis (MS is a heterogeneous disease which is poorly studied in Asia, where the disease is known to be rare with significant differences in clinical and radiological presentations and intrathecal antibody response. Therefore the objective of this study was to determine clinical presentation, radiological and neurophysiological characteristics, and oligoclonal band status in Sri Lankan MS patients, following careful exclusion of patients with neuromyelitis optica spectrum disorders and other conditions mimicking multiple sclerosis. Sixty-nine MS patients were recruited to the study adhering to McDonald 2010 criteria. Their clinical presentation, characteristics of central nervous system lesions in magnetic resonance imaging, visual evoked potential (VEP results, oligoclonal bands (OCB, and AQP4 antibody status were studied. Of 69 MS patients, 54%, 6%, and 1% were relapsing remitting, secondary progressive, and primary progressive, respectively, and 39% were patients with clinically isolated syndrome. The commonest clinical presentations were cerebral motor followed by cerebral sensory and optic neuritis. Majority had typical periventricular and infratentorial lesions in MRI. Though not clinically apparent, bilateral delay of P100 wave latency was present in 52%. OCB positivity was 42% and AQP4 antibody was positive in only one patient. In conclusion, this group of Sri Lankan MS patients shares most of the clinical and radiological features of Caucasian MS patients. However, the OCB positivity is lower in this group, when compared to the Caucasian MS populations.

  19. Awake craniotomy: improving the patient's experience.

    Science.gov (United States)

    Potters, Jan-Willem; Klimek, Markus

    2015-10-01

    Awake craniotomy patients are exposed to various stressful stimuli while their attention and vigilance is important for the success of the surgery. We describe several recent findings on the perception of awake craniotomy patients and address nonpharmacological perioperative factors that enhance the experience of awake craniotomy patients. These factors could also be applicable to other surgical patients. Proper preoperative counseling gives higher patient satisfaction and should be individually tailored to the patient. Furthermore, there is a substantial proportion of patients who have significant pain or fear during an awake craniotomy procedure. There is a possibility that this could induce post-traumatic stress disorder or related symptoms. Preoperative preparation is of utmost importance in awake craniotomy patients, and a solid doctor-patient relationship is an important condition. Nonpharmacological intraoperative management should focus on reduction of fear and pain by adaptation of the environment and careful and well considered communication.

  20. Patient-centered medical home transformation with payment reform: patient experience outcomes.

    Science.gov (United States)

    Heyworth, Leonie; Bitton, Asaf; Lipsitz, Stuart R; Schilling, Thad; Schiff, Gordon D; Bates, David W; Simon, Steven R

    2014-01-01

    To examine changes in patient experience across key domains of the patient-centered medical home (PCMH) following practice transformation with Lean quality improvement methodology inclusive of payment reform. Pre-intervention/post-intervention analysis of intervention with a comparison group, a quasi-experimental design. We surveyed patients following office visits at the intervention (n = 2502) and control (n = 1622) practices during the 15-month period before and 14-month period after PCMH Lean transformation (April-October 2009). We measured and compared pre-intervention and post-intervention levels of patient satisfaction and other indicators of patient-centered care. Propensity weights adjusted for potential case-mix differences in intervention and control groups; propensity-adjusted proportions accounted for physician-level clustering. More intervention patients were very satisfied with their care after the PCMH Lean intervention (68%) compared with pre-intervention (62%). Among control patients, there was no corresponding increase in satisfaction (63% very satisfied pre-intervention vs 64% very satisfied post-intervention). This comparison resulted in a statistical trend (P = .10) toward greater overall satisfaction attributable to the intervention. Post-intervention, patients in the intervention practice consistently rated indicators of patient-centered care higher than patients in the control practice, particularly in the personal physician and communication domain. In this domain, intervention patients reported superior provider explanations, time spent, provider concern, and follow-up instructions compared with control participants, whereas control group ratings fell in the post-intervention period (P for difference Lean enhancement with payment reform, patient experience was sustained or improved across key PCMH domains.

  1. [The influence of high-tone power therapy on the functional status of patients with multiple sclerosis].

    Science.gov (United States)

    Kubsik, Anna; Klimkiewicz, Paulina; Klimkiewicz, Robert; Jankowska, Katarzyna; Jankowska, Agnieszka; Woldańska-Okońska, Marta

    2014-07-01

    Multiple sclerosis is a chronic, inflammatory, demyelinating disease of the central nervous system, which is characterized by diverse symptomatology. Most often affects people at a young age gradually leading to their disability. Looking for new therapies to alleviate neurological deficits caused by the disease. One of the alternative methods of therapy is high - tone power therapy. The article is a comparison of high-tone power therapy and kinesis in improving patients with multiple sclerosis. The aim of this study was to evaluate the effectiveness of high-tone power therapy and exercises in kinesis on the functional status of patients with multiple sclerosis. The study involved 20 patients with multiple sclerosis, both sexes, treated at the Department of Rehabilitation and Physical Medicine in Lodz. Patients were randomly divided into two groups studied. In group high-tone power therapy applied for 60 minutes, while in group II were used exercises for kinesis. Treatment time for both groups of patients was 15 days. To assess the functional status scale was used: Expanded Disability Status Scale of Kurtzke (EDSS), as well as by Barthel ADL Index. Assessment of quality of life were made using MSQOL Questionnaire-54. For the evaluation of gait and balance using Tinetti scale, and pain VAS rated, and Laitinen. Changes in muscle tone was assessed on the basis of the Ashworth scale. Both group I and II improved on scales conducted before and after therapy. In group I, in which the applied high-tone power therapy, reported statistically significant results in 9 out of 10 tested parameters, while in group II, which was used in the exercises in kinesis an improvement in 6 out of 10 tested parameters. Correlating the results of both the test groups in relation to each other did not show statistically significant differences. High-Tone Power Therapy beneficial effect on the functional status of patients with multiple sclerosis. Obtaining results in terms of number of tested

  2. Directing Improvements in Primary Care Patient Experience through Analysis of Service Quality.

    Science.gov (United States)

    Hudson Smith, Mel; Smith, David

    2018-06-03

    To examine the influence of dimensions of service quality on patient experience of primary care. Data from the national GP Patient Survey in England 2014/15, with responses from 858,351 patients registered at 7,918 practices. Expert panel and principal component analysis helped identify relevant dimensions of service quality. Regression was then used to examine the relationships between these dimensions and reported patient experience. Aggregated scores for each practice were used, comprising the proportion of positive responses to each element of the study. Of eight service quality dimensions identified, six have statistically significant impacts on patient experience but only two have large effects. Patient experience is highly influenced by practice responsiveness and the interactions with the physician. Other dimensions have small or even slightly negative influence. Service quality provided by nurses has negligible effect on patient experience. To improve patient experience in primary health care, efforts should focus on practice responsiveness and interactions with the physician. Other areas have little influence over patient experience. This suggests a gap in patients' perspectives on health care, which has policy implications for patient education. © Health Research and Educational Trust.

  3. The Global Cognition, Frontal Lobe Dysfunction and Behavior Changes in Chinese Patients with Multiple System Atrophy.

    Directory of Open Access Journals (Sweden)

    Bei Cao

    Full Text Available Studies on cognition in multiple system atrophy (MSA patients are limited.A total of 110 MSA patients were evaluated using Addenbrooke's Cognitive Examination-Revised (ACE-R, Frontal Assessment Battery (FAB, Frontal Behavioral Inventory (FBI, and Unified MSA Rating Scale (UMSARS tests. Fifty-five age-, sex-, education- and domicile-matched healthy controls were recruited to perform the FAB and ACE-R scales.Approximately 32.7% of the patients had global cognitive deficits with the most impaired domain being verbal fluency and visuospatial ability (26.4%, followed by memory (24.5%, language (20% and orientation/attention (20% based on a cut-off score of ACE-R ≤ 70. A total of 41.6% of the patients had frontal lobe dysfunction, with inhibitory control (60.9% as the most impaired domain based on a cut-off score of FAB ≤14. Most patients (57.2% showed moderate frontal behavior changes (FBI score 4-15, with incontinence (64.5% as the most impaired domain. The binary logistic regression model revealed that an education level < 9 years (OR:13.312, 95% CI:2.931-60.469, P = 0.001 and UMSARS ≥ 40 (OR: 2.444, 95%CI: 1.002-5.962, P< 0.049 were potential determinants of abnormal ACE-R, while MSA-C (OR: 4.326, 95%CI: 1.631-11.477, P = 0.003, an education level < 9 years (OR:2.809 95% CI:1.060-7.444, P = 0.038 and UMSARS ≥ 40 (OR:5.396, 95%CI: 2.103-13.846, P < 0.0001 were potential determinants of abnormal FAB.Cognitive impairment is common in Chinese MSA patients. MSA-C patients with low education levels and severe motor symptoms are likely to experience frontal lobe dysfunction, while MSA patients with low education levels and severe motor symptoms are likely to experience global cognitive deficits. These findings strongly suggest that cognitive impairment should not be an exclusion criterion for the diagnosis of MSA.

  4. Leaders' Experiences with High School-College Writing Center Collaborations: A Qualitative Multiple-Case Study

    Science.gov (United States)

    Story, Julie A.

    2014-01-01

    The purpose of this qualitative multiple-case study was to explore academic leaders' experiences with the organizational elements of their own high school-college writing center collaborations. Conjoining theories framed this study: collaborative leadership theory, Kenneth Bruffee's notion of social constructionism and collaborative learning…

  5. Experiences of care planning in England: interviews with patients with long term conditions

    Directory of Open Access Journals (Sweden)

    Newbould Jenny

    2012-07-01

    Full Text Available Abstract Background The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority in England for chronic disease management. However, it is not clear how care planning is currently understood, translated and implemented in primary care. This study explores experience of care planning in patients with long term conditions in three areas in England. Methods We conducted semi-structured interviews with 23 predominantly elderly patients with multiple long term conditions. The interviews were designed to explore variations in and emergent experiences of care planning. Qualitative analysis of interview transcripts involved reflexively coding and re-coding data into categories and themes. Results No participants reported experiencing explicit care planning discussions or receiving written documentation setting out a negotiated care plan and they were unfamiliar with the term ‘care planning’. However, most described some components of care planning which occurred over a number of contacts with health care professionals which we term”reactive” care planning. Here, key elements of care planning including goal setting and action planning were rare. Additionally, poor continuity and coordination of care, lack of time in consultations, and patient concerns about what was legitimate to discuss with the doctor were described. Conclusions Amongst this population, elements of care planning were present in their accounts, but a structured, comprehensive process and consequent written record (as outlined in English Department of Health policy was not evident. Further research needs to explore the advantages and disadvantages of different approaches to care planning for different patient groups.

  6. Use of multiple methods to determine factors affecting quality of care of patients with diabetes.

    Science.gov (United States)

    Khunti, K

    1999-10-01

    The process of care of patients with diabetes is complex; however, GPs are playing a greater role in its management. Despite the research evidence, the quality of care of patients with diabetes is variable. In order to improve care, information is required on the obstacles faced by practices in improving care. Qualitative and quantitative methods can be used for formation of hypotheses and the development of survey procedures. However, to date few examples exist in general practice research on the use of multiple methods using both quantitative and qualitative techniques for hypothesis generation. We aimed to determine information on all factors that may be associated with delivery of care to patients with diabetes. Factors for consideration on delivery of diabetes care were generated by multiple qualitative methods including brainstorming with health professionals and patients, a focus group and interviews with key informants which included GPs and practice nurses. Audit data showing variations in care of patients with diabetes were used to stimulate the brainstorming session. A systematic literature search focusing on quality of care of patients with diabetes in primary care was also conducted. Fifty-four potential factors were identified by multiple methods. Twenty (37.0%) were practice-related factors, 14 (25.9%) were patient-related factors and 20 (37.0%) were organizational factors. A combination of brainstorming and the literature review identified 51 (94.4%) factors. Patients did not identify factors in addition to those identified by other methods. The complexity of delivery of care to patients with diabetes is reflected in the large number of potential factors identified in this study. This study shows the feasibility of using multiple methods for hypothesis generation. Each evaluation method provided unique data which could not otherwise be easily obtained. This study highlights a way of combining various traditional methods in an attempt to overcome the

  7. Entrepreneurs Experience and Firm Innovativeness: Multiple Mediation of Attitudinal and Behavioral Competencies

    OpenAIRE

    Bernard Nassiuma; Jamin Masasabi; Denyse Snelder; Anne Nangulu

    2018-01-01

    This study was anchored on a postpositivism paradigm and the Theory of perceived attributes and individual innovativeness, regarding the multiple serial mediations of attitudinal and behavioral competencies in the relationship between the entrepreneurs’ experience and firm innovativeness. To test the hypothesized relationship a cross-sectional design and qualitative approach were employed. The study drew on a sample of 698 Micro and Small-scale entrepreneurs in Western Kenya. Questionnaires ...

  8. Structured diagnostic imaging in patients with multiple trauma; Strukturierte radiologische Diagnostik beim Polytrauma

    Energy Technology Data Exchange (ETDEWEB)

    Linsenmaier, U.; Rieger, J.; Rock, C.; Pfeifer, K.J.; Reiser, M. [Institut fuer Klinische Radiologie, Klinikum der Universitaet Muenchen, Innenstadt (Germany); Kanz, K.G. [Chirurgische Klinik, Klinikum der Universitaet Muenchen, Innenstadt (Germany)

    2002-07-01

    Purpose. Development of a concept for structured diagnostic imaging in patients with multiple trauma.Material and methods. Evaluation of data from a prospective trial with over 2400 documented patients with multiple trauma. All diagnostic and therapeutic steps, primary and secondary death and the 90 days lethality were documented.Structured diagnostic imaging of multiple injured patients requires the integration of an experienced radiologist in an interdisciplinary trauma team consisting of anesthesia, radiology and trauma surgery. Radiology itself deserves standardized concepts for equipment, personnel and logistics to perform diagnostic imaging for a 24-h-coverage with constant quality.Results. This paper describes criteria for initiation of a shock room or emergency room treatment, strategies for documentation and interdisciplinary algorithms for the early clinical care coordinating diagnostic imaging and therapeutic procedures following standardized guidelines. Diagnostic imaging consists of basic diagnosis, radiological ABC-rule, radiological follow-up and structured organ diagnosis using CT. Radiological trauma scoring allows improved quality control of diagnosis and therapy of multiple injured patients.Conclusion. Structured diagnostic imaging of multiple injured patients leads to a standardization of diagnosis and therapy and ensures constant process quality. (orig.) [German] Fragestellung. Entwicklung eines strukturierten Konzeptes zur radiologischen Diagnostik polytraumatisierter Patienten.Methodik. Die Datenevaluation erfolgte auf Basis einer prospektiven interdisziplinaere Polytraumastudie mit ueber 2400 Patienten. Alle diagnostischen und therapeutischen Schritte werden jeweils unter Angabe von Zeitpunkt und auftretenden Komplikationen erfasst, ein primaeres oder sekundaeres Versterben und die 90-Tage-Letalitaet werden dokumentiert.Die strukturierte radiologische Diagnostik von Mehrfachverletzen verlangt die Integration eines erfahrenen Radiologen in

  9. Orthodontic treatment for a patient with multiple sclerosis

    Science.gov (United States)

    Bakathir, Manal A

    2017-01-01

    Multiple sclerosis (MS) is a chronic, autoimmune inflammatory disorder of the central nervous system (CNS) that affects myelinated axons, destroying the myelin and damaging axons to varying degrees. The course of MS is highly varied and unpredictable. Metals used during orthodontic treatment can negatively affect imaging techniques used to diagnose and monitor the progression of MS, while medications used to treat MS can negatively affect orthodontic tooth movement. The present case report highlights some of the challenges encountered during orthodontic treatment of a patient with MS and how to overcome them. The patient was a 20-year-old woman with complaints of diastema and spacing in the upper arch. Although closing the spaces was challenging due to some of the MS medications, she was treated successfully, without complications, within 20 months using closing loops. PMID:28717636

  10. Is Local Radiotherapy Still Valuable for Patients With Multiple Intrahepatic Hepatocellular Carcinomas?

    International Nuclear Information System (INIS)

    Koom, Woong Sub; Seong, Jinsil; Han, Kwang Hyub; Lee, Do Yun; Lee, Jong Tae

    2010-01-01

    Purpose: To investigate whether local radiotherapy (RT) is valuable for patients with multiple hepatocellular carcinomas (HCCs). Methods and Materials: From July 1992 to August 2006, 107 patients with unresectable HCC were treated with local RT after incomplete transcatheter arterial chemoembolization (TACE). The RT field included a main tumor with or without other tumor nodules, depending on the effectiveness of TACE. The median RT dose was 50.4Gy in conventional fractionation. Patients were categorized into four groups: Group 1, single tumor (39 patients); Group 2, multiple tumors within the RT field (25 patients); Group 3, controlled tumors out of the RT field (19 patients); and Group 4, tumors that remained viable out of the RT field (24 patients). Results: Group 1 showed the best survival rate (MST, 35 months; 2-year OS, 60%) and Group 4 the worst (MST, 5 months; 2-year OS, 16%). Group 2 and Group 3 showed similar survival (MST, 13 vs. 19 months; 2-year OS, 35% vs. 46%; p = 0.698). Significantly worse intrahepatic control in Group 4 was observed. The survival in Groups 2 and 3 (MST, 16 months) was significantly different from that in Group 4 (p = 0.004), and was marginally significant compared with that in Group 1 (p = 0.051). Conclusions: Local RT to the main tumor could be applicable in well-controlled intrahepatic tumors out of the RT field. Patients with viable intrahepatic tumors out of the RT field showed worse survival. In future clinical trials, these patients need to be excluded.

  11. Fingolimod hydrochloride for the treatment of relapsing remitting multiple sclerosis.

    Science.gov (United States)

    Thomas, Katja; Proschmann, Undine; Ziemssen, Tjalf

    2017-10-01

    Fingolimod was the first oral and the first in class disease modifying treatment in multiple sclerosis that acts as sphingosine-1-phospathe receptor agonist. Since approval in 2010 there is a growing experience with fingolimod use in clinical practice, but also next-generation sphingosin-1-receptor agonists in ongoing clinical trials. Growing evidence demonstrates additional effects beyond impact on lymphocyte circulation, highlighting further promising targets in multiple sclerosis therapy. Areas covered: Here we present a systematic review using PubMed database searching and expert opinion on fingolimod use in clinical practice. Long-term data of initial clinical trials and post-marketing evaluations including long-term efficacy, safety, tolerability and management especially within growing disease modifying treatment options and pre-treatment constellation in multiple sclerosis patients are critically discussed. Furthermore novel findings in mechanism of actions and prospective on additional use in progressive forms in multiple sclerosis are presented. Expert opinion: There is an extensive long-term experience on fingolimod use in clinical practice demonstrating the favorable benefit-risk of this drug. Using a defined risk management approach experienced MS clinicians should apply fingolimod after critical choice of patients and review of clinical aspects. Further studies are essential to discuss additional benefit in progressive forms in multiple sclerosis.

  12. Effect of fingolimod on platelet count among multiple sclerosis patients

    Directory of Open Access Journals (Sweden)

    Mehrdad Farrokhi

    2015-01-01

    Conclusions: MS patients taking oral fingolimod treatment may be at risk for side-effects caused by low Plt levels. This may not be a factor for patients with higher or normal Plt levels. However, a patient with naturally low Plt levels may experience a drop below the normal level and be at risk for excessive bleeding. In addition to these possible harmful side-effects, the decreased Plt population may pose positive effects for MS patients.

  13. A study of stigma among Iranian family caregivers of patients with multiple sclerosis: A descriptive explorative qualitative study.

    Science.gov (United States)

    Masoudi, Reza; Khayeri, Fereydoon; Rabiei, Leili; Zarea, Kourosh

    2017-04-01

    This study was done to investigate the experiences of family caregivers of people with multiple sclerosis (MS) about stigmatization in Iranian health care context. Stigmatization has been observed obviously among patients with MS but few studies have been conducted on stigma among the family caregivers of these patients. This qualitative study with thematic analysis was done to explore this issue. Fourteen family caregivers of patients with MS were selected by purposive sampling. The data were collected through in-depth and unstructured interviews. Four main subthemes emerged from the analysis of the transcripts: "feeling shame", "fear of being ridiculed by others", "ignored by family" and "concealing disease to be secure against the perceptions of disease". Healthcare professionals should be encouraged to inform caregivers about social engagement strategies and to train them on the management of stigma as an important factor for the reduction of their social problems. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Lumbar Spinal Stenosis Due to Ligamentum Flavum Hypertrophy in a Patient with Multiple Exostosis

    Directory of Open Access Journals (Sweden)

    Sevgi Ižkbali Afsar

    2016-09-01

    Full Text Available Hereditary multiple exostosis is an autosomal dominant disease characterized by multiple exostoses (osteochondromas usually affecting the metaphysical regions of long bones, usually of the lower extremity, and seldom occurring in the axial skeleton. In the literature, hereditary multiple exostosis cases that developed spinal canal stenosis due to spinal osteochondromas have been reported. Lumbar spinal stenosis may occur in a hereditary multiple exostosis patient due to ligamentum flavum hypertrophy, which is a hyperosteotic process that differs from exostosis. We discuss one such case, along with pathogenetic mechanisms and clinical features.

  15. HLA typing in patients with multiple evanescent white dot syndrome (MEWDS).

    Science.gov (United States)

    Borruat, F X; Herbort, C P; Spertini, F; Desarnaulds, A B

    1998-03-01

    Multiple evanescent white dot syndrome (MEWDS) is an acquired chorioretinal disorder of unknown etiology. We investigated the possibility that MEWDS might be related to a specific HLA subtyping. Blood was obtained from nine patients affected by MEWDS. HLA-B51 was found in four of these nine patients with MEWDS. There was a 3.7-fold increased frequency of HLA-B51 in patients affected by MEWDS (relative risk 5.86). MEWDS might then be related to the presence of a specific HLA subtype, HLA-B51. However, due to the small sample size, our results need to be confirmed by further testing.

  16. Assessment of Personality Types and Locus of Control in Multiple Sclerosis Patients

    Directory of Open Access Journals (Sweden)

    Sh. Mazaheri

    2008-07-01

    Full Text Available Introduction & Objective: Multiple sclerosis (MS is an autoimmune disease with unknown cause. MS is one of the disabling neurologic diseases in adult especially young range that myelin part of central nervous system (CNS is destructed. The aim of this study was assessment of types A and B personality and internal and external locus of control in multiple sclerosis (MS patients and comparison of the results with control group.Materials & Methods: In a case-control study, 30 patients with MS and 30 normal persons as control group evaluated with neurological examination, Rotter locus of control test and Friedman-Rosenman questionnaire for detection of types A and B personality. We employed to analyze the results.Results: 43 percent and 57 percent of MS patients had internal and external locus of control respectively. 63 percent and 37 percent of MS patients had type A and B personality respectively. 60 percent and 40 percent of control group had internal and external locus of control respectively. 20 percent and 80 percent of control group had type A and B personality respectively. Difference between personality type in two groups was significant (P<0.01.Conclusions: In this study, MS patients had more type A personality in comparison to control group.

  17. Spiritual well-being of patients with multiple sclerosis.

    Science.gov (United States)

    Allahbakhshian, Maryam; Jafarpour, Mahshid; Parvizi, Soroor

    2011-01-01

    Spiritual well-being is one of the fundamental concepts in chronic diseases which create meaning and purpose in life and is an important approach in promoting general health and quality of life. This study performed to determine the level of spiritual health and its dimensions in patients with multiple sclerosis (MS). 236 members of Iranian MS Society were volunteered to participate in a descriptive co-relational study. Spiritual well-being was evaluated by The Spiritual Well-Being Scale (SWBS) questionnaires in two religious and Existential dimensions. Descriptive statistics, ANOVA, t-test and Pearson correlation coefficient were used to analyse the data. The majority of patients (% 97.9) showed moderate spiritual well-being (mean score = 74.3, SD= 8.90). Although Existential well-being (mean score = 40.3, SD= 5.51) was higher than religious well- being (mean score = 33.9, SD= 4.88). A significant relationship was seen between economic status and the spiritual well-being. The results emphasize on the necessity of spiritual well-being as an effective factor on different aspects of these patients' life. This key point is useful and even necessary to be considered to design programs of care and cure for these patients in a country (like Iran) with cultural and religious beliefs. On the other hand, patients' economic status should be considered.

  18. Improving patients' and staff's experiences of acute care.

    Science.gov (United States)

    Chaplin, Rob; Crawshaw, Jacob; Hood, Chloe

    2015-03-01

    The aim of this audit was to assess the effect of the Quality Mark programme on the quality of acute care received by older patients by comparing the experiences of staff and older adults before and after the programme. Data from 31 wards in 12 acute hospitals were collected over two stages. Patients and staff completed questionnaires on the perceived quality of care on the ward. Patients rated improved experiences of nutrition, staff availability and dignity. Staff received an increase in training and reported better access to support, increased time and skill to deliver care and improved morale, leadership and teamwork. Problems remained with ward comfort and mealtimes. Overall, results indicated an improvement in ratings of care quality in most domains during Quality Mark data collection. Further audits need to explore ways of improving ward comfort and mealtime experience.

  19. Insulin resistance in drug naive patients with multiple sclerosis

    OpenAIRE

    Kostić Smiljana; Kolić Ivana; Raičević Ranko; Stojanović Zvezdana; Kostić Dejan; Dinčić Evica

    2017-01-01

    Background/Aim. Due to the fact that there is a relatively small number of data related to systemic insulin abnormalities in the multiple sclerosis (MS), the main objective of our study was to determine whether a dysbalance of glucose and insulin metabolism exist in patients with natural course of MS. Our hypothesis was that the metabolic disorder that characterizes state of the insulin resistance (IR) and reduced insulin sensitivity (IS) in untreated patie...

  20. Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review.

    Science.gov (United States)

    de Bruin, Simone R; Versnel, Nathalie; Lemmens, Lidwien C; Molema, Claudia C M; Schellevis, François G; Nijpels, Giel; Baan, Caroline A

    2012-10-01

    To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers. Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden. Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with multiple chronic conditions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Managing multimorbidity: how can the patient experience be improved?

    Directory of Open Access Journals (Sweden)

    Stanimir Hasardzhiev

    2016-02-01

    Full Text Available Abstract The patient’s experience of their own healthcare is an important aspect of care quality that has been shown to improve clinical and other outcomes. Very little is currently known about patient experience in the management of multimorbidity, although preliminary evidence suggests that it may be poor. Individuals with multimorbidity report better experiences of care when they are knowledgeable and involved in the decision-making, when their care is well coordinated, and communication is good. A greater focus on disease prevention, stronger collaboration between health and social care services, and the provision of more integrated care for people with mental and physical health problems would also help to improve the patient experience. Advocacy groups can amplify the patient voice and improve access to care, as well as provide information and support to patients and their families. Patients have an important role in preventing multimorbidity and improving its management, and should be involved in the development of health policies and the delivery of healthcare services. Inequalities in access to quality healthcare must also be addressed. Journal of Comorbidity 2016;6(128–32

  2. Charged particle multiplicity distributions in Au-Au collisions at RHIC-BNL energies (BRAHMS Experiment)

    International Nuclear Information System (INIS)

    Argintaru, D.; Bearden, I.G.; Beavis, D.

    2002-01-01

    The BRAHMS Experiment (Broad RAnge Hadronic Magnetic Spectrometers) takes place at the Relativistic Heavy Ion Collider (RHIC) from Brookhaven National Laboratory and searches for a transition of matter into a new phase called quark-gluon plasma (QGP), a phase transition that appears in extreme conditions of nuclear matter densities and temperatures. Important signals for this transition are related to dependencies of the charged particle multiplicity distributions on the pseudorapidity range. The charged particle multiplicity distributions in Au-Au collisions at RHIC energies are obtained from the global detector measurements. These detectors are: - An array of Si strip detectors and scintillation tiles placed around the interaction region; they cover the range η < 2 in pseudorapidity, measuring the majority of charged particles; - Two systems of Cerenkov detectors (Beam-Beam Counters) placed both sides of the nominal interaction point at 220 cm and cover the range 3 < η < 4.3 in pseudorapidity. These detectors are used for vertex determination and supply a level zero trigger for the entire experiment; - Zero Degree Calorimeters placed at zero degree with respect to the beam axis, both sides of the vertex, measuring the spectator neutrons from the nuclear reactions. These detectors supplies information about the reaction centrality and could estimate the interaction vertex. The paper presents some results on charged particle multiplicities in different pseudorapidity ranges at different impact parameters. Interesting dependencies of the average charged particle multiplicities on the pseudorapidity range, impact parameters and total available energy in the centre of mass system. Some comparisons with the simulation codes predictions and theoretical model estimations are included, too. (authors)

  3. Relationship between foot sensation and standing balance in patients with multiple sclerosis.

    Science.gov (United States)

    Citaker, Seyit; Gunduz, Arzu Guclu; Guclu, Meral Bosnak; Nazliel, Bijen; Irkec, Ceyla; Kaya, Defne

    2011-06-01

    The aims of the present study were to investigate the relationship between the foot sensations and standing balance in patients with Multiple Sclerosis (MS) and find out the sensation, which best predicts balance. Twenty-seven patients with MS (Expanded Disability Status Scale 1-3.5) and 10 healthy volunteers were included. Threshold of light touch-pressure, duration of vibration, and distance of two-point discrimination of the foot sole were assessed. Duration of static one-leg standing balance was measured. Light touch-pressure, vibration, two-point discrimination sensations of the foot sole, and duration of one-leg standing balance were decreased in patients with MS compared with controls (pbalance in patients with MS. In the multiple regression analysis conducted in the 27 MS patients, 47.6% of the variance in the duration of one-leg standing balance was explained by two-point discrimination sensation of the heel (R(2)=0.359, p=0.001) and vibration sensation of the first metatarsal head (R(2)=0.118, p=0.029). As the cutaneous receptors sensitivity decreases in the foot sole the standing balance impairs in patients with MS. Two-point discrimination sensation of the heel and vibration sensation of the first metatarsal head region are the best predictors of the static standing balance in patients with MS. Other factors which could be possible to predict balance and effects of sensorial training of foot on balance should be investigated. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. A clinical decision-making mechanism for context-aware and patient-specific remote monitoring systems using the correlations of multiple vital signs.

    Science.gov (United States)

    Forkan, Abdur Rahim Mohammad; Khalil, Ibrahim

    2017-02-01

    In home-based context-aware monitoring patient's real-time data of multiple vital signs (e.g. heart rate, blood pressure) are continuously generated from wearable sensors. The changes in such vital parameters are highly correlated. They are also patient-centric and can be either recurrent or can fluctuate. The objective of this study is to develop an intelligent method for personalized monitoring and clinical decision support through early estimation of patient-specific vital sign values, and prediction of anomalies using the interrelation among multiple vital signs. In this paper, multi-label classification algorithms are applied in classifier design to forecast these values and related abnormalities. We proposed a completely new approach of patient-specific vital sign prediction system using their correlations. The developed technique can guide healthcare professionals to make accurate clinical decisions. Moreover, our model can support many patients with various clinical conditions concurrently by utilizing the power of cloud computing technology. The developed method also reduces the rate of false predictions in remote monitoring centres. In the experimental settings, the statistical features and correlations of six vital signs are formulated as multi-label classification problem. Eight multi-label classification algorithms along with three fundamental machine learning algorithms are used and tested on a public dataset of 85 patients. Different multi-label classification evaluation measures such as Hamming score, F1-micro average, and accuracy are used for interpreting the prediction performance of patient-specific situation classifications. We achieved 90-95% Hamming score values across 24 classifier combinations for 85 different patients used in our experiment. The results are compared with single-label classifiers and without considering the correlations among the vitals. The comparisons show that multi-label method is the best technique for this problem

  5. A permutation-based multiple testing method for time-course microarray experiments

    Directory of Open Access Journals (Sweden)

    George Stephen L

    2009-10-01

    Full Text Available Abstract Background Time-course microarray experiments are widely used to study the temporal profiles of gene expression. Storey et al. (2005 developed a method for analyzing time-course microarray studies that can be applied to discovering genes whose expression trajectories change over time within a single biological group, or those that follow different time trajectories among multiple groups. They estimated the expression trajectories of each gene using natural cubic splines under the null (no time-course and alternative (time-course hypotheses, and used a goodness of fit test statistic to quantify the discrepancy. The null distribution of the statistic was approximated through a bootstrap method. Gene expression levels in microarray data are often complicatedly correlated. An accurate type I error control adjusting for multiple testing requires the joint null distribution of test statistics for a large number of genes. For this purpose, permutation methods have been widely used because of computational ease and their intuitive interpretation. Results In this paper, we propose a permutation-based multiple testing procedure based on the test statistic used by Storey et al. (2005. We also propose an efficient computation algorithm. Extensive simulations are conducted to investigate the performance of the permutation-based multiple testing procedure. The application of the proposed method is illustrated using the Caenorhabditis elegans dauer developmental data. Conclusion Our method is computationally efficient and applicable for identifying genes whose expression levels are time-dependent in a single biological group and for identifying the genes for which the time-profile depends on the group in a multi-group setting.

  6. Is fatigue related to temperament and character dimansions in patients with multiple sklerozis?

    Directory of Open Access Journals (Sweden)

    Suzan Üstün

    2012-06-01

    Full Text Available OBJECTIVE: To examine the relationship between fatigue and temperament-character inventory among patients with Multiple Sclerosis (MS. METHODS: This study was conducted at a tertiary referral center between August-December 2010. Overall 75 patients with MS and 75 healthy volunteers in the control group were included into study. Patients with MS and controls were divided into two groups as ‘’Fatigue’’ and ‘’non-Fatigue’’. The personal features of patients and controls were determined using the ‘‘Temperament-Character Inventory’’. Fatigue individuals were detected using the ‘‘Fatigue Severity Scale’’. Statistical analyses were done by SPSS 16.0 software. RESULTS: In the study, ‘‘Harm Avoidance’’ and “Impulsiveness” were high, but ‘‘Social Acceptance’’ was low, among MS patients. Namely, fatigue patients with MS are more reluctant, passive, distrustful, easily fatigue, pessimistic, avoiding from harmful conditions and intolerant individuals than non-fatigue patients with MS and controls. Patients with MS were found more fatigue than healthy individuals although they were not entered to the ‘’fatigue classification’’ according to FSS. ‘‘Persistence’’ and ‘‘Purposefulness’’ scores were low among MS patients. Namely, fatigue patients with MS are more indolent, inactive, hesitant, irregular, rarely working for high success, tend to easily renunciation, and purposeless individuals than healthy volunteers. CONCLUSION: Fatigue significantly affects the temperament and character features in patients with Multiple Sclerosis

  7. Dedifferentiated chondrosarcoma in patients with multiple osteochondromatosis: report of a case and review of the literature

    International Nuclear Information System (INIS)

    Kilpatrick, S.E.; Pike, E.J.; Ward, W.G.; Pope, T.L.

    1997-01-01

    Multiple osteochondromatosis (MOS) is a familial disorder of autosomal dominant transmission characterized by the development of multiple exostoses and often derangements of epiphyseal cartilage, sometimes resulting in long bone growth retardation. Patients with the disorder appear to be at increased risk for developing secondary chondrosarcomas. Rarely, dedifferentiated chondrosarcomas may also occur. We report a single case of a 27-year-old man with multiple osteochondromatosis who developed a fatal dedifferentiated chondrosarcoma. Radiographically, the neoplasm arose from the pelvis completely destroying the left pubic ramus. Subsequently, the patient underwent preoperative chemotherapy followed by a left external hemipelvectomy. On pathologic examination, the tumor was characterized by high-grade pleomorphic sarcoma sharply juxtaposed to a low-grade chondrosarcoma. The patient ultimately died of widespread metastatic sarcoma. (orig.). With 7 figs

  8. Dedifferentiated chondrosarcoma in patients with multiple osteochondromatosis: report of a case and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Kilpatrick, S.E. [Department of Pathology, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States); Pike, E.J. [Department of Radiology, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States); Ward, W.G. [Department of Orthopaedics, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States); Pope, T.L. [Department of Radiology, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States)

    1997-06-01

    Multiple osteochondromatosis (MOS) is a familial disorder of autosomal dominant transmission characterized by the development of multiple exostoses and often derangements of epiphyseal cartilage, sometimes resulting in long bone growth retardation. Patients with the disorder appear to be at increased risk for developing secondary chondrosarcomas. Rarely, dedifferentiated chondrosarcomas may also occur. We report a single case of a 27-year-old man with multiple osteochondromatosis who developed a fatal dedifferentiated chondrosarcoma. Radiographically, the neoplasm arose from the pelvis completely destroying the left pubic ramus. Subsequently, the patient underwent preoperative chemotherapy followed by a left external hemipelvectomy. On pathologic examination, the tumor was characterized by high-grade pleomorphic sarcoma sharply juxtaposed to a low-grade chondrosarcoma. The patient ultimately died of widespread metastatic sarcoma. (orig.). With 7 figs.

  9. Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism.

    Science.gov (United States)

    Yi, Hyon-Seung; Kim, Ji Min; Ju, Sang Hyeon; Lee, Younghak; Kim, Hyun Jin; Kim, Koon Soon

    2016-02-01

    Isolated hypogonadotropic hypogonadism (IHH) is known to decrease bone mineral density due to deficiency of sex steroid hormone. Graves' disease is also an important cause of secondary osteoporosis. However, IHH does not preclude the development of primary hyperthyroidism caused by Graves' disease, leading to more severe osteoporosis rapidly. Here, we describe the first case of 35-year-old Asian female patient with IHH accompanied by Graves' disease and osteoporosis-induced multiple fractures. Endocrine laboratory findings revealed preserved anterior pituitary functions except for secretion of gonadotropins and showed primary hyperthyroidism with positive autoantibodies. Sella magnetic resonance imaging showed slightly small sized pituitary gland without mass lesion. Dual energy X-ray absorptiometry revealed severe osteoporosis in lumbar spine and femur neck of the patient. Plain film radiography of the pelvis and shoulder revealed a displaced and nondisplaced fracture, respectively. After surgical fixation with screws for the femoral fracture, the patient was treated with antithyroid medication, calcium, and vitamin D until now and has been recovering fairly well. We report a patient of IHH with Graves' disease and multiple fractures that is a first case in Korea.

  10. Features of borderline personality disorder as a mediator of the relation between childhood traumatic experiences and psychosis-like experiences in patients with mood disorder.

    Science.gov (United States)

    Baryshnikov, Ilya; Aaltonen, Kari; Suvisaari, Jaana; Koivisto, Maaria; Heikkinen, Martti; Joffe, Grigori; Isometsä, Erkki

    2018-03-01

    Psychosis-like experiences (PEs) are common in patients with non-psychotic disorders. Several factors predict reporting of PEs in mood disorders, including mood-associated cognitive biases, anxiety and features of borderline personality disorder (BPD). Childhood traumatic experiences (CEs), often reported by patients with BPD, are an important risk factor for mental disorders. We hypothesized that features of BPD may mediate the relationship between CEs and PEs. In this study, we investigated the relationships between self-reported PEs, CEs and features of BPD in patients with mood disorders. As part of the Helsinki University Psychiatric Consortium study, McLean Screening Instrument (MSI), Community Assessment of Psychic Experiences (CAPE-42) and Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n = 282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, multiple regression and mediation analyses were conducted. Total scores of MSI correlated strongly with scores of the CAPE-42 dimension "frequency of positive symptoms" (rho = 0.56; p ≤ 0.001) and moderately with scores of TADS (rho = 0.4; p ≤ 0.001). Total score of MSI and its dimension "cognitive symptoms", including identity disturbance, distrustfulness and dissociative symptoms, fully mediated the relation between TADS and CAPE-42. Each cognitive symptom showed a partial mediating role (dissociative symptoms 43% (CI = 25-74%); identity disturbance 40% (CI = 30-73%); distrustfulness 18% (CI = 12-50%)). Self-reported cognitive-perceptual symptoms of BPD fully mediate, while affective, behavioural and interpersonal symptoms only partially mediate the relationships between CEs and PEs. Recognition of co-morbid features of BPD in patients with mood disorders reporting PEs is essential. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Physician groups' use of data from patient experience surveys.

    Science.gov (United States)

    Friedberg, Mark W; SteelFisher, Gillian K; Karp, Melinda; Schneider, Eric C

    2011-05-01

    In Massachusetts, physician groups' performance on validated surveys of patient experience has been publicly reported since 2006. Groups also receive detailed reports of their own performance, but little is known about how physician groups have responded to these reports. To examine whether and how physician groups are using patient experience data to improve patient care. During 2008, we conducted semi-structured interviews with the leaders of 72 participating physician groups (out of 117 groups receiving patient experience reports). Based on leaders' responses, we identified three levels of engagement with patient experience reporting: no efforts to improve (level 1), efforts to improve only the performance of low-scoring physicians or practice sites (level 2), and efforts to improve group-wide performance (level 3). Groups' level of engagement and specific efforts to improve patient care. Forty-four group leaders (61%) reported group-wide improvement efforts (level 3), 16 (22%) reported efforts to improve only the performance of low-scoring physicians or practice sites (level 2), and 12 (17%) reported no performance improvement efforts (level 1). Level 3 groups were more likely than others to have an integrated medical group organizational model (84% vs. 31% at level 2 and 33% at level 1; P customer service. The most commonly reported improvement initiatives were changing office workflow, providing additional training for nonclinical staff, and adopting or enhancing an electronic health record. Despite statewide public reporting, physician groups' use of patient experience data varied widely. Integrated organizational models were associated with greater engagement, and efforts to enhance clinicians' interpersonal skills were uncommon, with groups predominantly focusing on office workflow and support staff.

  12. A silicon multiplicity detector system for an experiment on the interaction of antiprotons with nuclei at BNL

    International Nuclear Information System (INIS)

    Ahmad, S.; Bonner, B.E.; Buchanan, J.A.; Clement, J.M.; Empl, A.; Mutchler, G.S.; Toshkov, S.; Chan, C.S.; Kramer, M.A.; Lindenbaum, S.J.; Hallman, T.J.; Madansky, L.; Peaslee, D.C.

    1991-01-01

    A Large Angle Multiplicity Detector (LAMD) system has been developed and used at the BNL experiment E854: Antiproton Nucleus Interactions. This system performed well with an energetic antiproton beam. Charged particle multiplicity distributions from pbar annihilations were measured. We discuss the design and performance of the LAMD system in this paper. 6 refs., 10 figs

  13. Nursing staff-led behavioural group intervention in psychiatric in-patient care: Patient and staff experiences.

    Science.gov (United States)

    Salberg, Johanna; Folke, Fredrik; Ekselius, Lisa; Öster, Caisa

    2018-02-15

    A promising intervention in mental health in-patient care is behavioural activation (BA). Interventions based on BA can be used by mental health nurses and other staff members. The aim of this study was to evaluate patients' and staff members' experiences of a nursing staff-led behavioural group intervention in mental health in-patient care. The intervention was implemented at three adult acute general mental health in-patient wards in a public hospital setting in Sweden. A self-administrated questionnaire, completed by 84 patients and 34 nurses and nurse assistants, was administered, and nonparametric data analysed using descriptive statistics. Our findings revealed that both patients and nursing staff ranked nursing care and care environment as important aspects in the recovery process. Patients and staff members reported overall positive experiences of the group sessions. Patients with higher frequencies of attendance and patients satisfied with overall care had a more positive attitude towards the intervention. A more positive experience of being a group leader was reported by staff members who had been leading groups more than ten times. The most common impeding factor during implementation, reported by staff members, was a negative attitude to change. Conducive factors were having support from a psychologist and the perception that patients were showing interest. These positive experiences reported by patients and nursing staff, combined with previous research in this field, are taking us one step further in evaluating group sessions based on BA as a meaningful nursing intervention in mental health in-patient care. © 2018 Australian College of Mental Health Nurses Inc.

  14. The LBL [Lawrence Berkeley Laboratory] multiple beam experiments

    International Nuclear Information System (INIS)

    Fessenden, T.J.; Keefe, D.; Kim, C.; Meuth, H.; Warwick, A.

    1987-03-01

    The multiple-beam induction linac approach to a heavy ion driver for inertial confinement, fusion features continuous current amplification along the accelerator and a minimum of beam manipulations from source to pellet. Current amplification and bunch length control require careful shaping of the accelerating voltages. MBE-4 is designed as a four-beam induction linac that models much of the accelerator physics of the electrostatically focused section of a significantly longer induction accelerator. Four space-charge-dominated Cs + beams, initially about one meter in length at a current of 13 mA, are focused by electrostatic quadrupoles and accelerated in parallel from 200 to nearly 600 keV. The energy will reach approximately one MeV when the accelerator is complete. Experiments have proceeded in parallel with the construction of the apparatus which began in FY 85 and is now more than half complete. The results show a current amplification, so far, by a factor of 2.8 in good agreement with the longitudinal acceleration calculations

  15. The Impact of Multiple Malignancies on Patients with Bladder Carcinoma: A Population-Based Study Using the SEER Database

    Directory of Open Access Journals (Sweden)

    Joshua R. Ehrlich

    2009-01-01

    Results. Analyses demonstrated diminished survival among AB and ABS cohorts. However, when cohorts were substratified by stage, patients in the high-stage BS cohort appeared to have a survival advantage over high-stage BO patients. Conclusions. Bladder cancer patients with multiple malignancies have diminished survival. The survival advantage of high-stage BS patients is likely a statistical phenomenon. Such findings are important to shape future research and to improve our understanding of patients with multiple malignancies.

  16. Correlation between MRI findings, blood pressure and mental ability in patients with multiple lacunar infarcts

    International Nuclear Information System (INIS)

    Fukuda, Hitoshi; Kobayashi, Shotai; Okada, Kazunori; Tsunematsu, Tokugoro

    1991-01-01

    We studied the association between mental ability as rated by Hasegawa's scale, the severity of hypertension, the severity of brain atrophy, and the severity of lesions in the cerebral white matter on magnetic resonance imaging in 34 patients with multiple cerebral infarcts but without obvious cortical lesions. Data were analyzed using multiple regression analysis. The patients having both marked brain atrophy and severe white matter lesions showed an impairment of mental ability. Brain atrophy was correlated with aging and the severity of white matter lesions. There was a significant positive correlation between the diastolic blood pressure and the severity of white matter lesions. These findings suggest that the white matter lesions in patients with multiple cerebral infarcts are correlated with brain atrophy and mental deterioration, and that uncontrolled hypertension is an important risk factor in exacerbating the lesions in the cerebral white matter. (author)

  17. A Survey of Severity and Distribution of Musculoskeletal Pain in Multiple Sclerosis Patients; a Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Masoud ShayestehAzar

    2015-04-01

    Full Text Available Background: Pain, a common phenomenon in multiple sclerosis (MS patients, is associated with many symptoms and problems.  To investigation severity and distribution of musculoskeletal pain in MS patients. Methods: In this cross-sectional study, 115 members of the Mazandaran MS Association with confirmed MS were randomly selected to participate in the study. The patients were asked to fill out Numerical Rating Score and Nodric questionnaires, respectively. The data was analyzed by SPSS ver. 16 software. Results: The mean age of the participants was 30.43±5.86 years and 88 cases (76.5% were female. The mean disease duration was 26.34±24.32 months and 87.8% of the cases were experiencing pain at the time of study. The mean pain severity was 3.75±2.25 and worst pain experienced was 5.73±2.12. The most common pain sites were: the knees (55.7%, wrist (43.5%, and neck (41.7%. Women experience higher prevalence of shoulder, upper back, and ankle pain (P

  18. Early alveolar and systemic mediator release in patients at different risks for ARDS after multiple trauma.

    Science.gov (United States)

    Raymondos, Konstantinos; Martin, Michael U; Schmudlach, Tanja; Baus, Stefan; Weilbach, Christian; Welte, Tobias; Krettek, Christian; Frink, Michael; Hildebrand, Frank

    2012-02-01

    Alveolar IL-8 has been reported to early identify patients at-risk to develop ARDS. However, it remains unknown how alveolar IL-8 is related to pulmonary and systemic inflammation in patients predisposed for ARDS. We studied 24 patients 2-6h after multiple trauma. Patients with IL-8 >200 pg/ml in bronchoalveolar lavage (BAL) were assigned to the group at high risk for ARDS (H, n = 8) and patients with BAL IL-8 mediators. The enhanced alveolar and systemic inflammation associated with alveolar IL-8 release should be considered to identify high-risk patients for pulmonary complications after multiple trauma to adjust surgical and other treatment strategies to the individual risk profile. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. IMPROVING FUNCTIONAL INDEPENDENCE OF PATIENTS WITH MULTIPLE SCLEROSIS BY PHYSICAL THERAPY AND OCCUPATIONAL THERAPY

    Directory of Open Access Journals (Sweden)

    Ana-Maria Ticărat

    2011-06-01

    Full Text Available Introduction. Patients with multiple sclerosis can have a normal life despite of their real or possible disability and of the progressive nature of it. Scope. Patients who follow physical therapy and occupational therapy will have an increased quality of life and a greater functional independence.Methods. The randomized study was made on 7 patients with multiple sclerosis, from Oradea Day Centre, 3 times/week, ages between 35 – 55 years, functional level between mild and sever. Assessment and rehabilitation methods: inspection, BARTHEL Index. Frenkel method, brething exercises, weights exercises, gait exercises, writind exercises and games were used in the rehabilitation process. Group therapies: sociotherapy, arttherapy, music therapy. Results analysis consisted of the comparison of baseline and final means.Results. By analizing baseline and final means for Barthel Index for each functon separately, it was shown a mild improvement of functional independence for almost assessed functions, with at least 1-1,5 points.Conclusions. Persons with multiple sclerosis who follow physical therapy and occupational therapy presents a better functional independence after the treatment.

  20. Related B cell clones populate the meninges and parenchyma of patients with multiple sclerosis.

    Science.gov (United States)

    Lovato, Laura; Willis, Simon N; Rodig, Scott J; Caron, Tyler; Almendinger, Stefany E; Howell, Owain W; Reynolds, Richard; O'Connor, Kevin C; Hafler, David A

    2011-02-01

    In the central nervous system of patients with multiple sclerosis, B cell aggregates populate the meninges, raising the central question as to whether these structures relate to the B cell infiltrates found in parenchymal lesions or instead, represent a separate central nervous system immune compartment. We characterized the repertoires derived from meningeal B cell aggregates and the corresponding parenchymal infiltrates from brain tissue derived primarily from patients with progressive multiple sclerosis. The majority of expanded antigen-experienced B cell clones derived from meningeal aggregates were also present in the parenchyma. We extended this investigation to include 20 grey matter specimens containing meninges, 26 inflammatory plaques, 19 areas of normal appearing white matter and cerebral spinal fluid. Analysis of 1833 B cell receptor heavy chain variable region sequences demonstrated that antigen-experienced clones were consistently shared among these distinct compartments. This study establishes a relationship between extraparenchymal lymphoid tissue and parenchymal infiltrates and defines the arrangement of B cell clones that populate the central nervous system of patients with multiple sclerosis.

  1. Similarly Torn, Differentially Shorn? The Experience and Management of Conflict between Multiple Roles, Relationships, and Social Categories

    Directory of Open Access Journals (Sweden)

    Janelle M. Jones

    2017-10-01

    Full Text Available In three studies we examined the experience and management of conflict between different types of multiple identities. Participants described a conflict between pairs of role, relational, or social identities before rating the experience (i.e., magnitude, stress, and growth and management of conflict on a newly developed scale assessing four strategies: reconciliation, where identities are integrated, realignment, where one identity is chosen over another, retreat, where both identities are avoided, and reflection, where fit (with others, situation determines identity selection. In general, the types of identities mattered for conflict management but not its experience: Magnitude and growth did not differ, however, stress was greater for role identity conflicts (Study 3 only and participants endorsed the use of more realignment for role conflicts (Study 2 and more retreat for relational conflicts (Study 3 relative to other types of identity conflicts. Furthermore, findings suggested that the perceived flexibility of identities, not their importance or valence, were associated with realignment and retreat for roles and with retreat for relationships. Experiencing conflicts between multiple identities leaves people similarly torn, but multiple roles and relationships may be differentially shorn to manage conflict.

  2. Similarly Torn, Differentially Shorn? The Experience and Management of Conflict between Multiple Roles, Relationships, and Social Categories

    Science.gov (United States)

    Jones, Janelle M.; Hynie, Michaela

    2017-01-01

    In three studies we examined the experience and management of conflict between different types of multiple identities. Participants described a conflict between pairs of role, relational, or social identities before rating the experience (i.e., magnitude, stress, and growth) and management of conflict on a newly developed scale assessing four strategies: reconciliation, where identities are integrated, realignment, where one identity is chosen over another, retreat, where both identities are avoided, and reflection, where fit (with others, situation) determines identity selection. In general, the types of identities mattered for conflict management but not its experience: Magnitude and growth did not differ, however, stress was greater for role identity conflicts (Study 3 only) and participants endorsed the use of more realignment for role conflicts (Study 2) and more retreat for relational conflicts (Study 3) relative to other types of identity conflicts. Furthermore, findings suggested that the perceived flexibility of identities, not their importance or valence, were associated with realignment and retreat for roles and with retreat for relationships. Experiencing conflicts between multiple identities leaves people similarly torn, but multiple roles and relationships may be differentially shorn to manage conflict. PMID:29051744

  3. Similarly Torn, Differentially Shorn? The Experience and Management of Conflict between Multiple Roles, Relationships, and Social Categories.

    Science.gov (United States)

    Jones, Janelle M; Hynie, Michaela

    2017-01-01

    In three studies we examined the experience and management of conflict between different types of multiple identities. Participants described a conflict between pairs of role, relational, or social identities before rating the experience (i.e., magnitude, stress, and growth) and management of conflict on a newly developed scale assessing four strategies: reconciliation , where identities are integrated, realignment , where one identity is chosen over another, retreat , where both identities are avoided, and reflection , where fit (with others, situation) determines identity selection. In general, the types of identities mattered for conflict management but not its experience: Magnitude and growth did not differ, however, stress was greater for role identity conflicts ( Study 3 only ) and participants endorsed the use of more realignment for role conflicts ( Study 2 ) and more retreat for relational conflicts ( Study 3 ) relative to other types of identity conflicts. Furthermore, findings suggested that the perceived flexibility of identities, not their importance or valence, were associated with realignment and retreat for roles and with retreat for relationships. Experiencing conflicts between multiple identities leaves people similarly torn, but multiple roles and relationships may be differentially shorn to manage conflict.

  4. The importance of the patient's subjective experience in stroke rehabilitation.

    Science.gov (United States)

    Prigatano, George P

    2011-01-01

    Kaufman's observation that the patients' reactions to their impairments and disabilities need to be addressed in stroke rehabilitation has been shown to be an accurate and perceptive statement. In this article, 3 levels of stroke rehabilitation are outlined, and the importance of focusing on the third level (the level of subjective experience) is emphasized. Identification of the patients' subjective experience allows one to understand what is most frustrating to them. After addressing those frustrations, patients are more eager to engage the rehabilitation process. Within the context of this rehabilitation process, helping patients clarify what their subjective or phenomenological state is as it relates to their stroke is crucial in having them not only engage the rehabilitation process, but ultimately find meaning in life in the face of their stroke. This can be a difficult task because patients often do not have the words to clarify what their inner psychological experiences are following a stroke. Helping to provide guidelines for this can result in a meaningful experience for both the patient and the therapists involved in their care.

  5. Self-cathing experience journal: Enhancing the patient and family experience in clean intermittent catheterization.

    Science.gov (United States)

    Holland, Jennifer E; DeMaso, David R; Rosoklija, Ilina; Johnson, Kathryn L; Manning, Diane; Bellows, Alexandra L; Bauer, Stuart B

    2015-08-01

    This pilot study evaluated the safety, feasibility, and usefulness of the Self-Cathing Experience Journal (SC-EJ), an online resource for patients and families to address issues and stigma surrounding clean intermittent catheterization (CIC). Modeled after previous assessments of the Cardiac and Depression Experience Journals (EJs), this project uniquely included patients and caregivers. We explored whether patients and caregivers would find the SC-EJ helpful in increasing their understanding of CIC, accepting the medical benefits of self-catheterization, improving hopefulness, and diminishing social isolation. Patients seen in a tertiary urology clinic were asked to view the SC-EJ for 30 min and rate its safety and efficacy. The cross-sectional sample included 25 families: 17 surveys were completed by the patient and their caregiver, five by the patient only, and three by the caregiver only. Mean patient age was 15.7 ± 5.8 years (range 7-29 years). The patients were 64% female, and 72% used CIC due to neurological diagnoses. Mean overall patient satisfaction with the SC-EJ was moderately high (mean = 5, out of a 7-point Likert scale from 1 = not at all to 7 = extremely). Mean overall caregiver satisfaction was high (mean = 5.55) and was similar to caregiver satisfaction scores recorded in caregivers with children with congenital heart disease and depression (mean = 5.7 and mean = 5.75, respectively). No significant differences were noted in satisfaction between CIC patients and CIC caregivers or among caregivers of the three populations surveyed (CIC, Cardiac, and Depression). CIC patients and caregivers reported that SC-EJ viewing gave them a strong sense that others are facing similar issues (patient mean = 6.15, caregiver mean = 6.21) and that it was helpful to read about other families' CIC experiences (patient mean = 6, caregiver mean = 5.89). The SC-EJ appears to be safe, feasible, and useful to patients and families using CIC. Ratings from caregivers of

  6. 20 Years of standard patch testing in an eczema population with focus on patients with multiple contact allergies

    DEFF Research Database (Denmark)

    Carlsen, Berit Christina; Menné, Torkil; Johansen, Jeanne Duus

    2007-01-01

    Results of standard patch tests performed with the same methodology in one centre are rarely available over a large time span. This gives the unique opportunity to study not only prevalence but also persistency of contact allergy and characterize subpopulations. The objectives were to investigate...... sensitivity rates and persistencies of patch test results and characterize patients with multiple contact allergies. A 20-year retrospective database-based study of 14 998 patients patch tested with the European Standard Series was performed. 34.5% were sensitized, primarily women. Sensitivity to nickel......(Me)isothiazolinone, and primin and poor for paraben mix. 5.1% were multiple allergic, primarily women, and 90% got diagnosed by the first test. Frequency of multiple allergies increased with age. More multiple- than mono/double-allergic patients were tested multiple times. Persistency and sensitivity rates in a Danish eczema...

  7. Multiple Payload Ejector for Education, Science and Technology Experiments

    Science.gov (United States)

    Lechworth, Gary

    2005-01-01

    The education research community no longer has a means of being manifested on Space Shuttle flights, and small orbital payload carriers must be flown as secondary payloads on ELV flights, as their launch schedule, secondary payload volume and mass permits. This has resulted in a backlog of small payloads, schedule and cost problems, and an inability for the small payloads community to achieve routine, low-cost access to orbit. This paper will discuss Goddard's Wallops Flight Facility funded effort to leverage its core competencies in small payloads, sounding rockets, balloons and range services to develop a low cost, multiple payload ejector (MPE) carrier for orbital experiments. The goal of the MPE is to provide a low-cost carrier intended primarily for educational flight research experiments. MPE can also be used by academia and industry for science, technology development and Exploration experiments. The MPE carrier will take advantage of the DARPAI NASA partnership to perform flight testing of DARPA s Falcon small, demonstration launch vehicle. The Falcon is similar to MPE fiom the standpoint of focusing on a low-cost, responsive system. Therefore, MPE and Falcon complement each other for the desired long-term goal of providing the small payloads community with a low-cost ride to orbit. The readiness dates of Falcon and MPE are complementary, also. MPE is being developed and readied for flight within 18 months by a small design team. Currently, MPE is preparing for Critical Design Review in fall 2005, payloads are being manifested on the first mission, and the carrier will be ready for flight on the first Falcon demonstration flight in summer, 2006. The MPE and attached experiments can weigh up to 900 lb. to be compatible with Falcon demonstration vehicle lift capabilities fiom Wallops, and will be delivered to the Falcon demonstration orbit - 100 nautical mile circular altitude.

  8. Multiple fMRI system-level baseline connectivity is disrupted in patients with consciousness alterations.

    Science.gov (United States)

    Demertzi, Athena; Gómez, Francisco; Crone, Julia Sophia; Vanhaudenhuyse, Audrey; Tshibanda, Luaba; Noirhomme, Quentin; Thonnard, Marie; Charland-Verville, Vanessa; Kirsch, Murielle; Laureys, Steven; Soddu, Andrea

    2014-03-01

    In healthy conditions, group-level fMRI resting state analyses identify ten resting state networks (RSNs) of cognitive relevance. Here, we aim to assess the ten-network model in severely brain-injured patients suffering from disorders of consciousness and to identify those networks which will be most relevant to discriminate between patients and healthy subjects. 300 fMRI volumes were obtained in 27 healthy controls and 53 patients in minimally conscious state (MCS), vegetative state/unresponsive wakefulness syndrome (VS/UWS) and coma. Independent component analysis (ICA) reduced data dimensionality. The ten networks were identified by means of a multiple template-matching procedure and were tested on neuronality properties (neuronal vs non-neuronal) in a data-driven way. Univariate analyses detected between-group differences in networks' neuronal properties and estimated voxel-wise functional connectivity in the networks, which were significantly less identifiable in patients. A nearest-neighbor "clinical" classifier was used to determine the networks with high between-group discriminative accuracy. Healthy controls were characterized by more neuronal components compared to patients in VS/UWS and in coma. Compared to healthy controls, fewer patients in MCS and VS/UWS showed components of neuronal origin for the left executive control network, default mode network (DMN), auditory, and right executive control network. The "clinical" classifier indicated the DMN and auditory network with the highest accuracy (85.3%) in discriminating patients from healthy subjects. FMRI multiple-network resting state connectivity is disrupted in severely brain-injured patients suffering from disorders of consciousness. When performing ICA, multiple-network testing and control for neuronal properties of the identified RSNs can advance fMRI system-level characterization. Automatic data-driven patient classification is the first step towards future single-subject objective diagnostics

  9. Managing the side effects of multiple sclerosis therapy: pharmacotherapy options for patients.

    Science.gov (United States)

    Rommer, Paulus S; Zettl, Uwe K

    2018-04-01

    Multiple sclerosis (MS) is an immune-mediated and neurodegenerative disease with an unpredictable outcome. Immune-modulatory treatment aims at decreasing long-term disability. With the increasing number of treatment options, it is essential to fully digest the possible side effects of the available therapeutics and to monitor patients is essential. Areas covered: All approved disease-modifying drugs (DMD) for MS are discussed in this review. Mode of action, adverse effects, reported risks for infections and malignancies, and pregnancy related issues are discussed in the review. The authors also provide suggestions for monitoring therapy. For all approved DMDs the pivotal studies have been included for possible side effects, as well as reports by health authorities. For this manuscript, PubMed was checked for reports on side effects for various drugs. Expert opinion: Treatment options in MS are manifold, each carrying different risks. The safety-risk profile for approved agents is favorable. Knowing and monitoring these possible side effects is essential to minimize risks associated with treatment. Presently, the long-term experience for some of these therapies is missing and this must be addressed.

  10. To provide care and be cared for in a multiple-bed hospital room.

    Science.gov (United States)

    Persson, Eva; Määttä, Sylvia

    2012-12-01

    To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  11. Patients' experience with cancer recurrence: a meta-ethnography.

    Science.gov (United States)

    Wanat, Marta; Boulton, Mary; Watson, Eila

    2016-03-01

    Recurrence is a difficult stage in the cancer journey as it brings to the fore the life-threatening nature of the illness. This meta-ethnography examines and synthesises the findings of qualitative research regarding patients' experience of cancer recurrence. A systematic search of the qualitative studies published between January 1994 to April 2014 was undertaken. Seventeen relevant papers were identified, and a meta-ethnography was conducted. Six third-order concepts were developed to capture patients' experiences: experiencing emotional turmoil following diagnosis, which described the emotional impact of diagnosis and the influence of previous experiences on how the news were received; experiencing otherness, encompassing changed relationships; seeking support in the health care system, describing the extent of information needs and the importance of the relationship with health care professionals; adjusting to a new prognosis and uncertain future, highlighting the changes associated with uncertainty; finding strategies to deal with recurrence, describing ways of maintaining emotional well-being and regaining a sense of control over cancer; and facing mortality, describing the difficulties in facing death-related concerns and associated consequences. This meta-ethnography clarifies the fundamental aspects of patients' experience of recurrence. It suggests that health care professionals can promote a positive experience of care and help lessen the psychosocial impact of recurrence by providing information in an approachable way and being sensitive to their changing needs. It also points to the importance of supporting patients in adopting strategies to regain a sense of control and to address their potential mortality and its impact on loved ones. Copyright © 2015 John Wiley & Sons, Ltd.

  12. (alpha)B-crystallin in cerebrospinal fluid of patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Støvring, Birgitte; Vang, Ole; Christiansen, Michael

    2005-01-01

    Background: aB-crystallin is a chaperone protein and a potential myelin antigen to human T cells in Multiple Sclerosis (MS). In this study we investigate the existence of aB-crystallin in the cerebrospinal fluid (CSF) of patients with clinical symptoms of MS and control individuals without...

  13. Intersectionality and the LGBT Cancer Patient.

    Science.gov (United States)

    Damaskos, Penny; Amaya, Beau; Gordon, RuthAnn; Walters, Chasity Burrows

    2018-02-01

    To present the ways in which race, ethnicity, class, gender, and sexual orientation interact in the context of cancer risk, access to care, and treatment by health care providers. Cancer risk factors, access to care, and treatment for lesbian, gay, bisexual, and transgender (LGBT) patients are discussed within the context of intersectionality and cultural humility. Peer reviewed articles, cancer organizations, and clinical practice. LGBT patients have multiple identities that intersect to create unique experiences. These experiences shape their interactions with the health care system with the potential for positive or negative consequences. More data is needed to describe the outcomes of those experiences and inform clinical practice. Oncology nurses have an obligation to acknowledge patients' multiple identities and use the practice of cultural humility to provide individualized, patient-centered care. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Anesthesia in the patient with multiple drug allergies: are all allergies the same?

    Science.gov (United States)

    Dewachter, Pascale; Mouton-Faivre, Claudie; Castells, Mariana C; Hepner, David L

    2011-06-01

    During the preoperative evaluation, patients frequently indicate 'multiple drug allergies', most of which have not been validated. Potential allergic cross-reactivity between drugs and foods is frequently considered as a risk factor for perioperative hypersensitivity. The aim of this review is to facilitate the recognition of risk factors for perioperative anaphylaxis and help the management of patients with 'multiple drug allergies' during the perioperative period. Neuromuscular blocking agents (NMBAs) and antibiotics are the most common drugs triggering perioperative anaphylaxis. Quaternary ammonium ions have been suggested to be the allergenic determinant of NMBAs. Even though the 'pholcodine hypothesis' has been suggested to explain the occurrence of NMBA-induced allergy, this concept remains unclear. Although many practitioners believe that certain food allergies present an issue with the use of propofol, there is no role to contraindicate propofol in egg-allergic, soy-allergic or peanut-allergic patients. IgE-mediated hypersensitivity has been reported with seafood and iodinated drugs, IgE-mediated hypersensitivity has been reported with seafood and iodinated drugs, but there is no cross-reactivity between them. The allergenic determinants have been characterized for fish, shellfish and povidone iodine and remain unknown for contrast agents. There are many false assumptions regarding drug allergies. The main goal of this article is to review the potential cross-reactivity among specific families of drugs and foods in order to facilitate the anesthetic management of patients with 'multiple drug allergies'.

  15. Rehabilitation and multiple limb amputations: A clinical report of patients injured in combat.

    Science.gov (United States)

    Melcer, Ted; Pyo, Jay; Walker, Jay; Quinn, Kimberly; Lebedda, Martin; Neises, Kamaran; Nguyen, Christina; Galarneau, Michael

    2016-01-01

    This clinical report describes the outpatient rehabilitation program for patients with multiple limb amputations enrolled in the Comprehensive Combat and Complex Casualty Care facility at the Naval Medical Center San Diego. Injury-specific data for 29 of these patients wounded by blast weaponry in Afghanistan in 2010 or 2011 were captured by the Expeditionary Medical Encounter Database at the Naval Health Research Center and were reviewed for this report. Their median Injury Severity Score was 27 (N = 29; range, 11-54). Patients averaged seven moderate to serious injuries (Abbreviated Injury Scale scores ≥2), including multiple injuries to lower limbs and injuries to the torso and/or upper limbs. All patients received care from numerous clinics, particularly physical therapy during the first 6 mo postinjury. Clinic use generally declined after the first 6 mo with the exception of prosthetic devices and repairs. The clinical team implemented the Mayo-Portland Adaptability Inventory, 4th Revision (MPAI-4) to assess functioning at outpatient program initiation and discharge (n = 23). At program discharge, most patients had improved scores for the MPAI-4 items assessing mobility, pain, and transportation, but not employment. Case reports described rehabilitation for two patients with triple amputations and illustrated multispecialty care and contrasting solutions for limb prostheses.

  16. Patient experience shows little relationship with hospital quality management strategies.

    NARCIS (Netherlands)

    Groene, O.; Arah, O.A.; Klazinga, N.S.; Wagner, C.; Bartels, P.D.; Kristensen, S.; Saillour, F.; Thompson, C.A.; Pfaff, H.; DerSarkissian, M.; Suñol, R.

    2015-01-01

    Objectives: Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes

  17. Robust design method and thermostatic experiment for multiple piezoelectric vibration absorber system

    International Nuclear Information System (INIS)

    Nambu, Yohsuke; Takashima, Toshihide; Inagaki, Akiya

    2015-01-01

    This paper examines the effects of connecting multiplexing shunt circuits composed of inductors and resistors to piezoelectric transducers so as to improve the robustness of a piezoelectric vibration absorber (PVA). PVAs are well known to be effective at suppressing the vibration of an adaptive structure; their weakness is low robustness to changes in the dynamic parameters of the system, including the main structure and the absorber. In the application to space structures, the temperature-dependency of capacitance of piezoelectric ceramics is the factor that causes performance reduction. To improve robustness to the temperature-dependency of the capacitance, this paper proposes a multiple-PVA system that is composed of distributed piezoelectric transducers and several shunt circuits. The optimization problems that determine both the frequencies and the damping ratios of the PVAs are multi-objective problems, which are solved using a real-coded genetic algorithm in this paper. A clamped aluminum beam with four groups of piezoelectric ceramics attached was considered in simulations and experiments. Numerical simulations revealed that the PVA systems designed using the proposed method had tolerance to changes in the capacitances. Furthermore, experiments using a thermostatic bath were conducted to reveal the effectiveness and robustness of the PVA systems. The maximum peaks of the transfer functions of the beam with the open circuit, the single-PVA system, the double-PVA system, and the quadruple-PVA system at 20 °C were 14.3 dB, −6.91 dB, −7.47 dB, and −8.51 dB, respectively. The experimental results also showed that the multiple-PVA system is more robust than a single PVA in a variable temperature environment from −10 °C to 50 °C. In conclusion, the use of multiple PVAs results in an effective, robust vibration control method for adaptive structures. (paper)

  18. Patients' Experiences with and Attitudes towards a Diabetes Patient Web Portal.

    Science.gov (United States)

    Ronda, Maaike C M; Dijkhorst-Oei, Lioe-Ting; Rutten, Guy E H M

    2015-01-01

    A diabetes patient web portal allows patients to access their personal health record and may improve diabetes outcomes; however, patients' adoption is slow. We aimed to get insight into patients' experiences with a web portal to understand how the portal is being used, how patients perceive the content of the portal and to assess whether redesign of the portal might be needed. A survey among 1500 patients with type 1 and type 2 diabetes with a login to a patient portal. 62 primary care practices and one outpatient hospital clinic, using a combined patient portal. We compared patients who requested a login but never used it or once ('early quitters') with patients who used it at least two times ('persistent users'). 632 patients (42.1%) returned the questionnaire. Their mean age was 59.7 years, 63.1% was male and 81.8% had type 2 diabetes. 413 (65.3%) people were persistent users and 34.7% early quitters. In the multivariable analysis, insulin use (OR2.07; 95%CI[1.18-3.62]), experiencing more frequently hyperglycemic episodes (OR1.30;95%CI[1.14-1.49]) and better diabetes knowledge (OR1.02, 95%CI[1.01-1.03]) do increase the odds of being a persistent user. Persistent users perceived the usefulness of the patient portal significantly more favorable. However, they also more decisively declared that the patient portal is not helpful in supporting life style changes. Early quitters felt significantly more items not applicable in their situation compared to persistent users. Both persistent users (69.8%) and early quitters (58.8%) would prefer a reminder function for scheduled visits. About 60% of both groups wanted information about medication and side-effects in their portal. The diabetes patient web portal might be improved significantly by taking into account the patients' experiences and attitudes. We propose creating separate portals for patients on insulin or not.

  19. Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy

    Directory of Open Access Journals (Sweden)

    Francesco Tonelli

    2012-01-01

    Full Text Available Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1 correct hypercalcemia, thus preventing persistent or recurrent hyperparathyroidism; 2 avoid persistent hypoparathyroidism; and 3 facilitate the surgical treatment of possible recurrences. Currently, two types of surgical approach are indicated: 1 subtotal parathyroidectomy with removal of at least 3-3 K glands; and 2 total parathyroidectomy with grafting of autologous parathyroid tissue. Transcervical thymectomy must be performed with both of these procedures. Unsuccessful surgical treatment of hyperparathyroidism is more frequently observed in multiple endocrine neoplasia type 1 than in sporadic hyperparathyroidism. The recurrence rate is strongly influenced by: 1 the lack of a pre-operative multiple endocrine neoplasia type 1 diagnosis; 2 the surgeon's experience; 3 the timing of surgery; 4 the possibility of performing intra-operative confirmation (histologic examination, rapid parathyroid hormone assay of the curative potential of the surgical procedure; and, 5 the surgical strategy. Persistent hyperparathyroidism seems to be more frequent after subtotal parathyroidectomy than after total parathyroidectomy with autologous graft of parathyroid tissue. Conversely, recurrent hyperparathyroidism has a similar frequency in the two surgical strategies. To plan further operations, it is very helpful to know all the available data about previous surgery and to undertake accurate identification of the site of recurrence.

  20. Quality of life in patients with multiple myeloma treated with percutaneous vertebroplasty

    Directory of Open Access Journals (Sweden)

    Omar Jamit Bohsain

    2014-03-01

    Full Text Available OBJECTIVE: To determine the quality of life in patients with multiple myeloma treated with vertebroplasty. Multiple myeloma has a prevalence of 1% in all neoplastic diseases and 10% of hematological malignancies. Bone pain is the initial symptom in most cases. METHODS: A series of cases study was conducted. Patients were assessed by the Karnofsky scale to measure its functionality, the WHO analgesic scale to assess the type of analgesic and visual analog scale (VAS and the Oswestry questionnaire for pain. RESULTS: Of 24 patients, 10 were cases (vertebroplasty (41.7% and 14 were controls (conservative (58.3%, 13 (54.2% were female and 11 (45.8% male, with an average age of 60 years (SD = 12 and 63 kg of average weight (SD = 12, mean height of 1.59 cm (SD = 9 and mean body mass index of 24.8 (SD = 3.7. Survival was obtained from the time of diagnosis to death, and 2 (8.3% patients died within the first 2 years and 1 (4.2% after 3 years. CONCLUSIONS: Patients with MM who have vertebral fractures are excellent candidates to undergo vertebroplasty, because this represents a greater benefit in their quality of life, which has a direct impact on their level of functionality, giving them greater self-sufficiency and reducing their pain because of the benefits of the thermogenic effect of vertebroplasty.

  1. Neuro-Oncology Branch patient experience and expertise | Center for Cancer Research

    Science.gov (United States)

    Experience and Expertise We have more than 20 years of experience working with patients and their physicians to offer a comprehensive approach to patient care. Patients travel from all over the world to be evaluated and treated by our clinical team. The Brain Tumor Clinic sees hundreds of new patients and 2,000–3,000 follow-up patients each year. 

  2. Patient Experience Shows Little Relationship with Hospital Quality Management Strategies

    NARCIS (Netherlands)

    Groene, Oliver; Arah, Onyebuchi A.; Klazinga, Niek S.; Wagner, Cordula; Bartels, Paul D.; Kristensen, Solvejg; Saillour, Florence; Thompson, Andrew; Thompson, Caroline A.; Pfaff, Holger; Dersarkissian, Maral; Sunol, Rosa

    2015-01-01

    Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for

  3. Patient with confirmed LEOPARD syndrome developing multiple melanoma.

    Science.gov (United States)

    Colmant, Caroline; Franck, Deborah; Marot, Liliane; Matthijs, Gert; Sznajer, Yves; Blomme, Sandrine; Tromme, Isabelle

    2018-01-01

    LEOPARD syndrome, also known as Gorlin syndrome II, cardiocutaneous syndrome, lentiginosis profusa syndrome, Moynahan syndrome, was more recently coined as Noonan syndrome with multiple lentigines (NSML), inside the RASopathies. Historically, the acronym LEOPARD refers to the presence of distinctive clinical features such as: lentigines (L), electrocardiographic/conduction abnormalities (E), ocular hypertelorism (O), pulmonary stenosis (P), genital abnormalities (A), retardation of growth (R), and sensorineural deafness (D). This condition is identified in 85% of patients with phenotype hallmarks caused by presence a germline point mutation in PTPN11 gene. Association of melanoma to NSML seems to be rare: to our knowledge, two patients so far were reported in the literature. We herein present a patient diagnosed with LEOPARD syndrome, in whom molecular investigation confirmed the presence of the c.1403C>T mutation in exon 12 of the PTPN11 gene, who developed four superficial spreading melanomas and three atypical lentiginous hyperplasias. Three of the melanomas were achromic or hypochromic, three were in situ, and one had a Breslow index under 0.5 mm. Dermoscopic examination showed some characteristic white structures in most of the lesions, which were a signature pattern and a key for the diagnosis.

  4. Multimodal diagnosis of multiple and heterogeneous liver lesions in a young patient; Multimodale Bildgebung multipler Leberlaesionen bei einem jungen Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Kiessling, F.; Schlemmer, H.-P. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg (Germany). Abteilung fuer onkologische Diagnostik und Therapie

    2005-10-01

    The classification of liver lesions is often problematic in particular if they are multiple and show an heterogeneous shape. Here we report of a young patient with multiple liver lesions of up to 3 cm size. Using ultrasound, the lesions were hyper-, hypoechogen or mixed. In serial contrast enhanced CT scans some of the lesions showed the typical enhancement pattern of hemangiomas, however, the diagnosis could still not be faithfully determined for all lesions. Therefore, the patient was conducted to contrast enhanced MRI (Gd-DTPA and MnDPDP). While with Gd-DTPA some of the lesions showed a strong enhancement, they remained hypointense after administration of MnDPDP. Finally to exclude a metastatic disease a {sup 99m}Tc-erythrocyte SPECT was performed confirming the diagnosis of hemangiomas for most of the lesions. Diagnosis was not assessed by biopsy because this would only clarify the diagnosis for one or few of the lesions. The patient was subsequently followed up for 3 years and all lesions remained unchanged. This case clearly illustrates the difficulty to get a certain diagnosis of multiple liver lesions with heterogeneous appearance despite the multimodal diagnostic conduct. (orig.) [German] Bei einer Routineuntersuchung wurden bei einem jungen Patienten sonographisch multiple Leberrundherde mit hyper-, hypoechogener und gemischter Echogenitaet detektiert. Auch mittels triphasischer kontrastmittelverstaerkter CT gelang nur bei einem Teil der Herde die Einstufung als Haemangiome anhand ihres Irisblendenphaenomens. MRT-Untersuchungen unter Verwendung von Gd-DTPA und MnDPDP wurden angeschlossen. Mit Gd-DTPA zeigten einige Herde ein kraeftiges Enhancement, unter Verwendung von MnDPDP jedoch blieben sie hypointens. Auf eine Biopsie wurde verzichtet, da diese nur bei einem oder wenigen Herden die Diagnose liefern wuerde, die anderen Herde aber unter Beruecksichtigung ihrer Heterogenitaet unklar geblieben waeren. Eine Sicherung der Diagnose gelang fuer die meisten

  5. Triple dose of gadolinium-DTPA and delayed MRI in patients with benign multiple sclerosis.

    Science.gov (United States)

    Filippi, M; Capra, R; Campi, A; Colombo, B; Prandini, F; Marcianò, N; Gasparotti, R; Comi, G

    1996-01-01

    OBJECTIVES--To evaluate whether a triple dose of gadolinium-DTPA (Gd-DTPA) or delayed MRI increase the number, size, and conspicuousness of enhancing lesions in patients with benign multiple sclerosis. METHODS--T1 weighted brain MRI was carried out on 20 patients with benign multiple sclerosis (expanded disability status scale 10 years) in two sessions. In the first session, one scan was obtained before and two scans five to seven minutes and 20-30 minutes after the injection of 0.1 mmol/kg Gd-DTPA (standard dose). In the second session, six to 24 hours later, the same procedure was repeated with 0.3 mmol/kg Gd-DTPA (triple dose). RESULTS--Nine enhancing lesions were found in seven patients (35%) using the standard dose of Gd-DTPA. The numbers of enhancing lesions increased to 13 (P = 0.03) and the number of patients with such lesions to eight (40%) on the delayed standard dose scans. On the early triple dose scans, we found 19 enhancing lesions in 10 patients (50%). The number of enhancing lesions was significantly higher (P = 0.01) than that obtained with the early standard dose. The number of enhancing lesions was 18 and the number of "active" patients 11 (55%) on the delayed triple dose scans. The enhancing areas increased progressively from the early standard dose scans to the delayed triple dose scans. The contrast ratios of the lesions detected in early standard dose scans was lower than those of lesions present in the early (P = 0.01) and delayed (P = 0.04) triple dose scans. CONCLUSIONS--More enhancing lesions were detected in patients with benign multiple sclerosis with both delay of MRI and the use of triple dose of Gd-DTPA suggesting that the amount of inflammation in the lesions of such patients is mild and heterogeneous. Images PMID:8778257

  6. Vitamin D supplementation reduces relapse rate in relapsing-remitting multiple sclerosis patients treated with natalizumab

    DEFF Research Database (Denmark)

    Laursen, Julie Hejgaard; Søndergaard, Helle Bach; Sørensen, Per Soelberg

    2016-01-01

    Background Vitamin D insufficiency is common among multiple sclerosis patients, and hypovitaminosis D has been associated with multiple sclerosis (MS) risk and disease activity.  Objective To investigate how recommendations on vitamin D3 supplements affect 25-hydroxyvitamin D (25(OH)D) levels in ...

  7. Neuroactive steroid levels in plasma and cerebrospinal fluid of male multiple sclerosis patients.

    Science.gov (United States)

    Caruso, Donatella; Melis, Marta; Fenu, Giuseppe; Giatti, Silvia; Romano, Simone; Grimoldi, Maria; Crippa, Donatella; Marrosu, Maria Giovanna; Cavaletti, Guido; Melcangi, Roberto Cosimo

    2014-08-01

    Neuroactive steroid family includes molecules synthesized in peripheral glands (i.e., hormonal steroids) and directly in the nervous system (i.e., neurosteroids) which are key regulators of the nervous function. As already reported in clinical and experimental studies, neurodegenerative diseases affect the levels of neuroactive steroids. However, a careful analysis comparing the levels of these molecules in cerebrospinal fluid (CSF) and in plasma of multiple sclerosis (MS) patients is still missing. To this aim, the levels of neuroactive steroids were evaluated by liquid chromatography-tandem mass spectrometry in CSF and plasma of male adults affected by Relapsing-Remitting MS and compared with those collected in control patients. An increase in pregnenolone and isopregnanolone levels associated with a decrease in progesterone metabolites, dihydroprogesterone, and tetrahydroprogesterone was observed in CSF of MS patients. Moreover, an increase of 5α-androstane-3α,17β-diol and of 17β-estradiol levels associated with a decrease of dihydrotestosterone also occurred. In plasma, an increase in pregnenolone, progesterone, and dihydrotestosterone and a decrease in dihydroprogesterone and tetrahydroprogesterone levels were reported. This study shows for the first time that the levels of several neuroactive steroids, and particularly those of progesterone and testosterone metabolites, are deeply affected in CSF of relapsing-remitting MS male patients. We here demonstrated that, the cerebrospinal fluid and plasma levels of several neuroactive steroids are modified in relapsing remitting multiple sclerosis male patients. Interestingly, we reported for the first time that, the levels of progesterone and testosterone metabolites are deeply affected in cerebrospinal fluid. These findings may have an important relevance in therapeutic and/or diagnostic field of multiple sclerosis. © 2014 International Society for Neurochemistry.

  8. Periprosthetic joint infection: are patients with multiple prosthetic joints at risk?

    Science.gov (United States)

    Jafari, S Mehdi; Casper, David S; Restrepo, Camilo; Zmistowski, Benjamin; Parvizi, Javad; Sharkey, Peter F

    2012-06-01

    Patients who present with a periprosthetic joint infection in a single joint may have multiple prosthetic joints. The risk of these patients developing a subsequent infection in another prosthetic joint is unknown. Our purposes were (1) to identify the risk of developing a subsequent infection in another prosthetic joint and (2) to describe the time span and organism profile to the second prosthetic infection. We retrospectively identified 55 patients with periprosthetic joint infection who had another prosthetic joint in place at the time of presentation. Of the 55 patients, 11 (20%) developed a periprosthetic joint infection in a second joint. The type of organism was the same as the first infection in 4 (36%) of 11 patients. The time to developing a second infection averaged 2.0 years (range, 0-6.9 years). Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Pelvic fracture in the patient with multiple injuries: factors and lesions associated with mortality.

    Science.gov (United States)

    Martínez, Fernando; Alegret, Núria; Carol, Federico; Laso, M Jesús; Zancajo, Juanjo; García, Esteban; Ros, Vanesa

    2018-01-01

    The main objective of this study was to identify demographic, clinical, analytical factors or injuries associated with 30-day mortality in patients with pelvic fractures. Prospective observational study of patients with multiple injuries including pelvic fractures between January 2009 and January 2017. We recorded demographic, clinical, and laboratory data on arrival at the emergency department; type of pelvic fracture; treatments; associated lesions; and 30-day mortality. Univariable and multivariable models were used to analyze the data. A total of 2061 multiple-injury patients were attended; 118 had pelvic fractures. Fifteen of the patients with pelvic fractures (12.7%) died within 30 days. Arterial blood pressure on admission was less than 90 mm Hg in 23.7%, heart rate was over 100 beats per minute in 41.52%, lactic acid level was 20 mg/dL or higher in 67.6%, and base excess of -6 or less was recorded for 26.3%. The mean Injury Severity Score was 20 points. Angiographic embolization was required in 80.6% and preperitoneal packing in 3.4%. The main associated lesions were rib fractures (35.6%), hemo-pneumothorax (31.3%), spinal injuries (35.6%), and head injuries (30%). The 6 independent variables associated with risk of death in multiple-injury patients with pelvic fractures are age, female sex, complex fractures (Tile type C), lactic acid level of 20 mg/dL or more, base excess of -6 or less, and bowel perforation.

  10. Multiple Sclerosis in the Contemporary Age: Understanding the Millennial Patient with Multiple Sclerosis to Create Next-Generation Care.

    Science.gov (United States)

    Hansen, Madison R; Okuda, Darin T

    2018-02-01

    The average age of onset of multiple sclerosis (MS) is between 20 and 40 years of age. Therefore, most new patients diagnosed with MS within the next 10 to 15 years will be from the millennial generation, representing those born between 1982 and 2000. Certain preferences and trends of this contemporary generation will present new challenges to the MS physician and effective MS care. By first understanding these challenges, relevant and successful solutions can be created to craft a system of care that best benefits the millennial patient with MS. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Thoracic paravertebral block versus intravenous patient-controlled analgesia for pain treatment in patients with multiple rib fractures.

    Science.gov (United States)

    Yeying, Ge; Liyong, Yuan; Yuebo, Chen; Yu, Zhang; Guangao, Ye; Weihu, Ma; Liujun, Zhao

    2017-12-01

    Objectives To assess the effect of thoracic paravertebral block (PVB) on pain management and preservation of pulmonary function compared with intravenous, patient-controlled analgesia (IVPCA) in patients with multiple rib fractures (MRFs). Methods Ninety patients with unilateral MRFs were included in this prospective study and randomly assigned to the TPVB or IVPCA group. The visual analogue scale (VAS) pain score, blood gas analysis, and bedside spirometry were measured and recorded at different time points after analgesia. Results TPVB and IVPCA provided good pain relief. VAS scores were significantly lower in the TPVB group than in the IVPCA group at rest and during coughing ( P pain relief and preservation of pulmonary function in patients with MRFs.

  12. PET in patients with clear-cut multiple chemical sensitivity (MCS); PET bei Patienten mit klar definierter multipler chemischer Sensibilitaet (MCS)

    Energy Technology Data Exchange (ETDEWEB)

    Bornschein, S. [Toxikologische Abt. der II. Medizinischen Klinik und Poliklinik der Technischen Univ. Muenchen, Klinikum rechts der Isar, Muenchen (Germany); Klinik und Poliklinik fuer Psychiatrie und Psychotherapie der Technischen Univ. Muenchen, Klinikum rechts der Isar, Muenchen (Germany); Hausteiner, C.; Foerstl, H. [Klinik und Poliklinik fuer Psychiatrie und Psychotherapie der Technischen Univ. Muenchen, Klinikum rechts der Isar, Muenchen (Germany); Drzezga, A.; Schwaiger, M. [Nuklearmedizinische Klinik und Poliklinik der Technischen Univ. Muenchen, Klinikum rechts der Isar, Muenchen (Germany); Bartenstein, P. [Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Mainz (Germany); Zilker, Th. [Toxikologische Abt. der II. Medizinischen Klinik und Poliklinik der Technischen Univ. Muenchen, Klinikum rechts der Isar, Muenchen (Germany)

    2002-12-01

    Aim: Multiple chemical sensitivity (MCS) is a controversially discussed symptom complex. Patients afflicted by MCS react to very low and generally non-toxic concentrations of environmental chemicals. It has been suggested that MCS leads to neurotoxic damage or neuroimmunological alteration in the brain detectable by positron emission tomography (PET) and single photon emission computer tomography (SPECT). These methods are often applied to MCS patients for diagnosis, although they never proved appropriate. Method: We scanned 12 MCS patients with PET, hypothesizing that it would reveal abnormal findings. Results: Mild glucose hypometabolism was present in one patient. In comparison with normal controls, the patient group showed no significant functional brain changes. Conclusion: This first systematic PET study in MCS patients revealed no hint of neurotoxic or neuroimmunological brain changes of functional significance. (orig.) [German] Ziel: Multiple chemische sensibilitaet (MCS) ist ein umstrittenes Krankheitsbild, das durch Reaktionen auf geringe, fueer Normalpersonen unschaedliche Mengen an Umweltchemikalien gekennzeichnet ist. Es wurde postuliert, dass MCS zu neurotoxischer Schaedigung bzw. neuroimmunologischer Veraenderung im Gehirn fuehrt, die mittels funktioneller bildgebender Verfahren, z. B. positronenemissionstomographie (PET), single-photon-emissions-computer-tomographie (SPECT) dargestellt werden koennte. Obwohl hierfuer kein wissenschaftlicher Beleg erbracht wurde, werden diese Methoden vielfach diagnostisch bei MCS-Patienten eingesetzt. Methode: Wir untersuchten 12 MCS-Patienten mit PET, um etwaige funktionelle Hirnveraenderungen nachzuweisen. Ergebnisse: Im Einzelvergleich war bei einem Patienten ein diskreter Glukose-Hypometabolismus in einzelnen Hirnregionen vorhanden. Im Gruppenvergleich konnte keine signifikante Abweichung von der Norm gefunden werden. Schlussfolgerung: Diese erste systematische PET-Studie bei MCS-Patienten erbrachte keinen

  13. Temporal acuity and speech recognition score in noise in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Mehri Maleki

    2014-04-01

    Full Text Available Background and Aim: Multiple sclerosis (MS is one of the central nervous system diseases can be associated with a variety of symptoms such as hearing disorders. The main consequence of hearing loss is poor speech perception, and temporal acuity has important role in speech perception. We evaluated the speech perception in silent and in the presence of noise and temporal acuity in patients with multiple sclerosis.Methods: Eighteen adults with multiple sclerosis with the mean age of 37.28 years and 18 age- and sex- matched controls with the mean age of 38.00 years participated in this study. Temporal acuity and speech perception were evaluated by random gap detection test (GDT and word recognition score (WRS in three different signal to noise ratios.Results: Statistical analysis of test results revealed significant differences between the two groups (p<0.05. Analysis of gap detection test (in 4 sensation levels and word recognition score in both groups showed significant differences (p<0.001.Conclusion: According to this survey, the ability of patients with multiple sclerosis to process temporal features of stimulus was impaired. It seems that, this impairment is important factor to decrease word recognition score and speech perception.

  14. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis.

    Science.gov (United States)

    Broggi, G; Ferroli, P; Franzini, A; Servello, D; Dones, I

    2000-01-01

    To examine surgical findings and results of microvascular decompression (MVD) for trigeminal neuralgia (TN), including patients with multiple sclerosis, to bring new insight about the role of microvascular compression in the pathogenesis of the disorder and the role of MVD in its treatment. Between 1990 and 1998, 250 patients affected by trigeminal neuralgia underwent MVD in the Department of Neurosurgery of the "Istituto Nazionale Neurologico C Besta" in Milan. Limiting the review to the period 1991-6, to exclude the "learning period" (the first 50 cases) and patients with less than 1 year follow up, surgical findings and results were critically analysed in 148 consecutive cases, including 10 patients with multiple sclerosis. Vascular compression of the trigeminal nerve was found in all cases. The recurrence rate was 15.3% (follow up 1-7 years, mean 38 months). In five of 10 patients with multiple sclerosis an excellent result was achieved (follow up 12-39 months, mean 24 months). Patients with TN for more than 84 months did significantly worse than those with a shorter history (p<0.05). There was no mortality and most complications occurred in the learning period. Surgical complications were not related to age of the patients. Aetiopathogenesis of trigeminal neuralgia remains a mystery. These findings suggest a common neuromodulatory role of microvascular compression in both patients with or without multiple sclerosis rather than a direct causal role. MVD was found to be a safe and effective procedure to relieve typical TN in patients of all ages. It should be proposed as first choice surgery to all patients affected by TN, even in selected cases with multiple sclerosis, to give them the opportunity of pain relief without sensory deficits.

  15. Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures.

    Science.gov (United States)

    Qiu, Meiguang; Shi, Zhanjun; Xiao, Jun; Zhang, Xuming; Ling, Shishui; Ling, Hao

    2016-12-01

    The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest ( n  = 38) and multiple non-flail rib fracture groups ( n  = 124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to full-time employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

  16. The role of appraisal and coping style in relation with societal participation in fatigued patients with multiple sclerosis: a cross-sectional multiple mediator analysis

    NARCIS (Netherlands)

    Akker, L.E. van den; Beckerman, H.; Collette, E.H.; Bleijenberg, G.; Dekker, J.; Knoop, H.; Groot, V. de; Jong, B.A. de; et al.,

    2016-01-01

    To determine the relationship between appraisal and societal participation in fatigued patients with Multiple Sclerosis (MS), and whether this relation is mediated by coping styles. 265 severely-fatigued MS patients. Appraisal, a latent construct, was created from the General Self-Efficacy Scale and

  17. The role of appraisal and coping style in relation with societal participation in fatigued patients with multiple sclerosis : a cross-sectional multiple mediator analysis

    NARCIS (Netherlands)

    van den Akker, Lizanne Eva; Beckerman, Heleen; Collette, Emma Hubertine; Bleijenberg, Gijs; Dekker, Joost; Knoop, Hans; de Groot, Vincent; TREFAMS-ACE study group, study group; de Groot, V.; Beckerman, H.; Malekzadeh, A.; van den Akker, L. E.; Looijmans, M.; Sanches, S. A.; Dekker, J.; Collette, E. H.; van Oosten, B. W.; Teunissen, C. E.; Blankenstein, M. A.; Eijssen, I. C J M; Rietberg, M.; Heine, M.; Verschuren, O.; Kwakkel, G.; Visser-Meily, J. M A; van de Port, I. G L; Lindeman, E.; Blikman, L. J M; van Meeteren, J.; Bussmann, J. B J; Stam, H. J.; Hintzen, R. Q.; Hacking, H. G A; Hoogervorst, E. L.; Frequin, S. T F M; Knoop, H.; de Jong, B. A.; de Laat, F. A J; Verhulsdonck, M. C.; van Munster, E. T H; Oosterwijk, C. J.; Aarts, G. J.

    2016-01-01

    To determine the relationship between appraisal and societal participation in fatigued patients with Multiple Sclerosis (MS), and whether this relation is mediated by coping styles. 265 severely-fatigued MS patients. Appraisal, a latent construct, was created from the General Self-Efficacy Scale and

  18. [Nursing Experience With a Patient With Gastrostomy Leakage Resulting in Moisture-Associated Skin Damage].

    Science.gov (United States)

    Hsu, Mei-Yu; Hsu, Hsiao-Hui; Lyu, Ji-Yan

    2016-10-01

    Leakage is a common complication of gastrostomy. Exposure of the skin surrounding the gastrostomy tube to moisture or chemical irritants may cause moisture-associated skin damage (MASD) and seriously affect the patient's quality of life. This case study describes a nursing experience with gastrostomy leakage that resulted in MASD. An assessment conducted from July 29, 2015 to August 20, 2015 revealed that heavy gastronomy leakage had caused extensive skin erosion, ulceration, hyperplasia, and superficial infection. Simultaneously, the patient was required to conduct complex stoma care, which resulted in physical and psychological exhaustion. Changes in traditional tube and wound care were discussed on multiple occasions with an interdisciplinary healthcare team. Based on the evidence-based literature, we provide gastrostomy and MASD management strategies. Through team collaboration, we prevented gastric contents from contacting the patient's skin directly, improved patient comfort, controlled effluent and skin infections, maintained fluid and electrolyte balances, and acce-lerated the healing of the damaged skin. We recommend that healthcare professionals caring for patients with gastrostomy leakage be provided with early skin protection programs to learn the standard methods for identifying and correcting leakage factors, containing effluent, and adequately stabilizing the gastrostomy tube in order to reduce the impact on the patient's quality of life. In addition, patient education on tube and skin care should be provided to prevent the reoccurrence of complications.

  19. Multiple Myeloma in a Patient with Acromegaly

    Directory of Open Access Journals (Sweden)

    Yu Mi Kang

    2015-03-01

    Full Text Available Acromegaly is a slowly progressing condition resulting from excess growth hormone (GH, generally caused by a GH-secreting pituitary adenoma. Cancer is the third most common cause of mortality in patients with acromegaly, and insulin-like growth factor 1 (IGF-1 is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis. Multiple myeloma (MM is a plasma cell neoplasm, and previous studies have suggested the possible role of IGF-1 in its development of MM. However, no cases of acromegaly accompanied with MM have been reported in Asia to date. We here report the case of a 58-year-old woman with acromegaly accompanied with MM who presented with longstanding acromegalic manifestations resulting from a GH-secreting pituitary adenoma and also exhibited anemia, a reversed albumin/globulin ratio, and plasmacytosis on bone marrow examination. Because IGF-1 has been suggested to play an important role in the development and progression of MM, the patient promptly underwent surgical removal of the pituitary adenoma via a transsphenoidal approach. Since there is currently no consensus on therapeutic guidelines and suggested prognosis for MM with acromegaly, long-term follow-up of such cases is needed.

  20. Endovascular treatment of chronic cerebro spinal venous insufficiency in patients with multiple sclerosis modifies circulating markers of endothelial dysfunction and coagulation activation: a prospective study.

    Science.gov (United States)

    Napolitano, Mariasanta; Bruno, Aldo; Mastrangelo, Diego; De Vizia, Marcella; Bernardo, Benedetto; Rosa, Buonagura; De Lucia, Domenico

    2014-10-01

    We performed a monocentric observational prospective study to evaluate coagulation activation and endothelial dysfunction parameters in patients with multiple sclerosis undergoing endovascular treatment for cerebro-spinal-venous insufficiency. Between February 2011 and July 2012, 144 endovascular procedures in 110 patients with multiple sclerosis and chronical cerebro-spinal venous insufficiency were performed and they were prospectively analyzed. Each patient was included in the study according to previously published criteria, assessed by the investigators before enrollment. Endothelial dysfunction and coagulation activation parameters were determined before the procedure and during follow-up at 1, 3, 6, 9, 12, 15 and 18 months after treatment, respectively. After the endovascular procedure, patients were treated with standard therapies, with the addition of mesoglycan. Fifty-five percent of patients experienced a favorable outcome of multiple sclerosis within 1 month after treatment, 25% regressed in the following 3 months, 24.9% did not experience any benefit. In only 0.1% patients, acute recurrence was observed and it was treated with high-dose immunosuppressive therapy. No major complications were observed. Coagulation activation and endothelial dysfunction parameters were shown to be reduced at 1 month and stable up to 12-month follow-up, and they were furthermore associated with a good clinical outcome. Endovascular procedures performed by a qualified staff are well tolerated; they can be associated with other currently adopted treatments. Correlations between inflammation, coagulation activation and neurodegenerative disorders are here supported by the observed variations in plasma levels of markers of coagulation activation and endothelial dysfunction.

  1. Sintering equation: determination of its coefficients by experiments - using multiple regression

    International Nuclear Information System (INIS)

    Windelberg, D.

    1999-01-01

    Sintering is a method for volume-compression (or volume-contraction) of powdered or grained material applying high temperature (less than the melting point of the material). Maekipirtti tried to find an equation which describes the process of sintering by its main parameters sintering time, sintering temperature and volume contracting. Such equation is called a sintering equation. It also contains some coefficients which characterise the behaviour of the material during the process of sintering. These coefficients have to be determined by experiments. Here we show that some linear regressions will produce wrong coefficients, but multiple regression results in an useful sintering equation. (orig.)

  2. Emergency CT in blunt abdominal trauma of multiple injury patients

    International Nuclear Information System (INIS)

    Kinnunen, J.; Kivioja, A.; Poussa, K.; Laasonen, E.M.

    1994-01-01

    Multiple injury patients with blunt abdominal trauma (n = 110) were examined by abdominal CT. An i.v., but not peroral, contrast medium was used, thereby eliminating the delay caused by administering peroral contrast medium and any subsequent delay in making the diagnoses and beginning operative treatment. Eighteen patients underwent emergency laparotomy after the initial CT examination. The preoperative CT findings were compared to the laparotomy findings. CT revealed all but one of the severe parenchymal organ lesions requiring surgery. The one liver laceration that went undetected had caused hemoperitoneum, which was diagnosed by CT. The bowel and mesenteric lesions presented as intra-abdominal blood, and the hemoperitoneum was discovered in every patient with these lesions. Fourteen patients also initially had positive abdominal CT findings; 10 of them underwent an additional abdominal CT within 3 days, but the repeat studies did not reveal any lesions in need of surgery. Omission of the oral contrast medium did not jeopardize making the essential diagnoses, but it did save time. (orig.)

  3. Social support as a predictor of perceived health status in patients with multiple sclerosis

    NARCIS (Netherlands)

    Krokavcova, Martina; van Dijk, Jitse P.; Nagyova, Iveta; Rosenberger, Jaroslav; Gavelova, Miriam; Middel, Berrie; Gdovinova, Zuzana; Groothoff, Johan W.

    2008-01-01

    Objective: The main aim of this study was to investigate whether different levels of perceived social support are associated with different levels of perceived health status in multiple sclerosis (MS) patients. Methods: Two hundred and seven MS patients (38.4 +/- 10.6 years, 66.2% female) completed

  4. Severe sensory neuropathy in patients with adult-onset multiple acyl-CoA dehydrogenase deficiency.

    Science.gov (United States)

    Wang, Zhaoxia; Hong, Daojun; Zhang, Wei; Li, Wurong; Shi, Xin; Zhao, Danhua; Yang, Xu; Lv, He; Yuan, Yun

    2016-02-01

    Multiple Acyl-CoA dehydrogenase deficiency (MADD) is an autosomal recessive disorder of fatty acid oxidation. Most patients with late-onset MADD are clinically characterized by lipid storage myopathy with dramatic responsiveness to riboflavin treatment. Abnormalities of peripheral neuropathy have rarely been reported in patients with late-onset MADD. We describe six patients who presented with proximal limb weakness and loss of sensation in the distal limbs. Muscle biopsy revealed typical myopathological patterns of lipid storage myopathy and blood acylcarnitine profiles showed a combined elevation of multiple acylcarnitines supporting the diagnosis of MADD. However, nerve conduction investigations and sural nerve biopsies in these patients indicated severe axonal sensory neuropathy. Causative ETFDH gene mutations were found in all six cases. No other causative gene mutations were identified in mitochondrial DNA and genes associated with hereditary neuropathies through next-generation-sequencing panel. Late-onset patients with ETFDH mutations can present with proximal muscle weakness and distal sensory neuropathy, which might be a new phenotypic variation, but the precise underlying pathogenesis remains to be elucidated. Copyright © 2015. Published by Elsevier B.V.

  5. Diagnostic evaluation of dysphagia in multiple sclerosis patients using a Persian version of DYMUS questionnaire.

    Science.gov (United States)

    Pajouh, Sahar Danesh; Moradi, Negin; Shaterzadeh Yazdi, Mohammad Jafar; Latifi, Seyed Mahmoud; Mehravar, Mohammad; Majdinasab, Nastaran; Olapour, Ali Reza; Soltani, Majid; Khanchezar, Fatemeh

    2017-10-01

    Multiple sclerosis is a chronic neurological disease that may cause swallowing disorders. Dysphagia is a common problem, which patients with different levels of disability may encounter, but it is usually underestimated; therefore, effective assessments need to be performed before any serious complications. The aim of this study was to identify the frequency and characteristics of dysphagia in multiple sclerosis patients of Khuzestan MS society, using a Persian version of Dysphagia in Multiple Sclerosis (DYMUS) questionnaire. 105 consecutive MS patients (84 F and 21 M, mean age 33.8 ± 8.5 years, mean disease duration 3.5 ± 3.1 years, mean Expanded Disability Status Scale (EDSS) 1.8 ± 1.3) participated in the study and the DYMUS questionnaire was administered by a trained speech therapist. The results have shown that 55 MS patients (52.4%) had dysphagia and the dysphagia was significantly associated with the disease course of MS (p = 0.02). However, significant associations between DYMUS values and EDSS, disease duration, age, and gender were not observed. (Respectively, p = 0.4, p = 0.09, p = 0.1, p = 1.0). In the dysphagia group, based on dysphagia severity, 17.1% and 35.2% of patients had mild and alarming dysphagia, respectively. Although, the patients with alarming dysphagia had longer disease duration, higher EDSS score and more with SP, PP and PR disease course than the patients with mild dysphagia, these differences were not significant. The oropharyngeal dysphagia in MS patients is very common even in early stages of the disease; therefore, it is important to assess these patients carefully and to initiate a treatment program if needed. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Are multiple-trial experiments appropriate for eyewitness identification studies? Accuracy, choosing, and confidence across trials.

    Science.gov (United States)

    Mansour, J K; Beaudry, J L; Lindsay, R C L

    2017-12-01

    Eyewitness identification experiments typically involve a single trial: A participant views an event and subsequently makes a lineup decision. As compared to this single-trial paradigm, multiple-trial designs are more efficient, but significantly reduce ecological validity and may affect the strategies that participants use to make lineup decisions. We examined the effects of a number of forensically relevant variables (i.e., memory strength, type of disguise, degree of disguise, and lineup type) on eyewitness accuracy, choosing, and confidence across 12 target-present and 12 target-absent lineup trials (N = 349; 8,376 lineup decisions). The rates of correct rejections and choosing (across both target-present and target-absent lineups) did not vary across the 24 trials, as reflected by main effects or interactions with trial number. Trial number had a significant but trivial quadratic effect on correct identifications (OR = 0.99) and interacted significantly, but again trivially, with disguise type (OR = 1.00). Trial number did not significantly influence participants' confidence in correct identifications, confidence in correct rejections, or confidence in target-absent selections. Thus, multiple-trial designs appear to have minimal effects on eyewitness accuracy, choosing, and confidence. Researchers should thus consider using multiple-trial designs for conducting eyewitness identification experiments.

  7. Genetic variations of patients with familial or multiple melanoma in Southern Brazil.

    Science.gov (United States)

    Grazziotin, T C; Rey, M C W; Bica, C G; Pinto, L A; Bonamigo, R R; Puig-Butille, J A; Cuellar, F; Puig, S

    2013-02-01

    Patients with familial melanoma or multiple primary melanoma represent a high-risk population to hereditary melanoma. Mutations in susceptibility genes, such as CDKN2A, CDK4 and MC1R, have been associated with the development of melanoma. The purpose of this study was to determine the genotypic background of patients with familial and/or multiple melanoma in southern Brazil. This study analysed 33 cases (5 patients with multiple primary melanoma and 28 patients from families with at least two well documented cases) and 29 controls. Genomic analysis of CDKN2A and CDK4 genes by PCR-SSCP analysis and sequencing and direct sequencing of MC1R were performed in all individuals. No functional mutations in CDKN2A or CDK4 were detected in the 62 individuals. Infrequent variants in polymorphic loci of CDKN2A gene were identified in 15 participants (24.2%) and 24/33 (72.8%) cases and 19/27 (70.4%) controls reported at least one infrequent variant in MC1R (P = 0.372). Furthermore, a non-significant tendency towards an association between melanoma risk and MC1R variants G274A and C451T and a non-significant linear tendency to the number of infrequent high-risk variants in MC1R were observed. These results suggest that in southern Brazilian population, CDKN2A or CDK4 germinal alterations may have a weaker influence than previously thought and environmental risk factors may play a central role in melanoma susceptibility. However, considering the tendency observed for gene MC1R, low-penetrance genes may be a relevant aetiological factor in southern Brazil with fair skin population and high sunlight exposure. © 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.

  8. Patient experience of access to primary care: identification of predictors in a national patient survey.

    Science.gov (United States)

    Kontopantelis, Evangelos; Roland, Martin; Reeves, David

    2010-08-28

    The 2007/8 GP Access Survey in England measured experience with five dimensions of access: getting through on the phone to a practice, getting an early appointment, getting an advance appointment, making an appointment with a particular doctor, and surgery opening hours. Our aim was to identify predictors of patient satisfaction and experience with access to English primary care. 8,307 English general practices were included in the survey (of 8,403 identified). 4,922,080 patients were randomly selected and contacted by post and 1,999,523 usable questionnaires were returned, a response rate of 40.6%. We used multi-level logistic regressions to identify patient, practice and regional predictors of patient satisfaction and experience. After controlling for all other factors, younger people, and people of Asian ethnicity, working full time, or with long commuting times to work, reported the lowest levels of satisfaction and experience of access. For people in work, the ability to take time off work to visit the GP effectively eliminated the disadvantage in access. The ethnic mix of the local area had an impact on a patient's reported satisfaction and experience over and above the patient's own ethnic identity. However, area deprivation had only low associations with patient ratings. Responses from patients in small practices were more positive for all aspects of access with the exception of satisfaction with practice opening hours. Positive reports of access to care were associated with higher scores on the Quality and Outcomes Framework and with slightly lower rates of emergency admission. Respondents in London were the least satisfied and had the worst experiences on almost all dimensions of access. This study identifies a number of patient groups with lower satisfaction, and poorer experience, of gaining access to primary care. The finding that access is better in small practices is important given the increasing tendency for small practices to combine into larger

  9. Patient experience of access to primary care: identification of predictors in a national patient survey

    Directory of Open Access Journals (Sweden)

    Kontopantelis Evangelos

    2010-08-01

    Full Text Available Abstract Background The 2007/8 GP Access Survey in England measured experience with five dimensions of access: getting through on the phone to a practice, getting an early appointment, getting an advance appointment, making an appointment with a particular doctor, and surgery opening hours. Our aim was to identify predictors of patient satisfaction and experience with access to English primary care. Methods 8,307 English general practices were included in the survey (of 8,403 identified. 4,922,080 patients were randomly selected and contacted by post and 1,999,523 usable questionnaires were returned, a response rate of 40.6%. We used multi-level logistic regressions to identify patient, practice and regional predictors of patient satisfaction and experience. Results After controlling for all other factors, younger people, and people of Asian ethnicity, working full time, or with long commuting times to work, reported the lowest levels of satisfaction and experience of access. For people in work, the ability to take time off work to visit the GP effectively eliminated the disadvantage in access. The ethnic mix of the local area had an impact on a patient's reported satisfaction and experience over and above the patient's own ethnic identity. However, area deprivation had only low associations with patient ratings. Responses from patients in small practices were more positive for all aspects of access with the exception of satisfaction with practice opening hours. Positive reports of access to care were associated with higher scores on the Quality and Outcomes Framework and with slightly lower rates of emergency admission. Respondents in London were the least satisfied and had the worst experiences on almost all dimensions of access. Conclusions This study identifies a number of patient groups with lower satisfaction, and poorer experience, of gaining access to primary care. The finding that access is better in small practices is important given

  10. Glucose uptake heterogeneity of the leg muscles is similar between patients with multiple sclerosis and healthy controls during walking.

    Science.gov (United States)

    Kindred, John H; Ketelhut, Nathaniel B; Rudroff, Thorsten

    2015-02-01

    Difficulties in ambulation are one of the main problems reported by patients with multiple sclerosis. A previous study by our research group showed increased recruitment of muscle groups during walking, but the influence of skeletal muscle properties, such as muscle fiber activity, has not been fully elucidated. The purpose of this investigation was to use the novel method of calculating glucose uptake heterogeneity in the leg muscles of patients with multiple sclerosis and compare these results to healthy controls. Eight patients with multiple sclerosis (4 men) and 8 healthy controls (4 men) performed 15 min of treadmill walking at a comfortable self-selected speed following muscle strength tests. Participants were injected with ≈ 8 mCi of [(18)F]-fluorodeoxyglucose during walking after which positron emission tomography/computed tomography imaging was performed. No differences in muscle strength were detected between multiple sclerosis and control groups (P>0.27). Within the multiple sclerosis, group differences in muscle volume existed between the stronger and weaker legs in the vastus lateralis, semitendinosus, and semimembranosus (Pmuscle group or individual muscle of the legs (P>0.16, P≥0.05). Patients with multiple sclerosis and healthy controls showed similar muscle fiber activity during walking. Interpretations of these results, with respect to our previous study, suggest that walking difficulties in patients with multiple sclerosis may be more associated with altered central nervous system motor patterns rather than alterations in skeletal muscle properties. Published by Elsevier Ltd.

  11. Spontaneous intracranial hemorrhage and multiple intracranial aneurysms in a patient with Roberts/SC phocomelia syndrome.

    Science.gov (United States)

    Wang, Anthony C; Gemmete, Joseph J; Keegan, Catherine E; Witt, Cordelie E; Muraszko, Karin M; Than, Khoi D; Maher, Cormac O

    2011-11-01

    Roberts/SC phocomelia syndrome (RBS) is a rare but distinct genetic disorder with an autosomal recessive inheritance pattern. It has been associated with microcephaly, craniofacial malformation, cavernous hemangioma, encephalocele, and hydrocephalus. There are no previously reported cases of RBS with intracranial aneurysms. The authors report on a patient with a history of RBS who presented with a spontaneous posterior fossa hemorrhage. Multiple small intracranial aneurysms were noted on a preoperative CT angiogram. The patient underwent emergency craniotomy for evacuation of the hemorrhage. A postoperative angiogram confirmed the presence of multiple, distal small intracranial aneurysms.

  12. [Utility of Multiple Increased Lung Cancer Tumor Markers in Treatment of Patients with Advanced Lung Adenocarcinoma].

    Science.gov (United States)

    Peng, Yan; Wang, Yan; Hao, Xuezhi; Li, Junling; Liu, Yutao; Wang, Hongyu

    2017-10-20

    Among frequently-used tumor markers in lung cancer, carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125), cytokeratin 19 (CYFRA21-1) and squamous carcinoma antigen (SCC), neuron specific enolase (NSE) and pro-gastrin-releasing peptide (ProGRP) are respectively expressed highly in lung adenocarcinoma, lung squamous carcinoma and small cell lung cancer. By comparing patients with multiple increased tumor markers (group A) and patients with increase of CEA and/or CA125 (group B), this study aims to investigate the utility of multiple increased tumor markers in therapeutic evaluation and prediction of disease relapsing in patients with advanced lung adenocarcinoma. Patients with stage IV lung adenocarcinoma who receiving the first line chemotherapy in Cancer Hospital, Chinese Academy of Medical Sciences were enrolled and retrospectively analyzed. Clinical characteristic, serum tumor markers before chemotherapy, efficacy evaluation, progression-free survival (PFS) were analyzed. Except CEA and CA125, the highest ratio of increased tumor markersin group A was CYFRA21-1 (93%), then was NSE (36%), SCC (13%) and ProGRP (12%). Patients with multiple increased tumor markers tend to have more distant metastasis (Ptumor markers have high risk of relapse, and maintenance therapy can reduce relapse risk.

  13. Impact of protected mealtimes on ward mealtime environment, patient experience and nutrient intake in hospitalised patients.

    Science.gov (United States)

    Hickson, M; Connolly, A; Whelan, K

    2011-08-01

    Malnutrition is a common problem in hospitalised inpatients, resulting in a range of negative clinical, patient-centred and economic sequelae. Protected mealtimes (PM) aim to enhance the quality of the mealtime experience and maximise nutrient intake in hospitalised patients. The present study aimed to measure mealtime environment, patient experience and nutrient intake before and after the implementation of PM.   PM were implemented in a large teaching hospital through a range of different approaches. Direct observations were used to assess ward-level mealtime environment (e.g. dining room use, removal of distractions) (40 versus 34 wards) and individual patient experience (e.g. assistance with eating, visitors present) (253 versus 237 patients), and nutrient intake was assessed with a weighed food intake at lunch (39 versus 60 patients) at baseline and after the implementation of PM, respectively. Mealtime experience showed improvements in three objectives: more patients were monitored using food/fluid charts (32% versus 43%, P = 0.02), more were offered the opportunity to wash hands (30% versus 40%, P = 0.03) and more were served meals at uncluttered tables (54% versus 64%, P = 0.04). There was no difference in the number of patients experiencing mealtime interruptions (32% versus 25%, P = 0.14). There was no difference in energy intake (1088 versus 837 kJ, P = 0.25) and a decrease in protein intake (14.0 versus 7.5 g, P = 0.04) after PM. Only minor improvements in mealtime experience were made after the implementation of PM and so it is not unexpected that macronutrient intake did not improve. The implementation of PM needs to be evaluated to ensure improvements in mealtime experience are made such that measurable improvements in nutritional and clinical outcomes ensue. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

  14. Multiple sclerosis, brain radiotherapy, and risk of neurotoxicity: The Mayo Clinic experience

    International Nuclear Information System (INIS)

    Miller, Robert C.; Lachance, Daniel H.; Lucchinetti, Claudia F.; Keegan, B. Mark; Gavrilova, Ralitza H.; Brown, Paul D.; Weinshenker, Brian G.; Rodriguez, Moses

    2006-01-01

    Purpose: The aim of this study was a retrospective assessment of neurotoxicity in patients with multiple sclerosis (MS) receiving external beam radiotherapy (EBRT) to the brain. Methods and Materials: We studied 15 consecutively treated patients with MS who received brain EBRT. Neurologic toxicity was assessed with the Common Toxicity Criteria v.3.0. Results: Median follow-up for the 5 living patients was 6.0 years (range, 3.3-27.4 years). No exacerbation of MS occurred in any patient during EBRT. Five patients had Grade 4 neurologic toxicity and 1 had possible Grade 5 toxicity. Kaplan-Meier estimated risk of neurotoxicity greater than Grade 4 at 5 years was 57% (95% confidence interval, 27%-82%). Toxicity occurred at 37.5 to 54.0 Gy at a median of 1.0 year (range, 0.2-4.3 years) after EBRT. Univariate analysis showed an association between opposed-field irradiation of the temporal lobes, central white matter, and brainstem and increased risk of neurotoxicity (p < 0.04). Three of 6 cases of toxicity occurred in patients treated before 1986. Conclusions: External beam radiotherapy of the brain in patients with MS may be associated with an increased risk of neurotoxicity compared with patients without demyelinating illnesses. However, this risk is associated with treatment techniques that may not be comparable to modern, conformal radiotherapy

  15. Stroke patients' experiences with Wii Sports® during inpatient rehabilitation

    DEFF Research Database (Denmark)

    Celinder, Dora; Peoples, Hanne

    2012-01-01

    INTRODUCTION: Commercial virtual reality games have been used as adjunct therapy for stroke rehabilitation, mainly after patients have been discharged. The aim of this study was to explore stroke patients' experiences with Wii Sports® as a supplement to conventional occupational therapy in a cont......INTRODUCTION: Commercial virtual reality games have been used as adjunct therapy for stroke rehabilitation, mainly after patients have been discharged. The aim of this study was to explore stroke patients' experiences with Wii Sports® as a supplement to conventional occupational therapy...... therapy services may benefit patient rehabilitation directly or provide motivation for alternative leisure activities....

  16. Sevoflurane anaesthesia for nasal surgery in a patient with multiple chemical sensitivity.

    Science.gov (United States)

    Fernández Martín, M T; Álvarez López, J C

    2018-01-01

    Multiple chemical sensitivity syndrome is a group of complex disorders that include psychiatric disorders, chronic fatigue and/or respiratory problems. This syndrome could be triggered by specific allergens and toxins that cause neurophysiological sensitization and the appearance of the clinical symptomatology. Anaesthesia for these patients always poses a challenge for the anaesthetist, because they need to find and use drugs that do not trigger or aggravate the symptoms of the disease. Therefore, sevoflurane in these circumstances might be "the ideal anaesthetic". Performing general anaesthesia with sevoflurane as the sole anaesthetic agent, together with a series of environmental measures formed the basis for successful anaesthesia and surgery in our patient with a multiple chemical sensitivity syndrome. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Altered serotonin transporter availability in patients with multiple sclerosis

    International Nuclear Information System (INIS)

    Hesse, Swen; Sabri, Osama; Moeller, Franziska; Thomae, Eva; Then Bergh, Florian; Petroff, David; Lobsien, Donald; Luthardt, Julia; Becker, Georg-Alexander; Patt, Marianne; Seese, Anita; Meyer, Philipp M.; Regenthal, Ralf

    2014-01-01

    Modulation of the immune system by the CNS may involve serotonergic regulation via the brain serotonin transporters (SERT). This regulation may be disturbed in patients with CNS disorders including multiple sclerosis (MS). Central serotonergic mechanisms have not been investigated in MS by in vivo imaging. The objective of the study was to assess the availability of SERT in antidepressant-naive patients with MS by means of PET. Included in this study were 23 patients with MS and 22 matched healthy volunteers who were investigated with PET and the SERT-selective marker [ 11 C]DASB, and distribution volume ratios were determined. Clinical assessment of the patients included the expanded disability status scale, the MS fatigue scale Wuerzburger Erschoepfungsinventar bei MS (WEIMuS) and the Beck Depression Inventory (BDI). The PET data were analysed with both volume-of-interest and voxel-based analyses to determine regional SERT availability. Patients had lower SERT availability in the cingulate cortex, the thalamus and the insula, and increased availability in the orbitofrontal cortex. Patients with relapsing/remitting MS tended to have lower SERT in the hippocampus, whereas patients with primary progressive disease showed increased SERT availability in prefrontal regions. There was a positive correlation between SERT availability in the insula and both depression and fatigue scores (r = 0.56 vs. BDI, p = 0.02; r = 0.49 vs. WEIMuS, p = 0.05). Serotonergic neurotransmission in MS patients is altered in limbic and paralimbic regions as well as in the frontal cortex that this appears to contribute to psychiatric symptoms of MS. (orig.)

  18. Altered serotonin transporter availability in patients with multiple sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Hesse, Swen; Sabri, Osama [University of Leipzig, Department of Nuclear Medicine, Leipzig (Germany); Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig (Germany); Moeller, Franziska; Thomae, Eva; Then Bergh, Florian [University of Leipzig, Department of Neurology, Leipzig (Germany); Petroff, David [University of Leipzig, Coordinating Centre for Clinical Studies, Leipzig (Germany); Lobsien, Donald [University of Leipzig, Department of Neuroradiology, Leipzig (Germany); Luthardt, Julia; Becker, Georg-Alexander; Patt, Marianne; Seese, Anita; Meyer, Philipp M. [University of Leipzig, Department of Nuclear Medicine, Leipzig (Germany); Regenthal, Ralf [University of Leipzig, Clinical Pharmacology, Rudolf-Boehm-Institute of Pharmacology and Toxicology, Leipzig (Germany)

    2014-05-15

    Modulation of the immune system by the CNS may involve serotonergic regulation via the brain serotonin transporters (SERT). This regulation may be disturbed in patients with CNS disorders including multiple sclerosis (MS). Central serotonergic mechanisms have not been investigated in MS by in vivo imaging. The objective of the study was to assess the availability of SERT in antidepressant-naive patients with MS by means of PET. Included in this study were 23 patients with MS and 22 matched healthy volunteers who were investigated with PET and the SERT-selective marker [{sup 11}C]DASB, and distribution volume ratios were determined. Clinical assessment of the patients included the expanded disability status scale, the MS fatigue scale Wuerzburger Erschoepfungsinventar bei MS (WEIMuS) and the Beck Depression Inventory (BDI). The PET data were analysed with both volume-of-interest and voxel-based analyses to determine regional SERT availability. Patients had lower SERT availability in the cingulate cortex, the thalamus and the insula, and increased availability in the orbitofrontal cortex. Patients with relapsing/remitting MS tended to have lower SERT in the hippocampus, whereas patients with primary progressive disease showed increased SERT availability in prefrontal regions. There was a positive correlation between SERT availability in the insula and both depression and fatigue scores (r = 0.56 vs. BDI, p = 0.02; r = 0.49 vs. WEIMuS, p = 0.05). Serotonergic neurotransmission in MS patients is altered in limbic and paralimbic regions as well as in the frontal cortex that this appears to contribute to psychiatric symptoms of MS. (orig.)

  19. Multiple yellow plaques assessed by angioscopy with quantitative colorimetry in patients with myocardial infarction.

    Science.gov (United States)

    Inami, Shigenobu; Ishibashi, Fumiyuki; Waxman, Sergio; Okamatsu, Kentaro; Seimiya, Koji; Takano, Masamichi; Uemura, Ryota; Sano, Junko; Mizuno, Kyoichi

    2008-03-01

    Multiple angioscopic yellow plaques are associated with diffuse atherosclerotic plaque, and may be prevalent in patients with myocardial infarction (MI), so in the present study the yellow plaques in the coronary arteries of patients with MI was evaluated using quantitative colorimetry, and compared with those of patients with stable angina (SA). In the recorded angioscopic images of 3 coronary vessels in 29 patients (15 patients with MI, 14 with SA), yellow plaques were determined as visually yellow regions with b* value >0 (yellow color intensity) measured by the quantitative colorimetric method. A total of 90 yellow plaques were identified (b* =19.35+/-8.3, 3.05-45.35). Yellow plaques were significantly more prevalent in 14 (93%) of 15 culprit lesions of MI as compared with 8 (57%) of 14 of SA (p=0.03). In non-culprit segments, yellow plaques were similarly prevalent in 13 (87%) patients with MI and 11 (79%) with SA (p=0.65). Overall, multiple (> or =2) yellow plaques were prevalent in 13 (87%) patients with MI, similar to the 10 (71%) with SA (p=0.38). The number of yellow plaques was significantly higher in patients with MI (3.8+/-1.9) than in those with SA (2.4+/-1.6, p=0.03). The present study suggests that patients with MI tend to have diffuse atherosclerotic plaque in their coronary arteries.

  20. Common experiences of patients following suboptimal treatment outcomes: implications for epilepsy surgery.

    Science.gov (United States)

    Fernando, Dinusha K; McIntosh, Anne M; Bladin, Peter F; Wilson, Sarah J

    2014-04-01

    Few studies have investigated the patient experience of unsuccessful medical interventions, particularly in the epilepsy surgery field. The present review aimed to gain insight into the patient experience of seizure recurrence after epilepsy surgery by examining the broader literature dealing with suboptimal results after medical interventions (including epilepsy surgery). To capture the patient experience, the literature search focused on qualitative research of patients who had undergone medically unsuccessful interventions, published in English in scholarly journals. Twenty-two studies were found of patients experiencing a range of suboptimal outcomes, including seizure recurrence, cancer recurrence and progression, unsuccessful joint replacement, unsuccessful infertility treatment, organ transplant rejection, coronary bypass graft surgery, and unsuccessful weight-loss surgery. In order of frequency, the most common patient experiences included the following: altered social dynamics and stigma, unmet expectations, negative emotions, use of coping strategies, hope and optimism, perceived failure of the treating team, psychiatric symptoms, and control issues. There is support in the epilepsy surgery literature that unmet expectations and psychiatric symptoms are key issues for patients with seizure recurrence, while other common patient experiences have been implied but not systematically examined. Several epilepsy surgery specific factors influence patient perceptions of seizure recurrence, including the nature of postoperative seizures, the presence of postoperative complications, and the need for increased postoperative medications. Knowledge of common patient experiences can assist in the delivery of patient follow-up and rehabilitation services tailored to differing outcomes after epilepsy surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Alemtuzumab in the treatment of multiple sclerosis: patient selection and special considerations

    Directory of Open Access Journals (Sweden)

    Dörr J

    2016-10-01

    Full Text Available Jan Dörr,1,2 Karl Baum1 1Multiple Sclerosis Center, Neurology Department, Klinik Hennigsdorf, Hennigsdorf, 2NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Germany Abstract: Multiple sclerosis (MS is among the most common chronic inflammatory diseases of the central nervous system. Although not curable, the constantly increasing armamentarium of disease-modifying drugs now allows control of disease activity in many patients. The humanized monoclonal antibody alemtuzumab is a powerful drug licensed for the treatment of MS. Upon binding to the CD52 surface protein on CD4+ and CD8+ T cells, B cells, and monocytes, circulating CD52+ cells are eliminated via antibody- and complement-mediated lysis, and a less autoreactive adaptive immune system is reconstituted. The efficacy of alemtuzumab in terms of both clinical and magnetic resonance imaging outcomes has been demonstrated in several phase II/III trials including long-term extensions and follow-up studies. Treatment response to alemtuzumab is strongest as long as active inflammation is the predominant pathophysiological feature, and it is becoming less efficacious in neurodegeneration-dominated later stages of the disease. Thus, the optimal placement of alemtuzumab within treatment algorithms of MS is crucial. The impressive efficacy of alemtuzumab is counteracted by a less favorable safety profile. Besides usually manageable infusion-associated side effects, development of secondary autoimmunity in almost half of treated patients is the most disconcerting risk of alemtuzumab. The high frequency, the delayed occurrence, and the potentially severe course of secondary autoimmune diseases require awareness and a close long-term monitoring of patients treated with alemtuzumab. Biomarkers that would allow prediction of treatment response to alemtuzumab on the one hand and identification of patients at risk for the development of secondary autoimmune diseases on

  2. Assessing obstetric patient experience: a SERVQUAL questionnaire.

    Science.gov (United States)

    Garrard, Francesca; Narayan, Harini

    2013-01-01

    Across health services, there is a drive to respond to patient feedback and to incorporate their views into service improvement. The SERVQUAL method has been used in several clinical settings to quantify whether services meet patient expectations. However, work has been limited in the obstetric population. This paper seeks to address these issues. This study used an adapted SERVQUAL questionnaire to assess a reconfigured antenatal clinic service. The most important care aspects, as rated by patients, were used to construct the SERVQUAL questions. The questionnaire was administered to eligible women in two parts. The first was completed before their first hospital antenatal appointment and the second either at home (a postal-chasing exercise) or while waiting for their next appointment. Only fully completed questionnaires (both parts) were analysed. Service strengths included staff politeness, patient respect and privacy. Areas for improvement included hand cleanliness, women's involvement in decision making and communicating risk. However, the low variability in patient responses makes concrete conclusions difficult and methodological issues complicate evaluating hand cleanliness. The new antenatal clinic service received low negative weighted and un-weighted overall scores. The SERVQUAL measure was developed from patient feedback and used to further improve services. The SERVQUAL-based measure allowed an internal evaluation of patient experience and highlighted areas for improvement. However, without validation, the questionnaire cannot be used as an outcome measure and variation between published SERVQUAL questionnaires makes comparisons difficult. This highlights an important balance in patient evaluation measures--between locally responsive and externally comparable. The SERVQUAL approach allows healthcare teams to evaluate patient experience, while accounting for variation in their expectations and priorities. The study highlights several areas that are

  3. Effect of 153Sm-EDTMP on survival time in patients with nasopharyngeal carcinoma and multiple bone metastases

    International Nuclear Information System (INIS)

    Fan Wei; Zheng Zongyuan; Xu Guangpu

    2004-01-01

    Objective: To evaluate the effect on survival of Samarium-153-ethylene diamine tetramethylene phosphonate (153Sm-EDTMP) in patients with nasopharyngeal carcinoma (NPC) and multiple bone metastases. Methods: From 1993 to 1999, 160 patients (127 men, 33 women; median age 35 years) presented with NPC and multiple bone metastases. Of these, 40 patients had undergone chemotherapy, and 72 palliative radiotherapy. Patients were randomly divided into four groups: Group 1 (N = 20) received analgesics (control); Groups 2, 3 and 4 (N = 80, 40, and 20, respectively) received one, two or three courses, respectively, of 153Sm-EDTMP (77.7 MBq/kg/course; course interval, 4 wk). Results: Eight patients died of non-cancer-related causes, and 24 were lost to follow-up. The median survival time for Group 1 (7.8 months) was significantly less (p < 0.05) than that of Groups 2, 3 and 4 (11.6, 13.4 and 12.8 months, respectively). Patients given 153Sm-EDTMP who had had revious external radiation survived longer (p < 0.05) than those in the other treatment groups. Conclusions: Internal radiotherapy with 153Sm-EDTMP can extend survival time in patients with nasopharyngeal carcinoma and multiple bone metastases; when combined with external radiotherapy in appropriate patients, its effect on survival time is enhanced.. (authors)

  4. Fingolimod Treatment in Relapsing-Remitting Multiple Sclerosis Patients: A Prospective Observational Multicenter Postmarketing Study

    Directory of Open Access Journals (Sweden)

    Rocco Totaro

    2015-01-01

    Full Text Available Objective. The aim of this prospective observational multicenter postmarketing study was to evaluate fingolimod efficacy in a real world clinical setting. Methods. One hundred forty-two subjects with relapsing-remitting multiple sclerosis (RRMS were enrolled in three multiple sclerosis centers throughout Central and Southern Italy between January 2011 and September 2013. After enrollment, regular visits and EDSS assessment were scheduled every 3 months, and MRI scan was obtained every 12 months. Patients were followed up from 1 to 33 months (mean 14.95 ± 9.15 months. The main efficacy endpoints included the proportion of patients free from clinical relapses, from disability progression, from magnetic resonance imaging activity, and from any disease activity. Results. Out of 142 patients enrolled in the study, 88.1% were free from clinical relapse and 69.0% were free from disability progression; 68.5% of patients remained free from new or newly enlarging T2 lesions and 81.7% of patients were free from gadolinium enhancing lesions. Overall the proportion of patients free from any disease activity was 41.9%. Conclusions. Our data in a real world cohort are consistent with previous findings that yield convincing evidence for the efficacy of fingolimod in patients with RRMS.

  5. Effect of disease duration on personality type in multiple sclerosis patients and healthy individual

    Directory of Open Access Journals (Sweden)

    Sahar Vesal

    2016-01-01

    Full Text Available Background: Multiple sclerosis may have profound emotional consequences. The relation between psychological and physical factors could lead patients toward unforeseen disease. This study focuses on multiple sclerosis (MS disease duration on personality type A and B in relation to individuals' behaviors. Materials and Methods: This descriptive-analytical study was conducted in Isfahan Alzahra hospital in 2013. Three hundred MS patients and 100 healthy individuals were determined. The distributed questionnaires related to MS patients and considering the descriptive statistics such as demographic variables. Data were analyzed by SPSS software (version 18 based on Chi-square test and independent T-test. Results: Disease duration varied between 1 to 38 years: 30% (1-4 years, 38% (5-10 years, 20% (10-20 years, and 12% (more than 20 years. Significant relationship was observed between disease duration and tendency to type A (higher stress. This relation was positive and significant in Relapsing Remitting MS patients; but negative correlation was seen in Secondary Progressive MS patients. These patients tended to type B (lower stress when disease duration increased. Conclusions: Individuals with disease duration of one year and less than one year tend to type A personality, while patients with increment of disease duration have tendency to type B.

  6. Sacroplasty for Local or Massive Localization of Multiple Myeloma

    International Nuclear Information System (INIS)

    Basile, Antonio; Tsetis, Dimitrios; Cavalli, Maide; Fiumara, Paolo; Raimondo, Francesco Di; Coppolino, Francesco; Coppolino, Carmelo; Mundo, Elena; Desiderio, Carla; Granata, Antonio; Patti, Maria Teresa

    2010-01-01

    The purpose of this study was to assess the efficacy of cementoplasty in the treatment of sacral multiple myelomas. We retrospectively reviewed the records of eight patients (four women and four men; age range 47-68 years; mean age 57.8) who underwent cementoplasty for painful osteolytic localization of multiple myeloma between April 2007 and May 2009. The patients had difficulty walking because of increasing pain. Six patients had persistent pain despite other cementoplasties for vertebral and femoral localization, whereas two patients referred at the time of diagnosis had only sacral lesions. The clinical indication for treatment was (1) a pain intensity score ≥5 on visual analogue scale (VAS) and (2) pain totally or partially refractory to analgesic treatment in patients with a life expectancy >3 months. Technical planning was based on computed tomography and/or magnetic resonance imaging. Six patients had previously undergone radiotherapy or chemotherapy and were receiving varying doses of analgesics, whereas sacroplasty represented the first treatment for two patients. Five patients had monolateral local involvement, and the other patients had massive involvement of the sacrum; Technical success was achieved in all cases. We had only one small and asymptomatic foraminal leak. All patients experienced improvement in symptoms after the procedure, as demonstrated by improved VAS scores and performance status (PS) and decreased analgesic dose constant during follow-up. In our experience, percutaneous stabilization can be used effectively and safely in patients with focal or extensive involvement of the sacrum by multiple myeloma.

  7. Patient experience and satisfaction with inpatient service: development of short form survey instrument measuring the core aspect of inpatient experience.

    Directory of Open Access Journals (Sweden)

    Eliza L Y Wong

    Full Text Available Patient experience reflects quality of care from the patients' perspective; therefore, patients' experiences are important data in the evaluation of the quality of health services. The development of an abbreviated, reliable and valid instrument for measuring inpatients' experience would reflect the key aspect of inpatient care from patients' perspective as well as facilitate quality improvement by cultivating patient engagement and allow the trends in patient satisfaction and experience to be measured regularly. The study developed a short-form inpatient instrument and tested its ability to capture a core set of inpatients' experiences. The Hong Kong Inpatient Experience Questionnaire (HKIEQ was established in 2010; it is an adaptation of the General Inpatient Questionnaire of the Care Quality Commission created by the Picker Institute in United Kingdom. This study used a consensus conference and a cross-sectional validation survey to create and validate a short-form of the Hong Kong Inpatient Experience Questionnaire (SF-HKIEQ. The short-form, the SF-HKIEQ, consisted of 18 items derived from the HKIEQ. The 18 items mainly covered relational aspects of care under four dimensions of the patient's journey: hospital staff, patient care and treatment, information on leaving the hospital, and overall impression. The SF-HKIEQ had a high degree of face validity, construct validity and internal reliability. The validated SF-HKIEQ reflects the relevant core aspects of inpatients' experience in a hospital setting. It provides a quick reference tool for quality improvement purposes and a platform that allows both healthcare staff and patients to monitor the quality of hospital care over time.

  8. Comparison of patients' expectations and experiences at traditional pharmacies and pharmacies offering enhanced advanced pharmacy practice experiences.

    Science.gov (United States)

    Kassam, Rosemin; Collins, John B; Berkowitz, Jonathan

    2010-06-15

    To compare patients' expectations and experiences at pharmacies offering traditional APPE learning opportunities with those offering enhanced APPEs that incorporate pharmaceutical care activities. A survey of anchored measures of patient satisfaction was conducted in 2 groups of APPE- affiliated community pharmacies: those participating in an enhanced APPE model versus those participating in the traditional model. The enhanced intervention included preceptor training, a comprehensive student orientation, and an extended experience at a single pharmacy rather than the traditional 2 x 4-week experience at different pharmacies. While patient expectations were similar in both traditional and enhanced APPE pharmacies, patients in enhanced pharmacies reported significantly higher in-store satisfaction and fewer service gaps. Additionally, satisfaction was significantly higher for patients who had received any form of consultation, from either pharmacist or students, than those reporting no consultations. Including provision of pharmaceutical care services as part of APPEs resulted in direct and measurable improvements in patient satisfaction.

  9. Physiotherapy and patients with osteogenesis imperfecta: an experience report

    Directory of Open Access Journals (Sweden)

    Carmem Lia Martins Moreira

    Full Text Available Introduction Individuals with osteogenesis imperfecta (OI have bone fragility and osteopenia which cause fractures, mobility restriction and pain. Objective This article examines a physiotherapy experience with people diagnosed with OI in an OI reference center of Rio de Janeiro. Materials and methods This was an exploratory qualitative study, based on field notes related to physiotherapy care to 92 patients of both genders with clinical diagnoses of OI, aged between 30 days and 37 years old, during the period 2004–2008. The analysis comprised a reading of the field notes as a corpus, considering them as a means of understanding the subjects’ perspectives. Two different forms of codification were applied — open and focused — followed by semiotic analysis techniques. Results Early encouragement to perform active movements within a safe environment, or even after fractures, reduced articular contractures and enhanced muscular tonus; physiotherapy manipulation facilitated the integration of body perception in relation to movements and responses to tactile-kinesthetic-vestibular stimuli; promoting family involvement, by adopting practical solutions adapted to each patient’s reality, contributed to reduce fear of fractures and allowed the construction of a new functional image. Conclusion Physiotherapy assessment and treatment should be based not only on clinical and neurofunctional elements and technical strategies, but also on a dialogue that includes the multiple dimensions of the patients and their family members, in order to engage them in a learning process to stimulate potentials, abilities and competences.

  10. Metastatic calcification in a patient with multiple myeloma diagnosed as SDRA

    International Nuclear Information System (INIS)

    Munive, Abraham Ali; Ojeda Leon, Paulina; Caicedo, Monica

    2001-01-01

    We present the case of a 44 year-old man with multiple myeloma who presented with a fever that is managed initially as pneumonia multilobar and later because of the persistence of alveolar infiltrates and severe; hypoxaemia as SDRA. The patient in the end passed away and was diagnosed with a metastatic calcification through open lung biopsy

  11. Patients' experience of nursing with Acromegaly

    DEFF Research Database (Denmark)

    Jensen, Jonna Gintberg; Høi, Henriette Brahe

    for junior doctors was informative educational. Subsequently various initiatives were undertaken to optimize nursing. Among other things, hiring a specialist chief nurse, an informative theme evening for the staff, preparation of a short-term record for documentation, endocrinology training program......, and in 2011 a quantitative survey of 20 patients was completed. Patients' experiences of nursing in the control admissions were in focus. The inclusion criterion was that the patients had followed the control admissions since 2005. The results were: A greater satisfaction with call letter, receipt...... and hospitalization, a significant positive change in nursing since 2007, and the staff showed greater interest and commitment. However, there is still room for improvement as to daily discomfort....

  12. Natalizumab treatment for multiple sclerosis: updated recommendations for patient selection and monitoring

    DEFF Research Database (Denmark)

    Kappos, Ludwig; Bates, David; Edan, Gilles

    2011-01-01

    Natalizumab, a highly specific a4-integrin antagonist, is approved for treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). It is generally recommended for individuals who have not responded to a currently available first-line disease-modifying therapy or who have very...

  13. Fatigue in rheumatoid arthritis: from patient experience to measurement

    NARCIS (Netherlands)

    Nikolaus, Stephanie

    2012-01-01

    Many patients with rheumatoid arthritis (RA) complain about fatigue. In-depths interviews with patients showed that fatigue is experienced as an annoying symptom that can have far-reaching consequences for daily life. However, not each patient has the same experience of fatigue: emotions,

  14. Is patient satisfaction and perceived service quality with musculoskeletal rehabilitation determined by patient experiences?

    Science.gov (United States)

    Medina-Mirapeix, Francesc; Jimeno-Serrano, Francisco J; Escolar-Reina, Pilar; Del Baño-Aledo, M Elena

    2013-06-01

    To assess the relationships between patient experiences and two overall evaluations - satisfaction and service quality - in outpatient rehabilitation settings. A cross-sectional, self-reported survey carried out in the year 2009. Three outpatient rehabilitation units belonging to Spanish hospitals located in Barcelona, Madrid and Seville. Four hundred and sixty-five outpatients (response rate 90%) mean age 39.4 (SD = 11.9) years. Self-reported experiences on aspects of care, participants' perception of service quality, satisfaction with care, socio-demographic and health characteristics. Satisfaction and service quality were highly correlated (rho = 0.72, Pservice quality (with adjusted R(2) 31.5% and 37.1%, respectively) indicated that patients' experiences and global rating of health improvement have more effect on those evaluations than socio-demographic characteristics. Mean satisfaction was 8.9 (SD = 1.2), and 88% of respondents described high service quality. However, nearly 25% of the respondents who reported high-quality evaluations also indicated a problem score of more than 50% in almost all aspects of care studied. Satisfaction and service quality provide a poor indicator of patients' experiences. Both are two proxies but distinct constructs in rehabilitation care. Besides, not all problems encountered by patients are equally important to them.

  15. Clinical Experience of Auditory Brainstem Response Testing on Pediatric Patients in the Operating Room

    Directory of Open Access Journals (Sweden)

    Guangwei Zhou

    2012-01-01

    Full Text Available Objectives. To review our experience of conducting auditory brainstem response (ABR test on children in the operating room and discuss the benefits versus limitations of this practice. Methods. Retrospective review study conducted in a pediatric tertiary care facility. A total of 267 patients identified with usable data, including ABR results, medical and surgical notes, and follow-up evaluation. Results. Hearing status successfully determined in all patients based on the ABR results form the operating room. The degrees and the types of hearing loss also documented in most of the cases. In addition, multiple factors that may affect the outcomes of ABR in the operating room identified. Conclusions. Hearing loss in children with complicated medical issues can be accurately evaluated via ABR testing in the operating room. Efforts should be made to eliminate adverse factors to ABR recording, and caution should be taken when interpreting ABR results from the operating room.

  16. A Patient with Multiple Keratinocytic Cancers (MKC): Uncommon Presentation in a Bulgarian Patient.

    Science.gov (United States)

    Tchernev, Georgi; Philipov, Stanislav; Chokoeva, Anastasiya Atanasova; Wollina, Uwe; Lotti, Torello; Lozev, Ilia; Yungareva, Irina; Maximov, Georgi Konstantinov

    2018-01-25

    Keratinocyte skin cancers, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common cancer occurring in people with fair skin, worldwide. Despite all known triggers, several suggested contributors are still investigated. We will focus our attention on the personal history of previous cancers and radiation exposure as occupational risk factors, as in the presented case. We report a patient, with multiple BCCs, and subsequent occurrence of a SCC on photo-exposed area of the face, as we want to emphasize the importance of strict following up of these patients, regarding the risk for developing new tumors in short periods of time, no matter if the triggering exposure factor is known from the history, or not. Although keratinocytes tumours are associated with the low mortality rate, we focus the attention on the fact, that the history of non-melanoma skin cancer is associated with increased mortality.

  17. Aerobic capacity explains physical functioning and participation in patients with multiple sclerosis-related fatigue

    OpenAIRE

    Emma Rosalie Driehuis; Lizanne Eva van den Akker; Vincent de Groot; Heleen Beckerman

    2018-01-01

    Objective: To investigate whether aerobic capacity explains the level of self-reported physical activity, physical functioning, and participation and autonomy in daily living in persons with multiple sclerosis-related fatigue. Design: A cross-sectional study. Patients: Sixty-two participants with multiple sclerosis-related fatigue. Methods: Aerobic capacity was measured with a leg ergometer and was expressed as maximal oxygen uptake (VO2max, in ...

  18. Transplantation of Human Embryonic Stem Cells in Patients with Multiple Sclerosis and Lyme Disease

    OpenAIRE

    Shroff, Geeta

    2016-01-01

    Case series Patient: Male, 42 ? Female, 30 Final Diagnosis: Human embryonic stem cells showed good therapeutic potential for treatment of multiple sclerosis with lyme disease Symptoms: Fatigue ? weakness in limbs Medication: ? Clinical Procedure: Human embryonic stem cells transplantation Specialty: Transplantology Objective: Rare disease Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease in which the myelin sheath of nerve cells is damaged. It can cause dela...

  19. Impacts of education level and employment status on healthrelated quality of life in multiple sclerosis patients

    Directory of Open Access Journals (Sweden)

    Selma Šabanagić-Hajrić

    2015-02-01

    Full Text Available Aim To evaluate the impacts of education level and employment status on health-related quality of life (HRQoL in multiple sclerosis patients. Methods This study included 100 multiple sclerosis patients treated at the Department of Neurology, Clinical Center of the University of Sarajevo. Inclusion criteria were the Expanded Disability Status Scale (EDSS score between 1.0 and 6.5, age between 18 and 65 years, stable disease on enrollment. Quality of life (QoL was evaluated by the Multiple Sclerosis Quality of Life-54 questionnaire (MSQoL-54. Mann-Whitney and Kruskal-Wallis test were used for comparisons. Linear regression analyses were performed to evaluate prediction value of educational level and employment status in predicting MSQOL-54 physical and mental composite scores. Results Full employment status had positive impact on physical health (54.85 vs. 37.90; p<0.001 and mental health (59.55 vs. 45.90; p<0.001 composite scores. Employment status retained its independent predictability for both physical (r2=0.105 and mental (r2=0.076 composite scores in linear regression analysis. Patients with college degree had slightly higher median value of physical (49.36 vs. 45.30 and mental health composite score (66.74 vs. 55.62 comparing to others, without statistically significant difference. Conclusion Employment proved to be an important factor in predicting quality of life in multiple sclerosis patients. Higher education level may determine better QOL but without significant predictive value. Sustained employment and development of vocational rehabilitation programs for MS patients living in the country with high unemployment level is an important factor in improving both physical and mental health outcomes in MS patients.

  20. The BDNF Val66Met polymorphism has opposite effects on memory circuits of multiple sclerosis patients and controls.

    Directory of Open Access Journals (Sweden)

    Francesco Fera

    Full Text Available Episodic memory deficits are frequent symptoms in Multiple Sclerosis and have been associated with dysfunctions of the hippocampus, a key region for learning. However, it is unclear whether genetic factors that influence neural plasticity modulate episodic memory in MS. We thus studied how the Brain Derived Neurotrophic Factor Val(66Met genotype, a common polymorphism influencing the hippocampal function in healthy controls, impacted on brain networks underlying episodic memory in patients with Multiple Sclerosis. Functional magnetic resonance imaging was used to assess how the Brain Derived Neurotrophic Factor Val(66Met polymorphism modulated brain regional activity and functional connectivity in 26 cognitively unimpaired Multiple Sclerosis patients and 25 age- and education-matched healthy controls while performing an episodic memory task that included encoding and retrieving visual scenes. We found a highly significant group by genotype interaction in the left posterior hippocampus, bilateral parahippocampus, and left posterior cingulate cortex. In particular, Multiple Sclerosis patients homozygous for the Val(66 allele, relative to Met(66 carriers, showed greater brain responses during both encoding and retrieval while the opposite was true for healthy controls. Furthermore, a robust group by genotype by task interaction was detected for the functional connectivity between the left posterior hippocampus and the ipsilateral posterior cingulate cortex. Here, greater hippocampus-posterior cingulate cortex connectivity was observed in Multiple Sclerosis Met(66 carriers relative to Val(66 homozygous during retrieval (but not encoding while, again, the reverse was true for healthy controls. The Val(66Met polymorphism has opposite effects on hippocampal circuitry underlying episodic memory in Multiple Sclerosis patients and healthy controls. Enhancing the knowledge of how genetic factors influence cognitive functions may improve the clinical

  1. Clinical observation of 89Sr treatment efficacy of multiple bone metastases in breast and prostate cancer patients

    International Nuclear Information System (INIS)

    Yuan Chao; Li Weipeng; Hu Yongquan; Tao Jian

    2010-01-01

    Objective: To evaluate the efficacy of 89 Sr in treatment of multiple bone metastases of breast and prostate cancer patients. Methods: Seventy multiple bone metastases patients (30 females with breast cancer and 40 males with prostate cancer) were treated with 89 Sr. The clinical effectiveness was assessed by Karnofsky performance score and whole body bone scanning data. Results: The total pain relief rate was 79% in bone metastases of breast cancer and 85% in bone metastases of prostate cancer, respectively. There was no significant differences between the two groups (χ 2 =0.78, P>0.05). The Karnofsky score was significantly improved in both groups (t=2.46, P 89 Sr treatment was good, and the quality of life was improved in patients with multiple bone metastases breast or prostate cancer. (authors)

  2. [Assessment of the pain patients with the multiple sclerosis after applying the physiotherapy treatment].

    Science.gov (United States)

    Kubsik, Anna; Klimkiewicz, Robert; Klimkiewicz, Paulina; Janczewska, Katarzyna; Jankowska, Agnieszka; Łukasiak, Adam; Woldańska-Okońska, Marta

    2016-04-01

    Multiple sclerosis is one of the most common demyelinating disease of the CNS connected with the autoimmune action. The effect of the disease is progressive disability, and one of the symptoms is pain. In relieving pain in the course of MS physical procedures and exercises of physiotherapy are used. The aim of the study was assessment of the pain in patients with the multiple sclerosis after applying laser radiation, magnetostimulation and kinesiotherapy. The studied material was consisted of 120 patients with multiple sclerosis of both sexes (82 women and 38 men) aged 21-81 years. Patients were randomly divided into 4 treatment groups and the assesment was performed three times. In the first group laser therapy, in the group II laser and magnetostimulation, in the third group kinesiotherapy, in the fourth group magnetostimulation was used. The same program of physiotherapy in all groups was used. All patients were performed the following tests to assess of the pain: The Laitinen Modified Questionnaire Indicators of Pain of and the Visual- Analogue Scale (VAS). In all treatment groups was observed tends to decrease a result of a point in The Laitinen Modified Questionnaire Indicators of Pain and the Visual-Analogue Scale (VAS). Correlation between groups demonstrated statistically significant result on the level ptreatment was applied towards group II assessed with parameter of the Questionnaire of Pain according to Laitinen, as well as towards group II and III assessed with parameter - of the Visual Analogue Scale (VAS). The good result, i.e. the reduction of the spot value, after the III examination towards the preliminary examination were got in the group II. Laser radiation is an effective method which has an analgesisc action. The combination of laser radiation and magnetostimulation reduces pain in patients with multiple sclerosis, and also allows to maintain a therapeutic effect even after the cessation of the application of these procedures, which indicates

  3. Altered 67Ga citrate distribution in patients with multiple red blood cell transfusions

    International Nuclear Information System (INIS)

    Engelstad, B.; Luk, S.S.; Hattner, R.S.

    1982-01-01

    Gallium-67 citrate studies from four patients who received multiple red blood cell transfusions were reviewed. Increased kidney, bladder, or bone localization was associated with decreased liver and colon activity. The findings suggest altered distribution due to competition with iron for receptor binding. Identification of inflammatory disease in two patients was possible. However, the effect of transfusions on detection of inflammatory or neoplastic diseases requires further evaluation

  4. Occurrence and prognostic significance of cytogenetic evolution in patients with multiple myeloma

    Science.gov (United States)

    Binder, M; Rajkumar, S V; Ketterling, R P; Dispenzieri, A; Lacy, M Q; Gertz, M A; Buadi, F K; Hayman, S R; Hwa, Y L; Zeldenrust, S R; Lust, J A; Russell, S J; Leung, N; Kapoor, P; Go, R S; Gonsalves, W I; Kyle, R A; Kumar, S K

    2016-01-01

    Cytogenetic evaluation at the time of diagnosis is essential for risk stratification in multiple myeloma, however little is known about the occurrence and prognostic significance of cytogenetic evolution during follow-up. We studied 989 patients with multiple myeloma, including 304 patients with at least two cytogenetic evaluations. Multivariable-adjusted regression models were used to assess the associations between the parameters of interest and cytogenetic evolution as well as overall survival. The prognostic significance of baseline cytogenetic abnormalities was most pronounced at the time of diagnosis and attenuated over time. In the patients with serial cytogenetic evaluations, the presence of t(11;14) at the time of diagnosis was associated with decreased odds of cytogenetic evolution during follow-up (odds ratio (OR)=0.22, 95% confidence interval (CI)=0.09–0.56, P=0.001), while the presence of at least one trisomy or tetrasomy was associated with increased odds (OR=2.96, 95% CI=1.37–6.42, P=0.006). The development of additional abnormalities during the 3 years following diagnosis was associated with increased subsequent mortality (hazard ratio=3.31, 95% CI=1.73–6.30, P<0.001). These findings emphasize the importance of the underlying clonal disease process for risk assessment and suggest that selected patients may benefit from repeated risk stratification. PMID:26967818

  5. Analysis of the quantitative dermatoglyphics of the digito-palmar complex in patients with multiple sclerosis.

    Science.gov (United States)

    Supe, S; Milicić, J; Pavićević, R

    1997-06-01

    Recent studies on the etiopathogenesis of multiple sclerosis (MS) all point out that there is a polygenetical predisposition for this illness. The so called "MS Trait" determines the reactivity of the immunological system upon ecological factors. The development of the glyphological science and the study of the characteristics of the digito-palmar dermatoglyphic complex (for which it was established that they are polygenetically determined characteristics) all enable a better insight into the genetic development during early embriogenesis. The aim of this study was to estimate certain differences in the dermatoglyphics of digito-palmar complexes between the group with multiple sclerosis and the comparable, phenotypically healthy groups of both sexes. This study is based on the analysis of 18 quantitative characteristics of the digito-palmar complex in 125 patients with multiple sclerosis (41 males and 84 females) in comparison to a group of 400 phenotypically healthy patients (200 males and 200 females). The conducted analysis pointed towards a statistically significant decrease of the number of digital and palmar ridges, as well as with lower values of atd angles in a group of MS patients of both sexes. The main discriminators were the characteristic palmar dermatoglyphics with the possibility that the discriminate analysis classifies over 80% of the examinees which exceeds the statistical significance. The results of this study suggest a possible discrimination of patients with MS and the phenotypically health population through the analysis of the dermatoglyphic status, and therefore the possibility that multiple sclerosis is genetically predisposed disease.

  6. Evaluation of Hemodynamic Properties of Cerebral Venous Drainage in Patients with Multiple Sclerosis: A Case-Control Study

    International Nuclear Information System (INIS)

    Jandaghi, Ali Babaei; Amanian, Dayan; Roudbari, Seyed Ali; Kanafi, Alireza Rajabzadeh; Pourghorban, Ramin

    2014-01-01

    The purpose of this study was to compare patients with multiple sclerosis and healthy control subjects as regards hemodynamics of cerebral venous drainage. Between December 2012 and May 2013, 44 consecutive patients with multiple sclerosis and 44 age- and sex-matched healthy subjects underwent the B-mode, color Doppler, and duplex Doppler evaluations of the internal jugular vein (IJV) and vertebral vein. The following four parameters were investigated: IJV stenosis, reversal of postural control of the cerebral venous outflow pathways, absence of detectable blood flow in the IJVs and/or vertebral veins, and reflux in the IJVs and/or vertebral veins in the sitting or supine position. In the study group, IJV stenosis, postural control reversal of the cerebral venous outflow pathways, and absence of flow in the IJVs and/or vertebral veins were found in 3 (6.8%), 2 (4.5%), and 3 (6.8%) patients, respectively. In the control group, IJV stenosis (P=0.12), postural control reversal of the cerebral venous outflow pathways (P=0.50), and absence of flow (P=0.12) were not detected. Abnormal reflux was found neither in multiple sclerosis patients nor in healthy subjects. No significant difference in the cerebral venous drainage through the IJV or vertebral vein was found between patients with multiple sclerosis and healthy subjects within any of the investigated ultrasonographic parameters

  7. Assessment of patient experience with unilateral vocal fold immobility: a preliminary study.

    Science.gov (United States)

    Francis, David O; McKiever, Monique E; Garrett, C Gaelyn; Jacobson, Barbara; Penson, David F

    2014-09-01

    Systematically moving toward patient-centered care for unilateral vocal fold immobility (UVFI) requires comprehensive understanding of the variability of actual patient experiences. This rigorous qualitative study assesses UVFI-related disability and proposes a preliminary taxonomy of UVFI patient experience. (1) Semistructured interviews and (2) taxonomy development. Consecutive UVFI patients presenting July to September, 2012, prospectively underwent open-ended interviews investigating how UVFI affected their quality of life (QOL) and had caused disability. Comments reported by >20% were synthesized into axes based on content similarity. Variables were arranged into a preliminary taxonomy of UVFI patient experience, which was evaluated for four attributes of face validity. The majority of 39 patients had "extensive" baseline voice use (56%) and an iatrogenic etiology (62%). Taxonomy of patient experience included three main axes of symptomatic classification: (1) voice, (2) swallowing, and (3) breathing-all with intrinsic (physical and emotional) and extrinsic (social) subaxes that describe major impacts on QOL. Voice complaints were 100% penetrant, whereas breathing and swallowing symptoms afflicted 76% and 66%, respectively, of interviewees. Of affected patients, solid and liquid dysphagia was experienced by 70% and 63%, respectively. Of dyspneic patients, shortness of breath existed with talking (97%) and exercise (72%). Persistent throat congestion (76%), weakened cough (62%), globus (62%), and dysfunctional valsalva (41%) were frequent. Patient experience with UVFI has been incompletely characterized. This qualitative assessment and preliminary taxonomy highlight several related patient experiences not well documented in the literature or incorporated into currently available metrics. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  8. A qualitative study of English community pharmacists' experiences of providing lifestyle advice to patients with cardiovascular disease.

    Science.gov (United States)

    Morton, Kirsty; Pattison, Helen; Langley, Chris; Powell, Rachael

    2015-01-01

    Cardiovascular disease (CVD) progression is modifiable through lifestyle behaviors. Community pharmacists are ideally placed to facilitate self-management of cardiovascular health however research shows varied pharmacist engagement in providing lifestyle advice. This study explored community pharmacists' experiences and perceptions of providing lifestyle advice to patients with CVD. Semi-structured interviews were conducted with fifteen pharmacists (1 supermarket; 7 multiple; 7 independent) recruited through multiple methods from community pharmacies across the Midlands, England. A thematic analysis was conducted using a Framework approach. Pharmacists categorized patients according to their perceptions of the patients' ability to benefit from advice. Many barriers to providing lifestyle advice were identified. Confidence to provide lifestyle advice varied, with pharmacists most comfortable providing lifestyle advice in conjunction with conversations about medicines. Some pharmacists felt lifestyle advice was an integral part of their role whilst others questioned whether pharmacists should give lifestyle advice at all, particularly when receiving no remuneration for doing so. Pharmacists viewed providing lifestyle advice as important but identified many barriers to doing so. Lifestyle advice provision was influenced by pharmacists' perceptions of patients. Professional identity and associated role conflict appeared to underpin many of the barriers to pharmacists providing lifestyle advice. Pharmacists may benefit from enhanced training to: increase their confidence to provide lifestyle advice; integrate lifestyle advice with regular pharmaceutical practice and challenge their perceptions of some patients' receptiveness to lifestyle advice and behavior change. Changes to the way UK pharmacists are remunerated may increase the provision of lifestyle advice. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Antiepileptic and Antidepressive Polypharmacy in Patients with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Georg Anton Giæver Beiske

    2015-01-01

    Full Text Available Objective. Patients with multiple sclerosis (MS are often suffering from neuropathic pain. Antiepileptic drugs (AEDs and tricyclic antidepressants (TCAs are commonly used and are susceptible to be involved in drug interactions. The aim of this retrospective study was to investigate the prevalence of use of antiepileptic and antidepressive drugs in MS patients and to discuss the theoretical potential for interactions. Methods. Review of the medical records from all patients treated at a dedicated MS rehabilitation centre in Norway between 2009 and 2012. Results. In total 1090 patients attended a rehabilitation stay during the study period. Of these, 342 (31%; 249 females with mean age of 53 (±10 years and EDSS 4.8 (±1.7 used at least one AED (gabapentin 12.7%, pregabalin 7.7%, clonazepam 7.8%, and carbamazepine 2.6% or amitriptyline (9.7%. Polypharmacy was widespread (mean 5.4 drugs with 60% using additional CNS-active drugs with a propensity to be involved in interactions. Age, gender, and EDSS scores did not differ significantly between those using and not using AED/amitriptyline. Conclusion. One-third of MS patients attending a rehabilitation stay receive AED/amitriptyline treatment. The high prevalence of polypharmacy and use of CNS-active drugs calls for awareness of especially pharmacodynamic interactions and possible excessive adverse effects.

  10. Diagnosis and treatment of latent tuberculosis in patients with multiple sclerosis, expert consensus. On behalf of the Colombian Association of Neurology, Committee of Multiple Sclerosis.

    Science.gov (United States)

    Navas, Carlos; Torres-Duque, Carlos A; Munoz-Ceron, Joe; Álvarez, Carlos; García, Juan R; Zarco, Luis; Vélez, Lázaro A; Awad, Carlos; Castro, Carlos Alberto

    2018-01-01

    Multiple sclerosis is an inflammatory and neurodegenerative demyelinating disease. Current treatment of multiple sclerosis focuses on the use of immunomodulatory, immunosuppressant, and selective immunosuppressant agents. Some of these medications may result in high risk of opportunistic infections including tuberculosis. The purpose of this study was to obtain consensus from a panel of neurologists, pulmonologists, infectious disease specialists, and epidemiology experts regarding the diagnosis, treatment, and monitoring of latent tuberculosis in patients with multiple sclerosis. A panel of experts in multiple sclerosis and tuberculosis was established. The methodological process was performed in three phases: definition of questions, answer using Delphi methodology, and the discussion of questions not agreed. Tuberculosis screening is suggested when multiple sclerosis drugs are prescribed. The recommended tests for latent tuberculosis are tuberculin and interferon gamma release test. When an anti-tuberculosis treatment is indicated, monitoring should be performed to determine liver enzyme values with consideration of age as well as comorbid conditions such as a history of alcoholism, age, obesity, concomitant hepatotoxic drugs, and history of liver disease. Latent tuberculosis should be considered in patients with multiple sclerosis who are going to be treated with immunomodulatory and immunosuppressant medications. Transaminase level monitoring is required on a periodic basis depending on clinical and laboratory characteristics. In addition to the liver impairment, other side effects should be considered when Isoniazid is prescribed.

  11. The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

    Directory of Open Access Journals (Sweden)

    Tintoré M

    2016-12-01

    Full Text Available Mar Tintoré,1 Maggie Alexander,2 Kathleen Costello,3 Martin Duddy,4 David E Jones,5 Nancy Law,6 Gilmore O’Neill,7 Antonio Uccelli,8 Robert Weissert,9 Sibyl Wray10 1Multiple Sclerosis Centre of Catalonia, Hospital Vall d’Hebron, Barcelona, Spain; 2European Multiple Sclerosis Platform, Brussels, Belgium; 3National Multiple Sclerosis Society, Denver, CO, USA; 4Royal Victoria Infirmary, Newcastle-upon-Tyne, UK; 5Department of Neurology, University of Virginia, Charlottesville, VA, USA; 6Nancy Law Consulting LLC, Parker, CO, USA; 7Biogen, Cambridge, MA, USA; 8Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; 9Department of Neurology, University of Regensburg, Regensburg, Germany; 10Hope Neurology Multiple Sclerosis Center, Knoxville, TN, USA Background: Managing multiple sclerosis (MS treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. Methods: A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. Results: A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT; satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment

  12. Günther Tulip and Celect IVC filters in multiple-trauma patients.

    Science.gov (United States)

    Rosenthal, David; Kochupura, Paul V; Wellons, Eric D; Burkett, Allison B; Methodius-Rayford, Walaya C

    2009-08-01

    To evaluate results with the retrievable Günther Tulip (GT) and Celect inferior vena cava filters (IVCFs) placed at the intensive care unit (ICU) bedside under "real-time" intravascular ultrasound (IVUS) guidance in multiple-trauma patients. Between December 2004 and December 2008, 187 multiple-trauma patients (109 men; mean age 44+/-2 years, range 17-71) with contraindications to low-dose anticoagulation therapy or sequential compression devices had Günther Tulip (n = 97) or Celect (n = 90) retrievable IVCFs placed under real-time IVUS guidance. Günther Tulip filters were inserted using a "double-puncture" technique. The Celect IVCFs were placed with a simplified single-puncture technique in which the filter introducer sheath was advanced until the radiopaque tip "covered" the IVUS image of the renal vein, indicating that the filter sheath was in position for filter deployment. The 2 filter groups were compared on the endpoints of technical implantation success, retrievability, prevention of PE, and procedure-related deep vein thrombosis (DVT). As verified by abdominal radiography, 93.1% (174/187) of IVCFs were placed without complications; 6 IVCFs (all GT; p = 0.03 versus Celect) were misplaced in the iliac vein but uneventfully retrieved and replaced in the IVC within 24 hours. Two insertion site femoral vein DVTs (both in the dual puncture group; p>0.2) and 5 groin hematomas occurred during follow-up. GT filters were in place a mean of 107 days and Celect 97 days. In this time, 2 pulmonary embolisms occurred (1 in each group; p>0.2). Of the 115 filters scheduled for retrieval (50 Günther Tulip, 65 Celect), 33 (23 Günther Tulip, 10 Celect) could not be retrieved (p = 0.0004). Vena cavography identified filter tilting (>20 degrees ) in 21 cases (15 GT, 6 Celect), while 12 filters (8 GT, 4 Celect) had extended indwell times (mean 187 days) and excessive tissue ingrowth covering the retrieval hook. Subjectively, the Celect filters were clinically "easier" to

  13. Restoration of γ-ray multiplicity distributions from experiments with low efficiency multiplicity filters

    International Nuclear Information System (INIS)

    Bellia, G.; Del Zoppo, A.; Migneco, E.; Russo, G.; Istituto Nazionale di Fisica Nucleare, Catania

    1984-01-01

    The restoration of γ-ray multiplicity distributions from experimental p-fold coincidence distributions is discussed. It is shown that the restoration of the multiplicity from measurements with low total detection efficiency is an 'incorrectly posed problem'. While in the literature the analysis of the experimental data has been attempted only in terms of the lowest central moments of the multiplicity distribution, in this paper an unfolding method based on the minimization of the directioned discrepancies in the probability space is used. The method is found to work very well even if the total efficiency Ω <= 0.1. Realistic tests and a comparison with the usual method of analysis are presented. (orig.)

  14. Collecting and Analyzing Patient Experiences of Health Care From Social Media.

    Science.gov (United States)

    Rastegar-Mojarad, Majid; Ye, Zhan; Wall, Daniel; Murali, Narayana; Lin, Simon

    2015-07-02

    Social Media, such as Yelp, provides rich information of consumer experience. Previous studies suggest that Yelp can serve as a new source to study patient experience. However, the lack of a corpus of patient reviews causes a major bottleneck for applying computational techniques. The objective of this study is to create a corpus of patient experience (COPE) and report descriptive statistics to characterize COPE. Yelp reviews about health care-related businesses were extracted from the Yelp Academic Dataset. Natural language processing (NLP) tools were used to split reviews into sentences, extract noun phrases and adjectives from each sentence, and generate parse trees and dependency trees for each sentence. Sentiment analysis techniques and Hadoop were used to calculate a sentiment score of each sentence and for parallel processing, respectively. COPE contains 79,173 sentences from 6914 patient reviews of 985 health care facilities near 30 universities in the United States. We found that patients wrote longer reviews when they rated the facility poorly (1 or 2 stars). We demonstrated that the computed sentiment scores correlated well with consumer-generated ratings. A consumer vocabulary to describe their health care experience was constructed by a statistical analysis of word counts and co-occurrences in COPE. A corpus called COPE was built as an initial step to utilize social media to understand patient experiences at health care facilities. The corpus is available to download and COPE can be used in future studies to extract knowledge of patients' experiences from their perspectives. Such information can subsequently inform and provide opportunity to improve the quality of health care.

  15. Multiple sclerosis

    International Nuclear Information System (INIS)

    Sadashima, Hiromichi; Kusaka, Hirofumi; Imai, Terukuni; Takahashi, Ryosuke; Matsumoto, Sadayuki; Yamamoto, Toru; Yamasaki, Masahiro; Maya, Kiyomi

    1986-01-01

    Eleven patients with a definite diagnosis of multiple sclerosis were examined in terms of correlations between the clinical features and the results of cranial computed tomography (CT), and magnetic resonance imaging (MRI). Results: In 5 of the 11 patients, both CT and MRI demonstrated lesions consistent with a finding of multiple sclerosis. In 3 patients, only MRI demonstrated lesions. In the remaining 3 patients, neither CT nor MRI revealed any lesion in the brain. All 5 patients who showed abnormal findings on both CT and MRI had clinical signs either of cerebral or brainstem - cerebellar lesions. On the other hand, two of the 3 patients with normal CT and MRI findings had optic-nerve and spinal-cord signs. Therefore, our results suggested relatively good correlations between the clinical features, CT, and MRI. MRI revealed cerebral lesions in two of the four patients with clinical signs of only optic-nerve and spinal-cord lesions. MRI demonstrated sclerotic lesions in 3 of the 6 patients whose plaques were not detected by CT. In conclusion, MRI proved to be more helpful in the demonstration of lesions attributable to chronic multiple sclerosis. (author)

  16. Long-term survival of patients with multiple myeloma and acute renal failure at presentation.

    Science.gov (United States)

    Lazarus, H M; Adelstein, D J; Herzig, R H; Smith, M C

    1983-03-01

    Eight patients presented with simultaneous multiple myeloma and acute renal failure requiring hemodialysis. Patients had no known pre-existing renal disease nor exposure to nephrotoxic agents or x-ray contrast dye. Renal failure was attributed to light chain nephropathy in all cases. In 4 of these patients the diagnosis of myeloma was initially unsuspected. Renal biopsies in 3 of these patients, and post-mortem material in a fourth revealed the changes of "myeloma kidney." No patient regained renal function and all required chronic hemodialysis. Among these eight patients, three survived for periods greater than 21 months.

  17. Multiple acquisition of magic angle spinning solid-state NMR experiments using one receiver: Application to microcrystalline and membrane protein preparations

    Science.gov (United States)

    Gopinath, T.; Veglia, Gianluigi

    2015-04-01

    Solid-state NMR spectroscopy of proteins is a notoriously low-throughput technique. Relatively low-sensitivity and poor resolution of protein samples require long acquisition times for multidimensional NMR experiments. To speed up data acquisition, we developed a family of experiments called Polarization Optimized Experiments (POE), in which we utilized the orphan spin operators that are discarded in classical multidimensional NMR experiments, recovering them to allow simultaneous acquisition of multiple 2D and 3D experiments, all while using conventional probes with spectrometers equipped with one receiver. POE allow the concatenation of multiple 2D or 3D pulse sequences into a single experiment, thus potentially combining all of the aforementioned advances, boosting the capability of ssNMR spectrometers at least two-fold without the addition of any hardware. In this perspective, we describe the first generation of POE, such as dual acquisition MAS (or DUMAS) methods, and then illustrate the evolution of these experiments into MEIOSIS, a method that enables the simultaneous acquisition of multiple 2D and 3D spectra. Using these new pulse schemes for the solid-state NMR investigation of biopolymers makes it possible to obtain sequential resonance assignments, as well as distance restraints, in about half the experimental time. While designed for acquisition of heteronuclei, these new experiments can be easily implemented for proton detection and coupled with other recent advancements, such as dynamic nuclear polarization (DNP), to improve signal to noise. Finally, we illustrate the application of these methods to microcrystalline protein preparations as well as single and multi-span membrane proteins reconstituted in lipid membranes.

  18. The Lived Experiences of Nurses Caring For Dying Pediatric Patients.

    Science.gov (United States)

    Curcio, Danna L

    2017-01-01

    Nurses and healthcare professionals may have difficulty adjusting to and comprehending their experiences when a patient’s life ends. This has the potential to interfere with patient care. Reflection on past events and actions enables critical discovery of strategies to benefit both nurses and patients. This qualitative phenomenological study explores the lived experiences of nurses caring for dying pediatric patients. The philosophical underpinning of Merleau-Ponty (2008), in combination with the research method of van Manen (1990), was used for this study. The Roy Adaptation Model (RAM) (Roy, 2009; Roy & Andrews, 1991) was the nursing model that guided the study to help understand that nurses are an adaptive system, using censoring as a compensatory adaptive process to help function for a purposeful cause. Nine female nurse participants with one to four years of experience were interviewed. The context of the experiences told by nurses caring for dying pediatric patents uncovered seven essential themes of empathy, feelings of ambivalence, inevitability, inspiration, relationship, self-preservation, and sorrow, and these themes demonstrated a connection formed between the nurse and the patient.

  19. The effects of pilates on balance, mobility and strength in patients with multiple sclerosis.

    Science.gov (United States)

    Guclu-Gunduz, Arzu; Citaker, Seyit; Irkec, Ceyla; Nazliel, Bijen; Batur-Caglayan, Hale Zeynep

    2014-01-01

    Although there are evidences as to Pilates developing dynamic balance, muscle strength and flexibility in healthy people, evidences related to its effects on Multiple Sclerosis patients are insufficient. The aims of this study were to investigate the effects of Pilates on balance, mobility, and strength in ambulatory patients with Multiple Sclerosis. Twenty six patients were divided into two groups as experimental (n = 18) and control (n = 8) groups for an 8-week treatment program. The experimental group underwent Pilates and the control group did abdominal breathing and active extremity exercises at home. Balance and mobility were measured with Berg Balance Scale and Timed up and go test, upper and lower muscle strength with hand-held dynamometer. Confidence in balance skills while performing daily activities was evaluated with Activities Specific Balance Confidence Scale. Improvements were observed in balance, mobility, and upper and lower extremity muscle strength in the Pilates group (p 0.05). Due to its structure which is made up of balance and strengthening exercises, Pilates training may develop balance, mobility and muscle strength of MS patients. For this reason, we think that, Pilates exercises which are appropriate for the disability level of the patient may be suggested.

  20. Assessment of Early Cognitive Impairment in Patients with Clinically Isolated Syndromes and Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Leyla Baysal Kıraç

    2014-01-01

    Full Text Available Objective. The aim of our study was to investigate the frequency and pattern of cognitive impairment in patients with clinically isolated syndromes and definite diagnosis of multiple sclerosis within the last 2 years. Methods. We assessed the cognitive status of 46 patients aged 18–49 years with clinically isolated syndromes or definite diagnosis of multiple sclerosis who have onset of their symptoms within the last 2 years. Patients were matched with 40 healthy participants for age, sex, and educational level. Neuropsychological assessment was performed by stroop test, paced auditory serial addition test (PASAT, controlled oral word association test (COWAT, clock drawing test, trail making test (TMT, faces symbol test (FST. Hamilton Depression Scale and Modified Fatigue Impact Scale were used to quantify the severity of any depression and fatigue the subjects might suffer. Results. 19.6% of early MS/CIS group failed at 4 and more tests and had significant cognitive impairment focused on attention, executive functions, memory, and learning. No significant relationship was found between cognitive impairment and disability and fatigue scores. Discussion. Cognitive impairment can be present from the earliest stage of multiple sclerosis. It should be considered among the main manifestations of MS even in the earliest stages of the disease.

  1. Youth experiences with multiple types of prejudice-based harassment.

    Science.gov (United States)

    Bucchianeri, Michaela M; Gower, Amy L; McMorris, Barbara J; Eisenberg, Marla E

    2016-08-01

    Despite prejudice-based harassment's associations with serious physical and mental health risks, research examining multiple forms of harassment among children/adolescents is lacking. This study documents the prevalence of prejudice-based harassment (i.e., harassment on the basis of gender, race/ethnicity, weight or physical appearance, sexual orientation, and disability status) among a large, statewide, school-based Midwestern U.S. sample of 162,034 adolescents. Weight-/appearance-based harassment was most prevalent among both girls (25.3%) and boys (19.8%). Adolescents from certain vulnerable groups experienced higher rates of multiple types of harassment, even when controlling for other sociodemographic characteristics. Prejudice-based harassment experiences are prevalent among adolescent girls and boys. Differential rates of each type of harassment are reported across groups within the corresponding sociodemographic status (e.g., white female adolescents report a significantly lower rate of race-based harassment (4.8%), as compared to Native American (18.6%), mixed/other race (18.9%), Hispanic/Latina (21.5%), Asian/Pacific Islander (24.2%), or Black/African American (24.8%) female adolescents); but a pattern of cross-harassment also is evident, such that differences in prevalence of each harassment type emerge across a variety of statuses (e.g., disability-based harassment was statistically significantly higher among discordant heterosexual (12.7%), gay (13.0%), bisexual (15.3%), and unsure (15.3%) male adolescents than among heterosexual male (7.2%) adolescents). Adolescents from specific sociodemographic groups are particularly vulnerable to certain types of harassment. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  2. Dissociative experiences and quality of life in patients with non-epileptic attack disorder.

    Science.gov (United States)

    Mitchell, James W; Ali, Fizzah; Cavanna, Andrea E

    2012-11-01

    Dissociative experiences are commonly reported by patients with non-epileptic attack disorder (NEAD). This cross-sectional study examined the prevalence and characteristics of dissociative experiences in patients with NEAD and assessed their association with health-related quality of life (HRQoL). Fifty-three patients diagnosed with NEAD were consecutively recruited (70.0% female, mean age=42 years, 22.0% with comorbid epilepsy) from a specialist neuropsychiatric clinic. Our sample reported high levels of dissociative experiences, with 36.7% of patients scoring ≥30 on the Dissociative Experiences Scale (DES). Significant negative correlations were found between total DES scores and HRQoL, as measured by the QOLIE-31 questionnaire (r=-0.64, pdissociative experiences in this patient population, highlighting the importance of routinely screening patients for dissociative symptoms and their impact on patients' lives. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Experiences and perspectives on the GIST patient journey.

    Science.gov (United States)

    Macdonald, Nancy; Shapiro, Ari; Bender, Christina; Paolantonio, Marc; Coombs, John

    2012-01-01

    The tyrosine kinase inhibitor (TKI) imatinib has improved outcomes for patients with unresectable or metastatic gastrointestinal stromal tumors (GIST), and for patients receiving adjuvant therapy following GIST resection. This qualitative study explored the experiences and emotions of patients through GIST diagnosis, treatment initiation, disease control, and in some patients, loss of response and therapy switch. Ethnographic investigations were conducted, including semi- structured qualitative interviews of patients with resected or metastatic/unresectable GIST and their caregivers, from Canada (n = 15); the United States (n = 10); and Brazil, France, Germany, Russia, and Spain (n = 5 each). Some interviewees also kept 7-day photo journals. Responses were qualitatively analyzed to identify gaps and unmet needs where communication about disease, treatments, and adherence could be effective. Patients shared common experiences during each stage of disease management (crisis, hope, adaptation, new normal, and uncertainty). Patients felt a sense of crisis during diagnosis, followed by hope upon TKI therapy initiation. Over time, they came to adapt to their new lives (new normal) with cancer. With each follow-up, patients confronted the uncertainty of becoming TKI resistant and the possible need to switch therapy. During uncertainty many patients sought new information regarding GIST. Cases of disease progression and drug switching caused patients to revert to crisis and restart their emotional journey. Patients with primary or unresectable/metastatic GIST shared similar journeys, especially regarding uncertainty, although differences in the scope and timing of phases were observed. Strategies patients used to remain adherent included obtaining family support, setting reminder mechanisms, taking medicine at routine times, and storing medicine in prominent places. Physicians and support staff can manage patient expectations and encourage adherence to therapy, which may

  4. BIOFEEDBACK: A NEW METHOD FOR CORRECTION OF MOTOR DISORDERS IN PATIENTS WITH MULTIPLE SCLEROSIS

    Directory of Open Access Journals (Sweden)

    Ya. S. Pekker

    2014-01-01

    Full Text Available Major disabling factors in multiple sclerosis is motor disorders. Rehabilitation of such violations is one of the most important medical and social problems. Currently, most of the role given to the development of methods for correction of motor disorders based on accessing natural resources of the human body. One of these methods is the adaptive control with biofeedback (BFB. The aim of our study was the correction of motor disorders in multiple sclerosis patients using biofeedback training. In the study, we have developed scenarios for training rehabilitation program computer EMG biofeedback aimed at correction of motor disorders in patients with multiple sclerosis (MS. The method was tested in the neurological clinic of SSMU. The study included 9 patients with definite diagnosis of MS with the presence of the clinical picture of combined pyramidal and cerebellar symptoms. Assessed the effectiveness of rehabilitation procedures biofeedback training using specialized scales (rating scale functional systems Kurtzke; questionnaire research quality of life – SF-36, evaluation of disease impact Profile – SIP and score on a scale fatigue – FSS. In the studied group of patients decreased score on a scale of fatigue (FSS, increased motor control (SIP2, the physical and mental components of health (SF-36. The tendency to reduce the amount of neurological deficit by reducing the points on the pyramidal Kurtske violations. Analysis of the exchange rate dynamics of biofeedback training on EMG for trained muscles indicates an increase in the recorded signal OEMG from session to session. Proved a tendency to increase strength and coordination trained muscles of patients studied.Positive results of biofeedback therapy in patients with MS can be recommended to use this method in the complex rehabilitation measures to correct motor and psycho-emotional disorders.

  5. Experiences of Family Members of Dying Patients Receiving Palliative Sedation.

    Science.gov (United States)

    Tursunov, Olga; Cherny, Nathan I; Ganz, Freda DeKeyser

    2016-11-01

    To describe the experience of family members of patients receiving palliative sedation at the initiation of treatment and after the patient has died and to compare these experiences over time.
. Descriptive comparative study.
. Oncology ward at Shaare Zedek Medical Center in Jerusalem, Israel.
. A convenience sample of 34 family members of dying patients receiving palliative sedation. 
. A modified version of a questionnaire describing experiences of family members with palliative sedation was administered during palliative sedation and one to four months after the patient died. Descriptive statistics were used to describe the results of the questionnaire, and appropriate statistical analyses were conducted for comparisons over time.
. Experiences of family members and time.
. Most relatives were satisfied with the sedation and staff support. Palliative sedation was experienced as an ethical way to relieve suffering. However, one-third felt that it shortened the patient's life. An explanation of the treatment was given less than half of the time and was usually given on the same day treatment was started. This explanation was given by physicians and nurses. Many felt that they were not ready for changes in the patient's condition and wanted increased opportunities to discuss the treatment with oncology care providers. No statistically significant differences in experiences were found over time. 
. Relatives' experiences of palliative sedation were generally positive and stable over time. Important experiences included timing of the initiation of sedation, timing and quality of explanations, and communication.
. Nurses should attempt to initiate discussions of the possible role of sedation in the event of refractory symptoms and follow through with continued discussions. The management of refractory symptoms at the end of life, the role of sedation, and communication skills associated with decision making related to palliative sedation should be a

  6. Evaluation of Clinical Gait Analysis parameters in patients affected by Multiple Sclerosis: Analysis of kinematics.

    Science.gov (United States)

    Severini, Giacomo; Manca, Mario; Ferraresi, Giovanni; Caniatti, Luisa Maria; Cosma, Michela; Baldasso, Francesco; Straudi, Sofia; Morelli, Monica; Basaglia, Nino

    2017-06-01

    Clinical Gait Analysis is commonly used to evaluate specific gait characteristics of patients affected by Multiple Sclerosis. The aim of this report is to present a retrospective cross-sectional analysis of the changes in Clinical Gait Analysis parameters in patients affected by Multiple Sclerosis. In this study a sample of 51 patients with different levels of disability (Expanded Disability Status Scale 2-6.5) was analyzed. We extracted a set of 52 parameters from the Clinical Gait Analysis of each patient and used statistical analysis and linear regression to assess differences among several groups of subjects stratified according to the Expanded Disability Status Scale and 6-Minutes Walking Test. The impact of assistive devices (e.g. canes and crutches) on the kinematics was also assessed in a subsample of patients. Subjects showed decreased range of motion at hip, knee and ankle that translated in increased pelvic tilt and hiking. Comparison between the two stratifications showed that gait speed during 6-Minutes Walking Test is better at discriminating patients' kinematics with respect to Expanded Disability Status Scale. Assistive devices were shown not to significantly impact gait kinematics and the Clinical Gait Analysis parameters analyzed. We were able to characterize disability-related trends in gait kinematics. The results presented in this report provide a small atlas of the changes in gait characteristics associated with different disability levels in the Multiple Sclerosis population. This information could be used to effectively track the progression of MS and the effect of different therapies. Copyright © 2017. Published by Elsevier Ltd.

  7. Decision-Making in Multiple Sclerosis Patients: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Mireille Neuhaus

    2018-01-01

    Full Text Available Background. Multiple sclerosis (MS is frequently associated with cognitive and behavioural deficits. A growing number of studies suggest an impact of MS on decision-making abilities. The aim of this systematic review was to assess if (1 performance of MS patients in decision-making tasks was consistently different from controls and (2 whether this modification was associated with cognitive dysfunction and emotional alterations. Methods. The search was conducted on Pubmed/Medline database. 12 studies evaluating the difference between MS patients and healthy controls using validated decision-making tasks were included. Outcomes considered were quantitative (net scores and qualitative measurements (deliberation time and learning from feedback. Results. Quantitative and qualitative decision-making impairment in MS was present in 64.7% of measurements. Patients were equally impaired in tasks for decision-making under risk and ambiguity. A correlation to other cognitive functions was present in 50% of cases, with the highest associations in the domains of processing speed and attentional capacity. Conclusions. In MS patients, qualitative and quantitative modifications may be present in any kind of decision-making task and can appear independently of other cognitive measures. Since decision-making abilities have a significant impact on everyday life, this cognitive aspect has an influential importance in various MS-related treatment settings.

  8. Decision-Making in Multiple Sclerosis Patients: A Systematic Review.

    Science.gov (United States)

    Neuhaus, Mireille; Calabrese, Pasquale; Annoni, Jean-Marie

    2018-01-01

    Multiple sclerosis (MS) is frequently associated with cognitive and behavioural deficits. A growing number of studies suggest an impact of MS on decision-making abilities. The aim of this systematic review was to assess if (1) performance of MS patients in decision-making tasks was consistently different from controls and (2) whether this modification was associated with cognitive dysfunction and emotional alterations. The search was conducted on Pubmed/Medline database. 12 studies evaluating the difference between MS patients and healthy controls using validated decision-making tasks were included. Outcomes considered were quantitative (net scores) and qualitative measurements (deliberation time and learning from feedback). Quantitative and qualitative decision-making impairment in MS was present in 64.7% of measurements. Patients were equally impaired in tasks for decision-making under risk and ambiguity. A correlation to other cognitive functions was present in 50% of cases, with the highest associations in the domains of processing speed and attentional capacity. In MS patients, qualitative and quantitative modifications may be present in any kind of decision-making task and can appear independently of other cognitive measures. Since decision-making abilities have a significant impact on everyday life, this cognitive aspect has an influential importance in various MS-related treatment settings.

  9. Impulsive response of an automatic transmission system with multiple clearances: Formulation, simulation and experiment

    Science.gov (United States)

    Crowther, Ashley R.; Singh, Rajendra; Zhang, Nong; Chapman, Chris

    2007-10-01

    Impulsive responses in geared systems with multiple clearances are studied when the mean torque excitation and system load change abruptly, with application to a vehicle driveline with an automatic transmission. First, torsional lumped-mass models of the planetary and differential gear sets are formulated using matrix elements. The model is then reduced to address tractable nonlinear problems while successfully retaining the main modes of interest. Second, numerical simulations for the nonlinear model are performed for transient conditions and a typical driving situation that induces an impulsive behaviour simulated. However, initial conditions and excitation and load profiles have to be carefully defined before the model can be numerically solved. It is shown that the impacts within the planetary or differential gears may occur under combinations of engine, braking and vehicle load transients. Our analysis shows that the shaping of the engine transient by the torque converter before reaching the clearance locations is more critical. Third, a free vibration experiment is developed for an analogous driveline with multiple clearances and three experiments that excite different response regimes have been carried out. Good correlations validate the proposed methodology.

  10. The Assessment of Cognitive Emotion Regulation Strategies, Sensory Processing Sensitivity and Anxiety Sensitivity in Patients with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Esmeil Soleymani

    2016-11-01

    Full Text Available Abstract Background: The purpose of this study was to compare the cognitive emotional regulation strategies, sensory processing sensitivity and anxiety sensitivity in patients with multiple sclerosis and normal people. Materials and Methods: Statistical population of this study was all of patients with multiple sclerosis that referred to M.S association of Iran in the tehran. Sample of this study was 30 individuals of patients with multiple sclerosis selected by available sampling method and were matched with 30 individuals of normal people. Two groups completed cognitive emotion regulation, high sensory processing sensitivity and anxiety sensitivity questionnaires. Data were analyzed by one-way analysis of variance and Multivariate Analysis of Variance. Results: The results indicated that there is significant difference between two groups in view of cognitive emotion regulation strategies in which the mean of scores of patients with multiple sclerosis in maladaptive strategies of self- blame, catastrophizing and other blame were more than normal people and mean of scores of them in adaptive strategies of positive refocusing, positive reappraisal and putting into perspective were less than normal people. The results also indicated that there is a significant difference between two groups in anxiety sensitivity and sensory processing sensitivity. Conclusion: The most of emotional problems in patients with multiple sclerosis can be the result of more application of maladaptive strategies of cognitive emotion regulation, high sensory processing sensitivity and high anxiety sensitivity.

  11. Representations of Patients' Experiences of Autonomy in Graphic Medicine.

    Science.gov (United States)

    Tschaepe, Mark

    2018-02-01

    I advocate using graphic medicine in introductory medical ethics courses to help trainees learn about patients' experiences of autonomy. Graphic narratives about this content offer trainees opportunities to gain insights into making diagnoses and recommending treatments. Graphic medicine can also illuminate aspects of patients' experiences of autonomy differently than other genres. Specifically, comics allow readers to consider visual and text-based representations of a patient's actions, speech, thoughts, and emotions. Here, I use Ellen Forney's Marbles: Mania, Depression, Michelangelo, and Me: A Graphic Memoir and Peter Dunlap-Shohl's My Degeneration: A Journey Through Parkinson's as two examples that can serve as pedagogical resources. © 2018 American Medical Association. All Rights Reserved.

  12. Cognitive performance of neuromyelitis optica patients: comparison with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Sandra Vanotti

    2013-06-01

    Full Text Available The aim of the present research was to investigate cognitive pattern of patients with neuromyelitis optica (NMO and to compare it with multiple sclerosis (MS patients' performance. Methods: Fourteen NMO, 14 relapsing remitting multiple sclerosis (RRMS, and 14 healthy control patients participated in the investigation. Neuropsychological functions were evaluated with the Brief Repeatable Neuropsychological Battery for MS; Symbol Digit Modalities Test; Digit Span; and Semantic Fluency. Results: Fifty-seven percent of NMO patients and 42.85% of the MS ones had abnormal performance in at least two cognitive tests. The NMO Group showed abnormal performance in verbal fluency, verbal and visual memories, with greater attention deficits. NMO patients outperformed healthy control in the paced auditory serial addition test (PASAT. However, no difference was found between NMO and RRMS patients. Conclusions: The NMO Group showed more dysfunction in attention and verbal fluencies than in verbal and visual memories. When compared with the MS patients, a similar dysfunction pattern was found. O objetivo da presente pesquisa foi investigar o padrão cognitivo de pacientes com neuromielite óptica (NMO e compará-lo com o desempenho de pacientes com esclerose múltipla (EM. Métodos: Quatorze pacientes com NMO, 14 com esclerose múltipla recorrente remitente (EMRR e 14 participantes do Controle saudáveis participaram da presente investigação. As funções neuropsicológicas foram avaliadas com a Bateria Breve de Testes Neuropsicológicos de Rao, Teste Símbolo Digit e a Fluência Semântica. Resultados: Cinquenta e sete por cento dos pacientes com NMO e 42,85% daqueles com EM apresentaram desempenho anormal em pelo menos dois testes cognitivos. O Grupo NMO apresentarou desempenho anormal na fluência verbal e nas memórias visual e verbal, com maiores déficits de atenção. Pacientes com NMO superaram os controles saudáveis em PASAT. No entanto, não foi

  13. Risk factors for colorectal cancer in patients with multiple serrated polyps: a cross-sectional case series from genetics clinics.

    Directory of Open Access Journals (Sweden)

    Daniel D Buchanan

    2010-07-01

    Full Text Available Patients with multiple serrated polyps are at an increased risk for developing colorectal cancer (CRC. Recent reports have linked cigarette smoking with the subset of CRC that develops from serrated polyps. The aim of this work therefore was to investigate the association between smoking and the risk of CRC in high-risk genetics clinic patients presenting with multiple serrated polyps.We identified 151 Caucasian individuals with multiple serrated polyps including at least 5 outside the rectum, and classified patients into non-smokers, current or former smokers at the time of initial diagnosis of polyposis. Cases were individuals with multiple serrated polyps who presented with CRC. Controls were individuals with multiple serrated polyps and no CRC. Multivariate logistic regression was performed to estimate associations between smoking and CRC with adjustment for age at first presentation, sex and co-existing traditional adenomas, a feature that has been consistently linked with CRC risk in patients with multiple serrated polyps. CRC was present in 56 (37% individuals at presentation. Patients with at least one adenoma were 4 times more likely to present with CRC compared with patients without adenomas (OR = 4.09; 95%CI 1.27 to 13.14; P = 0.02. For females, the odds of CRC decreased by 90% in current smokers as compared to never smokers (OR = 0.10; 95%CI 0.02 to 0.47; P = 0.004 after adjusting for age and adenomas. For males, there was no relationship between current smoking and CRC. There was no statistical evidence of an association between former smoking and CRC for both sexes.A decreased odds for CRC was identified in females with multiple serrated polyps who currently smoke, independent of age and the presence of a traditional adenoma. Investigations into the biological basis for these observations could lead to non-smoking-related therapies being developed to decrease the risk of CRC and colectomy in these patients.

  14. Systematic review of multidisciplinary rehabilitation in patients with multiple trauma.

    Science.gov (United States)

    Khan, F; Amatya, B; Hoffman, K

    2012-01-01

    Multiple trauma is a cause of significant disability in adults of working age. Despite the implementation of trauma systems for improved coordination and organization of care, rehabilitation services are not yet routinely considered integral to trauma care processes. MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, Physiotherapy Evidence Database, Latin American and Caribbean Literature on Health Sciences and Cochrane Library databases were searched up to May 2011 for randomized clinical trials, as well as observational studies, reporting outcomes of injured patients following multidisciplinary rehabilitation that addressed functional restoration and societal reintegration based on the International Classification of Functioning, Disability and Health. No randomized and/or controlled clinical trials were identified. Fifteen observational studies involving 2386 participants with injuries were included. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach assessed methodological quality as 'poor' in all studies, with selection and observer bias. Although patients with low functional scores showed improvement after rehabilitation, they were unable to resume their pretrauma level of activity. Their functional ability was significantly associated with motor independence on admission and early acute rehabilitation, which contributed to a shorter hospital stay. Injury location, age, co-morbidity and education predicted long-term functional consequences. Trauma care systems were associated with reduced mortality. The gaps in evidence include: rehabilitation settings, components, intensity, duration and types of therapy, and long-term outcomes for survivors of multiple trauma. Rehabilitation is an expensive resource and the evidence to support its justification is needed urgently. The issues in study design and research methodology in rehabilitation are challenging. Opportunities

  15. Multiple cavernous malformations presenting in a patient with Poland syndrome: A case report

    Directory of Open Access Journals (Sweden)

    De Salles Antonio AF

    2011-09-01

    Full Text Available Abstract Introduction Poland syndrome is a congenital disorder related to chest and hand anomalies on one side of the body. Its etiology remains unclear, with an ipsilateral vascular alteration (of unknown origin to the subclavian artery in early embryogenesis being the currently accepted theory. Cavernous malformations are vascular hamartomas, which have been linked to a genetic etiology, particularly in familial cases, which commonly present with multiple lesions. Our case report is the first to describe multiple cavernous malformations associated with Poland syndrome, further supporting the vascular etiology theory, but pointing to a genetic rather than a mechanistic factor disrupting blood flow in the corresponding vessels. Case presentation A 41-year-old Caucasian man with Poland syndrome on the right side of his body presented to our hospital with a secondary generalized seizure and was found to have multiple cavernous malformations distributed in his brain, cerebellum, and brain stem, with a predominance of lesions in the left hemisphere. Conclusion The distribution of cavernous malformations in the left hemisphere and the right-sided Poland syndrome in our patient could not be explained by a mechanistic disruption of one of the subclavian arteries. A genetic alteration, as in familial cavernous malformations, would be a more appropriate etiologic diagnosis of Poland syndrome in our patient. Further genetic and pathological studies of the involved blood vessels in patients with Poland syndrome could lead to a better understanding of the disease.

  16. [Ulysses network: an approach to integral post-ICU treatment of patients with multiple organ dysfunction syndrome].

    Science.gov (United States)

    Nolla-Salas, M; Monmany-Roca, J; Vázquez-Mata, G

    2007-01-01

    The concept of continuity of care by intensivists as an element of quality control in the medical care of Intensive Care Unit (ICU) patients surviving multiple organ dysfunction syndrome has led to a rethinking of the ICU model in recent years. We discuss the rationale to design and implement a hospital-based, prospective, randomized, multicenter Intervention/Control study in order to estimate the impact of an interdisciplinary intervention during the post-ICU recovery phase on medium-term medical outcomes in ICU patients with multiple organ dysfunction.

  17. Type D, anxiety and depression in association with quality of life in patients with Parkinson's disease and patients with multiple sclerosis

    NARCIS (Netherlands)

    Dubayova, Tatiana; Krokavcova, Martina; Nagyova, Iveta; Rosenberger, Jaroslav; Gdovinova, Zuzana; Middel, Berrie; Groothoff, Johan W.; van Dijk, Jitse P.

    The present study examines the role of Type D personality, anxiety and depression in quality of life (QoL) in patients with two chronic neurological diseases-Parkinson's disease (PD) and multiple sclerosis (MS). This cross-sectional study included 142 PD patients (73 % males; mean age 67.6 +/- A 9.2

  18. Functional Magnetic Resonance Imaging with Concurrent Urodynamic Testing Identifies Brain Structures Involved in Micturition Cycle in Patients with Multiple Sclerosis.

    Science.gov (United States)

    Khavari, Rose; Karmonik, Christof; Shy, Michael; Fletcher, Sophie; Boone, Timothy

    2017-02-01

    Neurogenic lower urinary tract dysfunction, which is common in patients with multiple sclerosis, has a significant impact on quality of life. In this study we sought to determine brain activity processes during the micturition cycle in female patients with multiple sclerosis and neurogenic lower urinary tract dysfunction. We report brain activity on functional magnetic resonance imaging and simultaneous urodynamic testing in 23 ambulatory female patients with multiple sclerosis. Individual functional magnetic resonance imaging activation maps at strong desire to void and at initiation of voiding were calculated and averaged at Montreal Neuroimaging Institute. Areas of significant activation were identified in these average maps. Subgroup analysis was performed in patients with elicitable neurogenic detrusor overactivity or detrusor-sphincter dyssynergia. Group analysis of all patients at strong desire to void yielded areas of activation in regions associated with executive function (frontal gyrus), emotional regulation (cingulate gyrus) and motor control (putamen, cerebellum and precuneus). Comparison of the average change in activation between previously reported healthy controls and patients with multiple sclerosis showed predominantly stronger, more focal activation in the former and lower, more diffused activation in the latter. Patients with multiple sclerosis who had demonstrable neurogenic detrusor overactivity and detrusor-sphincter dyssynergia showed a trend toward distinct brain activation at full urge and at initiation of voiding respectively. We successfully studied brain activation during the entire micturition cycle in female patients with neurogenic lower urinary tract dysfunction and multiple sclerosis using a concurrent functional magnetic resonance imaging/urodynamic testing platform. Understanding the central neural processes involved in specific parts of micturition in patients with neurogenic lower urinary tract dysfunction may identify areas

  19. Efficacy of rasagiline in patients with the parkinsonian variant of multiple system atrophy: a randomised, placebo-controlled trial.

    Science.gov (United States)

    Poewe, Werner; Seppi, Klaus; Fitzer-Attas, Cheryl J; Wenning, Gregor K; Gilman, Sid; Low, Phillip A; Giladi, Nir; Barone, Paolo; Sampaio, Cristina; Eyal, Eli; Rascol, Olivier

    2015-02-01

    Multiple system atrophy is a complex neurodegenerative disorder for which no effective treatment exists. We aimed to assess the effect of rasagiline on symptoms and progression of the parkinsonian variant of multiple system atrophy. We did this randomised, double-blind, placebo-controlled trial between Dec 15, 2009, and Oct 20, 2011, at 40 academic sites specialised in the care of patients with multiple systemic atrophy across 12 countries. Eligible participants aged 30 years or older with possible or probable parkinsonian variant multiple system atrophy were randomly assigned (1:1), via computer-generated block randomisation (block size of four), to receive either rasagiline 1 mg per day or placebo. Randomisation was stratified by study centre. The investigators, study funder, and personnel involved in patient assessment, monitoring, analysis and data management were masked to group assignment. The primary endpoint was change from baseline to study end in total Unified Multiple System Atrophy Rating Scale (UMSARS) score (parts I and II). Analysis was by modified intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00977665. We randomly assigned 174 participants to the rasagiline group (n=84) or the placebo group (n=90); 21 (25%) patients in the rasagiline group and 15 (17%) in the placebo group withdrew from the study early. At week 48, patients in the rasagiline group had progressed by an adjusted mean of 7·2 (SE 1·2) total UMSARS units versus 7·8 (1·1) units in those in the placebo group. This treatment difference of -0·60 (95% CI -3·68 to 2·47; p=0·70) was not significant. 68 (81%) patients in the rasagiline group and 67 (74%) patients in the placebo group reported adverse events, and we recorded serious adverse events in 29 (35%) versus 23 (26%) patients. The most common adverse events in the rasagiline group were dizziness (n=10 [12%]), peripheral oedema (n=9 [11%]), urinary tract infections (n=9 [11%]), and orthostatic

  20. Percutaneous vertebroplasty under local anaesthesia: feasibility regarding patients' experience

    Energy Technology Data Exchange (ETDEWEB)

    Bonnard, Eric; Foti, Pauline; Amoretti, Nicolas [Nice University Hospital, Diagnostic and Interventional Radiology Unit, Nice (France); Kastler, Adrian [Grenoble University Hospital, Neuroradiology and MRI Unit, CLUNI, Grenoble (France)

    2017-04-15

    Evaluate patients' intraoperative experience of percutaneous vertebroplasty (PV) performed without general anaesthesia in order to assess the feasibility of local anaesthesia and simple analgesic medication as pain control protocol. Ninety-five patients who underwent single-site PV were consecutively included in the study between 2011 and 2013. Each procedure was achieved under local anaesthesia and perfusion of paracetamol, tramadol and dolasetron, with combined CT and fluoroscopy guidance. Numeric pain scale (NPS) was collected before, during and after intervention. After intervention, patients were asked to evaluate their experience as ''very bad'', ''bad'', ''fair'', ''good'' or ''very good'', independently of the pain. Indications for vertebroplasty were osteopenic fractures (78 %), aggressive angiomas (13 %) and somatic tumours (9 %). In 76 % of cases, patients' experience was described as ''very good'' (44 %) or ''good'' (32 %), whereas 19 % described it as ''fair'' and 5 % as ''very bad''. Mean operative NPS was 5.5. After intervention, NPS was significantly lower with a decrease of 4.5 points. No differences were found according to the localization, type of lesion, age or sex either in terms of experience or NPS. Percutaneous vertebroplasty is feasible under local anaesthesia alone, with a very good or good experience in 76 % of the patients. (orig.)