Incidental findings of liver, biliary system, pancreas and spleen in asymptomatic patients. Assessment and management recommendations; Zufallsbefunde von Leber, Gallensystem, Pankreas und Milz bei asymptomatischen Patienten. Bewertung und Managementempfehlung

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Scharitzer, M.; Tamandl, D.; Ba-Ssalamah, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

2017-04-15

The increased use of highly developed imaging procedures, such as multidetector-row computed tomography and magnetic resonance imaging has led to a substantial increase of asymptomatic and unexpected findings. Abdominal CT investigations are particularly affected with a large number of incidental findings. This valuable diagnostic procedure also entails the risk of complex and cost-intensive subsequent investigations with partly invasive procedures. For this reason radiologists are more often confronted with the difficult task of correctly assessing these lesions, to decide on the need for additional investigations and to inform the patient in detail about the clinical relevance. The aims of this article are to describe the most common abdominal incidentalomas, to assist with the interpretation and differential diagnosis and to give recommendations for further management. (orig.) [German] Die vermehrte Verwendung hoch entwickelter bildgebender Verfahren wie Multidetektorcomputertomographie und Magnetresonanztomographie hat zu einer betraechtlichen Zunahme asymptomatischer und unerwarteter Befunde gefuehrt. Besonders betroffen sind abdominelle CT-Untersuchungen mit einer Vielzahl inzidenteller Befunde. Dieses wertvolle Diagnoseverfahren birgt auch die Gefahr aufwendiger und auch kostenintensiver Folgeuntersuchungen mit z. T. invasiven Verfahren. Vor diesem Hintergrund stellt sich fuer den Radiologen immer haeufiger die schwierige Aufgabe, diese Laesionen korrekt einzuschaetzen, ueber die Notwendigkeit einer weiteren Abklaerung zu entscheiden und den Patienten umfassend ueber die klinische Relevanz zu informieren. Das Ziel dieses Artikels ist es, die am haeufigsten vorkommenden abdominellen Zufallsbefunde zu beschreiben sowie Hilfestellung bei ihrer Interpretation und Differenzialdiagnose mit Empfehlungen fuer das weitere Management zu geben. (orig.)

371 Exhumierungen : eine Untersuchung aus morphologischer, versicherungsmedizinischer und rechtsmedizinischer Sicht

OpenAIRE

Ulm, Kristin

2008-01-01

In der vorliegenden Arbeit wurden die Ergebnisse von 371 Exhumierungen aus den Jahren 1967 bis 1998 ausgewertet unter der Fragestellung, ob aussagekräftige morphologische Befunde auch noch nach einer längeren Leichenliegezeit erhoben werden und versicherungsmedizinische Fragen hierdurch beantwortet werden können. Die erhobenen morphologischen Befunde sowohl auf mikroskopischer als auch auf makroskopischer Ebene wurden zu einem Erwartungskatalog zusammengefasst und mit den Ergebnissen der...

Seldom appreciated findings in knee joints; Selten wahrgenommene Befunde am Kniegelenk

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Glaser, Christian; Heuck, Andreas; Theisen, Daniel; Horng, Annie [Radiologisches Zentrum Muenchen-Pasing (RZM), Muenchen (Germany)

2015-03-15

Synovial plicae and meniscocapsular lesions are rare and rarely described findings. While synovial plicae may become symptomatic following trauma or repetitive overuse, they are primarily normal anatomic structures. Most often the mediopatellar plica is affected. Lesions of the meniscocapsular junction often are associated with ACL tears and affect the posteromedial corner more frequently than the posterolateral corner. Imaging is little specific for both entities and therefore a pathology should be called only in close correlation with the patient's clinical complaints. However, especially in physically active patients and when there is no evidence for other pathologies, MRI can pave the way to a targeted investigation and therapy.

Diagnostic imaging in psychiatry; Bildgebende Verfahren in der Psychiatrie

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Stoppe, G.; Hentschel, F.; Munz, D.L. (eds.)

2000-07-01

The textbook presents an exhaustive survey of diagnostic imaging methods available for clinical evaluation of the entire range of significant psychiatric symptoms via imaging of the anatomy and functions of the brain. The chapters discuss: The methods and their efficient use for given diagnostic objectives, image analysis, description and interpretation of findings with respect to the clinical symptoms. Morphology and functional correlation of findings. The book is intended to help psychiatrists and neurologists as well as doctors in the radiology and nuclear medicine departments. (orig./CB) [German] Die Entwicklung der modernen Bildgebung ermoeglicht faszinierende Einblicke in Anatomie und Funktionen des Gehirns und ihre Veraenderungen bei psychiatrischen Erkrankungen. Die Methodik der Untersuchungsverfahren und die Befunde bei allen wichtigen psychiatrischen Krankheitsbildern sind in diesem Buch systematisch und umfassend beschrieben: - gezielter und effizienter Einsatz der Verfahren, - Bildanalyse und Befundbeschreibung, - Bewertung der Befunde und Beziehung zum klinischen Bild, - morphologische und funktionelle Korrelate der Befunde. Psychiater und Neurologen werden ebenso angesprochen wie Radiologen und Nuklearmediziner. (orig.)

MR-myelography in patients with spinal canal stenosis; MR-Myelographie bei Spinalkanalstenosen

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Freund, M.; Hutzelmann, A.; Steffens, J.C.; Heller, M. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet zu Kiel (Germany); Buhl, R. [Klinik fuer Neurochirurgie, Christian-Albrechts-Universitaet zu Kiel (Germany)

1997-11-01

Purpose: The purpose of this prospective study was to evaluate the clinical value of 3D-MR-myelography (3D-MRM) in comparison to myelography and intra-operative findings. Material and Methods: 25 patients with suspected lumbar spinal canal stenosis were studied via myelography and 3D-MRM (volume-data set, 3D-FISP sequenz, T{sub R} 73 ms, T{sub E} 21 ms, flipangle 7 , sagittal slices) besides the routinely acquired sagittal and axial T{sub 1}- and T{sub 2}-weighted images. Diagnoses were made by two radiologists and one neurosurgeon without knowing the clinical history and symptoms, in two separate sessions. Results were compared to intraoperative findings. Results: 3D-MRM has the same diagnostic sensitivity (25/25=100%) as conventional X-ray myelography (25/25=100%) compared to intraoperative findings, but is not invasive and shows more diagnostic details than myelography. Especially in cases of high-grade spinal canal stenosis there is often a lack of intrathecal contrast medium distally of the stenosis. (orig./AJ) [Deutsch] Ziel: Bewertung der 3D-MR-Myelographie (3D-MRM) in der Diagnostik lumbaler Spinalkanalstenosen im Vergleich zu Myelographie und Korrelation mit intraoperativem Befund. Material und Methode: In einer fortlaufenden, prospektiven Studie wurden 25 Patienten mit den Symptomen einer lumbalen Spinalkanalstenose kernspintomographisch untersucht. Neben den ueblichen sagittalen und axialen T{sub 1}- und T{sub 2}-gewichteten Aufnahmen wurde ein Volumendatensatz mit einer 3D-FISP Sequenz (T{sub R} 73 ms, T{sub E} 21 ms, Flipwinkel 7 ) akquisiert. Die Nachverarbeitung erfolgte mittels Maximum Intensitaets-Projektion (MIP): 18 Projektionen von 0 -180 . Die 3D-MRM wurde der Myelographie gegenuebergestellt, beide Untersuchungen wurden getrennt von drei Untersuchern blind ausgewertet. Ergebnisse: Sowohl die 3D-MRM als auch die der Myelographie zeigten bei Patienten mit lumbaler Spinalkanalstenose in Korrelation zum intraoperativen Befund eine Uebereinstimmung

Clinically relevant incidental cardiovascular findings in CT examinations; Klinisch relevante kardiovaskulaere Zufallsbefunde bei CT-Untersuchungen

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Voigt, P.; Fahnert, J.; Kahn, T.; Surov, A. [Universitaetsklinikum Leipzig, Klinik fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany); Schramm, D.; Bach, A.G. [Universitaetsklinikum Halle (Saale), Klinik fuer Radiologie, Halle (Germany)

2017-04-15

Incidental cardiovascular findings are a frequent phenomenon in computed tomography (CT) examinations. As the result of a dedicated PubMed search this article gives a systemic overview of the current literature on the most important incidental cardiovascular findings, their prevalence and clinical relevance. The majority of incidental cardiovascular findings are of only low clinical relevance; however, highly relevant incidental findings, such as aortic aneurysms, thromboses and thromboembolic events can also occasionally be found, especially in oncology patients. The scans from every CT examination should also be investigated for incidental findings as they can be of decisive importance for the further clinical management of patients, depending on their clinical relevance. (orig.) [German] Inzidentelle kardiovaskulaere Befunde sind ein haeufiges Phaenomen bei CT-Untersuchungen. Mit dieser Arbeit soll nach gezielter PubMed-Recherche ein systematischer Literaturueberblick ueber die wichtigsten kardiovaskulaeren Zufallsbefunde sowie deren Haeufigkeit und klinische Relevanz gegeben werden. Die Mehrzahl der inzidentellen kardiovaskulaeren Befunde sind klinisch nur von untergeordneter Bedeutung, allerdings werden immer wieder auch hochgradig relevante Zufallsbefunde wie beispielsweise Aortenaneurysmata oder - gerade bei onkologischen Patienten - Thrombosen und thrombembolische Ereignisse detektiert. Jede CT-Untersuchung sollte gezielt nach inzidentellen Befunden durchsucht werden, da diese je nach klinischer Relevanz von entscheidender Bedeutung fuer das weitere klinische Management des Patienten sein koennen. (orig.)

Malignant and benign diseases of the breast in 41 male patients: mammography, sonography and pathological correlations; Maligne und benigne Erkrankungen der Brust bei 41 maennlichen Patienten: Mammographie und Sonographie mit histopathologischer Korrelation

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Partik, B.; Mallek, R.; Pokieser, P.; Wunderbaldinger, P.; Helbich, T.H. [Vienna Univ. (Austria). Klinik fuer Radiodiagnostik; Rudas, M. [Vienna Univ. (Austria). Inst. fuer Klinische Pathologie

2001-11-01

Aim: The goal of our study was to evaluate findings in mammography and sonography in male patients with pathohistologically proven diseases of the breast. Material and Methods: Mammographies and sonographies, which were obtained in 41 male patients in a 6-year period, were retrospectively evaluated in accordance with the BI-RADS trademark classification. Results: Histologically 13 carcinomas, 21 gynecomastias, 3 pseudogynecomastias, 2 epithelial inclusion cysts and 2 other benign lesions were diagnosed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of mammography in differentiation of benign versus malignant disease were 92%, 89%, 80%, 96% and 90%, respectively. Additional sonography did not change these results. However, sonography increased diagnostic confidence in 18.2% (2/11) of suspicious lesions. Conclusion: In our study the invasive ductal carcinoma of male patients was a predominantly lobulated, ill-defined lesion in mammography and sonography. The differentiation of carcinoma to pseudogynecomastia and diffuse or dendritic gynecomastia was securely feasible. However, we could not reliably distinguish between carcinoma and some benign mass lesions. In cases of mammographically diagnosed masses or unclear mammography, additional sonography should be performed to increase the diagnostic confidence. (orig.) [German] Ziel: Die Befunde von Mammographie und Sonographie bei histologisch gesicherten malignen und benignen Mammaerkrankungen maennlicher Patienten zu evaluieren. Material und Methode: Retrospektiv wurden die in einem Zeitraum von 6 Jahren durchgefuehrten Mammographien und Sonographien bei 41 maennlichen Patienten in Anlehnung an die BI-RADS trademark Klassifikation ausgewertet. Resultate: Es wurden 13 Karzinome, 21 Gynaekomastien, 3 Pseudogynaekomastien, 2 Atherome und 2 weitere benigne Laesionen histologisch diagnostiziert. Die Mammographie zeigte in der Differenzierung maligne versus benigne Laesion

Migraine accompagnee: Clinical and neutroradiological findings. Migraine Accompagnee: Klinische und neutroradiologische Befunde

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Schaefer, E M

1981-01-01

This study analyses clinical data, EEC and X-ray findings of 102 stationary examined migraine patients, 62 of whom suffered from migraine accompagnee. Sex distribution, age at onset of disease, hereditary disease disposition and EEC findings largely correspond to the data given in literature. As it had been expected, the X-ray images of the skull and the cerebral angiographies performed in 46 patients suffering from migraine accompagnee did not show any pathological findings. The X-ray images were compared with those taken of patients without migraine anamnesis in order to detect non-pathologic variations. Neither differences in the intensity of vascular and diplovenous marking could be found in the native images of the skull nor any variations of the circle of Willis. The dependency of the posterior cerebral artery on the carotid circulation existing in 41% of the migraine accompagnee does not lead to any particular alteration of the accompanying symptoms and signs. The idea is discussed to divide the migraine syndrome into simple, focal and complicated migraine on the basis of a uniform pathogenesis. (orig./MG).

Migraine accompagnee: Clinical and neutroradiological findings. Migraine Accompagnee: Klinische und neutroradiologische Befunde

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Schaefer, E M

1981-01-01

This study analyses clinical data, EEC and X-ray findings of 102 stationary examined migraine patients, 62 of whom suffered from migraine accompagnee. Sex distribution, age at onset of disease, hereditary disease disposition and EEC findings largely correspond to the data given in literature. As it had been expected, the X-ray images of the skull and the cerebral angiographies performed in 46 patients suffering from migraine accompagnee did not show any pathological findings. The X-ray images were compared with those taken of patients without migraine anamnesis in order to detect non-pathologic variations. Neither differences in the intensity of vascular and diplovenous marking could be found in the native images of the skull nor any variations of the circle of Willis. The dependency of the posterior cerebral artery on the carotid circulation existing in 41% of the migraine accompagnee does not lead to any particular alteration of the accompanying symptoms and signs. The idea is discussed to divide the migraine syndrome into simple, focal and complicated migraine on the basis of a uniform pathogenesis.

''Routine'' brain CT in psychiatric patients - does it make sense?; ''Routine''-Schaedel-CT in der psychiatrischen Diagnostik

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Pickuth, D.; Heywang-Koebrunner, S.H.; Spielmann, R.P. [Martin-Luther-Universitaet Halle-Wittenberg, Halle (Germany). Klinik und Poliklinik fuer Diagnostische Radiologie

1999-11-01

Purpose: To prospectively assess the spectrum of brain CT findings in psychiatric patients and to determine the number of patients that had an underlying cause for the symptoms. Patients and methods: Over a period of six months, 142 patients (78 males, 64 females; median age 61 [18-91] years) were referred for CT brain scans. Their scans were reviewed, along with the clinical information that was provided in the request form. All the hard copies were reviewed to assess areas of ischaemia, infarction, atrophy, tumours, and haematomas. The majority of requests were to exclude vascular event or space-occupying lesions. Clinical indications included mood disorders (depression, mania), schizophrenic disorders, dementia, personality and behavioural disorders. Results: 31 (22%) were normal. 111 (78%) had varying degrees of ischaemia, infarction and cerebral/cerebellar atrophy. 7 (4.9%) had space-occupying lesions which included two gliomas and five meningiomas. There were two chronic subdural haematomas and one arteriovenous malformation. Conclusion: 1. In our series, pathologic findings in 'routine' brain CT's were encountered in 78%. 2. The incidence of brain tumours was 4.9%, compared with 0.00005% of the general population. 3. CT scanning in psychiatric patients is cost-effective and especially indicated when there is an atypical presentation, or inadequate response to standard treatment. (orig.) [German] Hintergrund: Bei psychiatrischen Patienten wird vielerorts routinemaessig eine kraniale Computertomographie (CCT) durchgefuehrt. Ob der Nutzen die Kosten rechtfertigt, wurde im Rahmen einer Prospektivstudie untersucht. Patienten und Methode: In einem Zeitraum von 6 Monaten wurde bei 142 psychiatrischen Patienten (78 Maenner, 64 Frauen, 18-91 Jahre, Median 61 Jahre) ein CCT angefertigt. Die Untersuchung erfolgt nativ in 5-mm-Schichtdicke, bei klinischem Verdacht auf eine intrakraniale Raumforderung auch kontrastverstaerkt. Ueberweisungsdiagnosen waren v

Analysis of the contents of German magazines for tumor patients.

Science.gov (United States)

Hübner, Jutta; Münstedt, Karsten; Senf, Bianca; Micke, Oliver

2013-01-01

Cancer patients have high information needs. Besides direct discussion with the physician, media provide important access to information. In the age of the internet, print media are still being used by many patients. In Germany, several magazines for cancer patients are distributed at no cost to cancer institutions for display. The aim of our study was to assess the content of these magazines. In a first step, a search of the literature concerning patient information needs and evaluation of patient information was done. This search revealed important criteria for evaluation. 2 instruments are recognized internationally as appropriate in evaluating and certifying patient information: HONcode and DISCERN. As we did not find an instrument for the evaluation of patient magazines, we combined the central items from both instruments. With this new instrument, we assessed the 2010 issues of all 5 magazines . The Krebsmagazin offers a vast range of different topics in cancer and thus aims at general patient education, irrespective of the level of knowledge. Befund Krebs offers a wider variety of topics in each issue. Understanding the articles requires basic knowledge. The same applies to Leben? Leben! which specifically addresses the topic of breast cancer. All 3 journals provide information in line with evidence-based medicine. K Journal - Mensch & Krebs provides information on conventional as well as alternative treatments, the latter not being evidence-based. Several issues contained both advertisements and articles by providers of alternative therapies. Signal only deals with alternative medicine in cancer care and does not provide scientifically proven data. As our analysis shows, content and evidence vary greatly in the magazines currently distributed in Germany. Physicians should familiarize themselves with the characteristics of the different journals before recommending them. Copyright © 2013 S. Karger AG, Basel.

The clinical use of mammography in the male; Klinische Relevanz der Mammographie beim Mann

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Merkle, E [Ulm Univ. (Germany). Abt. Radiologie; Mueller, M [Ulm Univ. (Germany). Abt. Radiologie; Vogel, J [Ulm Univ. (Germany). Abt. Radiologie; Klatt, S [Ulm Univ. (Germany). Abt. Innere Medizin I; Goerich, J [Ulm Univ. (Germany). Abt. Radiologie; Berger, H G [Ulm Univ. (Germany). Allgemeinchirurgische Abt.; Brambs, H J [Ulm Univ. (Germany). Abt. Radiologie

1996-01-01

During a period of four years 104 mammograms were performed in 89 men. Mastectomies were carried out on 23 men (group 1). 66 patients (group 2) were followed up clinically and in 15 patients serial mammograms were obtained. In group 1 there were 5 patients with bilateral gynaecomastia, 9 with unilateral gynaecomastia and two with pseudogynaecomastia and there were 7 patients with malignancies. In group 2 there were 46 patients with bilateral gynaecomastia and 10 patients with unilateral gynaecomastia. Pseudogynaecomastia was found in 25 patients. There were 7 malignancies, of which 5 had been suspected clinically and one had been diagnosed as gynaecomastia by mammography. Two carcinomas in situ were missed clinically and also by mammography. When malignancy is not suspected on clinical grounds the first examination should be sonography. Where, however, malignancy is suspected, and for follow-up, mammography retains its primary position. (orig./MG) [Deutsch] In einem 4-Jahres-Zeitraum wurden bei 89 Maennern insgesamt 104 Mammogramme angefertigt. 23 Maenner (=Gruppe 1) wurden mastektomiert. 66 Patienten (=Gruppe 2) wurden klinisch und zum Teil mammographisch kontrolliert. Alle Mammogramme wurden in Unkenntnis des klinischen Befundes retrospektiv ausgewertet und, wenn moeglich, dem histologischen Ergebnis gegenuebergestellt. In der Gruppe 1 fand sich eine beidseitige Gynaekomastie in 5/23 Faellen, eine einseitige Form in 9/23 Faellen, eine Pseudogynaekomastie in 2/23 Faellen und ein Malignom in 7/23 Faellen. In Gruppe 2 ergab sich eine beidseitige Gynaekomastie in 46/81 Faellen gegenueber einer einseitigen Form in 10/81 Faellen. Eine Pseudogynaekomastie fand sich in 25/81 Faellen. Von 7 Malignomen waren 5 klinisch suspekt, wobei eines mammographisch als Gynaekomastie imponierte. Zwei In-situ-Karzinome waren sowohl mammographisch als auch klinisch okkult. Klinisch nicht malignomsuspekte Befunde sollten primaer der Mammasonographie zugefuehrt werden. Bei

Neuro-MRI-findings in patients with primary panhypopituitarism; Neuro-MR-Befunde beim primaeren Panhypopituitarismus

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Fellner, F. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Diagnostische Radiologie]|[Oberoesterreichische Landesnervenklinik Wagner Jauregg, Linz (Austria). Inst. fuer Neuroradiologie; Triebe, S.; Baum, U.; Schmitt, R.; Flottemesch, J.; Bautz, W. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Diagnostische Radiologie; Hensen, J. [Erlangen-Nuernberg Univ., Erlangen (Germany). Abt. fuer Endokrinologie und Stoffwechsel

1998-12-31

We report a case of congenital panhypopituitarism. MR imaging of the brain revealed a hypoplastic adenohypophysis and a hypoplastic pituitary stalk which was interrupted in its superior segment. An ectopic neurohypophysis was found located in the area of the hypothalamus (``hypothalamic hot spot``). The ectopic neurohypophysis showed strong enhancement after intravenous application of Gd-DTPA. MR imaging of the hypothalamic-hypophyseal axis is well suited for the differentiation between congenital and acquired forms of panhypopituitarism in clinically uncertain cases. (orig.) [Deutsch] Wir berichten ueber einen Patienten mit kongenitalem Panhypopituitarismus. Die MRT des Zerebrums zeigte eine hypoplastische Adenohypophyse sowie ein hypoplastisches Infundibulum hypophysis. Es fand sich eine ektope Neurohypophyse im Areal des Hypothalamus (`hypothalamic hot spot`). Die ektope Neurohypophyse zeigte nach Gadoliniumgabe eine kraeftige Kontrastmittelanreicherung. Die MRT der hypothalamisch-hypophysaeren Achse eignet sich somit in klinisch unklaren Faellen fuer die Differentialdiagnostik zwischen angeborenen und erworbenen Formen des Panhypopituitarismus. (orig.)

Spontaneous osteonecrosis of the knee joint: MR imaging before and after administration of gadopentetate-dimeglumine, comparison to CT, scintigraphy, and histology; Spontane Osteonekrose des Kniegelenkes: MRT im Vergleich zur CT, Szintigraphie und Histologie

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Lang, P. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States); Grampp, S. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States); Vahlensieck, M. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States)]|[Radiologische Klinik, Bonn Univ. (Germany); Mauz, M. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States)]|[Radiologische Klinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Steiner, E. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Schwickert, H. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States)]|[Radiologische Klinik, Universitaetsklinik Mainz (Germany); Gindele, A. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States); Felix, R. [Radiologische Klinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Genant, H.K. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States)

1995-06-01

Eight patients with spontaneous osteonecrosis of the knee joint underwent MR imaging before and after i.v. administration of Gd-DTPA. Nuclear scintigraphy was performed in all 8 patients, three patients also had CT scans of the knee area. Histologic correlation was available in three patients. Increased radionuclide uptake was observed in all patients. In one patient, however, scintigraphy showed increased radionuclide uptake consistent with ostenecrosis only in the medial femoral condyle, while MR imaging demonstrated osteonecrosis both in the medial as well as the lateral femoral condyles. MR demonstrated areas of low signal intensity on precontrast T{sub 1}-weighted images in the femoral condyle in all patients. All these areas showed high signal intensity on T{sub 2}-weighted images. On postcontrast T{sub 1}-weighted images, signal intensity increase was either homogeneous throughout the lesion or it was seen at the periphery of the lesion in a band-like pattern. Histologically, the areas of high signal intensity on T{sub 2}-weighted and on postcontrast T{sub 1}-weighted images corresponded to granulation tissue. (orig./MG) [Deutsch] Wir untersuchten acht Patienten mit einer spontanen Osteonekrose des Kniegelenkes mit der MRT. Ein Vergleich zum szintigraphischen Befund wurde bei allen 8 Patienten und zur CT bei drei Patienten angestellt. Eine histologische Korrelation war bei drei Patienten moeglich. Bei allen 8 Patienten zeigten die T{sub 1}-gewichteten MR-Tomographien Zonen mit reduzierter Signalintensitaet in den Kondylen, waehrend die Laesionen in den T{sub 2}-gewichteten Aufnahmen eine hoehere Signalintensitaet als das normale Knochenmark hatten. Nach Gabe von Gd-DTPA war entweder eine homogene Signalerhoehung oder eine bandfoermige Signalintensitaetszunahme in der Peripherie der Laesion zu sehen. Die Zonen mit hoher Signalintensitaet in der T{sub 2}-gewichteten Aufnahme oder mit Kontrastmittelanreicherung entsprachen histologisch Granulationsgewebe an der

Neuroradiological findings in perinatally HIV-infected children. Neuroradiologische Befunde bei perinatal HIV-infizierten Kindern

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Spreer, J [Radiologische Abt., Universitaetsklinik Koeln (Germany); Enenkel-Stoodt, S [Abt. fuer Allgemeine Paediatrie 2, Universitaetsklinik Frankfurt am Main (Germany); Funk, M [Abt. fuer Paediatrische Haematologie und Onkologie, Universitaetsklinik Frankfurt am Main (Germany); Fiedler, A [Abt. fuer Paediatrische Neurologie, Universitaetsklinik Frankfurt am Main (Germany); Simone, A de [Neuroradiologische Abt., Universitaetsklinik Frankfurt am Main (Germany); Hacker, H [Neuroradiologische Abt., Universitaetsklinik Frankfurt am Main (Germany)

1994-08-01

The neuroradiological studies (CT, MRI, angiography) in 21 children with perinatal HIV infection were reviewed retrospectively. No patient showed an intracranial mass lesion; after intravenous contrast medium application there was no case with disturbed blood-brain barrier. Common non-specific findings were atrophy and delayed myelination. In 7 cases atrophy was combined with multifocal nearly symmetric white matter lesions, which characteristically spared the U-fibres. Further findings included an intramedullary ring-shaped structure in the cervical cord, an AIDS-associated vasculopathy and symmetric calcifications in the basal ganglia. The spectrum of neuroradiological findings in paediatric AIDS patients differs from that in adults. Knowledge of these age-specific findings is important because the number of HIV-infected children is rising. (orig.)

Fallbericht: Seltene Raumforderungen der Leiste in der klinischen Erscheinung inguinaler Hernien: eine seminomatöse Lymphknotenmetastase und ein Liposarkom des Samenstranges

Directory of Open Access Journals (Sweden)

Burger M

2005-01-01

Full Text Available Einleitung: Wir berichten über eine seminomatöse inguinale Lymphknotenmetastase und ein Liposarkom des Samenstranges, die sich klinisch als eine inguinale Hernie präsentierten. Kasuistik: Fall 1: Ein 53jähriger Patient wurde unter der Annahme einer inguinalen Hernie links in einer chirurgischen Abteilung operiert. Es fand sich eine Raumforderung, welche in der Schnellschnittuntersuchung den Befund einer seminomatösen Lymphknotenmetastase ergab. In der folgenden Abklärung ergab sich ein linksseitiges pT2-Seminom. Anamnestisch wurde vor 26 Jahren eine inguinale Varikozelektomie links vorgenommen. Fall 2: Ein 61jähriger Patient stellte sich mit einer schmerzlosen Raumforderung der rechten Leiste vor, die klinisch als inguinale Hernie imponierte und seit drei Jahren größenprogredient war. Die Ultraschall- und MRT-Befunde wurden als eine inguinale Hernie mit einem Peritonealfett enthaltenden Bruchsack gedeutet. Intraoperativ fand sich ein Liposarkom des Samenstranges. Schlußfolgerung: Trotz der Häufigkeit inguinaler Herniotomien sind überraschende maligne Raumforderungen selten. Man sollte diese Möglichkeit aber bei transskrotalen Eingriffen in der Anamnese und bei nicht eindeutig einzuordnenden Befunden differentialdiagnostisch bedenken. Inguinale Lymphknotenmetastasen testikulärer Neoplasien sind selten, in der Literatur ist ein eindeutiger Zusammenhang mit Eingriffen im Skrotal- und Leistenbereich beschrieben. Die klinische Erscheinung einer solchen als Leistenhernie ist bisher noch nicht beschrieben worden. Liposarkome des Samenstranges sind ebenfalls selten. Therapeutisch sollte eine radikale chirurgische Exzision und in Fällen unklarer Absetzungsränder eine Radiatio erfolgen. Lokalrezidive treten häufig und eventuell auch spät auf.

Plain film emergency radiology of child abuse: a strategy; Die akute Roentgendiagnostik der Kindesmisshandlung: Eine Strategie

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Oestreich, A.E. [Children`s Hospital Medical Center, Cincinnati OH (United States). Dept. of Radiology

1998-04-01

A strategy is proposed for the dedicated interpretation of possible radiographic plain film signs that are suspicious for indicating child abuse. For each sign, the features `PRO` raise the question of abuse, while radiographic or clinical findings `CON` suggest an alternate explanation. Birth trauma, oesteogenesis imperfecta, rescue trauma, and metastatic neuroblastoma are among the many entities cited. A triad of situations may lead a radiologist to look systematically for changes from abuse; a triad of resolutions may result from the search. Periosteal reaction is the major factor in dating of fractures; physiologic periosteal reaction of infancy and periosteal reaction from previous fracture must be considered when so dating fractures. (orig.) [Deutsch] Es wird eine Strategie fuer die genaue Interpretation roentgenologischer Befunde, die auf eine Kindesmisshandlung hindeuten koennen, vorgeschlagen. Fuer jeden Befund werfen die unter `PRO` aufgefuehrten Merkmale die Frage nach einer Kindesmisshandlung auf, waehrend radiologische und klinische Befunde unter `CON` andere Erklaerungen nahelegen. Geburtstrauma, Osteogenesis imperfecta, Rettungstrauma und metastasierendes Neuroblastom sind unter den vielen zitierten Differentialdiagnosen. Drei moegliche Situationen koennen den Radiologen dazu veranlassen, systematisch nach Zeichen einer Kindesmisshandlung zu suchen, 3 moegliche Loesungen koennen aus dieser Suche hervorgehen. Eine Periostreaktion ist ein Kardinalbefund zur Datierung von Frakturen. Physiologische Periostreaktionen im fruehen Kindesalter und Periostreaktionen durch fruehere Frakturen muessen bei einer solchen Datierung von Frakturen mitbedacht werden. (orig.)

Neural correlates of working memory deficits in schizophrenic patients. Ways to establish neurocognitive endophenotypes of psychiatric disorders; Neuronale Korrelate gestoerter Arbeitsgedaechtnisfunktionen bei schizophrenen Patienten. Ansaetze zur Etablierung neurokognitiver Endophaenotypen psychiatrischer Erkrankungen

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Gruber, O. [Universitaet des Saarlandes, Klinik fuer Psychiatrie und Psychotherapie, Homburg (Saar) (Germany); Max-Planck-Institut fuer Kognitions- und Neurowissenschaften, Leipzig (Germany); Gruber, E.; Falkai, P. [Universitaet des Saarlandes, Klinik fuer Psychiatrie und Psychotherapie, Homburg (Saar) (Germany)

2005-02-01

This article briefly reviews some methodological limitations of functional neuroimaging studies in psychiatric patients. We argue that the investigation of the neural substrates of cognitive deficits in psychiatric disorders requires a combination of functional neuroimaging studies in healthy subjects with corresponding behavioral experiments in patients. In order to exemplify this methodological approach we review recent findings regarding the functional neuroanatomy of distinct components of human working memory and provide evidence for selective dysfunctions of cortical networks that underlie specific working memory deficits in schizophrenia. This identification of subgroups of schizophrenic patients according to neurocognitive parameters may facilitate the establishment of behavioral and neurophysiological endophenotypes and the development of a neurobiological classification of psychiatric disorders. (orig.) [German] Dieser Beitrag befasst sich mit einigen methodischen Problemen funktionell-bildgebender Studien mit psychiatrischen Patienten, aufgrund derer die Untersuchung der neuronalen Korrelate kognitiver Defizite bei psychiatrischen Erkrankungen einer Kombination funktionell-bildgebender Studien bei gesunden Normalprobanden mit Verhaltensuntersuchungen bei Patienten bedarf. Dieser methodische Ansatz wird am Beispiel von Arbeitsgedaechtnisfunktionen erlaeutert, wobei zunaechst neuere Erkenntnisse zur funktionellen Neuroanatomie verschiedener Komponenten des menschlichen Arbeitsgedaechtnisses referiert werden. Anschliessend werden bei schizophrenen Patienten erhobene Befunde vorgestellt, die auf spezifische Stoerungen der funktionellen Integritaet neuronaler Netzwerke mit Arbeitsgedaechtnisfunktionen hinweisen. Die damit verbundene Identifikation von Subgruppen schizophrener Patienten koennte zur Etablierung verhaltensneurophysiologisch definierter Endophaenotypen psychiatrischer Stoerungsbilder fuehren und die Entwicklung einer neurowissenschaftlich

MR imaging of the lateral collateral ligaments after ankle sprain; Aussenbandrupturen des Sprunggelenkes - Darstellung mit der MRT vor und nach funktioneller Therapie

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Grebe, P. [Klinik fuer Radiologie der Universitaetsklinik, Mainz (Germany); Kreitner, K.F. [Klinik fuer Radiologie der Universitaetsklinik, Mainz (Germany); Roeder, W. [Abt. fuer Chirurgie, St-Hildegardis-Krankenhaus, Mainz (Germany); Kersjes, W. [Klinik fuer Radiologie der Universitaetsklinik, Mainz (Germany); Hennes, R. [Abt. fuer Allgemein- und Unfallchirurgie, St. Josefshospital, Wiesbaden (Germany); Runkel, M. [Unfallchirurgische Klinik der Unversitaetsklinik, Mainz (Germany)

1995-09-01

35 patients with ankle sprain were examined by MRI and stress radiographs. 13 were operated afterwards, 22 patients underwent a functional conservative therapy and were examined by MRI and stress radiographs and second time after three months. MRI reports were correct in 12 of 13 operated cases. After conservative therapy we did not find any disrupted ankle ligament. MRI showed intact ligaments thickened by scar. (orig./MG) [Deutsch] 35 Patienten mit klinischem Verdacht auf Aussenbandruptur wurden mit der MRT untersucht. 13 Patienten wurden operiert, 22 konzervativ therapiert. Letztere wurden nach drei Monaten erneut mit MRT und gehaltenen Aufnahmen untersucht. Die MRT-Befunde stimmten in 12 von 13 Faellen mit den operativ erhobenen Befunden ueberein. Nach dreimonatiger konzervativer Therapie waren alle 22 Sprunggelenke stabil. Die rupturierten Baender stellten sich verdickt und durchgaengig dar. (orig./MG)

External therapy with radioactive urine: a pitfall during sceletal scintigraphy; Heisse Eigenurintherapie: ein ueberraschender Befund bei der Skelettszintigraphie

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Scheidhauer, K.; Urbannek, V. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Koeln (Germany)

1997-12-01

A 41-year old male patient suffering from psoriasis arthropathica underwent a two-phase bone scan for activity of joint affections. Extensive diffuse skin contamination of the extremities in the delayed images was due to the use of the patient`s own radioactive urine as an embrocation for psoriasis exanthema. (orig.) [Deutsch] Bei einem 41jaehrigen Patienten mit Psoriasisarthropathie fiel in der Skelettszintigraphie in den Aufnahmen der Mineralisationsphase eine flaechige Aktivitaetsbelegung der Beine auf. Als Ursache stellte sich das zwischenzeitliche Einreiben der Extremitaeten durch den Patienten mit dem radioaktiven Eigenurin wegen eines Exantherms heraus. (orig.)

Polycythemia vera: diagnosis, different therapy modalities and clinical value of the treatment with radiophosphorus today; Polycythaemia vera: Diagnostik, Differenzialtherapie und Stellenwert der {sup 32}P-Behandlung heute

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Bredow, J.; Pinkert, J.; Franke, W.G. [Klinik und Poliklinik fuer Nuklearmedizin TU Dresden (Germany); Schuler, U. [Medizinische Klinik und Poliklinik I, Universitaetsklinikum ' ' Carl Gustav Carus' ' an der TU Dresden (Germany)

2001-07-01

The definition, diagnostic criteria and clinical findings as well as the treatment with radioactive phosphorus is described more in detail. Today, the treatment with {sup 32}P is estimated to be an easy and safe method, especially for elderly patients (65 years or above), providing a cost-effective alternative to anti-proliferative drugs like hydroxyurea. (orig.) [German] Es wird auf das Krankheitsbild per se, die Diagnostikkriterien und klinischen Befunde eingegangen und die Radiophosphortherapie bei Patienten mit PCV beschrieben. Aus heutiger Sicht steht mit der Radiophosphortherapie der Polycythaemia vera ein einfaches und sicheres Verfahren zur Verfuegung, welches insbesondere bei aelteren (ueber 65-jaehrigen) Patienten eine praktikable und kostenguenstige Alternative zur medikamentoesen antiproliferativen Therapie mit Hydroxyharnstoff darstellt. (orig.)

PET/CT in lymphoma patients; PET-CT bei Lymphompatienten

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Steinert, H.C. [Universitaetsspital Zuerich, Klinik und Poliklinik fuer Nuklearmedizin (Switzerland)

2004-11-01

First results of PET/CT in Hodgkin's disease (HD) and aggressive non-Hodgkin's lymphoma (NHL) are reported. From March 2001 to August 2004 822 PET/CT were performed at our clinic in lymphoma patients for primary staging, restaging after therapy, and diagnosis of recurrence. For coregistration non contrast-enhanced low-dose CT were used. Due to the exact anatomic localization of {sup 18}F-FDG accumulating lesions equivocal or false positive PET findings are avoided. In comparison to contrast enhanced CT, PET/CT has a higher sensitivity and specificity in patients with HD and aggressive NHL. Integration of PET/CT in treatment planning of radiation therapy optimizes the field volume. Even in the initial phase of clinical evaluation, PET/CT has proven useful in staging and restaging of lymphoma. The exact anatomic localization of the PET findings is essential for a precise report, for treatment planning of radiation therapy, and for planning surgical biopsy. (orig.) [German] Erste Ergebnisse der PET-CT bei Morbus Hodgkin (HD) und den aggressiven Non-Hodgkin-Lymphomen (NHL) werden beschrieben. Von Maerz 2001 bis August 2004 wurden 822 PET-CT bei Lymphompatienten zum primaeren Staging, zum Restaging nach Therapie und zur Rezidivdiagnostik an unserer Klinik durchgefuehrt. Fuer die Koregistration wurde ein Low-dose-CT ohne i.v.-Kontrastmittel verwendet. Durch die exakte anatomische Zuordnung der {sup 18}F-FDG aufnehmenden Laesionen wurden unklare oder falsch-positive PET-Befunde vermieden. Die PET-CT erzielte im Vergleich zur KM-verstaerkten CT eine hoehere Sensitivitaet und Spezifitaet bei Patienten mit HD und aggressiven NHL. Die Integration der PET-CT in die Planung der Strahlentherapie fuehrte zu einer Optimierung der Feldgrenzen. Die PET-CT hat sich bereits in der Phase der initialen klinischen Evaluation als wertvoll beim Staging und Restaging von Lymphomen erwiesen. Die exakte anatomische Zuordnung der PET-Informationen ist fuer eine sichere Befundung

Long-term follow up MRI in children with severe head injury; Kernspintomographische Verlaufskontrolle bei Kindern nach Schaedel-Hirn-Trauma

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Dinter, D.; Schmidt, B.; Neff, K.W.; Georgi, M. [Heidelberg Univ., Mannheim (Germany). Fakultaet fuer Klinische Medizin; Koelfen, W. [Elisabeth-Krankenhaus, Rheydt (Germany). Paediatrische Klinik; Freund, M.C. [Universitaetsklinik fuer Radiodiagnostik, Innsbruck (Austria)

1999-10-01

Purpose: A prospective study was initiated for the correlation of the findings in the initial cranial CT with the long-term follow-up MRI in children with severe head injury. Another aim was the evaluation of frequency and location of lesions, found only in MRI. Methods: 70 children with severe head injury and initially performed pathological CCT were followed up (mean time 3 years) by MRI. Results: 71% of the children had a pathological MRI. In 43% of the children with subdural bleeding could be found parenchymal lesions in the underlying cortex. All 15 children with epidural bleeding had unsuspicious findings at the former hematoma. All of the contusions were found as parenchymal residual lesions. 44% of the children had evidence of parenchymal lesions in the follow-up MRI initially and retrospectively not revealable. 16 lesions in the corpus callosum were only revealed by MRI. Conclusion: This study shows the higher sensitivity of magnetic resonance imaging in non-hemorrhagic parenchymal lesions and in 'diffuse axonal injury'. A MRI-examination is recommended in children with severe head injury, especially in patients with normal CCT and posttraumatic neurological deficits. (orig.) [German] Fragestellung: Im Rahmen einer prospektiven Studie wurden die Befunde initial durchgefuehrter Computertomographien bei Kindern mit schwerem SHT mit den Ergebnissen einer MR-Nachuntersuchung korreliert und zusaetzlich eine Evaluation der Haeufigkeit und Lokalisation ausschliesslich kernspintomographisch nachweisbarer Laesionen durchgefuehrt. Methodik: 70 Kinder mit initial nach SHT durchgefuehrtem und pathologischem CT wurden im Rahmen eines Follow-up im zeitlichen Abstand von durchschnittlich 3 Jahren kernspintomographisch nachuntersucht. Ergebnisse: Bei 71% der nachuntersuchten Kinder konnten pathologische MRT-Befunde erhoben werden. 43% der Kinder mit einer subduralen Blutung wiesen kortikal, der ehemaligen Blutung anliegende, Parenchymlaesionen auf, dagegen

Präoperative Vorhersge der Rezidivrate des klinisch lokalisierten Prostatakarzinoms nach einer radikalen Prostatektomie

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Graefen M

1999-01-01

Full Text Available Die radikale Prostatektomie scheint die zur Zeit effektivste Therapie des klinisch lokalisierten Prostatakarzinoms zu sein. Dennoch liegt die Rezidivrate bei bis zu 40 % der operierten Patienten. Mit dieser Arbeit wurde anhand präoperativer Befunde ein Algorithmus entwickelt, mit welchem die Prognose des klinisch lokalisierten Prostatakarzinoms bereits vor einer operativen Therapie abgeschätzt werden kann. Hierzu wurden multiple präoperative Befunde, welche bei der Diagnose des Prostatakarzinoms erhoben werden, bezüglich ihres Einflusses auf einen PSA-Progress nach radikaler Prostatektomie geprüft. Dies erfolgte mittels einer univariaten Kaplan-Meier Analyse sowie einer multivariaten Statistik (Cox-Regression und CART-Analyse. Schwerpunkt bildete hierbei die Einbeziehung der Ergebnisse der systematischen Sextanten-Biopsie der Prostata. Alle präoperativen Befunde haben in der univariaten Kaplan-Meier Analyse einen signifikanten Einfluß auf ein PSA-Rezidiv. In der Cox-Regression hatte der Anteil an niedrigdifferenziertem Prostatakarzinom den größten Einfluß auf das Auftreten eines Tumorprogresses, gefolgt von der Anzahl der positiven Stanzen in der Biopsie und dem präoperativen PSA-Wert; alle anderen Parameter hatten keinen unabhängig signifikanten Einfluß auf den Tumorprogress. Mittels der zusätzlich durchgeführten CART Analyse konnten verschiedene Risikogruppen definiert werden, deren Rezidivrisiko bei 3 % für Patienten mit geringem Rezidivrisiko sowie 80 % für solche mit einem hohen Rezidivrisiko 2 Jahre nach der Operation betrug. Der niedrigdifferenzierte Tumoranteil hat somit den größten Einfluß auf die Prognose eines klinisch lokalisierten Prostatakarzinoms. Anhand der präsentierten CART-Analysen wurden einfach anwendbare Entscheidungsbäume entwickelt, mit denen eine Abschätzung des Therapieerfolges des klinisch lokalisierten Prostatakarzinoms bereits vor einer Operation möglich ist.

Auswirkungen der Zugänglichkeit independenten und interdependenten Selbstwissens auf den Selbstwert

OpenAIRE

Birkner, Norbert

2003-01-01

In drei Studien werden Befunde vorgelegt, die dafür sprechen, dass der Selbstwert von Personen mit independentem Selbstkonzept anders generiert wird als von Personen mit interdependentem Selbstkonzept, genauer sich aus unterschiedlichen Quellen speist. Innerhalb der drei Untersuchungsstichproben erfolgte die Klassifizierung der differenzierten Selbstkonstruktionen, die idealtypisch in individualistischen und kollektivistischen Kulturen entwickelt werden (Markus & Kitayama, 1991), auf Grundlag...

Modified double contrast-enhanced examination of the stomach of adipose patients after vertical gastroplasty; Modifizierte Doppelkontrast-Untersuchung des Magens bei adipoesen Patienten nach vertikaler Gastroplastie

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Raissaki, M.T. [Institut fuer Bildgebende Diagnostik, Universitaetsklinik Heraklion (Greece); Prassopoulos, P. [Institut fuer Bildgebende Diagnostik, Universitaetsklinik Heraklion (Greece); Hatjidakis, A.A. [Institut fuer Bildgebende Diagnostik, Universitaetsklinik Heraklion (Greece); Christodoulakis, M. [Klinik fuer Chirurgische Onkologie der Universitaetsklinik Heraklion (Greece); Melissas, J. [Klinik fuer Chirurgische Onkologie der Universitaetsklinik Heraklion (Greece); Gourtsoyiannis, N.C. [Institut fuer Bildgebende Diagnostik, Universitaetsklinik Heraklion (Greece)

1995-11-01

The study reported covers 28 patients who were examined once by radiology before surgery, and twice after surgery. The first post-surgery examination was done on days 5-7, the second during the 4th until 6th month after surgery. For the first examination, water-soluble contrast agent was initially applied, then barium containing contrast agent. The second examination was done by modified double contrast technique. The most frequent, pre-surgery findings revealed gastro-esophageal reflux in 13 patients. The first post-surgery control detected a somastenosis in 2 patients, while the second control examination detected complications of various nature in 11 patients and gastro-esophageal reflux in 5 patients. In 6 patients, discrepancy between clinical and radiological findings was stated. The pouch size did not correlate with the frequency of complications, or with the body-to-mass index decrease. The examination method proposed in this article yields pre-surgery information on the anatomy of the stomach, more accurate dewscription of post-surgery complications, and better evaluation of the antireflux effect of the vertical gastroplasty. (orig.) [Deutsch] In der Studie wurden 28 Patienten einmal praeoperativ und zweimal postoperativ roentgenologisch kontrolliert. Die erste postoperative Kontrolle fand am 5.-7. Tag und die zweite im 4.-6. Monat nach dem Eingriff statt. Bei der ersten Kontrolle wurde zuerst wasserloesliches und anschliessend bariumhaltiges Kontrastmittel benutzt, waehrend bei der zweiten Kontrolle eine modifizierte Doppelkontrast-Untersuchung durchgefuehrt wurde. Der haeufigste praeoperative Befund war der gastrooesophageale Reflux bei 13 Patienten. Bei der ersten praeoperativen Kontrolle fand sich bei 2 Patienten eine Stomastenose, waehrend bei der zweiten verschiedene Komplikationen bei 11 sowie gastrooesophagealer Reflux bei 5 Patienten vorlagen. Eine Diskrepanz zwischen radiologischen und klinischen Befunden fanden wir bei 6 Patienten. Die

Disturbance of serotonin 5HT{sub 2} receptors in remitted patients suffering from hereditary depressive disorder

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Larisch, R.; Vosberg, H.; Tosch, M.; Mueller-Gaertner, H.W. [Kliniken fuer Nuklearmedizin der Heinrich-Heine-Univ., Duesseldorf (Germany); Klimke, A.; Gaebel, W. [Kliniken fuer Psychiatrie der Heinrich-Heine-Univ., Duesseldorf (Germany); Mayoral, F.; Rivas, F. [Psychiatrische Klinik des Hospital Civil Carlos Haya, Malaga (Spain); Hamacher, K.; Coenen, H.H. [Inst. fuer Nuklearchemie des Forschungszentrums Juelich GmbH (Germany); Herzog, H.R. [Inst. fuer Medizin des Forschungszentrums Juelich GmbH (Germany)

2001-08-01

Aim: The characteristics of 5HT{sub 2} receptor binding were investigated in major depression in vivo using positron emission tomography and the radioligand F-18-altanserin. Methods: Twelve patients from families with high loading of depression living in a geographically restricted region were examined and compared with normal control subjects. At the time of the PET measurement all patients were remitted; in some of them remission was sustained by antidepressive medication. Binding potential was assessed by Logan's graphical analysis method. Results: The binding of F-18-altanserin was about 38% lower in patients than in healthy controls (p<0.001). A multiple regression analysis revealed that this difference was mainly induced by depression rather than by medication. Conclusions: The data suggest that 5HT{sub 2} receptors are altered in depression. We present evidence for a reduction of the receptor density, which might be usable as trait marker of subjects susceptible for depressive illness. (orig.) [German] Ziel: Die vorliegende Studie untersucht die 5HT{sub 2}-Rezeptorbindung bei depressiven Patienten in vivo mit der Positronen-Emissionstomographie und dem Radioliganden F-18-Altanserin. Methoden: Zwoelf Patienten aus Familien mit hoher Inzidenz fuer Depressionen, die in einer geographisch abgeschlossenen Region leben, wurden untersucht und mit gesunden Kontrollpersonen verglichen. Zum Zeitpunkt der PET-Messung waren alle Patienten klinisch remittiert, was bei einigen den Einsatz von Antidepressiva erforderlich machte. Das Bindungspotenzial wurde mit Logans graphischer Methode bestimmt. Ergebnisse: Die Altanserinbindung war bei den Patienten um ca. 38% niedriger als bei den Kontrollpersonen (p<0,001). Eine multiple Regressionsanalyse zeigte, dass dieser Unterschied in erster Linie durch die Erkrankung und nicht durch Praemedikation hervorgerufen wurde. Schlussfolgerung: Die Studie zeigt, dass die 5HT{sub 2}-Rezeptoren an der Depression beteiligt sind. Die

Geschäftsmodelle für digitale Bildungsangebote. Was wir von xMOOCs lernen können

OpenAIRE

Franken, Oliver B. T.; Fischer, Helge; Köhler, Thomas

2014-01-01

Der Beitrag beleuchtet xMOOCs aus strategischer Perspektive und exploriert die Geschäftsmodelle von Anbietern der MOOC-Plattformen Iversity, Coursera und Udacity im Rahmen einer vergleichenden Einzelfallstudie inhaltsanalytisch. Erläutert wird, warum die Verwendung von MOOCs in der wissenschaftlichen Aus- und Weiterbildung an Hochschulen interessant ist und welche akteursspezifischen Nutzenerwartungen es gibt. Diskutiert werden Befunde hinsichtlich der Angebote, Teilnehmer, Finanzierung, Ertr...

Ranking of CT in persistent vertigo after implantation of stapes prostheses; Stellenwert der Computertomographie bei persistierenden Gleichgewichtsstoerungen nach dem Einsatz von Stapesplastiken

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Koesling, S. [Leipzig Univ. (Germany). Klinik fuer Diagnostische Radiologie; Woldag, K. [Leipzig Univ. (Germany). Klinik und Poliklinik fuer Hals-Nasen-Ohren-Krankheiten; Meister, E.F. [Leipzig Univ. (Germany). Klinik und Poliklinik fuer Hals-Nasen-Ohren-Krankheiten; Reschke, I. [Leipzig Univ. (Germany). Klinik fuer Diagnostische Radiologie; Schulz, H.G. [Leipzig Univ. (Germany). Klinik fuer Diagnostische Radiologie

1995-01-01

10 of 150 patients had persistent vertigo after implanation of stapes prostheses. These patients were evaluated by high resolution CT in the axial and coronal plane. Scans showed in all cases findings which related to the symptoms. The CT findings were proved intraoperatively in 9 cases. A new indirect sign of a perilymphatic fistula is described in form of an air bulla at the end of the prosthesis. Retympanotomy could be planned better with the help of HR-CT. (orig.) [Deutsch] Von 150 Patienten zeigten 10 nach dem Einsatz einer Stapesprothese eine persistierende vestibulaere Symptomatik. Mittels der hochaufloesenden Felsenbein-CT in axialer und koronarer Schnittfuehrung konnten in allen Faellen in Symptomatik erklaerende Befunde erhoben werden. Eine operative Bestaetigung erfolgte in 9 Faellen. Als bisher in der Literatur in diesem Zusammenhang nicht beschriebenes, indirektes Zeichen einer Perilymphfistel wurde eine kleine Luftblase am Prothesenende nachgewiesen. Die HR-CT hat sich als wesentliche Erleichterung bei der Planung einer Retympanotomie erwiesen. (orig.)

MR-Guided vacuum biopsy of 206 contrast-enhancing breast lesions; MRT-gefuehrte Vakuumbiopsie bei 206 Kontrastmittel anreichernden Laesionen der Mamma

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Perlet, C.; Schneider, P.; Sittek, H.; Reiser, M.F. [Klinikum der Universitaet Grosshadern, Muenchen (Germany). Inst. fuer Klinische Radiologie; Amaya, B.; Grosse, A.; Heywang-Koebrunner, S.H. [Martin-Luther-Universitaet, Halle (Germany). Klinik fuer Diagnostische Radiologie

2002-01-01

Purpose: To determine the accuracy and clinical use of MR-guided vacuum biopsy (VB) of enhancing breast lesions. Material and Methods: 254 lesions were referred to MR-guided vacuum-assisted breast biopsy. In 43 (16%) patients the indication was dropped because the lesions could not be identified at the time VB was scheduled. This was due to hormonal influences (n=37), to too strong compression (n=3) or to misinterpretation of the initial diagnostic MRI. In 5 cases (2%) VB was not performed due to obesity (n=2); problems of access (n=2) or a defect of the MR-unit (n=1). VB was performed on altogether 206 lesions. In 4 cases (2%) VB was unsuccessful. This was immediately realized on the post-interventional images. Thus a false negative diagnosis was avoided. Verification included excision of the cavity in cases with proven malignancy or atypical ductal hyperplasia (ADH) and (for benign lesions) retrospective correlation of VB-histology with pre- and postinterventional MRI and subsequent follow-up. Results: 51/202 successful biopsies proved malignancy. In 7 cases ADH and in 144 cases a benign lesion was diagnosed. One DCIS was underestimated as ADH. All other benign or malignant diagnoses proved to be correct. Conclusion: MR-guided VB allows reliable histological work-up of contrast-enhancing small lesions which are not visible by any other modality. (orig.) [German] Zielsetzung: Evaluation der Wertigkeit und klinischen Anwendbarkeit der MRT-gefuehrten Vakuumbiopsie (VB) bei anreichernden Mammalaesionen. Material und Methoden: Insgesamt wurden 254 Laesionen der MRT-gefuehrten VB zugewiesen. Hiervon entfiel bei 43 Patientinnen (16%) die Biopsieindikation beim Planungs-MRT, da die urspruengliche Anreicherung hormonell (n=37), durch zu starke Kompression (n=3) oder durch eine Fehlinterpretation des vorausgegangenen diagnostischen MRT (n=3) nicht mehr abgrenzbar war. Bei 5 weiteren Laesionen (2%) war die Biopsie nicht moeglich (Adipositas n=2; Zugangsprobleme n=2; MRT

Functional MRI of the cervical spine after distortion injury; MR-Funktionsdiagnostik der Halswirbelsaeule nach Schleudertrauma

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Schnarkowski, P. [Muenchen Univ. (Germany). Inst. fuer Radiologische Diagnostik; Weidenmaier, W. [Muenchen Univ. (Germany). Inst. fuer Radiologische Diagnostik; Heuck, A. [Muenchen Univ. (Germany). Inst. fuer Radiologische Diagnostik; Reiser, M.F. [Muenchen Univ. (Germany). Inst. fuer Radiologische Diagnostik

1995-04-01

50 patients with a history of distortion injury of the cervical spine were examined with static and functional MRI. Functional MRI consisted of different patient`s positions from maximal extension to maximal flexion (30 , 0 , 25 , 40 , 50 ). T{sub 2}*-weighted gradient echo sequences were performed in a sagittal view for the different positions. Ligamentous instabilities and disc protrusions were seen only in functional MRI in 17 patients. These findings correlated with the neurological symptoms. Two patients were treated by operative fusion because of these findings. (orig.) [Deutsch] Bei 50 Patienten mit einem Schleudertrauma der Halswirbelsaeule wurden zu den statischen Magnetresonanztomogrammen der Halswirbelsaeule MR-Funktionsaufnahmen durchgefuehrt. Diese Funktionsaufnahmen erfolgten in 5 verschiedenen Flexionsgraden von maximaler Reklination bis zur maximalen Inklination (30 , 0 , 25 , 40 , 50 ). T{sub 2}*-gewichtete Gradienten-Echo-Sequenzen in sagittaler Schnittfuehrung wurden fuer jeden Flexionsgrad angefertigt. Bandinstabilitaeten und Bandscheibenvorwoelbungen konnten bei 17 Patienten nur in bestimmten Flexionsgraden erfasst werden. Diese 17 Patienten zeigten eine umschriebene neurologische Symptomatik, die von ihrer Lokalisation mit den in der MR-Funktionsdiagnostik erhobenen Befunden korrelierten. Zwei Patienten wurden aufgrund diese Befunde mit einer operativen Fusion therapiert. (orig.)

Initial diagnosis of therapeutically relevant thoracic lesions in polytraumatised patients; Zur Akutdiagnostik therapierelevanter Thoraxverletzungen bei schwer- und polytraumatisierten Patienten

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Danz, B. [Radiologische Abt., Bundeswehrkrankenhaus Ulm (Germany); Biehl, C. [Radiologische Abt., Bundeswehrkrankenhaus Ulm (Germany); Baehren, W. [Radiologische Abt., Bundeswehrkrankenhaus Ulm (Germany)

1996-04-01

To determine the value of supine chest radiography in comparison to orientating chest CT in the initial diagnostic evaluation of severely polytraumatised patients. 303 patients with primary indication for a cranial CT following trauma were investigated between 1988 and 1993. After performing the cranial CT all patients underwent a chest CT with an average of 6 CT slices without changing the position of the patient and with a median scan time of 4 minutes. The results of the chest CT were correlated with the findings of the supine chest radiography in regard to therapeutically relevant pathological changes. The sensitivity in detection of pneumothorax in supine chest radiography was 53% versus 97% in CT, atelectasis 20% versus 94%, lung contusion 79% versus 99%, haemotothorax 62% versus 97%. More fractures were found conventionally (sensitivity 94%) than by chest CT (sensitivity 44%). Supine chest radiography of polytraumatised patients is clearly inferior to orientating chest CT in demonstrating posttraumatic lesions; obtaining therapeutically relevant information justifies the additionally needed small amount of time. (orig.) [Deutsch] Das Ziel dieser retrospektiven Untersuchung bestand darin, die Wertigkeit der a.p. Thoraxaufnahme im Liegen im Vergleich zur orientierenden Computertomographie der Thoraxorgane im Rahmen der Akutdiagnostik bei schwer- und polytraumatisierten Patienten zu analysieren. Im Zeitraum von 1988 bis 1993 bestand bei 303 Patienten wegen eines Schaedel-Hirn-Traumas die primaere Indikation zu einem CCT. Im Anschluss an das CCT wurde routinemaessig ein orientierendes CT der Thoraxorgane mit im Durchschnitt 6 Schichten ohne Umlagerung und einem medianen Zeitaufwand von 4 Minuten durchgefuehrt. Die Befunde des CT des Thorax wurden mit den Ergebnissen der durchgefuehrten a.p. Thoraxliegendaufnahmen im Hinblick auf die Erfassung therapierelevanter pathologischer Veraenderungen verglichen. Die Sensitivitaet fuer die Erkennung eines Pneumothorax in

Geschäftsmodelle für digitale Bildungsangebote am Beispiel von xMOOCs. Anregungen für die wissenschaftliche Weiterbildung?!

Directory of Open Access Journals (Sweden)

Oliver B. T. Franken

2017-03-01

Full Text Available Dieser Beitrag beleuchtet Geschäftsmodelle für xMOOCs. Zugrunde liegen Befunde einer Studie für die Plattformbetreiber Coursera, Udacity, edX und iversity. Aus Sicht des Hochschulmanagements offerieren xMOOCs Anregungen für Gestaltung, Finanzierung und Marketing von wissenschaftlicher Weiterbildung. Für eine abschliessende Betrachtung der Mehrwerte von xMOOCs ist es zu früh. Es fehlen Belege.

Geschäftsmodelle für digitale Bildungsangebote am Beispiel von xMOOCs. Anregungen für die wissenschaftliche Weiterbildung?!

OpenAIRE

Oliver B. T. Franken

2017-01-01

Dieser Beitrag beleuchtet Geschäftsmodelle für xMOOCs. Zugrunde liegen Befunde einer Studie für die Plattformbetreiber Coursera, Udacity, edX und iversity. Aus Sicht des Hochschulmanagements offerieren xMOOCs Anregungen für Gestaltung, Finanzierung und Marketing von wissenschaftlicher Weiterbildung. Für eine abschliessende Betrachtung der Mehrwerte von xMOOCs ist es zu früh. Es fehlen Belege.

Synovial sarcoma of the foot; Synovialsarkom des Fusses

Energy Technology Data Exchange (ETDEWEB)

Beus, J. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Kreitner, K.F. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Rompe, J.D. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Orthopaedie; Riehle, H.M. [Mainz Univ. (Germany). Inst. fuer Pathologie

1996-09-01

The case of a 29 year-old female patient who had experienced pain in the right midfoot for 5 years which was diagnosed as a degenerative or rheumatic change and treated by physiotherapy and medication. By means of magnetic resonance imaging we identified a soft-tissue tumor of the midfoot. Histology provided the findings of a monophasic fibrous synovial sarcoma. The case history is reported together with a presentation of the disease and its radiological diagnosis. (orig.) [Deutsch] Es wird ueber den Fall einer 29jaehrigen Patientin berichtet, die 5 Jahre lang wegen Schmerzen im rechten Mittelfuss unter der Diagnose degenerativer oder rheumatischer Veraenderungen physikalisch und medikamentoes behandelt wurde. Magnetresonanztomographisch wurde ein Weichteiltumor des Mittelfusses diagnostiziert. Die histologische Untersuchung erbrachte den Befund eines monophasisch-fibroesen Synovialsarkoms. Mit der Kasuistik verbunden ist eine Darstellung des Krankheitsbildes und dessen radiologischer Diagnostik. (orig.)

Diagnostic radiology on multiple injured patients: interdisciplinary management; Radiologische Diagnostik beim Polytrauma: interdisziplinaeres Management

Energy Technology Data Exchange (ETDEWEB)

Linsenmaier, U.; Pfeifer, K.J. [Inst. fuer Radiologische Diagnostik, Klinikum der Univ. Muenchen (Germany); Kanz, K.G.; Mutschler, W. [Chirurgische Klinik Innenstadt, Klinikum der Univ. Muenchen, (Germany)

2001-06-01

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.) [German] Die Anwesenheit des Radiologen im Schockraum und dessen Teamfaehigkeit bestimmen den Status der diagnostischen Radiologie in der Traumaversorgung. Voraussetzung zur Mitarbeit im interdisziplinaeren Traumateam ist die detaillierte Kenntnis der wesentlichen Entscheidungskriterien, Algorithmen und Behandlungsablaeufe. Das hier vorgestellte interdisziplinaere Managementkonzept der radiologischen Diagnostik beim Polytrauma mit Basisdiagnostik, Organdiagnostik, radiologischer ABC-Regel und Algorithmen zur fruehklinischen Behandlung beruht auf einer prospektiven Polytraumastudie mit

Sie lebt! Zur Verbraucherforschung im deutschsprachigen Raum

DEFF Research Database (Denmark)

Oehler, Andreas; Reisch, Lucia

2012-01-01

jeweils eine existierende Aktivität; eine deutliche Lücke, die es zu schließen gilt (Wachstumsfelder der Verbraucherforschung). Zur Finanzierung der Verbraucherforschung ergibt sich der deutliche Befund, dass mit weitem Abstand die „Bordmittel“ der jeweiligen Professur bzw. des jeweiligen Lehrstuhls als...... oder des BMELV darauf hindeuten, dass die Verbraucherforschung zunehmend als wichtiges Element oder gar als Voraussetzung für eine fundierte moderne Verbraucherpolitik gesehen wird....

Märkte und Macht der Internetkonzerne: Konzentration - Konkurrenz - Innovationsstrategien

OpenAIRE

Dolata, Ulrich

2014-01-01

In diesem Aufsatz, der auf einer systematischen Auswertung von Geschäftsberichten, Dokumenten, verfügbarem empirischem Material, Literatur und Presseberichten basiert, werden die Konzentrationsprozesse auf den wesentlichen Internetmärkten so- wie die Expansions- und Innovationsstrategien der fünf führenden Konzerne Google, Facebook, Apple, Amazon und Microsoft analysiert. Die Befunde, die der Text vorstellt, sind von einer Dezentralisierung der Markt- und Demokratisierung der Innovationsproze...

Vergleich verschiedener Beurteilungsverfahren an Röntgenbildern des Ellbogengelenkes beim Deutschen Schäferhund und Rottweiler unter Berücksichtigung des Einflusses der Lagerung als Basis einer züchterischen Selektion gegen die Ellbogengelenksdysplasie

OpenAIRE

Klein, Sandra

2010-01-01

Ziel dieser Untersuchung war es, drei Bewertungsverfahren zur Beurteilung der Ellbogengelenksdysplasie bei Hunden der Rasse Deutscher Schäferhund und Rottweiler miteinander zu vergleichen. Hierbei sollte insbesondere ein Einfluss der Lagerung während der Röntgenaufnahme überprüft werden. Bewertet wurden Röntgenaufnahmen von 19.798 Deutschen Schäferhunden und 2.430 Rottweiler, von denen bereits ein offizieller ED – Befund vorlag. Es erfolgte eine Beurteilung entsprechend der zwei Punktesch...

Neues aus dem Forschungsfeld Deutsch als Zweitsprache. Sammelrezension

Directory of Open Access Journals (Sweden)

Claus Altmayer

2015-03-01

Full Text Available Neues aus dem Forschungsfeld Deutsch als Zweitsprache. Sammelrezension (Teil 2 von Bernt Ahrenholz (Hrsg. (2009, Empirische Befunde zu DaZ-Erwerb und Sprachförderung. Beiträge aus dem 3. ‚Workshop Kinder mit Migrationshintergrund‘; Karen Schramm & Christoph Schröder (Hrsg. (2009, Empirische Zugänge zu Spracherwerb und Sprachförderung in Deutsch als Zweitsprache; Stefan Jeuk (2010, Deutsch als Zweitsprache in der Schule. Grundlagen - Diagnose – Förderung

Psychosocial Stress and Addison's Disease

OpenAIRE

Wolf, Jutta Manuela

2006-01-01

Die Psychoneuroimmunologie beschäftigt sich unter anderem mit der Frage, ob und unter welchen Bedingungen psychosozialer Stress krank macht. Humanstudien, die dieser Frage nachgehen, können dabei meist nur korrelative Zusammenhänge aufdecken. Um trotzdem Aussagen zu Mechanismen, Ursache-Wirkungsbeziehungen und klinische Relevanz treffen zu können, muss z.B. auf Befunde aus der Tierforschung oder aus in vitro-Studien zurückgegriffen werden. Ziel der vorliegenden Arbeit war es, eine Methode zu ...

Differential diagnoses of spinal tumors; Differenzialdiagnose spinaler Tumoren

Energy Technology Data Exchange (ETDEWEB)

Yilmaz, U. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

2011-12-15

A wide variety of degenerative, inflammatory and vascular diseases can resemble the clinical presentation and imaging findings of spinal tumors. This article provides an overview of the most frequent diseases which are important to recognize for diagnostic imaging of the spine. (orig.) [German] Eine Vielzahl degenerativer, entzuendlicher und vaskulaerer Erkrankungen kann das klinische Bild und radiologische Befunde spinaler Tumoren imitieren. Dieser Artikel dient der Uebersicht ueber die haeufigsten dieser Erkrankungen, deren Kenntnis wichtig fuer die spinale Bildgebung ist. (orig.)

Rechtspopulistische Einstellungen in Ost- und Westdeutschland

Directory of Open Access Journals (Sweden)

Beate Küpper

2017-12-01

Full Text Available Während sich die Mehrheit der Deutschen für Demokratie, Vielfalt und Gleichwertigkeit positioniert, sind zugleich rechtspopulistische Einstellungen lauter geworden. Der Beitrag berichtet über Befunde der Mitte-Studie der Friedrich-Ebert-Stiftung 2016 zu der Verbreitung rechtspopulistischer und rechtsextreme Einstellungen, wirft einen besonderen Blick auf potentielle Wähler_innen der AfD und diskutiert am Ende mögliche Erklärungen für die gefundenen Unterschiede zwischen Ost- und Westdeutschen.

Effect of radiosynovectomy in patients with inflammatory joint disorders not caused by rheumatoid arthritis; Wirksamkeit der Radiosynoviorthese bei degenerativ-entzuendlichen und chronisch-entzuendlichen Gelenkerkrankungen

Energy Technology Data Exchange (ETDEWEB)

Kroeger, S.; Klutmann, S.; Bohuslavizki, K.H.; Clausen, M. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin; Sawula, J.A.; Brenner, W.; Henze, E. [Kiel Univ. (Germany). Klinik fuer Nuklearmedizin

1999-07-01

Aim: Effect of radiosynovectomy (RS) should be evaluated both by subjective and objective parameters in patients with osteoarthritis and in patients with inflammatory joint disorders not caused by rheumatoid arthritis. Methods: A total of 98 joints in 61 patients were investigated. Patients were divided into two groups. The first group included 35 patients with therapy-resistant effusions caused by severe osteoarthritis (46 joints). The second group consisted of 26 patients (52 joints) with ankylosing spondylitis, reactive arthritis, undifferentiated spondylarthropathy, psoriatic arthritis, pigmented villo-nodular synovitis, and recurrent synovitis following surgery. Effect of RS was evaluated by a standardized questionnaire and quantified by T/B-ratios derived from blood pool images prior to and after RS. Results: Within the first patient group suffering from osteoarthritis, 40% showed a good or excellent improvement of clinical symptoms, 51% were unchanged, and in 9% symptoms worsened. Similar results were found in the second patient group. The majority of unchanged results were small finger joints. In contrast, wrist and knee joints showed a better improvement. Good correlation between results of bone scan and patients subjective impression was found in 38% and 67% in the first and the second patient group, respectively. Conclusion: Radiosynovectomy might be an effective treatment in osteoarthritis and inflammatory joint disorders not caused by rheumatoid arthritis. (orig.) [German] Ziel: Der Therapieerfolg der Radiosynoviorthese (RSO) sollte bei aktivierter Arthrose und anderen chronisch-entzuendlichen Gelenkerkrankungen anhand der subjektiven Befindlichkeit und objektiver Parameter evaluiert werden. Methoden: Es wurden insgesamt 98 Gelenke bei 61 Patienten behandelt. Entsprechend der Grunderkrankung umfasste die erste Gruppe 35 Patienten mit einer therapieresistenten, aktivierten Arthrose (46 Gelenke). Die zweite Patientengruppe beinhaltete 26 Patienten (52

S1-Leitlinie Lipödem.

Science.gov (United States)

Reich-Schupke, Stefanie; Schmeller, Wilfried; Brauer, Wolfgang Justus; Cornely, Manuel E; Faerber, Gabriele; Ludwig, Malte; Lulay, Gerd; Miller, Anya; Rapprich, Stefan; Richter, Dirk Frank; Schacht, Vivien; Schrader, Klaus; Stücker, Markus; Ure, Christian

2017-07-01

Die vorliegende überarbeitete Leitlinie zum Lipödem wurde unter der Federführung der Deutschen Gesellschaft für Phlebologie (DGP) erstellt und finanziert. Die Inhalte beruhen auf einer systematischen Literaturrecherche und dem Konsens von acht medizinischen Fachgesellschaften und Berufsverbänden. Die Leitlinie beinhaltet Empfehlungen zu Diagnostik und Therapie des Lipödems. Die Diagnose ist dabei auf der Basis von Anamnese und klinischem Befund zu stellen. Charakteristisch ist eine umschriebene, symmetrisch lokalisierte Vermehrung des Unterhautfettgewebes an den Extremitäten mit deutlicher Disproportion zum Stamm. Zusätzlich finden sich Ödeme, Hämatomneigung und eine gesteigerte Schmerzhaftigkeit der betroffenen Körperabschnitte. Weitere apparative Untersuchungen sind bisher besonderen Fragestellungen vorbehalten. Die Erkrankung ist chronisch progredient mit individuell unterschiedlichem und nicht vorhersehbarem Verlauf. Die Therapie besteht aus vier Säulen, die individuell kombiniert und an das aktuelle Beschwerdebild angepasst werden sollten: komplexe physikalische Entstauungstherapie (manuelle Lymphdrainage, Kompressionstherapie, Bewegungstherapie, Hautpflege), Liposuktion und plastisch-chirurgische Interventionen, Ernährung und körperliche Aktivität sowie ggf. additive Psychotherapie. Operative Maßnahmen sind insbesondere dann angezeigt, wenn trotz konsequent durchgeführter konservativer Therapie noch Beschwerden bestehen bzw. eine Progredienz des Befundes und/oder der Beschwerden auftritt. Eine begleitend zum Lipödem bestehende morbide Adipositas sollte vor einer Liposuktion therapeutisch angegangen werden. © 2017 The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

The clinical, radiological, and scan-examination in horses with backproblems; Die klinische, röntgenologische und szintigraphische Untersuchung bei den sogenannten Rückenproblemen des Pferdes

Energy Technology Data Exchange (ETDEWEB)

Nowak, M. [Tierklinik Hochmoor, Gescher (Germany)

1988-09-15

In 21 horses with the anamnesis backproblems there had been a clinical, scan- and X-ray-examination of the thoracal and lumbar vertebra in special consideration of the spinosus process and the dorsal intervertebral joint. But there was not always a relation between the clinical signs and X-rays or scan results. Not all positive X-rays found their corresponding scan activity and not all scan activities took place in X-rays. In many cases there was pathological change of the spinosus process and arthropathy of the dorsal intervertebral joint at the same time. Only with X-raying it is not possible to decide to operate the thoracolumbal, interspinale syndrom (TIS) or not [German] Bei 2l Pferden mit dem Vorbericht 'Rückenleiden' wurden klinisch, röntgenologisch und szintigraphisch die Brust- und Lendenwirbelsäule unter besonderer Berücksichtigung der Dornfortsätze und der dorsalen Intervertebralgelenke untersucht. Die erhobenen klinischen, röntgenologischen und szintigraphischen Befunde stimmten nicht immer überein. So waren nicht alle erhobenen Röntgenbefunde szintigraphisch aktiv, und für die szintigraphisch aktiven Zonen konnten nicht immer rötgenologische Befunde erhoben werden. Bei den Veränderungen der Dornfortsätze lagen oft gleichzeitig Arthrosen der dorsalen Intervertebralgelenke vor. Die Indikation ftir die Operation des thorakolumbalen, interspinalen Syndroms (TIS) kann deshalb nicht mit der Röntgenuntersuchung der Dornfortsätze allein gestellt werden.

Reaktionen auf das Stigma psychischer Erkrankung : Sozialpsychologische Modelle und empirische Befunde

OpenAIRE

Rüsch, N

2010-01-01

Zusammenfassung. In der jüngeren Forschung zu Stigma und Diskriminierung gewinnt die Frage an Bedeutung, wie Angehörige einer stigmatisierten Minderheit ihre eigene Stigmatisierung wahrnehmen und auf sie reagieren. Aus der sozialpsychologischen Literatur zu anderen Gruppen, etwa ethnischen Minderheiten, liegen gut belegte Modelle zu diesem Thema vor, die bisher jedoch noch kaum auf Menschen mit psychischen Erkrankungen angewandt wurden. Dazu zählen (1) ein Stress-Coping-Modell von St...

Magnetic resonance imaging in acute intractional tuberculosis; Magnetresonanztomographie bei akuter intrakranieller Tuberkulose

Energy Technology Data Exchange (ETDEWEB)

Venz, S. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Sander, B. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Benndorf, G. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Terstegge, K. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Podrabsky, P. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Cordes, M. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Felix, R. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany)

1994-12-31

We reported three cases of acute intracranial tuberculosis including miliary tuberculosis, basal meningitis, tuberculomas and neuritis of cranial nerves. All patients had native and contrast enhanced CT and MRI scans. MRI revealed more granulomas and a better imaging contrast in the detection of basal meningitis. Neuritis was diagnosed only with the MRI. MRI scans should be prefered as the imaging procedure in clinically presumed intracranial tuberculosis. (orig.) [Deutsch] Die Befunde von drei Patienten mit intrakranieller Tuberkulose (intrakranielle Miliartuberkulose, Meningitis tuberculosa, Neuritis und Tuberkulome) in der Magnetresonanztomographie (MRT) wurden mit der Computertomographie (CT) verglichen. Sowohl die MRT als auch die CT wurden nativ und nach Kontrastmittelgabe durchgefuehrt. Die MRT zeigte sich im Nachweis von Granulomen insbesondere im Bereich des Hirnstamms ueberlegen. Ebenso wurde ein hoeherer Bildkontrast bei der Darstellung der Meningitis beobachtet. Eine Neuritis der Hirnnerven war nur mit der MRT nachweisbar. Die kontrastmittelunterstuetzte MRT sollte in der bildgebenden Diagnostik einer intrakraniellen Turberkulose primaer zum Einsatz gelangen. (orig.)

PET activation in basal ganglia disorders: Parkinson`s disease and dystonia; PET-Aktivierungsstudien bei Basalganglienerkrankungen: Morbus Parkinson und Dystonien

Energy Technology Data Exchange (ETDEWEB)

Ceballos-Baumann, A.O. [Neurologische Klinik, Technische Univ. Muenchen (Germany); Boecker, H. [Neurologische Klinik, Technische Univ. Muenchen (Germany); Conrad, B. [Neurologische Klinik, Technische Univ. Muenchen (Germany)

1997-03-01

This article reviews PET activation studies with performance of different motor paradigms (joy-stick movements, imagination of movement, writing) in patients with movement disorders. The focus will be on Parkinson`s disease (PD) and dystonia. PET findings will be related to clinical and electrophysiological observations. PET activation studies before and after therapeutic interventions such as pallidotomy in Parkinson`s disease and botulinum toxin in writer`s cramp are described. The contribution of PET activation studies to the understanding of the pathophysiology of dystonia and PD is discussed. (orig.) [Deutsch] Der Beitrag beschreibt verschiedene PET-Aktivierungsstudien mit motorischen Paradigmen (`joystick`-Bewegungen, Vorstellung von Bewegung, Schreiben) bei Bewegungsstoerungen, im wesentlichen bei Patienten mit Dystonie, einer Hyperkinese, und Morbus Parkinson als Hypokinese. Die experimentellen Befunde werden mit der Klinik in Bezug gebracht. Neue Untersuchungen vor und nach therapeutischen Interventionen, wie die stereotaktische Pallidotomie bei Parkinson und die Botulinum-Toxin-Therapie bei Schreibkrampf, werden beschrieben. Der Beitrag von PET-Aktivierungsstudien zum Verstaendnis der Pathophysiologie von Bewegungsstoerungen wird diskutiert. (orig.)

Computed tomography in multiple trauma patients. Technical aspects, work flow, and dose reduction; Polytrauma-Computertomographie. Technische Grundlagen, Workflow und Dosisreduktion

Energy Technology Data Exchange (ETDEWEB)

Fellner, F.A. [AKH Linz - Kepler Universitaetsklinikum/JKU, Zentrales Radiologie Institut, Linz (Austria); Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen (Germany); Krieger, J.; Floery, D. [AKH Linz - Kepler Universitaetsklinikum/JKU, Zentrales Radiologie Institut, Linz (Austria); Lechner, N. [AKH Linz - Kepler Universitaetsklinikum/JKU, Abteilung fuer Medizintechnik, Linz (Austria)

2014-09-15

Patients with severe, life-threatening trauma require a fast and accurate clinical and imaging diagnostic workup during the first phase of trauma management. Early whole-body computed tomography has clearly been proven to be the current standard of care of these patients. A similar imaging quality can be achieved in the multiple trauma setting compared with routine imaging especially using rapid, latest generation computed tomography (CT) scanners. This article encompasses a detailed view on the use of CT in patients with life-threatening trauma. A special focus is placed on radiological procedures in trauma units and on the methods for CT workup in routine cases and in challenging situations. Another focus discusses the potential of dose reduction of CT scans in multiple trauma as well as the examination of children with severe trauma. Various studies have demonstrated that early whole-body CT positively correlates with low morbidity and mortality and is clearly superior to the use of other imaging modalities. Optimal trauma unit management means a close cooperation between trauma surgeons, anesthesiologists and radiologists, whereby the radiologist is responsible for a rapid and accurate radiological workup and the rapid communication of imaging findings. However, even in the trauma setting, aspects of patient radiation doses should be kept in mind. (orig.) [German] Polytraumatisierte Patienten beduerfen im Rahmen der initialen Schockraumversorgung einer schnellen und exakten klinischen und bildgebenden Diagnostik. Fuer ein optimales Schockraummanagement ist heute die essenzielle Bedeutung einer zeitnah durchgefuehrten Ganzkoerper-CT unbestritten. Insbesondere durch schnelle CT-Scanner der letzten Generationen kann im Rahmen der Schockraum-CT eine aehnlich gute Bildqualitaet wie in der Routinediagnostik erzielt werden. Dieser Artikel beleuchtet den Einsatz der CT im Schockraum bei polytraumatisierten Patienten, wobei das Hauptaugenmerk auf Methoden des

Hydro-MRI for abdominal diagnostics in children; Hydro-MRT in der Darmdiagnostik bei Kindern

Energy Technology Data Exchange (ETDEWEB)

Kern, A.; Schunk, K.; Oberholzer, K.; Thelen, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Kessler, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Kinderchirurgie

2001-11-01

A clinical evaluation of hydro-MRI as an alternative method to barium studies in children with abdominal pain of unknown origin is presented. Patients and Methods: 20 children with abdominal pain of unknown origin aged from 9 - 16 years were examined after oral bowel opacification using 1000 ml of 2.5% mannitol solution with a 1.0T MRI system. The investigation was done in 2 planes (coronal and axial) under breath-hold conditions. Imaging procedures included various sequences (T2W HASTE + FS, contrast-enhanced T1W FLASH FS). Suspicious findings in bowel segments and extra-intestinal changes were assessed. Results: In 21/24 examinations the small bowel was completely visualized, in 15/24 cases colon segments were identified. An accurate assessment of the terminal ileum was not possible in 3/24 procedures. Breathing artefacts occurred in 3/24 examinations. Signs of Crohn's disease were found in 4 examinations, inflammatory changes of the ileum were detected in 3 cases. Inflammation of the colon was demonstrated in 2 children. Furthermore, pathological findings included constipation in one child and inflammation of the ileo-colic and mesenterial lymph nodes were found in another child. Extra-intestinal changes in 3 children were caused by ovarian cysts, and in one case by pleural effusion. In 4 examinations we detected ascites in the absence of other pathological findings. In 5 children there was no pathological correlation in the bowel or extra-intestinal region for the complaints. The children tolerated the hydro-MRI very well. There were no side effects using oral mannitol. (orig.) [German] Ziel: Klinische Evaluation der Hydro-MRT bei Kindern mit unklarer abdomineller Symptomatik als alternative Methode zur fraktionierten Magen-Darm-Passage. Patienten und Methoden: 20 Kinder und Jugendliche im Alter von 9 bis 16 Jahren mit unklaren abdominellen Beschwerden bzw. mit Verdacht auf eine chronisch entzuendliche Darmerkrankung wurden nach einer oralen

MRI characteristics of spontaneous intracerebral hemorrhage; Das kernspintomographische Erscheinungsbild der spontanen intrazerebralen Blutung

Energy Technology Data Exchange (ETDEWEB)

Felber, S.; Schocke, M. [Innsbruck Univ. (Austria). Klinik fuer Radiologie; Innsbruck Univ. (Austria). Inst. fuer Magnetresonanztomographie und Spektroskopie; Auer, A.; Golaszewski, S.; Amort, B. [Innsbruck Univ. (Austria). Inst. fuer Magnetresonanztomographie und Spektroskopie; Nedden, D. zur [Innsbruck Univ. (Austria). Klinik fuer Radiologie

1999-10-01

We review the signal characteristics of intracerebral hematomas (ICH) on magnetic resonance imaging (MRI), with special emphasis on the diagnosis of intracerebral hemorrhage within the first hours after stroke. The detection of peracute ICH was evaluated in 42 patients of a prospective, MR randomized stroke trial. These patients underwent a protocol of T1 and T2 weighted sequences, diffusion weighted sequences and MR - angiography within 6 hours after onset of acute hemiparesis. The signal behaviour of ICH in any stage after bleeding was additionally reviewed in a retrospective series of 63 patients, who were submitted for MRI over a 12 months period because of known ICH. MRI correctly identified 4 hyperacute ICH in the prospective group and 4 hyperacute ICH in the retrospective group. These ICHs had high signal on T2 weighted images, were isointense in T1 weighted images and had signal voids on the diffusion weighted sequences. The signal intensities of acute, subacute and chronic ICHs correlated to previous experiences as reported in the literature. In conclusion, MRI reliably identified all hematomas even in the hyperacute stage. Diffusion weighted images were most sensitive to the presence of deoxyhemoglobine and helpful for the differentiation and characterization of acute ischemia. Therefore, MRI at 1.5 T can be employed as an alternative to CT for the emergency diagnosis of acute stroke. (orig.) [German] In dieser Uebersicht wird das kernspintomographische (KST) Erscheinungsbild der intrazerebralen Blutung (IZB) anhand eigener Erfahrungen und der Literatur diskutiert. Besonderes Gewicht wurde auf den KST Nachweis der hyperakuten IZB innerhalb der ersten Stunden gelegt. Es wurden einerseits die Befunde von 42 Patienten einer prospektiven, KST randomisierten Schlaganfallstudie ausgewertet, bei denen die KST als Erstuntersuchung innerhalb von 6 Stunden durchgefuehrt worden war. Andererseits werteten wir retrospektiv jene KST Untersuchungen aus, die im Jahr 1998

Leptomeningeosis leucaemica in connection with acute lymphatic leukemia. A case report; Leptomeningeosis leucaemica bei akuter lymphatischer Leukaemie. Ein Fallbericht

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Fellner, F.; Dobritz, M.; Cavallaro, A.; Schmitt, R.; Bautz, W. [Universitaet Erlangen-Nuernberg (Germany). Institut fuer Diagnostische Radiologie; Roesler, W. [Universitaet Erlangen-Nuernberg (Germany). Medizinische Klinik III; Keilholz, L. [Universitaet Erlangen-Nuernberg (Germany). Klinik fuer Strahlentherapie

1998-03-01

MRI is significantly better than CT for detection of leptomeningeosis leucaemica, due to better imaging of the anatomy and the diversity of the tomographic images. Based on the MRI information in the case reported, the decision was for radiotherapy of the cranium: Linear accelerator-based irradiation of the neurocranium up to and inclusive of C2, with 6 MeV photons via laterally opposing fields. The single dose was 1.50 Gy, and 16.50 Gy at the reference point at the time of a control examination. The radiotherapy was accompanied at the same time by a further intrathecal cytostasis. The treatment rapidly achieved improvement of the clinical findings, and the follow-up MRI correspondingly revealed almost complete remission of the leptomeningeal foci. (orig./CB) [Deutsch] Die MRT ist im Nachweis der Leptomeningeosis leucaemica der CT deutlich ueberlegen, bedingt durch die bessere Darstellung der anatomischen Strukturen und der Moeglichkeit der Bildakquisition in verschiedenen Ebenen. Aufgrund des MR-tomographischen Befundes wurde im vorliegenden Fall eine Radiatio des Craniums durchgefuehrt: Bestrahlung des Neurocraniums bis einschliesslich C2 am Linearbeschleuniger mit 6 MeV Photonen ueber seitlich opponierende Gegenfelder. Einzeldosis war 1,50 Gy, zum Zeitpunkt der Kontrolluntersuchung im Referenzpunkt bis 16,50 Gy. Zusaetzlich wurde gleichzeitig eine weitere intrathekale Zytostase durchgefuehrt. Waehrend der Therapie kam es rasch zu einer deutlichen Verbesserung des klinischen Befundes. Die MRT-Kontrolluntersuchung zeigte dementsprechend eine fast vollstaendige Remission der leptomeningealen Herde. (orig.)

Liver: radiological methods supplementary; Radiologische Diagnostik der Leber

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Delorme, S. [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Abt. Onkologische Diagnostik und Therapie

2000-10-01

Highly specific methods are required for the diagnostic workup of focal hepatic lesions, since benign circumscribed liver changes are very common. Although cross-sectional imaging techniques have a high diagnostic accuracy, radionuclide imaging techniques such as colloid, red blood cell, or hepatobiliary scan are commonly performed when a benign lesion is assumed since these permit a definite diagnosis with high specificity. The diagnosis of a primary or secondary malignant liver tumor, however, usually relies on radiological imaging techniques along, supported by needle biopsy. Whether positron emission tomography as a primary or supplementary diagnostic tool will have a role in the routine staging of malignant tumors remains to be determined. (orig.) [German] Die Abklaerung umschriebener Leberveraenderungen erfordert den Einsatz von Methoden hoher Spezifitaet, da die Praevalenz benigner, fokaler Laesionen sehr hoch ist. Hierfuer sind radiologische Schnittbildtechniken grundsaetzlich gut geeignet. Wenn aufgrund der sonographischen, computertomographischen oder magnetresonanztomographischen Befunde eine gutartige Laesion anzunehmen ist, werden jedoch haeufig ergaenzend die Kolloiderythrozyten- oder hepatobiliaere Szintigraphie - ggf. in Kombination - eingesetzt, da hiermit rasch eine abschliessende Diagnose mit hoher Spezifitaet gestellt werden kann. Bei malignen primaeren oder sekundaeren Lebertumoren hingegen werden nuklearmedizinische Zusatzuntersuchungen seltener angefordert, da der radiologische Befund, ggf. gestuetzt durch eine Ultraschall- oder CT-gezielte Biopsie, eine Diagnose in den meisten Faellen erlaubt. Inwieweit sich der primaere oder ergaenzende Einsatz der Positronenemissionstomographie im Vergleich zu radiologischen Schnittbildtechniken beim Staging boesartiger Tumoren bewaehrt, ist noch nicht abschliessend geklaert. (orig.)

Magnetic resonance maging of epidural and subdural spinal hematomas; Magnetresonanztomographie bei epiduralen und subduralen spinalen Haematomen

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Felber, S. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurologie]|[Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz]|[Universitaetskliniken des Saarlandes, Homburg/Saar (Germany). Inst. fuer Neuroradiologie; Langmaier, J. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurochirurgie; Judmaier, W. [Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz]|[Universitaetskliniken Innsbruck (Austria). Klinik fuer Radiologie; Dessl, A. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Radiologie; Ortler, M. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurochirurgie; Birbamer, G. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurologie]|[Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz; Piepgras, U. [Universitaetskliniken des Saarlandes, Homburg/Saar (Germany). Inst. fuer Neuroradiologie

1994-11-01

Epidural und subdural spinal hematomas were previously diagnosed by myelography and computed tomography (CT). Recent reports indicate that noninvasive detection is possible with magnetic resonance imaging. We report on nine patients who were investigated by magnetic resonance imaging (MR) prior to surgery for epidural and subdural spinal hematoma. The MR examinations were performed on 1.5-T and 1-T units. We used surface coils and employed T1-, PD- and T2-weighted spin echo sequences and a T2*-weighted gradient echo sequence. CT was available in four patients and myelography in two patients. Surgical correlation was available in all patients. The hematomas were located in the cervical spine (n=2), thoracic spine (n=6) and lumbar spine (n=2). They were epidural in five patients and subdural in four. Blinded reading correctly indentified all five epidural hematomas and three of the subdural hematomas; one subdural hematoma was misjudged as epidural. Peracute hematomas (<24 h) in three patients appeared isointense or slightly hyperintense on T1-weighted images and had mixed signal intensity on T2- and T2*-weighted images. Acute hematomas (1-3 days) in four patients were also isointense on T1-weighted images but were more hypointense on T2- and T2*-weighted images. Chronic heamatomas in two patients (7 days and 14 days) were hyperintense on all sequences. Differentiation between epi- and subdural hematomas required transverse T2*-weighted gradient echo sequences. Our results underline that MRI at 1 and 1.5 T is capable of identifying epidural and subdural spinal hematoma in the acute and peracute stage. MRI is superior to CT and myelography for the delineation of the craniocaudal extension in epidural and subdural spinal hematomas and should be the primary preoperative diagnostic method. (orig.) [Deutsch] Epidurale und subdurale spinale Haematome sind neurochirurgische Notfaelle, deren Diagnose bisher vorwiegend mittels Myelographie und Computertomographie gestellt

Surveillance of anal carcinoma after radiochemotherapy. A retrospective analysis of 80 patients

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Sauter, Matthias; Vavricka, Stephan R. [Triemli Hospital, Department of Medicine, Division of Gastroenterology, Zurich (Switzerland); University Hospital Zurich, Division of Gastroenterology and Hepatology, Zurich (Switzerland); Keilholz, Georg; Kranzbuehler, Helmut; Lombriser, Norbert [Triemli Hospital, Division of Radiation-Oncology, Zurich (Switzerland); Heinrich, Henriette; Misselwitz, Benjamin [University Hospital Zurich, Division of Gastroenterology and Hepatology, Zurich (Switzerland); Winder, Thomas [University Hospital Zurich, Department of Oncology, Zurich (Switzerland)

2017-08-15

/Becken) waehrend 42 (±27) Monaten bei 80 Patienten nach kurativer Radiochemotherapie eines ACa. Bei 7/80 Patienten (8,8 %) wurde bei oder vor der 6-Monats-Kontrolle nach Ende der Radiochemotherapie ein inkomplettes Ansprechen dokumentiert; 4 der 7 Faelle wurden aufgrund geplanter Nachsorgeuntersuchungen entdeckt. In 6 Faellen (7,5 %) wurde nach der 6-Monats-Kontrolle ein Rezidiv festgestellt. Die Rezidive waren Fernmetastasen in 5 Faellen und ein lokoregionaeres Rezidiv in einem Fall. In 3/6 Faellen (50%) wurden die Rezidive waehrend der geplanten Nachsorgeuntersuchung entdeckt. Bei einem asymptomatischen Patienten wurde in der Nachsorge eine singulaere Lebermetastase diagnostiziert; nach Resektion blieb der Patient waehrend der restlichen Nachsorge von 19 Monaten rezidivfrei. Die Nachsorge fuehrte zu einer hohen Rate an falsch-positiven Befunden (70 Befunde in 604 Untersuchungen), welche nur in 14 Faellen als wirklich relevant bestaetigt werden konnten. Mit der geplanten Nachsorge nach kurativer Radiochemotherapie beim ACa konnten systemische Rezidive entdeckt werden, die zumindest in einem Fall potenziell kurativ behandelt werden konnten. Die Effizienz einer abdominellen Bildgebung bei der Nachsorge des ACa sollte in einer prospektiven Studie untersucht werden. (orig.)

CNS manifestation in progressive facial hemiatrophy (Romberg's disease). MRI findings and review of the literature. Zerebrale Manifestation der progressiven fazialen Hemiatrophie (Romberg-Erkrankung). Kernspintomographische Befunde und Literaturuebersicht

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Terstegge, K [Strahlenklinik mit Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Henkes, H [Alfried Krupp Krankenhaus, Essen (Germany). Klinik fuer Radiologische Diagnostik und Neuroradiologie Univ. des Saarlandes, Homburg/Saar (Germany). Inst. fuer Neuroradiologie; Kunath, B [Medizinische Akademie ' ' Carl Gustav Carus' ' , Dresden (Germany). Klinik und Poliklinik fuer Neurologie; Felber, S [Univ. des Saarlandes, Homburg/Saar (Germany). Inst. fuer Neuroradiologie; Uhrmeister, P [Strahlenklinik mit Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Kern, A [Strahlenklinik mit Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany)

1993-10-01

In this article the authors describe the clinical and MR imaging findings of the CNS in three female patients with PFH and present a comprehensive review of the literature. One of three PFH patients had partial epilepsy. MRI showed ventricular enlargement, white matter lesions, flattening of the cortical surface and meningeal adhesions homolateral to the facial hemiatrophy. Two other patients had completely normal intracranial findings. These findings confirm that cerebral hemiatrophy can occur in a subgroup of PFH patients. The MRI pattern, however, does not seem to be consistent with a simple atrophic or malnutrition process. The authors consider chronic localized meningoencephalitis with vascular involvement as a possible underlying mechanism for the occasional CNS involvement in PFH. (orig./MG)

On the clinical impact of cerebral dopamine D{sub 2} receptor scintigraphy; Zur klinischen Wertigkeit der zerebralen Dopamin-D{sub 2}-Rezeptorszintigraphie

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Larisch, R. [Duesseldorf Univ. (Germany). Klinik fuer Nuklearmedizin; Klimke, A. [Duesseldorf Univ. (Germany). Psychiatrische Klinik

1998-12-31

The present review describes findings and clinical indications for the dopamine D{sub 2} receptor scintigraphy. Methods for the examination of D{sub 2} receptors are positron emission tomography (PET) using {sup 11}C- or {sup 18}F-labelled butyrophenones or benzamides or single photon emission tomography (SPECT) using {sup 123}I-iodobenzamide (IBZM) respectively. The most important indication in neurology is the differential diagnosis of Parkinsonism: Patients with early Parkinson`s disease show an increased D{sub 2} receptor binding (D{sub 2}-RB) compared to control subjects. However, patients suffering from Steele-Richardson-Olszewski-Syndrome or Multiple System Atrophy show a decreased D{sub 2}-RB and are generally non-responsive to treatment. Postsynaptic blockade of D{sub 2} receptors results in a drug induced Parkinsonian syndrome, which can be diagnosed by D{sub 2} scintigraphy. Further possible indications occur in psychiatry: The assessment of receptor occupancy is useful in schizophrenic patients treated with neuroleptics. Additionally, D{sub 2} receptor scintigraphy might help to clarify the differential diagnosis between neuroleptic malignant syndrome and lethal catatonia. The method might be useful for supervising neurobiochemical changes in drug dependency and during withdrawal. Assessment of dopamine D{sub 2} receptor binding can simplify the choice of therapy in depressive disorder: Patients showing a low D{sub 2} binding are likely to improve following an antidepressive drug treatment whereas sleep deprivation is promising in patients with high D{sub 2} binding. (orig.) [Deutsch] Die vorliegende Arbeit gibt eine Uebersicht ueber Befunde und klinische Indikationen zur Dopamin-D{sub 2}-Rezeptorszintigraphie. Methoden zur Untersuchung der D{sub 2}-Rezeptoren sind die Positronen-Emissions-Tomographie (PET) mit {sup 11}C- oder {sup 18}F-markierten Butyrophenonen oder Benzamiden oder die Einzelphotonen-Emissions-Tomographie (SPECT) mit {sup 123}I

Neuroimaging of cerebral vasculitis; Bildgebung zerebraler Vaskulitiden

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Wengenroth, M. [Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Institut fuer Neuroradiologie, Luebeck (Germany); Klinikum der Ludwig-Maximilians-Universitaet, Institut fuer klinische Radiologie, Muenchen (Germany); Saam, T. [Klinikum der Ludwig-Maximilians-Universitaet, Institut fuer klinische Radiologie, Muenchen (Germany); Haehnel, S. [Universitaetsklinikum Heidelberg, Abteilung Neuroradiologie, Heidelberg (Germany)

2016-01-15

Cerebral vasculitis can have a variety of origins. Furthermore, there are no vasculitis-specific symptoms or imaging signs and vasculitis of the CNS can mimic many other neurological diseases, which require different treatment approaches. Thus, the clinical and radiological diagnosis of cerebral vasculitis is challenging. Magnetic resonance imaging (MRI) and MR angiography (MRA) should be the radiological imaging methods of choice to assess the degree of parenchymal damage and to detect vessel wall changes. If the results are unclear digital subtraction angiography (DSA) should be pursued in order to also detect changes in medium sized vessels. Vasculitis of small vessels cannot be detected by vascular imaging and requires brain or leptomeningeal biopsy. In this review we present the current diagnostic approach and a variety of imaging findings in cerebral vasculitis and discuss the main radiological differential diagnoses. (orig.) [German] Die zerebrale Vaskulitis kann viele Ursachen haben. Daher ist die klinische und radiologische Diagnose schwierig, auch weil es etliche vaskulitistypische Symptome und MR-Befunde bei anderen Erkrankungen gibt. Die ZNS-Vaskulitis kann zahlreiche andere neurologische Erkrankungen imitieren, die unterschiedlicher Therapie beduerfen. MRT und MR-Angiographie (MRA) sind die Verfahren der Wahl, mit denen die radiologische Diagnostik begonnen werden sollte, um den Parenchymschaden und den Gefaessbefall zu beurteilen. Bei unklaren Befunden kann eine digitale Subtraktionsangiographie (DSA) ergaenzt werden, um auch mittelgrosse Gefaesse beurteilen zu koennen. Der Befall kleiner Gefaesse kann nur bioptisch nachgewiesen werden. In der folgenden Uebersicht stellen wir das diagnostische Herangehen bei zerebraler Vaskulitis vor, praesentieren zahlreiche Befunde und diskutieren die wichtigsten radiologischen Differenzialdiagnosen. (orig.)

Clinical magnetic resonance imaging. Frequent incidental cerebral findings; Klinische Magnetresonanztomographie. Haeufige zerebrale Zufallsbefunde

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Mueller, A.; Ditter, P.; Schild, H.H.; Hattingen, E. [Universitaetsklinikum Bonn, Funktionseinheit Neuroradiologie der Klinik fuer Radiologie, Bonn (Germany); Weidauer, S. [St.-Katharinen-Krankenhaus, Neurologische Klinik, Frankfurt/M (Germany)

2017-04-15

The increasing use of magnetic resonance imaging (MRI) in clinical diagnostics means that patients and physicians are confronted more often with incidental findings. In the literature there are fluctuating data on the incidence of such findings and guidelines concerning the further procedure exist in only very few cases, such as incidental aneurysms and pituitary adenomas. The diagnostic and therapeutic implications which can be derived from incidental findings depend on multiple factors, such as anatomical location, patient age, comorbidity and patient wishes. For this reason it often makes sense to refer patients with incidental findings to an interdisciplinary neurological center at an early stage. In this review frequent incidental cerebral findings, epidemiological data, imaging criteria and, where possible, recommendations for the further procedure are shown. (orig.) [German] Durch den gehaeuften Einsatz der MRT in der zerebralen Diagnostik werden Arzt und Patienten in zunehmendem Masse mit Zufallsbefunden, auch Nebenbefunde genannt, konfrontiert. In der Literatur existieren sehr schwankende Angaben zur Haeufigkeit solcher Zufallsbefunde. Nur fuer einzelne dieser Befunde, wie z. B. das inzidentelle Aneurysma oder das Hypophysenadenom, existieren Leitlinien fuer das weitere Prozedere. Die aus einem Zufallsbefund abzuleitenden diagnostischen und therapeutischen Konsequenzen sind von vielen Faktoren, wie z. B. der anatomischen Lage, dem Patientenalter, den Komorbiditaeten und dem Patientenwunsch abhaengig. Daher ist es oft sinnvoll, den Patienten mit einem Zufallsbefund fruehzeitig in einem interdisziplinaeren Neurozentrum vorzustellen. In der vorliegenden Arbeit werden haeufige zerebrale Zufallsbefunde mit epidemiologischen Daten, bildgebenden Kriterien und - wenn moeglich - Empfehlungen bzgl. des weiteren Vorgehens gezeigt. (orig.)

Späte Mutterschaft – (keine biografische Entscheidung

Directory of Open Access Journals (Sweden)

Martina Beham

2004-11-01

Full Text Available Der Übergang in die Mutterschaft findet zunehmend später statt. Über die Gründe liegen zahlreiche Vermutungen und einige theoretische Diskussionen, aber kaum empirische Befunde vor. Die Autorinnen möchten mit ihrer Studie einen Beitrag zum Abbau dieses Forschungsdefizits leisten. In ihrer empirisch-biografischen Untersuchung gehen Ingrid Herlyn und Dorothea Krüger der Frage nach, ob späte Erstmutterschaft ein neues biografisches Muster der Familiengründung darstellt oder ob Mutterschaft nach wie vor eine selbstverständlich anerkannte Norm ist, deren Realisierung im Lebenslauf lediglich zeitlich später stattfindet.

Examination of the somatostatin receptor status in non-medullary thyroid cancer; Untersuchungen zum Somatostatinrezeptor-Status bei nicht-medullaeren Schilddruesenkarzinomen

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Goerges, R.; Brandt-Mainz, K.; Bockisch, A. [Essen Univ. (Gesamthochschule) (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Kahaly, G. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Medizin - Endokrinologie und Stoffwechselerkrankungen; Mueller-Brand, J.; Maecke, H. [Kantonsspital Basel (Switzerland). Inst. fuer Nuklearmedizin; Walgenbach, S. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Allgemein- und Abdominalchirurgie; Bruns, C. [Praeklinische Forschung Novartis, Basel (Switzerland); Andreas, J. [Universitaetsklinik Mainz (Germany). Klinik und Poliklinik fuer Nuklearmedizin

1999-06-01

Aim: Recent in-vitro and in-vivo studies demonstrated a somatostatin receptor expression in some non-medullary thyroid carcinomas. In this study we investigated the somatostatin receptor status for this particular tumor entity in a larger patient group. Subject and methods: We compared 131-iodine with 111-In-pentetreotide scans in 24 patients with metastasizing, non-medullary thyroid cancer. The findings were correlated with other imaging modalities. Additionally, we performed receptor autoradiography in one patient, octreotide therapy in another patient and administration of 90-Y- and 111-In-DOTATOC in 2 consecutive patients. Results: In the 15 patients with papillary or follicular carcinoma, 111-In-pentetreotide was inferior to 131-I in 8/15, equal in 1/15, and superior in 6/15 patients. In 8/9 of the patients with Huerthle cell cacinoma, metastases showed a 111-In-pentetreotide accumulation of various intensity, while 131-iodine scans were negative except for one patient. 111-In-pentetreotide was equal or superior compared to 201-Tl or 99m-Tc-sestamibi, but for the most part inferior in comparison with 18-F-FDG-PET. The findings of 111-In-pentetreotide scintigraphy correlated well with the receptor autoradiography and the accumulation of DOTATOC, but not with the therapeutic effect of `cold` octreotide on the thyroid cancer metastases. Conclusions: Several metastases of papillary and follicular carcinoma, and the majority of Huerthle cell cancer metastases can express somatostatin receptors. 111-In-pentetreotide scintigraphy is a promising tool for localization of metastases especially in Huerthle cell cancer or if PET is not available, and may be useful for selection of possible candidates, if therapeutic effective {beta}-emitting somatostatin analogues will be available for routine application. (orig.) [Deutsch] Ziel: in aktuellen In-vitro und In-vivo-Untersuchungen wurde eine Somatostatinrezeptor-Expression bei einigen nicht

Retroperitoneal relapse of non-seminomatous testicular cancer: computed tomography findings before retroperitoneal lymphadenectomy; Retroperitoneale Rezidive nicht-seminomatoeser Hodentumoren: Computertomographische Befunde vor retroperitonealer Lymphadenektomie

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Hosten, N.; Stroszczynski, C.; Lemke, M.; Felix, R. [Strahlenklinik und Poliklinik, Charite Campus Virchow, Humboldt Univ. zu Berlin (Germany); Rick, O. [Abt. Innere Medizin mit Schwerpunkt Haematologie/Onkologie, Charite Campus Virchow, Humboldt Univ. zu Berlin (Germany)

1999-01-01

Purpose: In relapsing testicular cancer, additional chemotherapy is followed by abdominal CT. If residual lesions are found, retroperitoneal lymphadenectomy is considered. We studied retrospectively whether morphological criteria can help in selected cases in deciding about lymphadenectomy by distinguishing between vital tumor, scarring and mature teratoma. Methods: In 26 patients who had been treated by salvage chemotherapy and retroperitoneal lymphadenectomy for non-seminomatous testicular cancer between 1990 and 1997, abdominal computed tomography and histology were correlated. Results: Histological examination found scarring in 10 patients, vital tumor in 6, mature teratoma in 4, and simultaneous teratoma and vital tumor in 6. A single CT criterion for distinguishing between these histologies was not identified. In two patients with large masses which were partly cystic and partly solid vital tumor and teratoma were verified. Scarrings may be expected in cystic lesions at the level of the renal hilus which are lined by a thin and smooth wall. Size did not matter. Conclusion: Accurate differentiation between vital tumor and necrosis was not possible. Before lymphadenectomy CT, however, localised lesions. (orig.) [Deutsch] Ziel: Bei Patienten mit rezidivierten Hodentumoren wird nach erneuter Chemotherapie die abdominelle CT durchgefuehrt. Wenn verbliebene Raumforderungen nachgewiesen werden, wird eine retroperitoneale Lymphadenektomie in Betracht gezogen. Untersucht wurde, ob der Bildbefund Hinweise auf das Vorliegen von vitalem Tumor, Nekrose bzw. Narbe oder reifem Teratom geben kann, die in Einzelfaellen zur Indikationsstellung herangezogen werden koennten. Methoden: Bei 26 Patienten, die wegen eines rezidivierten nicht-seminomatoesen Hodentumors in den Jahren 1990 bis 1997 einer erneuten Chemotherapie mit anschliessender retroperitonealer Lymphadenektomie von Tumorresten unterzogen worden waren, wurden abdominelle CT und Histologie korreliert. Ergebnisse: Die

Focal breast lesions in clinical CT examinations of the chest. A retrospective analysis; Senologische Befunde bei CT-Untersuchungen des Thorax. Eine retrospektive Auswertung

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Krug, Kathrin Barbara; Houbois, Christian; Grinstein, Olga; Borggrefe, Jan; Puesken, Michael; Maintz, David [Cologne Univ. Medical School, Cologne (Germany). Dept. of Diagnostical and Interventional Radiology; Hanstein, Bettina; Malter, Wolfram [Cologne Univ. Medical School, Cologne (Germany). Breast Center and Dept. of Obstetrics and Gynecology; Hellmich, Martin [Cologne Univ. (Germany). Inst. of Medical Statistics, Informatics and Epidemiology

2017-10-15

Based on radiological reports, the percentage of breast cancers visualized as incidental findings in routine CT examinations is estimated at ≤2%. In view of the rising number of CT examinations and the high prevalence of breast cancer, it was the goal of the present study to verify the frequency and image morphology of false-negative senological CT findings. All first contrast-enhanced CT examinations of the chest in adult female patients carried out in 2012 were retrospectively included. A senior radiologist systematically assessed the presence of breast lesions on all CT images using the BI-RADS system. All BI-RADS ≥3 notations were evaluated by a second senior radiologist. A consensus was obtained in case of differing BI-RADS assessments. Reference diagnoses were elaborated based on all available clinical, radiological and pathological data. The findings of the CT reports were classified according to the BI-RADS system and were compared with the retrospective consensus findings as well as with the reference diagnoses. The range of indications comprised a broad spectrum including staging and follow-up examinations of solid tumors/lymphoma (N = 701, 59.9 %) and vascular (190, 16.2 %), inflammatory (48, 4.1 %) and pulmonologic (22, 1.9 %) issues. BI-RADS 1/2 classifications were present in 92.5 % and BI-RADS 6 classifications were assessed in 1.7 % of the 1170 included examinations. 68 patients (5.8 %) had at least one lesion retrospectively classified as BI-RADS 3 - 5. The histological potential was known in 57 of these lesions as benign (46, 3.9 %) or malignant (11, 0.9 %). 13 BI-RADS 4/5 consensus assessments (1.1 %) were false-positive. 2 of the 10 lesions classified as being malignant based on the further clinical and radiological course were not mentioned in the written CT reports (0.2 %). Both false-negative CT reports were therapeutically and prognostically irrelevant. The relative frequency of BI-RADS 3 - 5 findings was 5.8 %. It reflects the situation

MRI for therapy control in patients with aortic isthmus stenosis; MRT zur Therapiekontrolle bei Patienten mit Aortenisthmusstenose

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Wintersperger, B.J. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Toronto General Hospital, University of Toronto, Department of Medical Imaging, University Health Network, Toronto M5G 2N2 (Canada); Theisen, D.; Reiser, M.F. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany)

2011-01-15

Aortic isthmus stenosis is the most common congenital aortic anomaly and is often a problem for therapy surveillance. In addition to possible comorbidities (e.g. bicuspid aortic valve) it is accompanied by various middle and long-term complications depending on the primary choice of the therapeutic procedure. Magnetic resonance imaging (MRI) plays an important role for the mostly young patients in the control of the aortic isthmus stenosis and therapy because it is non-invasive and there is no X-ray exposure. Radiologists should be well-informed on the principles of the therapeutic procedure in order to be competent in the interpretation of MRI findings. Due to the continuous development of MRI technology, techniques for functional evaluation (e.g. dynamic MRA, 4D PC flow measurement) are increasingly becoming available in addition to high-resolution MR angiography (MRA), which could predict the risk of possible complications, such as aneurysms. However, in this aspect further studies are necessary. Interventional therapy with stents and stent grafts is often employed for the therapy of possible complications following an operation (aneurysms, restenosis) but because of massive metal artefacts the use of MRI is often sometimes severely limited. (orig.) [German] Die Aortenisthmusstenose als haeufigste angeborene Aortenanomalie stellt ein haeufiges Problem der Therapieueberwachung dar und ist neben moeglichen begleitenden Anomalien (z. B. bikuspidale Aortenklappe) in Abhaengigkeit vom primaer gewaehlten Therapieverfahren mit verschiedenen Komplikationen im mittel- bis laengerfristigem Verlauf vergesellschaftet. Bei der Kontrolle der Aortenisthmusstenose bzw. deren Therapie spielt die Magnetresonanztomographie (MRT) aufgrund der Nichtinvasivitaet und fehlenden Strahlenexposition bei den meist juengeren Patienten eine wichtige Rolle. Der Radiologe sollte ueber die Grundzuege der Therapieverfahren informiert sein, um die MRT-Befunde kompetent zu befunden. Durch stetige

Long term results of surgery in Perthes disease: Comparison of X-ray and MR-studies; Spaetergebnisse nach operativer Behandlung des Morbus Perthes: Vergleich der roentgenologischen und kernspintomographischen Untersuchung

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Tosch, U. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Berlin (Germany); Sparmann, M. [Orthopaedische Klinik im Oskar-Helene-Heim, Berlin (Germany); Stelling, E. [Orthopaedische Klinik im Oskar-Helene-Heim, Berlin (Germany); Tomala, D. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Berlin (Germany)

1995-05-01

Twenty patients treated by surgery for Perthes` disease were studied between 4 and 9 years postoperatively. In the clinical investigation eight patients complained of persistent stress-induced pain. In nine patients flexion, extension, ab- and adduction of the hip joint was limited. In the MRI-Study of ten hip joints a reduction of fatty marrow was seen in the femoral head. In 11 hip joints of patients complaining of persistent pain, a deformation of the femoral head (n = 2), a dysplasia of the femoral metaphysis (n = 2), and diaphysis (n = 4) or both (n = 2) were seen. In another five patients an additional dysplasia of the acetabulum was visualized. All these findings were diagnosed by X-ray studies as well. However, only by MRI were the extents of the postoperative defects of femoral spongiosa diagnosed in fifteen hip joints. (orig.) [Deutsch] 20 wegen eines Morbus Perthes operierte Patienten wurden 4-9 Jahre nach einer Umstellungsosteotomie klinisch, radiologisch und kernspintomographisch untersucht. Bei der klinischen Nachuntersuchung gaben 8 Patienten persistierende Beschwerden bei Belastung an. Bei der koerperlichen Untersuchung war die Flexion und Extension bei 9 sowie die Abduktion und Adduktion bei einem Patienten eingeschraenkt. Bei der kernspintomographischen Untersuchung liessen sich bei 10 Hueftgelenken Residuen des M. Perthes im Fettmark des Femurkopfs nachweisen. An 11 Hueftkoepfen wurden pathologische Veraenderungen wie eine Femurkopfentrundung (n = 2), eine Deformierung der Femurmeta- (n = 3) und -diaphyse (n = 4) bis hin zur hirtenstabfoermigen Konfiguration (n = 2) nachgewiesen. Bei 5 Patienten wurde eine Pfannendysplasie gefunden. Diese Befunde waren auch roentgenologisch darzustellen. Als postoperative Defekte waren im Schaftmark des Femurs eine langstreckige Hoehlenbildung mit Zysten oder durch Fettmark aufgefuellte Spongiosadefekte bei 15 Hueftgelenken nur kernspintomographisch nachweisbar. (orig.)

HRCT of the lung in collagen vascular diseases; HRCT der Lunge bei Kollagenosen

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Diederich, S. [Inst. fuer Klinische Radiologie, Westfaelische Wilhelms-Univ., Muenster (Germany); Roos, N. [Inst. fuer Klinische Radiologie, Westfaelische Wilhelms-Univ., Muenster (Germany); Schmitz-Linneweber, B. [Medizinische Klinik B, Westfaelische Wilhelms-Univ., Muenster (Germany); Gaubitz, M. [Medizinische Klinik B, Westfaelische Wilhelms-Univ., Muenster (Germany); Peters, P.E. [Inst. fuer Klinische Radiologie, Westfaelische Wilhelms-Univ., Muenster (Germany)

1996-07-01

Collagen vascular diseases, representing systemic soft tissue disorders, may cause a broad spectrum of pathologic changes of the respiratory tract. The type and extent of manifestations can vary considerably among individuals and entities. This survey describes the chest radiographic and, in particular, high-resolution computed tomographic and, in particular, high-resolution computed tomographic (HRCT) findings of individual lesions of the respiratory tract. It includes fibrosing alveolitis (alveolitis, interstitial pneumonia, pulmonary fibrosis) and bronchial (bronchitis/bronchiolitis, bronchiectasis), pleural and vascular manifestations, as well as lymphadenopathy and abnormalities related to therapy. We present typical patterns of changes in progressive systemic sclerosis (PSS, scleroderma), systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD, Sharp syndrome), Sjoegren syndrome, overlap syndrome and rheumatoid arthritis (RA). Furthermore, we describe findings which are specific for individual entities such as esophageal involvement in PSS, acute pneumonitis and pulmonary hemorrhage in SLE, lymphoproliferative disease in Sjoegren syndrome and necrobiotic nodules in RA. (orig.) [Deutsch] Die Kollagenosen koennen als systemische Bindegewebserkrankungen auch zu einem breiten Spektrum pathologischer Veraenderungen am Respirationstrakt fuehren, wobei sich Art und Ausmass der Manifestationen innerhalb einzelner Entitaeten und zwischen verschiedenen Krankheitsbildern erheblich unterscheiden koennen. In der vorliegenden Uebersicht werden die entsprechenden Befunde von Thoraxuebersichtsaufnahme und insbesondere hochaufloesender Computertomographie (HRCT) beschrieben. Beruecksichtigt werden dabei die fibrosierende Alveolitis (Alveolitis, interstitielle Pneumonie, Lungenfibrose), bronchiale (Bronchitis/Bronchiolitis, Bronchiektasen), pleurale und vaskulaere Manifestationen sowie Lymphadenopathie und therapie-induzierte Befunde. Typische Befundmuster

Interventional diagnostic breast procedures; Diagnostische Mammainterventionen

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Bick, U. [Inst. fuer Radiologie, Universitaetsklinikum Charite, Berlin (Germany); Dept. of Radiology, The Univ. of Chicago (United States); Diekmann, S.; Diekmann, F. [Inst. fuer Radiologie, Universitaetsklinikum Charite, Berlin (Germany)

2001-09-01

The comprehensive survey describes in great detail the indications, performance, and advantages and drawbacks of the various biopsy and localization techniques available today for interventional diagnostic evaluation of lesions of the breast. (orig./CB) [German] Die Feinnadelaspirationszytologie ist einfach und rasch durchfuehrbar, ist jedoch insbesondere in der Hand von unerfahrenen Untersuchern mit einer relativ hohen Rate von nicht auswertbaren und falsch-negativen Befunden verbunden. Das Verfahren wird am haeufigsten bei soliden oder zystischen Herdbefunden eingesetzt, die palpabel oder sonographisch nachweisbar sind. Bei inadaequatem Zellmaterial muss eine erneute Biopsie, ggf. mit einem anderen Verfahren, erfolgen. Die Nadelstanzbiopsie ist heutzutage das Verfahren der Wahl bei mammographisch oder sonographisch sichtbaren soliden Herdbefunden. Das Verfahren ist einfach und kostenguenstig durchfuehrbar und weist bei soliden Herdbefunden eine extrem hohe Sensitivitaet und Spezifitaet auf. Bei Mikroverkalkungen sollten immer ausreichend viele Stanzen (5 und mehr) entnommen werden. Bei Stanzbiopsien besteht grundsaetzlich die Gefahr einer Unterschaetzung des histologischen Befundes (ADH statt DCIS, in situ statt invasiv). Bei Diagnose ADH in der Stanzbiopsie sollte eine Exzision des Befundes erfolgen. Die vakuumassistierte Stanzbiopsie ist besonders beeignet zur Biopsie von unklaren Mikroverkalkungen, da durch die groessere entnommene Gewebemenge eine hoehere Spezifitaet und Sensitivitaet erreicht werden kann. Fuer MR-gesteuerte Biopsien hat dieses Verfahren den Vorteil, dass die Nadel nur einmal platziert werden muss. Die stereotaktische Exzisionsbiopsie ist ein relativ teures und invasives Verfahren, das insbesondere zur diagnostischen Abklaerung von unklaren Mikroverkalkungen eingesetzt wird. Hierbei steht das Verfahren in direkter Konkurrenz zur vakuumassistierten Stanzbiopsie. Inwieweit es fuer die stereotaktische Exzisionsbiopsie wirklich ein

Floating venous thrombi: diagnosis with spiral-CT-venography; Diagnose flottierender venoeser Thromben mittels Phlebo-Spiral-CT

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Gartenschlaeger, M. [Mainz Univ. (Germany). Klinik fuer Radiologie; Klose, K.J. [Univ. Marburg, Medizinisches Zentrum fuer Innere Medizin, Abt. Poliklinik (Germany); Schmidt, J.A. [Univ. Marburg, Medizinisches Zentrum fuer Radiologie, Abt. fuer Strahlendiagnostik (Germany)

1996-05-01

Local application of contrast agent into an ipsilateral dorsal foot vein and spiral CT were used to examine 16 consecutive cases with deep venous thrombosis proven at conventional venography; in addition, colour Doppler flow imaging was performed. At conventional venography, 8/16 thrombi appeared to be floating and the remaining 8/16 were adherent to the vessel wall. Spiral-CT showed 15/16 thrombi to be adherent to the vessel wall; the floating thrombus correlated with findings in conventional venography. At colour Doppler flow imaging 3/16 thrombi were considered floating, one of them was discordant to conventional venography. The comparison of conventional venography to spiral-CT demonstrates complete agreement for adherence to vessel wall seen in conventional venography (p=1,0) and significant discordance in cases with free-floating appearance in conventional venography. Adherence of thrombi to the wall of the vessel at conventional venography is in agreement with computed tomography. Conventional venography probably overestimates the prevalence of free floating thrombi. (orig./MG) [Deutsch] Mittels lokaler Kontrastmittelapplikation in eine ipsilaterale Fussrueckenvene und Spiral-CT wurden 16 konsekutive Faelle konventionell phlebographisch gesicherter Phlebothrombose untersucht, zusaetzlich wurde die farbkodierte Doppler-Ultraschalluntersuchung durchgefuehrt. In der konventionellen Phlebographie waren 8/16 Thromben flottierend, die uebrigen 8/16 wandadhaerent. In der Spiral-CT zeigten sich Wandadhaerenzen in 15/16 Faellen; der nachgewiesene flottierende Thrombus stimmte mit der konventionellen Phlebographie ueberein. Im farbkodierten Doppler-Ultraschall erschienen die Thromben in 3/16 Faellen flottierend, darunter ein von der konventionellen Phlebographie abweichender Befund. Der Vergleich von konventioneller und CT-Phlebographie ergab eine komplette Uebereinstimmung fuer konventionell phlebographisch nachgewiesene Wandadhaerenz und eine signifikante Abweichung

Diagnostic imaging in child abuse; Bildgebende Diagnostik der Kindesmisshandlung

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Stoever, B. [Charite, Campus Virchow-Klinikum, Universitaetsmedizin Berlin, Abteilung Paediatrische Radiologie, CC6, Diagnostische und interventionelle Radiologie und Nuklearmedizin, Berlin (Germany)

2007-11-15

Diagnostic imaging in child abuse plays an important role and includes the depiction of skeletal injuries, soft tissue lesions, visceral injuries in 'battered child syndrome' and brain injuries in 'shaken baby syndrome'. The use of appropriate imaging modalities allows specific fractures to be detected, skeletal lesions to be dated and the underlying mechanism of the lesion to be described. The imaging results must be taken into account when assessing the clinical history, clinical findings and differential diagnoses. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations must be performed in order to detect lesions of the central nervous system (CNS) immediately. CT is necessary in the initial diagnosis to delineate oedema and haemorrhages. Early detection of brain injuries in children with severe neurological symptoms can prevent serious late sequelae. MRI is performed in follow-up investigations and is used to describe residual lesions, including parenchymal findings. (orig.) [German] In der Diagnostik der Kindesmisshandlung ist die Bildgebung ein wesentlicher Faktor. Trotz scheinbar leerer Anamnese gelingt es, typische Verletzungsmuster als Misshandlungsfolge zu erkennen, sowohl im Bereich des Skeletts, der Weichteile, des Abdomens ('battered child syndrome', heute: 'non accidental injury', NAI) als auch im ZNS ('shaken baby syndrome'). Den klinischen Symptomen entsprechend, wird im Verdachtsfall ein adaequates diagnostisches Verfahren eingesetzt, das erwartete charakteristische Befunde nachweist, den Mechanismus der Verletzung aufzeigt und das Alter der Laesionen annaehernd festlegt. Radiologische Skelettbefunde werden hinsichtlich ihrer Spezifitaet fuer eine Misshandlung bewertet. Alle Resultate der Bildgebung sind zusammen mit Anamnese und klinischen Befunden zu deuten. Bei schwerer Misshandlung ohne aeussere Verletzungszeichen ist das rechtzeitige Erfassen einer ZNS

Dem Sog der Arbeit widerstehen. Leben im egalitären Modell

Directory of Open Access Journals (Sweden)

Aschermann Ellen

2007-07-01

Full Text Available Die Autorinnen untersuchen die Einschätzungen von deutschschweizer Ehepaaren und ihren heranwachsenden Kindern zum Leben in einem egalitären Familienmodell. Die Längsschnittstudie umfasst dabei einen Zeitraum von 10 Jahren. In halbstrukturierten Interviews werden die Veränderungen in der Organisation in Arbeits-, Haushalts- und Familienbereich erhoben und mittels qualitativer Analyse strukturiert. Der erste Band enthält die theoretischen Grundlagen und die Befunde zu den Veränderungen bei den Eltern. Im zweiten Band wird auf die Erfahrungen der Kinder eingegangen, die in diesen Familien aufwuchsen. Auch sie wurden mit halbstrukturierten Interviews befragt. Zusätzlich wird die Kinderperspektive mit einer stärker traditionell aufwachsenden Kontrollgruppe verglichen.

MR arthrography of the shoulder: possible indications for clinical use; Einsatzmoeglichkeiten der MR-Arthrographie bei Erkrankungen des Schultergelenkes

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Kreitner, K.F. [Mainz Univ. (Germany). Klinik mit Poliklinik fuer Radiologie; Grebe, P. [Mainz Univ. (Germany). Klinik mit Poliklinik fuer Radiologie; Kersjes, W. [Mainz Univ. (Germany). Klinik mit Poliklinik fuer Radiologie; Runkel, M. [Mainz Univ. (Germany). Klinik fuer Unfallchirurgie; Kirschner, P. [Elisabeth-Hospital, Mainz (Germany). Abt. fuer Unfall- und Wiederherstellungschirurgie St. Vincenz; Schild, H.H. [Mainz Univ. (Germany). Klinik mit Poliklinik fuer Radiologie

1994-02-01

In a prospective study possible indications for MR arthrography of the shoulder were evaluated. 37 patients were examined before and after intraarticular administration of a 2-mmolar solution of Gd-DTPA. MR arthrography was performed if there was no joint effusion and/or an uncertain finding concerning the rotator cuff or the capsulolabral complex on plain MR images. MR arthrography leads to a better demonstration of labrum pathology in 11/22 patients and to a superior delineation of the capsuloligamentous apparatus in 20/22 cases. In 9/15 patients with impingement lesions MR arthrography allowed a differentiation of severe tendinitis from partial and small full-thickness tears of the rotator cuff. MR arthrography of the shoulder joint enhances the accuracy of MR in case of an uncertain finding on plain MR images. (orig.) [Deutsch] In einer prospektiven Studie sollten Einsatzmoeglichkeiten der MR-Arthrographie bei Erkrankungen des Schultergelenkes herausgearbeitet werden. 37 Patienten wurden sowohl nativ als auch nach intraartikulaerer Gabe einer 2mmolaren Gd-DTPA-Loesung untersucht. Voraussetzungen fuer die KM-Gabe waren ein fehlender Gelenkerguss und/oder ein unklarer Befund des Labrum-Kapsel-Komplexes oder der Rotatorenmanschette in der Nativuntersuchung. Durch die MR-Arthrographie wurde bei 11/22 Patienten eine verbesserte Darstellung der Labrumpathologie erzielt; in 20/22 Faellen ergabe sich eine zuverlaessige Beurteilung der Gelenkkapsel. Bei 9/15 Patienten mit Erkrankungen der Rotatorenmanschette konnten Tendinitiden von partiellen und kleinen kompletten Rotatorenmanschettenrupturen sicher differenziert werden. Die MR-Arthrographie des Schultergelenkes fuehrt bei nicht eindeutigen Befunden in der Nativuntersuchung zu einer verbesserten Treffsicherheit der MR-Diagnostik. (orig.)

3D MRI of the colon: methods and first results of 5 patients; 3D-MRT des Kolons: Methodik und erste Ergebnisse

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Luboldt, W; Bauerfeind, P; Pelkonen, P; Steiner, P; Krestin, G P; Debatin, J F [MRI-Zentrum, Dept. Diagnostische Radiologie, Universitaetsspital, Zurich (Switzerland)

1997-09-01

Purpose: `Exoscopic` and endoscopic identification of colorectal pathologies via MRI. Methods: 5 patients (36-88 years), two normal and three with different colorectal pathologies (diverticular disease, polyps and carcinoma of the colon), were examined by MRI after colonoscopy. Subsequent to filling of the colon with a gadolinium-water mixture under MRI-monitoring, 3D-data sets of the colon were acquired in prone and supine positions over a 28 sec breathold interval. Subsequently multiplanar T{sub 1}-weighted 2D-sequences were acquired before and following i.v. administration of Gd-DTPA (0.1 mmol/kg BW). All imaging was performed in the coronal orientation. The 3D-data were interactively analysed based on various displays: Maximum intensity projection (MIP), surface shadowed display (SSD), multiplanar reconstruction (MPR), virtual colonoscopy (VC). Results: All of the colorectal pathologies could be interactively diagnosed by MPR. On MIP images some pathologies were missed. VC presented the morphology of colon haustra as well as of all endoluminally growing lesions in a manner similar to endoscopy. The colon masses showed uptake of contrast media and could thus be differentiated from air or faeces. (orig./AJ) [Deutsch] Ziel: Externe und endoskopische Identifizierung kolorektaler Pathologien mittels MRT. Material und Methoden: 5 Patienten (36-88 Jahre), zwei mit Normalbefund, drei mit verschiedenen kolorektalen pathologischen Befunden (Divertikulose, Polypen, Karzinom), wurden nach der Kolonoskopie mit der MRT untersucht. Dazu wurde das Kolon unter MR-Sichtkontrolle mit einer Gadolinium-Wasser-Mischung gefuellt und als 3D-Datensatz atemangehalten in Bauch- und Rueckenlage aufgenommen. Anschliessend wurden multiplanare, T{sub 1}-gewichtete 2D-Sequenzen vor und nach i.v. Gd-DTPA-Gabe akquiriert. Die 3D-Datensaetze wurden interaktiv unter Zuhilfenahme verschiedener Darstellungsformen analysiert: Maximale Intensitaetsprojektion (MIP), Oberflaechendarstellung

Osteonecrosis - A rare complication of HIV infection. Association with numerous risk factors; Osteonekrose: eine seltene Komplikation der HIV-Infektion. Assoziation mit bestimmten Risikofaktoren

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Meyer, D.; Behrens, G.; Stoll, M.; Schmidt, R.E. [Medizinische Hochschule Hannover (Germany). Abt. Klinische Immunologie

2000-03-13

Osteonecrosis is a rare complication of HIV infection. The presumptive cause of the aseptic osteonecrosis is a distrubed blood supply to the bone. Most cases of osteonecrosis are associated with numerous risk factors, such as use of steroids, alcohol abuse, coagulopathies or metabolic derangements. Since conventional X-rays appear unremarkable, early forms often go unrecognized or are diagnosed late. Methods of establishing the diagnosis are MRI and three-phase skeletal scintigraphy. The pathogenesis of osteonecrosis in HIV infection is unclear. So far, about 30 cases have been reported in the literature. We would recommend that in HIV patients with typical symptoms - in particular when classical risk factors are present - osteonecrosis be included in the differential diagnostic considerations. (orig.) [German] Die Osteonekrose ist eine seltene Komplikation der HIV-Infektion. Als Ursache werden Stoerungen in der Gefaessversorgung des Knochengewebes angenommen. Aufgrund unauffaelliger Befunde im konventionellen Roentgen werden Fruehformen haeufig verkannt oder erst verspaetet diagnostiziert. Methoden zur Diagnosesicherung sind die Kernspintomographie oder die 3-Phasen-Knochenszintigraphie. Die Pathogenese der Osteonekrose bei der HIV-Infektion ist unklar. Bisher sind in der Literatur etwa 30 Kasuistiken beschrieben. Wir empfehlen, bei Vorliegen einer typischen Symptomatik bei HIV-Patienten - insbesondere wenn typische Risikofaktoren vorliegen - die Osteonekrose in die differenzialdiagnostischen Ueberlegungen mit einzubeziehen. (orig.)

Radiological diagnosis of pulmonary metastases: imaging findings and diagnostic accuracy; Bildgebende Diagnose und Differenzialdiagnose von Lungenmetastasen

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Diederich, S. [Institut fuer Diagnostische und Interventionelle Radiologie/Nuklearmedizin, Marienhospital Duesseldorf (Germany)

2004-07-01

Pulmonary metastases typically present as mostly multiple and bilateral, well-defined, non-calcified pulmonary nodules with predominantly basal and peripheral location. Ill-defined, cavitating, calcified and endobronchial metastases are uncommon. In the absence of pathognomonic findings precise differentiation from other - even benign - pulmonary nodules is almost impossible. Demonstration of contrast enhancement at CT or MRI or evidence of growth at serial examinations support the diagnosis of pulmonary metastases. In uncertain cases percutaneous fine-needle aspiration or cutting needle biopsy will allow diagnosis with acceptable risk of complications and patient discomfort. The only relatively common complication of pneumothorax can and should be controlled by the interventional radiologist by aspiration or drainage. (orig.) [German] Lungenmetastasen stellen sich bildgebend typischerweise als meist multiple und bilaterale, scharf begrenzte weichteildichte Lungenrundherde mit basal und peripher betonter Lokalisation dar. Unscharfe Begrenzung, Einschmelzungen, Verkalkungen oder endobronchiale Lage sind selten. Aufgrund fehlender pathognomonischer Befunde ist eine eindeutige differenzialdiagnostische Abgrenzung von anderen - auch benignen - Lungenrundherden jedoch kaum moeglich. Der computertomographische oder magnetresonanztomographische Nachweis einer Kontrastmittelaufnahme oder von Wachstum in Verlaufsuntersuchungen unterstuetzt die Diagnose. In Zweifelsfaellen fuehrt die perkutane Biopsie als Feinnadelaspiration oder Stanzbiopsie bei vertretbarer Belastung des Patienten meist zur Diagnose. Die einzige relativ haeufige Nebenwirkung - der postpunktionelle Pneumothorax - kann und sollte vom interventionellen Radiologen durch Aspiration oder Katheterdrainage selbst therapiert werden. (orig.)

MR-Venography Using High Resolution True-FISP

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Spuentrup, E. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik; Beth Israel Deaconess Medical Center, Boston, MA (United States). Dept. of Medicine; Harvard Medical School, Boston, MA (United States); Buecker, A.; Guenther, R.W. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik; Stuber, M. [Beth Israel Deaconess Medical Center, Boston, MA (United States). Dept. of Medicine; Harvard Medical School, Boston, MA (United States); Philips Med. Syst., Best (Netherlands)

2001-08-01

A new fast MR-venography approach using a high resolution True-FISP imaging sequence was investigated in 20 patients suffering from 23 deep vein thromboses. Diagnosis was proven by X-ray venography, CT or ultrasound examination. The presented technique allowed for clear thrombus visualization with a high contrast to the surrounding blood pool even in calf veins. Acquisition time was less than 10 minutes for imaging the pelvis and the legs. No contrast media was needed. The presented high resolution True-FISP MR-veography is a promising non-invasive, fast MR-venography approach for detection of deep venous thrombosis. (orig.) [German] Eine neue schnelle, oertlich hochaufgeloeste MR-Phlebographietechnik mit einer axialen True-FISP Bildgebungssequenz wurde an 20 Patienten mit 23 nach-gewiesenen tiefen Beinvenenthrombosen untersucht. Die Befunde wurden mit einer konventionellen Roentgenphlebographie, einer CT oder einer Sonographie gesichert. Die vorgestellte Technik erlaubte in allen Faellen eine Thrombusdarstellung mit hohem Kontrast zum umgebenden venoesen Blut, wobei aufgrund der hohen Ortsaufloesung auch die Unterschenkelvenen beurteilt werden konnten. Die Datenaufnahmezeit zur Untersuchung des Beckens und der Beine betrug weniger als 10 Minuten. Kontrastmittel wurde nicht benoetigt. Die vorgestellte MR-Phlebographietechnik unter Verwendung einer oertlich hochauf-geloesten True-FISP Sequenz ist eine neue, vielversprechende, nicht-invasive Technik zur Diagnostik der tiefen Bein- und Beckenvenenthrombose. (orig.)

Prevalence of iodine- and thyroglobulin-negative findings in differentiated thyroid cancer. A retrospective analysis of patients treated from 1961 to 1998 in a university hospital; Haeufigkeit lod- und hTG-negativer Befunde beim differenzierten Schilddruesenkarzinom. Eine retrospektive Analyse der von 1961 bis 1998 in einer Universitaetsklinik behandelten Patienten

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Klutmann, S.; Jenicke, L.; Geiss-Toenshoff, M.; Bohuslavizki, K.H.; Mester, J.; Clausen, M. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin

2001-10-01

Aim: The prevalence of iodine- and thyroglobulin-negative findings was evaluated in all patients with differentiated thyroid cancer (DTC) treated from 1961 until 1998 at the Department of Nuclear Medicine, University Hospital Hamburg-Eppendorf. Methods: A total of 490 patients with papillary thyroid cancer (PCA) and 242 patients with follicular thyroid cancer (FCA) were analyzed retrospectively. Patients were divided into four groups: 1: no recurrence, 2: recurrent disease, 3: primary metastatic/progressive disease and 4: inconclusive follow-up. Results of iodine scan, serum-TG, and additional imaging modalities as well as histology were compared in all patients. Results: 21/490 (4,3%) of patients with PCA and 16/242 (6,6%) with FCA suffered from recurrent disease. 62/490 (12,7%) of patients with PCA and 59/242 (24,4%) with FCA had primary metastatic/progressive disease. 12/21 patients with PCA and 12/16 with FCA showing up with recurrent disease had a negative iodinescan. 11/21 of patients with PCA and 4/16 with FCA and tumor recurrence had negative serum-TG levels. 14/62 patients with PCA and 14/59 with FCA presenting with primary metastatic/progressive disease had negative iodinescan. 14/62 patients with PCA and 6/59 with FCA had negative serum-TG. Conclusion: The prevalence of iodine-negative recurrent/metastatic disease is in accordance to the literature, whereas the prevalence of TG-negative recurrent/metastatic was noted higher than reported previously. Thus, the commonly used follow-up scheme of DTC is confirmed. However, iodine scan should be regularly performed in patients with high risk of recurrence. (orig.) [German] Ziel: Retrospektiv wurden alle von 1961 bis 1998 in der Abteilung fuer Nukleamedizin des Universitaetsklinikums Hamburg-Eppendorf behandelten Patienten mit einem differenzierten Schilddruesenkarzinom bezueglich des Anteils lod- und/oder hTG-negativer Rezidive analysiert. Methoden: Es wurden 490 Patienten mit einem papillaeren

Imaging diagnostics of breast metastases from extramammary tumors; Bildgebende Diagnostik bei Brustmetastasen extramammaerer Tumoren

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Wienbeck, S.; Lotz, J. [Georg-August-Universitaet Goettingen, Institut fuer Diagnostische und Interventionelle Radiologie, Goettingen (Germany); Nemat, S. [Universitaet Homburg/Saar, Institut fuer Diagnostische und Interventionelle Radiologie, Homburg/Saar (Germany); Surov, A. [Universitaet Leipzig, Institut fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany)

2017-06-15

Breast metastases of solid extramammary tumors are very rare in comparison to primary malignancies of the breast and account for only 0.33-6.3% of all malignant neoplasms of the breast. The most common primary tumors are malignant melanoma, distant sarcomas, lung cancer, ovarian cancer, renal cell cancer and thyroid cancer in decreasing order of frequency. This review article summarizes the clinical features and the different imaging findings of breast metastases from different extramammary solid tumors. Breast metastases are often incidental findings in computed tomography (CT) or positron emission tomography CT (PET-CT) imaging. Mammography shows two different imaging patterns, namely focal lesions and diffuse architectural distortion with skin thickening. Breast metastases presenting as focal masses usually occur as solitary and more rarely as multiple round lesions with a smooth edge boundary. Associated calcifications are rare findings. Diffuse architectural distortion with skin thickening is more common in breast metastases from most gastric tumors, ovarian cancer and rhabdomyosarcoma. Using ultrasound most lesions are hypoechoic, oval or round with smooth boundaries and posterior acoustic enhancement. The magnetic resonance imaging (MRI) criteria of breast metastases show an inconstant signal behavior that cannot be safely classified as benign or malignant. In summary, in patients with known malignancies the presence of breast metastases should be considered even with imposing clinically and radiologically benign findings. (orig.) [German] Brustmetastasen solider extramammaerer Tumoren sind im Vergleich zu primaeren Malignomen der Brust mit einer Praevalenz von 0,33-6,3 % aller boesartigen Neubildungen in der Brust sehr selten. Die haeufigsten Primaertumoren sind dabei das maligne Melanom, ferner Sarkome, Bronchial-, Ovarial-, Nierenzell- und Schilddruesenkarzinome mit einer absteigenden Haeufigkeit ihres Auftretens. In dieser Uebersichtsarbeit werden die

CT findings in acute small bowel diverticulitis; Computertomographie bei akuter Duenndarmdivertikulitis

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Ferstl, F.J.; Obert, R. [Radiologisch-Nuklearmedizinisches Zentrum (RNZ) am St. Theresienkrankenhaus Nuernberg (Germany)

2004-02-01

Small bowel diverticulitis is a rare cause of an acute abdomen. Originating from acquired diverticula of the jejunum, less often of the ileum, or Meckel diverticulum, the symptoms are non-specific, simulating other acute inflammatory disorders, such as appendicitis, cholecystitis or colonic diverticulitis. The diagnosis of small bowel diverticulitis is solely based on radiologic findings, with computed tomography (CT) regarded as the method of choice. In recent years, a number of case reports have described the spectrum of the CT features in acute small bowel diverticulitis and its dependence on the severity of the inflammatory process. Typical findings are an inflamed diverticulum, inflammatory mesenteric infiltration, extraluminal gas collection and mural edema of adjacent small bowel loops with resultant separation of bowel loops. An enterolith is rarely found in an inflamed diverticulum. Complications include abscesses, fistulae, small bowel obstruction and free perforation with peritonitis. Small bowel diverticulitis can be a diagnostic problem if it involves the terminal ileum or Meckel's diverticulum. For preoperative confirmation of the presumed diagnosis of small bowel diverticulitis on CT, an enteroclysis for acquired diverticula or a technetium scan for Meckel's diverticulum should be performed. We present the CT findings in three patients of acute small bowel diverticulitis, two affecting the jejunum and one a Meckel's diverticulum. (orig.) [German] Die akute Duenndarmdivertikulitis ist eine seltene Ursache eines akuten Abdomens. Ausgehend von den erworbenen Divertikeln des Jejunums, seltener des Ileums, oder von einem Meckel-Divertikel, manifestiert sich die Divertikulitis klinisch durch eine unspezifische Symptomatik, die zuerst an die haeufigeren, akutentzuendlichen Erkrankungen des Abdomens wie z. B. Appendizitis, Cholezystitis oder Kolondivertikulitis denken laesst. Die Duenndarmdivertikulitis kann praeoperativ nur durch

Einflussgrößen des Kundenrückgewinnungserfolgs : Theoretische Betrachtung und empirische Befunde im Dienstleistungsbereich

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Homburg, Christian; Sieben, Frank G.; Stock-Homburg, Ruth

2003-01-01

While customer satisfaction and customer loyalty have attracted a lot of attention in the academic literature, customer recovery has been largely neglected. However, there is some evidence in business practice that customer recovery activities can be highly beneficial and profitable. Against this background, this study focuses on the conceptualization of antecedents of customer recovery success based on equity theory. Hypotheses are tested among private customers of a teleco...

Epiploic appendagitis of caecum: a diagnostic dilemma [Appendicitis epiploica des Blinddarms: ein diagnostisches Dilemma

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Rashid, Arshad

2012-10-01

Full Text Available [english] Epiploic appendagitis is a rare cause of acute abdomen. Depending on the site of occurrence, it can mimic any cause of acute abdomen or disease of the colon and caecal appendix; making its preoperative diagnosis very difficult. We present here a case of a 7-year-old boy misdiagnosed preoperatively as acute appendicitis and later on, upon surgical exploration, found to have caecal appendagitis. The affected epiploic appendage was removed and the patient had an uneventful recovery. We also review the relevant literature and discuss the measures to overcome this diagnostic dilemma. General surgeons should be aware of this self-limiting disease and consider it as a differential diagnosis of acute abdomen.[german] Appendicitis epiploica oder epiploische Appendagitis ist eine seltene Ursache des akuten Abdomens. Je nach Ort des Auftretens kann sie jede Ursache für akuten Unterleibsschmerz oder Erkrankungen des Dickdarms und Appendix vermiformis imitieren, was ihre präoperative Diagnose sehr schwierig macht. Wir präsentieren hier den Fall eines alten Jungen, bei dem präoperativ akute Blinddarmentzündung diagnostiziert wurde. Beim chirurgischen Eingriff stellte sich dann eine Appendicitis epiploica des Blinddarms als Befund heraus. Der betroffene Appendix epiploica wurde entfernt und der Patient erholte sich ohne besondere Vorkommnisse. Wir geben auch eine Übersicht über die relevante Literatur und diskutieren die Maßnahmen, um dieses diagnostische Dilemma zu überwinden. Allgemeine Chirurgen sollten sich dieser selbstlimitierenden Krankheit bewusst sein und sie als eine Differentialdiagnose bei akutem Abdomen in Betracht ziehen.

Incidental findings of the kidneys, adrenal glands, adnexa uteri, gastrointestinal tract, mesentery and lymph nodes. Assessment and management recommendations; Zufallsbefunde von Niere, Nebenniere, Adnexen, Gastrointestinaltrakt, Mesenterium und Lymphknoten. Bewertung und Managementempfehlung

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Scharitzer, M.; Tamandl, D.; Ba-Ssalamah, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

2017-04-15

Besides the upper abdominal parenchymal organs, the increasing application of cross-sectional imaging has also led to a rising number of incidental findings in the kidneys, adrenal glands, adnexa uteri, the gastrointestinal tract, mesentery and abdominal lymph nodes. Abdominal computed tomography investigations often show unexpected findings without any correlating symptoms. The growing clinical relevance is due to the large number of incidental findings as well as an increasing awareness of ethical and socioeconomic factors. When interpreting radiological findings not only morphological criteria but also individual risk factors of the patient and the clinical context are of great importance. The aims of this article are the description and evaluation of frequent incidental findings detected by computed tomography and to provide information about management recommendations. (orig.) [German] Neben den parenchymatoesen Oberbauchorganen hat der zunehmende Einsatz von Schnittbildverfahren zu einer vermehrten Anzahl von Zufallsbefunden der Nieren, Nebennieren, Adnexe, des Gastrointestinaltrakts, Mesenteriums und der intraabdominellen Lymphknoten gefuehrt. Abdominelle CT-Untersuchungen zeigen haeufig unerwartete Befunde ohne korrelierende Symptomatik. Die steigende klinische Relevanz ist einerseits auf die Zunahme inzidenteller Pathologien und andererseits auf ein wachsendes Bewusstsein ethischer und soziooekonomischer Faktoren zurueckzufuehren. Bei der radiologischen Interpretation sind neben morphologischen Kriterien sowohl die Einbeziehung der individuellen Risikofaktoren des Patienten als auch der klinische Gesamtkontext von grosser Bedeutung. Das Ziel dieses Artikels ist eine Beschreibung und Bewertung der in der Computertomographie detektierten genannten Zufallsbefunde sowie weiterer Managementempfehlungen. (orig.)

Spiral CT for evaluation of chest trauma; Spiral-CT beim Thoraxtrauma

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Roehnert, W. [Universitaetsklinikum Dresden (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Weise, R. [Universitaetsklinikum Dresden (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik

1997-07-01

After implementation of spiral CT in our department, we carried out an analysis for determining anew the value of CT as a modality of chest trauma diagnosis in the emergency department. The retrospective study covers a period of 10 months and all emergency patients with chest trauma exmined by spiral CT. The major lesions of varying seriousness covered by this study are: pneumothorax, hematothorax, pulmonary contusion or laceration, mediastinal hematoma, rupture of a vessel, injury of the heart and pericardium. The various fractures are not included in this study. In many cases, spiral CT within relatively short time yields significant diagnostic findings, frequently saving additional angiography. A rigid diagnostic procedure cannot be formulated. Plain-film chest radiography still remains a diagnostic modality of high value. (Orig.) [Deutsch] Nach Einfuehrung der Spiral-CT in unserer Einrichtung versuchten wir, den Stellenwert der Computertomographie in der Notfalldiagnostik des Thoraxtraumas neu zu bestimmen. Dazu wurden retrospektiv ueber einen Zeitraum von 10 Monaten alle mittels Spiral-CT untersuchten Notfallpatienten mit Thoraxverletzungen ausgewertet. Im Vordergrund standen folgende Befunde unterschiedlichen Schweregrades: Pneumothorax, Haematothorax, Lungenkontusion/-lazeration, Mediastinalhaematom, Gefaessruptur, Herz- und Herzbeutelverletzung. Auf die unterschiedlichen Frakturen wird bewusst nicht naeher eingegangen. In vielen Faellen liefert die Spiral-CT mit relativ geringem Zeitaufwand wesentliche diagnostische Aussagen. Haeufig kann auf eine Angiographie verzichtet werden. Ein starres diagnostisches Stufenschema laesst sich nicht definieren. Die Thoraxuebersichtsaufnahme besitzt einen unveraendert hohen Stellenwert. (orig.)

Social Entrepreneurship im etablierten Wohlfahrtsstaat : Aktuelle empirische Befunde zu neuen und alten Akteuren auf dem Wohlfahrtsmarkt

OpenAIRE

Heinze, Rolf G.; Schönauer, Anna-Lena; Schneiders, Katrin; Grohs, Stephan; Ruddat, Claudia

2013-01-01

Im internationalen Vergleich hat sich die wissenschaftliche Diskussion um die gesellschaftliche Relevanz des Phänomens „Social Entrepreneurship“ (SE) in Deutschland relativ spät entwickelt. In Asien wurde die Debatte insbesondere durch die von Muhammad Yunus 1983 gegründete Grameen Bank angestoßen und spätestens seit der Auszeichnung Yunus‘ mit dem Friedensnobelpreis wird SE in vielen Nationen zunehmend als Chance wahrgenommen, soziale Missstände effektiv und nachhaltig zu bekämpfen....

Side-effects and complications of intra-arterial tumour therapy - experience gained from 577 interventions; Nebenwirkungen und Komplikationen der intraarteriellen Tumortherapie - Erfahrungen aus 577 Interventionen

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Goerich, J. [Radiologische Universitaetsklinik Ulm (Germany); Hasan, I. [Radiologische Universitaetsklinik Bonn (Germany); Sittek, H. [Radiologische Universitaetsklinik Bonn (Germany); Harder, T. [Radiologische Universitaetsklinik Bonn (Germany); Rieber, A. [Radiologische Universitaetsklinik Ulm (Germany); Hartlapp, H.J. [Medizinische Universitaetsklinik Bonn (Germany); Keilholz, U. [Heidelberg Univ. (Germany). Medizinische Klinik und Poliklinik; Kunze, V. [Radiologische Universitaetsklinik Ulm (Germany); Brado, M. [Radiologische Universitaetsklinik Heidelberg (Germany); Reiser, M. [Radiologische Universitaetsklinik Bonn (Germany); Brambs, H. [Radiologische Universitaetsklinik Ulm (Germany)

1995-05-01

305 bearers of different types of tumour went through a total of 577 cycles of intra-arterial therapy (287 perfusions, 290 embolizations). The treatments were carried out for pelvic, hepatic, renal and mammary tumours, for bone metastization, pulmonary carcinomas as well as tumours of the gastrointestinal tract or the extremities. Except for 105 cases, all patients had previously been subjected to surgery or radiotherapy to cure the disease now treated by the intra-arterial method. Systemic chemotherapy had been performed in 58% of the patients. The cytostatic and embolization drugs used varied according to tumour histology and vascularization. Serious complications occurred in 1-2% of the patients. They were observed to be two times more frequent for tumour embolization (1.4%) as compared to intra-arterial perfusion therapy (0.7%). An invariable use of refined methods like intraarterial computerized angiotomography to monitor perfusion and a choice of cytostatic drugs also based on anatomic determinants may further diminish the number of serious complications during perfusion therapy. (orig./VHE) [Deutsch] Bei 305 Patienten mit unterschiedlichen Tumorerkrankungen wurden insgesamt 577 intraarterielle Therapiezyklen (287 Perfusionen, 290 Embolisationen) durchgefuehrt. Behandlungsursache waren Tumoren des Beckens, der Leber, der Niere, der Mamma, Knochenmetastasen, Lungenkarzinome, gastrointestinale Tumoren und Extremitaetstumoren. Mit Ausnahme von 105 Patienten war der zur intraarteriellen Therapie anstehende Befund lokal operiert und/oder strahlentherapeutisch vorbehandelt worden. Einer systemischen Chemotherapie hatten sich 58% der Patienten unterzogen. In Abhaengigkeit von der Tumorhistologie und -vaskularisation wurden unterschiedliche Zytostatika verwendet. Die Rate an schweren Komplikationen betrug 2%. Bei der Tumorembolisation waren schwerwiegende Komplikationen mit 1,4% doppelt so haeufig wie bei der intraarteriellen Perfusionstherapie. Verbesserte

Euthyroid goitre with and without functional autonomy: A comparison; Jodmangelstruma mit und ohne funktionelle Autonomie in der euthyreoten Phase: Ein Vergleich

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Hillenhinrichs, H.; Emrich, D. [Goettingen Univ. (Germany). Abt. fuer Nuklearmedizin

1998-05-01

Analysis of functional autonomy in euthyroid goitre. Methods: In an area of moderate iodine deficiency 163 goitrous patients without and 179 with functional autonomy all clinically euthyroid were compared by sex, age, signs and symptoms, sonographic results, qualitative and quantitative scintigraphy without and with suppression, TRH test, hormone concentrations and iodine excretion in the urine. Results: Age, signs and symptoms, thyroid volume and structure did not contribute sufficiently to diagnosis. To detect functional autonomy quantitative scintigraphy under suppression was superior to the TRH test. Increased hormone concentrations were observed in 15% of patients with functional autonomy. A global {sup 99m}Tc thyroid uptake of {>=}3% under suppression indicates a higher risk of spontaneous hyperthyroidism. It was present in 20% of patients with functional autonomy. Conclusion: to diagnose and treat adequately functional autonomy in euthyroid goitre quantitative scintigraphy, determination of TSH and hormone concentrations are inevitable. (orig.) [Deutsch] Analyse der funktionellen Autonomie in der euthyreoten Phase. Methoden: Es wurden 163 klinisch euthyreote Patienten mit Jodmangelstruma ohne und 179 mit funktioneller Autonomie anhand von Geschlechtsverhaeltnis, Lebensalter, Beschwerden, Symptomen, sonographischem Befund, qualitativer und quantitativer Szintigraphie ohne und mit Suppression, TRH-Test, Hormonkonzentrationen und Jodausscheidung im Urin verglichen. Ergebnisse: Lebensalter, Beschwerden und Symptome, Schilddruesenvolumen und Echomuster lieferten keinen ausreichend sicheren Beitrag zur Diagnose. Die quantitative Szintigraphie war dem TRH-Test ueberlegen. Erhoehte Hormonkonzentrationen ergaben sich bei 15% der Patienten mit funktioneller Autonomie. Als Grenzwert fuer ein erhoehtes spontanes Hyperthyreoserisiko wurde eine globale thyreoidale {sup 99m}Tc-Aufnahme unter Suppression von {>=}3% ermittelt, die in 20% der Patienten mit funktioneller

The stepchild of intestinal diagnostics. Evaluation of radiological methods to diagnose leiomyomas of the small bowel; Das Stiefkind der Darmdiagnostik. Wertigkeit radiologischer Diagnosemoeglichkeiten von Leiomyomen im Duenndarm

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Keberle, M.; Wittenberg, G.; Jenett, M.; Hahn, D. [Wuerzburg Univ. (Germany). Inst. fuer Roentgendiagnostik; Mueller, J.G. [Wuerzburg Univ. (Germany). Pathologisches Inst.

1998-11-01

Purpose: Various radiological methods to diagnose small bowel neoplasmas and problems of differential diagnosis specially considerating leiomyomas are discussed. Patients and methods: Two patients with leiomyoma of the ileum underwent enteroclysis, computed tomography of the abdomen, intra-arterial DSA and colour Doppler sonography. Another patient with leiomyosarcoma just underwent CT of the abdomen with CT-guided biopsy. Results: Due to the homogenous density and the smooth surface of the tumors in computed tomography and respectively enteroclysis and the presentation of the tumor vascularisation in the angiography and Colour Doppler sonography in both patients a leiomyoma of the small bowel was diagnosed. Postoperatively this diagnosis was histologically confirmed. The CT-findings of the patient with leiomyosarcoma were not suspicious of a malignant tumor. Conclusion: Radiologically it is not possible to determine the dignity of smooth muscle cell tumors safely. That is the reason why the diagnosis has to be achieved operatively. But the histopathological diagnosis based on the mitotic rate may be difficult. Therefore the after care has to be carried out thoroughly. (orig.) [Deutsch] Ziel: Es werden Diagnosemoeglichkeiten von Duenndarmtumoren und differentialdiagnostische Problemstellungen unter besonderer Beruecksichtigung des Leiomyoms diskutiert. Patienten und Methode: Bei zwei Patienten mit einem Leiomyom des Ileums wurde jeweils ein Enteroklysma nach Sellink, eine CT des Abdomens, eine intraarterielle DSA mit selektiver Darstellung der Art.mesenterica superior und eine farbkodierte Duplexsonographie (FKDS) durchgefuehrt. Bei einem Patienten mit Leiomyosarkom wurde lediglich eine CT des Abdomens mit CT-gesteuerter Biopsie durchgefuehrt. Ergebnisse: Aufgrund der homogenen Dichtewerte und der glatten Begrenzung der Tumoren in der CT bzw. dem Enteroklysma, ergaenzt durch die farbdopplersonographische und angiographische Darstellung der Tumorgefaesse, wurde bei

Anke Kerschgens: Die widersprüchliche Modernisierung der elterlichen Arbeitsteilung. Alltagspraxis, Deutungsmuster und Familienkonstellation in Familien mit Kleinkindern. Wiesbaden: VS Verlag für Sozialwissenschaften 2009.

Directory of Open Access Journals (Sweden)

Florian Schulz

2010-07-01

Full Text Available Anke Kerschgens untersucht in ihrem Buch die Bestimmungsgründe der Arbeitsteilung bei Elternpaaren mit Kleinkindern und legt dabei einen besonderen Schwerpunkt auf die unbewussten Gründe für eine den verbalisierten Einstellungen teilweise widersprechende Praxis. Auch wenn viele Befunde und Schlussfolgerungen nicht wirklich neu sind, bietet die Arbeit einen guten Anhaltspunkt für interdisziplinäre Fortentwicklungen von soziologischen Theorien der Arbeitsteilung.In her book, Anke Kerschgens examines the determinant factors for the division of labor in couples with small children. Here, she places specific emphasis on the unconscious reasons for a praxis that partially contradicts those attitudes verbalized by the parents. Even if many of the findings and conclusions are not really new, the work offers a good indication for further interdisciplinary developments of sociological theories of the division of labor.

Hin zu Utopia - eine empirische Spekulation

Directory of Open Access Journals (Sweden)

Wolfgang Frindte

2017-04-01

Full Text Available Hin zu Utopia - eine empirische Spekulation (von Wolfgang Frindte & Nico Dietrich Der vorliegende Text nutzt Befunde, die die Autoren im Rahmen einer Studie zu Einstellungen gegenüber Muslimen und dem Islam erhoben haben (Frindte/Dietrich 2017, um über die Möglichkeit einer kosmopolitischen Utopie zu spekulieren und nach den Akteuren der Zukunft und den künftigen Gestaltern eines friedlichen und menschenfreundlichen europäischen Kontinents zu fahnden. Im Ergebnis ihrer Suche kommen die Autoren zu dem Schluss: Es gibt noch immer gebildete und politisch informierte Menschen, die eine positive Sicht auf ethnische Minderheiten, Flüchtlinge im Allgemeinen und Muslime im Besonderen haben, autoritäre und machtorientierte Gesellschaftsstrukturen ablehnen und sich mit Europa identifizieren. Auf ihren persönlichen Einsatz, ihre Entschlossenheit, ihren Zusammenhalt über die Zeit und ihre Zukunftsorientierung kommt es an.

Risk-centered calculation of network charges in the power transmission sector; Risikoorientierte Kalkulation von Netznutzungsentgelten in der Stromverteilungswirtschaft

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Maennel, W. [Friedrich-Alexander-Univ., Erlangen-Nuernberg (Germany). Betriebswirtschafliches Inst.

2004-04-01

Utilities insist that contrary to the opinions of the Federal Cartel Office and network users, distribution network operation is a high-risk enterprise. The contribution starts by listing typical relevant risks in power distribution and then proceeds to discussing risk factors one by one. Empirical findings generated with the Capital Asset Pricing Mode (CAPM) prove that the conservative approach for calculating the risk-based surcharges laid down in the VV II plus agreement is appropriate. (orig./CB) [German] Entgegen der Auffassung von Bundeskartellbehoerden und Netznutzern ist das stark anlagenintensive Netzgeschaeft mit bedeutsamen Unternehmerrisiken behaftet, deren Ueberwaelzung nur begrenzt moeglich ist. Ausgehend von generell bedeutsamen und typischen Unternehmerrisiken im Stromverteilungssektor beschaeftigt sich der Artikel mit den direkt auf die Eigenkapitalverzinsung einwirkenden Risikofaktoren. Mit dem Capital Asset Pricing Mode (CAPM) genierierte empirische Befunde bestaetigen die konservativen Wagniszuschlaege in der VV II plus. (orig.)

Temporomandibular Joint: MRT Diagnostics; Temporomandibulargelenk: MRT-Diagnostik

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Kress, B. [Universitaetsklinikum Heidelberg (Germany). Abteilung Neuroradiologie; Universitaetsklinikum Heidelberg (Germany). Neurologische Klinik; Schmitter, M. [Universitaetsklinikum Heidelberg (Germany). Poliklinik fuer zahnaerztliche Prothetik; Universitaetsklinikum Heidelberg (Germany). Abteilung Neuroradiologie

2005-09-01

MRI of the temporomandibular joint (TMJ) requires 1.5 T. The radiologist must be familiar with the anatomy and pathology of the TMJ. This review gives a description of MRI protocols for the TMJ, and MRI anatomy and pathology of the TMJ (open and closed mouth) by means of MR images and drawings. Diagnosing of the TMJ related diseases depends on standardized clinical and MR examinations. Therefore close interdisciplinary cooperation between dentist and radiologist is necessary. (orig.) [German] Magnetresonanztomographie bei Kiefergelenkbeschwerden erfordert neben guter technischer Ausstattung Kenntnisse der Anatomie und Pathologie des Kiefergelenks. Diese Uebersicht stellt neben MRT-Protokollen die Anatomie und die pathologischen Befunde des Kiefergelenks bei geoeffnetem und geschlossenem Mund anhand von Abbildungen und Graphiken systematisch dar. Bildgebende Diagnostik des Kiefergelenks gruendet sich auf eine standardisierte klinische und magnetresonanztomographische Untersuchung und erfordert eine enge interdisziplinaere Kooperation zwischen Zahnmedizin und Radiologie. (orig.)

Creutzfeldt-Jakob disease: the value of MRI; Creutzfeldt-Jakob-Krankheit: Stellenwert der MRT

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Urbach, H.; Tschampa, H.J.; Keller, E.; Schild, H.H. [Radiologische Klinik, Neuroradiologie, Rheinische Friedrich-Wilhelms-Univ. Bonn (Germany); Paus, S. [Neurologische Klinik, Rheinische Friedrich-Wilhelms-Univ. Bonn (Germany)

2001-06-01

To define the role of MRI in the diagnosis of Creutzfeldt-Jakob disease (CJD). Methods: 14 patients with suspected CJD were studied within 3 years. MRI findings were correlated with WHO established diagnostic criteria (clinical findings, EEG, CSF with 14-3-3 protein assay). Results: 12 patients had CJD. One patient each suffered from Hashimoto's encephalitis and ALS dementia complex, respectively. Nine of 12 CJD patients had increased signal intensity of the striatum (n = 8), pulvinar thalami (n = 5) and/or cerebellar and cerebral cortex (n = 3), respectively. Signal intensity was most pronounced on FLAIR sequences; six patients were studied with diffusion-weighted MRI and showed impaired diffusion in these areas. Both patients without CJD did not show the abovementioned signal changes (sensitivity 75%, specificity and positive predictive value 100%, respectively). Conclusion: If patients with suspected CJD are studied with FLAIR and diffusion-weighted sequences, this disorder can reliably be proven or ruled out. Typical MRI findings narrow down the differential diagnosis and should be included in the WHO diagnostic criteria. (orig.) [German] Bestimmung des Stellenwerts der MRT in der Diagnostik der Creutzfeldt-Jakob-Krankheit (CJK). Methoden: Analyse der MRTs von 14 innerhalb von drei Jahren mit Verdacht auf CJK zugewiesenen Patienten. Korrelation der MRTs mit den entsprechend den WHO-Diagnosekriterien etablierten Untersuchungsverfahren (Klinik, EEG, Liquor mit 14-3-3 Protein-Nachweis). Ergebnisse: 12 Patienten hatten eine CJK, jeweils ein Patient hatte eine Hashimoto-Enzephalitis bzw. einen ALS-Demenz-Komplex. Bei 9 der 12 CJK-Patienten fanden sich beidseits Signalerhoehungen des Striatum (n = 8), des Pulvinar thalami (n = 5) und/oder des Kleinhirn- bzw. Grosshirnkortex (n = 3). Die Signalerhoehungen waren am deutlichsten auf FLAIR-Aufnahmen erkennbar; 6 mit diffusionsgewichteter MRT untersuchte Patienten wiesen eine eingeschraenkte Diffusion dieser Areale

Primary extraparenchymal hemorrhage of the posterior cranal fossa as a premonitory symptom of atlanto-axial instability; Traumatische extraparenchymale Blutung der hinteren Schaedelgrube als Warnsymptom einer atlantoaxialen Instabilitaet

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Holl, K.; Rolli, K.; Olschowski, A.; Wurm, G. [Neurochirurgische Abt., Landesnervenklinik Linz (Austria); Nussbaumer, K. [Neuroradiologische Abt., Landesnervenklinik Linz (Austria)

2001-07-01

The contribution discusses the cases of five patients with cranio-cerebral trauma, (four children and one adult patient), where CT examination revealed extraparenchymal hemorrhage of the posterior cranal fossa, which did not fit into their pattern of intracranial trauma and therefore gave reason to suspect a lesion of the upper cervical spine. The various types of hemorrhage found are explained, as well as the underlying cervical spine lesions, and the choice of respective therapies which proved to be successful. (orig./CB) [German] Wir berichten ueber fuenf Patienten nach Schaedel-Hirn-Trauma, deren gemeinsamer Befund in der kraniellen Computertomographie eine extraparenchymale Blutung der hinteren Schaedelgrube (HSG) ohne Zusammenhang mit dem uebrigen intrakraniellen Verletzungsmuster bzw. ohne sonstige intrakranielle Verletzung war. Es handelte sich um vier Kinder und einen Erwachsenen mit einem Durchschnittsalter von 8,8 (4-22) Jahren. Drei dieser Patienten wiesen eine epidurale Blutung am Clivus bzw. am Foramen magnum auf, bei einem Patienten handelte es sich um eine Subarachnoidalblutung um das Cerebellum, bei einem weiteren Patienten lag eine Blutung im IV. Ventrikel vor. Diese infratentoriellen Blutungen waren der erste Hinweis, dass eine Verletzung in der oberen Halswirbelsaeule (HWS) vorliegen koennte. Es wurde bei den vier Kindern als zugrundeliegende Ursache der Blutung eine ligamentaere Verletzung C1/C2 diagnostiziert, nur bei dem erwachsenen Patienten lag eine knoecherne Verletzung C1/C2 vor. Die Therapie erfolgte in den vier Faellen mit Instabilitaet chirurgisch, bei dem Patienten ohne Instabilitaet konservativ. Nach einem mittleren Nachbeobachtungszeitraum von 5,2 Jahren waren alle operierten Patienten klinisch gebessert bzw. weiterhin neurologisch unauffaellig. Es konnte bei allen Patienten eine stabile Situation C1/C2 bei guter Funktionalitaet der HWS nachgewiesen werden. (orig.)

Combined PACS and intranet information system in a University Hospital; Kombiniertes PACS und Intranet-Informationssystem an einem Universitaetsklinikum

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Heiss, D.; Pfluger, T.; Pfeifer, K.J.; Hahn, K. [Muenchen Univ. (Germany). Inst. fuer Radiologische Diagnostik; Koenig, A.; Endres, S. [Muenchen Univ. (Germany). Medizinische Klinik Innenstadt

2000-06-01

-Informationssystem entwickelt, das alle Abteilungen der Klinik mit Befund- und Bildinformationen aus der Radiologie versorgt. Aus dem Informationssystem sind darueber hinaus auch andere klinische Informationen wie Labordaten und EKG-Untersuchungen abrufbar. Ergebnisse: Nach einem einjaehrigen Betrieb hat sich das Informationssystem im klinischen Arbeitsablauf bewaehrt und dient den ueberweisenden Abteilungen als primaere Informationsquelle sowohl fuer radiologische Befunde und Bilder als auch fuer klinische Daten wie Laborparameter. Schlussfolgerungen: Vorteile aus der Digitalisierung ergeben sich unter anderem aus der Reduktion der Filmkosten, besonders aber aus der Optimierung der Arbeitsablaeufe durch die digitale Verfuegbarkeit der Bilddaten zu jeder Zeit an jedem Ort. (orig.)

Complex carotid cavernous sinus fistulas Barrow type D: endovascular treatment via the ophthalmic vein, imaging control with standardized MRI, long-term results; Interdisziplinaere Embolisation spontaner Karotis-Cavernosus-Fisteln Typ D nach Barrow ueber die Vena ophthalmica: klinische Langzeitergebnisse und kernspintomografische Befunde

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Struffert, T.; Grunwald, I.Q.; Reith, W. [Abteilung fuer Diagnostische und Interventionelle Neuroradiologie, Universitaetsklinikum des Saarlandes (Germany); Muecke, I. [Klinik fuer Augenheilkunde, Universitaetsklinikum des Saarlandes (Germany)

2007-04-15

Purpose: Since feeding arteries from both the internal and external carotid artery are common, cavernous fistulas of Barrow type D are difficult to treat. Embolization using the transarterial approach is considered to be the standard therapy. However, it is often impossible to embolize feeders from the internal carotid artery. The transorbital approach after anterior orbitotomy through the ophthalmic vein is an alternative in this complex situation. The following reports our experience with three female patients who underwent transvenous embolization. Procedural success was documented using standardized MRI and clinical reevaluation. Materials and Methods: Three female patients between 57 and 78 years of age were diagnosed with carotid cavernous fistulas by conventional angiogram. All patients were suffering from exophthalmus and visual impairment. Two patients showed secondary glaucoma and diplopia. In one patient we performed a technically successful transarterial embolization using particles, but no relevant improvement of the patient's condition was seen. Transfemoral transvenous access via the sinus petrosus was not possible in any patient. All patients were then embolized via the ophthalmic vein using GDC detachable coils. All patients were clinically reevaluated by an ophthalmologist. Also a standardized MRI was performed for documentation. Follow-up was performed for the first patient for 32 months, for the second patient for 34 months and for the third patient for 50 months. Results: Transvenous embolization was technically successful in all three cases. Clinical symptoms disappeared rapidly. Postprocedural MRI showed a symmetric diameter of the ophthalmic vein. Venous congestion of the orbit caused by fatty tissue edema regressed completely. Contrast-enhanced magnetic resonance angiography showed normal arterial vessels without evidence of fistula. (orig.)

MR spectroscopy in metabolic disorders of the brain; MR-Spektroskopie bei Stoffwechselerkrankungen des Gehirns

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Yilmaz, U. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

2017-06-15

Metabolic disorders of the brain often present a particular challenge for the neuroradiologist, since the disorders are rare, changes on conventional MR are often non-specific and there are numerous differential diagnoses for the white substance lesions. As a complementary method to conventional brain MRI, MR spectroscopy may help to reduce the scope of the differential diagnosis. Entities with specific MR spectroscopy patterns are Canavan disease, maple syrup urine disease, nonketotic hyperglycinemia and creatine deficiency. (orig.) [German] Die Diagnostik metabolischer Erkrankungen des Gehirns stellt eine besondere Herausforderung in der Neuroradiologie dar, da die Erkrankungen insgesamt selten, die bildmorphologischen Befunde haeufig unspezifisch sind und es eine Vielzahl von Differenzialdiagnosen fuer die Veraenderungen der weissen Substanz gibt. Als zusaetzliche Technik kann die MR-Spektroskopie bei Stoffwechselerkrankungen helfen, die Diagnose einzugrenzen. Krankheitsentitaeten, die spezifische Veraenderungen in der Spektroskopie aufweisen, sind der Morbus Canavan, die Ahornsirupkrankheit, die nichtketotische Hyperglyzinaemie und Kreatinmangelsyndrome. (orig.)

Cortical blindness after intoxication with heroin; Kortikale Blindheit nach Heroinintoxikation

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Braendli, M. [Institut fuer Diagnostische Radiologie, Universitaetskliniken, Kantonspital Basel (Switzerland); Otte, A.; Mueller-Brand, J. [Institut fuer Nuklearmedizin, Universitaetskliniken, Kantonspital Basel (Switzerland)

2000-07-01

For the case reported, both morphological and functional diagnostic examination methods were applied, such as MRI and CT, or SPECT using ECD as a tracer. The bilateral, occipital lesion finally could be detected with the SPECT examinations, and SPECT findings were clearly better than MRI findings, whereas even restrospective analysis of the CT images failed to show the lesion. Thus the functional imaging method in this case of a discrete bilateral occipital lesion was the most sentitive method. (orig./CB) [German] In unserem Fallbeispiel wurden sowohl morphologische (MRT, CT) als auch funktionelle Bildgebung (SPECT unter Verwendung von ECD als Tracer) ad extensum zur Diagnosefindung verwendet. Die bilaterale okzipitale Defektbildung konnte schliesslich mittels SPECT-Untersuchung deutlich besser dargestellt werden als mittels MRT. In der CT gelangte der Befund - auch bei retrospektiver Betrachtung - ueberhaupt nicht zur Darstellung. Damit war die funktionelle Bildgebung im Falle dieser diskreten bilateralen okzipitalen Defektbildung die sensitivste Methode. (orig.)

MR-specific staging of chondromalacia patellae using a special knee compressor: Comparison with arthroscopic findings. MRT-spezifische Einteilung der Chondromalacia patellae unter Zuhilfenahme eines speziellen Kniekompressors: Gegenueberstellung mit dem arthroskopischen Befund

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Andresen, R. (Klinik fuer Radiologie, Abt. Radiologische Diagnostik, Universitaetsklinik Steglitz, FU Berlin (Germany)); Radmer, S. (Orthopaedisches Fachinst., Berlin (Germany)); Koenig, H. (Klinik fuer Radiologie, Abt. Radiologische Diagnostik, Universitaetsklinik Steglitz, FU Berlin (Germany)); Wolf, K.J. (Klinik fuer Radiologie, Abt. Radiologische Diagnostik, Universitaetsklinik Steglitz, FU Berlin (Germany))

1993-12-01

The present study proposes a new MRI-specific staging of chondromalacia patellae (CMP) which is based on cartilage thickness decrease and signal intensity behaviour under compression as well as cartilage morphology in the plain image. The investigation was performed in 30 patients with varying knee complaints who underwent arthroscopy after MR imaging. It was demonstrated that three CMP stages can already be differentiated by MRI under compression in arthroscopically healthy cartilage. This proves a marked improvement in the early diagnosis of CMP. (orig.)

Warum will Charles Bovary kein Hausarzt mehr sein? – zur Medialität von Interviews mit angehenden Allgemeinmediziner_innen

Directory of Open Access Journals (Sweden)

Niklas Barth

2016-07-01

Full Text Available Im Zentrum dieses Beitrags stehen Interviews mit Ärzt_innen in Weiterbildung (ÄiW zum Facharzt/zur Fachärztin für Allgemeinmedizin. Aus der Analyse dieser Texte kann man erstens lernen, wie sich Motive überhaupt als plausible Motive darstellen lassen. Dabei sieht man zweitens, dass die Kommunikation von Kontingenz in diesen Erzählungen geradezu als Ressource benutzt wird, die Kontingenz einer zu erzählenden Geschichte zu bewältigen. Vor allem aber gerät drittens in den Interviews die Medialität des Forschungsprozesses selbst in den Blick. In der selektiven Form dieser Erzählungen liegt selbst schon ihr Befund. Eine Soziologie, die die Erzählungen ihrer Informant_innen fast trotzig für Krücken hält, um zum Leben selbst durchzustoßen, kann von diesem medientheoretischen Hinweis womöglich profitieren. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs160317

Bioindikation im Grundwasser funktioniert - Erwiderung zum Kommentar von T. Scheytt zum Beitrag "Grundwasserfauna als Indikator für komplexe hydrogeologische Verhältnisse am westlichen Kaiserstuhl" von Gutjahr, S., Bork, J. & Hahn, H.J. in Grundwasser 18 (3), 173-184 (2013)

Science.gov (United States)

Hahn, Hans Jürgen; Gutjahr, Simon

2014-09-01

In seinem Kommentar schließt Traugott Scheytt die faunistische Bioindikation über die Nutzung von Grundwassermessstellen aus methodischen Gründen aus. Er postuliert auch, dass die faunistische Indikation hydrogeologischer Zusammenhänge wegen der eingeschränkten Ausbreitungsfähigkeit der Tiere in Porengrundwasserleitern nicht möglich sei und stellt grundsätzlich die Befunde unserer Untersuchungen am Kaiserstuhl in Frage. Dabei überträgt Herr Scheytt seine Erfahrungen aus der unbelebten Hydrogeologie direkt auf den Lebensraum Grundwasser. Seine Argumentation berücksichtigt dabei weder die Prinzipien der Ökologie noch den aktuellen Stand der grundwasserökologischen Forschung. Wir gehen davon aus, dass für die Untersuchungen am Kaiserstuhl sowohl unsere Arbeitshypothese wie auch die angewandten Methoden und die Interpretation der Ergebnisse der Fragestellung angemessen sind und internationalem, wissenschaftlichem Standard entsprechen. Aus den oben benannten Gründen bleiben wir dabei: Biondikation im Grundwasser funktioniert und sie bietet hervorragende Möglichkeiten, gerade auch für die Hydrogeologie.

MR imaging in gynecology and obstetrics; MR-Tomographie in Gynaekologie und Geburtshilfe

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Bauer, M.; Tontsch, P.; Schulz-Wendtland, R. (eds.)

2000-07-01

The toolbook covers the full range of indications for MRI in obstetrics and gynecology. It is the joint work of radiologists and obstetrician-gynecologists and supplies state-of-the-art information needed by doctors in the private practice or a hospital department. Examples from the Table of Contents: Physical principles of MRI, applications and performance aspects. Systematic presentation of diagnostic findings for comparative analysis and assessment. Biological effects and risks. Benign and malignant neoplasms of the mammary glands and the female genital organs. MRI for prenatal care and diagnostic evaluation. New method: MR spectroscopy. (orig./CB) [German] Das Lehrbuch deckt alle Indikationen der MRT in Gynaekologie und Geburtshilfe ab. Es wurde von Radiologen und Frauenaerzten gemeinsam verfasst und ist daher praxisgerecht. Aus dem Inhalt: Physikalische Grundlagen und Durchfuehrung der MRT und Systematik fuer die Beurteilung der MRT-Befunde. Biologische Wirkungen und Risiken, benigne und maligne Erkrankungen der Brustdruese und der weiblichen Genitalorgane. MRT in der Schwangerschaft. Neue Methode: MR-Spektroskopie. (orig./AJ)

Noninfectious differential diagnoses of pneumonia; Nichtinfektioese Differenzialdiagnosen von Pneumonien

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Wielandner, A.; Toelly, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria); Agarwal, P. [Medizinische Universitaet Freiburg, Universitaetsklinik fuer Radiologie, Freiburg (Germany); Bardach, C. [Krankenhaus Hietzing, Abteilung fuer Radiologie, Wien (Austria)

2017-01-15

In patients with a clinical suspicion of pneumonia, typical clinical and laboratory features along with the detection of infiltrates on chest X-ray are as a rule considered diagnostic and therapy is immediately initiated; however, studies have shown that in up to 5% of patients with an initial suspicion of pneumonia, another noninfectious pulmonary disease was the underlying cause. Early recognition and differentiation of diseases mimicking pneumonia are prerequisites for an adequate therapy. The aim of this review is to present the important noninfectious differential diagnoses of pneumonia and to provide the reader with tools for a systematic diagnostic approach. A literature search was carried out. As alterations in the lungs often result in similar imaging appearances and a differentiation between transudates, exsudates, blood and cells is not feasible by chest X-ray or CT, a systematic approach is essential to make an appropriate diagnosis. Hence, consideration of the temporal course, predominant pattern, distribution of findings, additional findings and clinical presentation are indispensable. (orig.) [German] Bei der Verdachtsdiagnose Pneumonie sind die Kombination aus typischer Klinik, Labor und der Nachweis einer Verdichtung in der Roentgenthoraxaufnahme in der Regel diagnostisch und es wird umgehend mit der Therapie begonnen. Studien haben jedoch gezeigt, dass bei bis zu 5 % der Patienten mit Erstverdacht auf Pneumonie eine andere (pulmonale) Erkrankung zugrunde liegt. Ein fruehzeitiges Erkennen und eine Differenzierung von Erkrankungen, die eine Pneumonie vortaeuschen, sind fuer die weitere Behandlung essenziell. Uebersicht ueber wesentliche nichtinfektioese Differenzialdiagnosen der Pneumonie. Es wurde eine Literaturrecherche durchgefuehrt. Da krankhafte Lungenveraenderungen oft aehnliche Bilder hervorrufen und anhand der Roentgenthoraxaufnahme oder der CT-Untersuchung nicht zwischen Blut, Transsudat, Exsudat und Zellen differenziert werden kann, ist

Imaging of chondrosarcoma with histopathological and prognostic correlation. An analysis of 49 cases mainly based on plain film radiography

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Jurik, A.G. [Centre for Bone and Soft Tissue Tumours, Univ. Hospital, Aarhus (Denmark); Jensen, O. [Centre for Bone and Soft Tissue Tumours, Univ. Hospital, Aarhus (Denmark); Keller, J. [Centre for Bone and Soft Tissue Tumours, Univ. Hospital, Aarhus (Denmark); Nielsen, O.S. [Centre for Bone and Soft Tissue Tumours, Univ. Hospital, Aarhus (Denmark); Lundorf, E. [Centre for Bone and Soft Tissue Tumours, Univ. Hospital, Aarhus (Denmark); Daugaard, S. [Centre for Bone and Soft Tissue Tumours, Univ. Hospital, Aarhus (Denmark); Sneppen, O. [Centre for Bone and Soft Tissue Tumours, Univ. Hospital, Aarhus (Denmark)

1995-11-01

49 consecutive patients seen during an 11-year-period were analysed, including re-evaluation of their radiographic and histopathologic material. Forty-two patients had radiographic changes typical for cartilaginous tumours, in 37 with malignant stigmata. Seven patients had malignant changes not typical for chondrosarcoma. By histopathologic grading 16 patients had grade I, 17 grade II and 16 grade III tumours. Six of the grade II-III tumours were histopathologic variants (mesenchymal, dedifferentiated or myxoid chondrosarcomas). Surgical removal of the tumour was performed in 42 patients, 41 of whom were followed up for 0.4-11.4 years (median 3.8 years). Local recurrence occurred in 7 patients, and 11 patients developed metastases. Ten patients, 4 with local recurrence and metastases, and 6 with metastases only were dead at the end of the follow-up. The actuarial 5-year overall survival rate was 64%. The occurrence of local recurrence, metastases and death was found to be related to the histopathologic grades II and III. Atypical radiographic features only occurred in grade II-III tumours and were related to metastases and death, but not to local recurrence. (orig./MG) [Deutsch] 49 Patienten wurden waehrend eines Zeitraums von 11 Jahren analysiert, einschliesslich einer erneuten Bewertung ihrer radiologischen und histopathologischen Befunde. Bei 42 Patienten wurden radiologische Veraenderungen festgestellt, die fuer chondrogene Knochentumoren typisch sind, davon 37 mit boesartigen Anzeichen. Bei sieben Patienten bestanden boesartige Veraenderungen, die jedoch nicht typisch fuer ein Chondrosarkom waren. Das Grading bzw. die pathologische Stadienbestimmung aufgrund histologischer Kriterien ergab bei 16 Patienten den Malignitaetsgrad I, bei 17 II und bei 16 III. Sechs der Tumoren der Grade II-III waren histopathologische Varianten (mesenchymale Chondrosarkome, Atypie oder myxoide Chondrosarkome). Bei 42 Patienten wurde der Tumor chirurgisch entfernt und der

Pulmonary granulomatous diseases and pulmonary manifestations of systemic granulomatous disease. Including tuberculosis and nontuberculous mycobacteriosis; Pulmonale granulomatoese Erkrankungen und pulmonale Manifestationen systemischer Granulomatosen. Inklusive Tuberkulose und nichttuberkuloese Mykobakteriosen

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Piel, S. [Universitaet Heidelberg, Zentrum fuer interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Heidelberg (Germany); Kreuter, M.; Herth, F. [Universitaet Heidelberg, Zentrum fuer interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Kauczor, H.U. [Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Heussel, C.P. [Universitaet Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany)

2016-10-15

Granulomas as signs of specific inflammation of the lungs are found in various diseases with pulmonary manifestations and represent an important imaging finding. The standard imaging modality for the work-up of granulomatous diseases of the lungs is most often thin-slice computed tomography (CT). There are a few instances, e. g. tuberculosis, sarcoidosis and silicosis, where a chest radiograph still plays an important role. Further radiological modalities are usually not needed in the routine work-up of granulomatous diseases of the chest. In special cases magnetic resonance imaging (MRI) and positron emission tomography (PET)-CT scans play an important role, e. g. detecting cardiac sarcoidosis by cardiac MRI or choline C-11 PET-CT in diagnosing lung carcinoma in scar tissue after tuberculosis. The accuracy of thin-slice CT is very high for granulomatous diseases. In cases of chronic disease and fibrotic interstitial lung disease it is important to perform thin-slice CT in order to diagnose a specific disease pattern. Thin-slice CT is also highly sensitive in detecting disease complications and comorbidities, such as malignancies. Given these indications thin-slice CT is generally accepted in the routine daily practice. A thin-slice CT and an interdisciplinary discussion are recommended in many cases with a suspected diagnosis of pulmonary granulomatous disease due to clinical or radiographic findings. (orig.) [German] Granulome als Zeichen der spezifischen Entzuendung im Lungengewebe treten bei zahlreichen Erkrankungen mit pulmonaler Manifestation auf und stellen einen wichtigen Befund in der Bildgebung dar. Das radiologische Standardverfahren bei pulmonalen Granulomatosen ist meistens die Duennschichtcomputertomographie, in wenigen Faellen, wie z. B. bei Tuberkulose, Sarkoidose und Silikose, spielt die Roentgenthoraxuebersicht immer noch eine wichtige Rolle. Bei der Standardabklaerung der meisten Granulomatosen ist die Hinzunahme weiterer Verfahren nicht

Magnetic resonance imaging of the hand in rheumatoid arthritis. New scientific insights and practical application; Magnetresonanztomographie der Hand bei rheumatoider Arthritis. Wissenschaftliche Ergebnisse und praktische Anwendung

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Hermann, K.G.A. [Charite - Universitaetsmedizin Berlin, Institut fuer Radiologie am Campus Mitte, Berlin (Germany)

2006-05-15

Magnetic resonance imaging (MRI) is a sensitive diagnostic modality for the detection of inflammatory changes in peripheral joints. Nevertheless, the widespread clinical use of MRI in assessing patients with early rheumatoid arthritis is still hampered by the technical complexity and higher cost of MRI compared with conventional radiography. This overview summarizes the results of recent research and gives practical tips on how to perform MRI of the hands. The authors present an MR protocol for hand imaging, discuss the pros and cons of low-field MR scanners, and outline pitfalls and artifacts. The MRI changes associated with rheumatoid arthritis such as synovitis, tenosynovitis, erosions, and bone marrow edema are described including their prognostic significance. The proven facts on the validation and grading of MR changes in rheumatoid arthritis are summarized. Finally, the role of MRI in the differential diagnosis of arthritis is critically discussed. (orig.) [German] Die Magnetresonanztomographie (MRT) ist ein sensitives Verfahren zur Detektion entzuendlicher Veraenderungen der peripheren Gelenke. Den breiten Einsatz der MRT im Fruehstadium der rheumatoiden Arthritis behindern derzeit jedoch der im Vergleich zur konventionellen Roentgendiagnostik hoehere technische Aufwand und vermehrte Kosten. Diese Uebersichtsarbeit fasst wichtige Studienergebnisse zusammen und gibt praktische Hinweise fuer Hand-MRTs. Ein geeignetes Sequenzprotokoll wird vorgestellt, Vor- und Nachteile von Niederfeld-MRTs werden beruecksichtigt, moegliche Fehlerquellen und Artefakte diskutiert. Magnetresonanztomographische Befunde bei rheumatoider Arthritis wie Synovitis, Tenosynovitis, Erosionen und Knochenmarkoedeme werden beschrieben und deren prognostische Bedeutung dargestellt. Gesicherte Fakten zur Validierung und Moeglichkeiten der Graduierung MR-tomographischer Veraenderungen bei rheumatoider Arthritis werden zusammengefasst. Der Nutzen der MRT zur differenzialdiagnostischen

Magnetic resonance imaging findings after shoulder surgery: What the radiologist needs to know; Besonderheiten der Magnetresonanztomographie nach operativer Schulterintervention

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Fahlenkamp, U.L.; Hermann, K.G.A. [Universitaetsklinikum Charite - Campus Mitte, Institut fuer Radiologie, Berlin (Germany); Gerhardt, C. [Universitaetsklinikum Charite - Campus Mitte, Centrum fuer muskuloskeletale Chirurgie, Berlin (Germany)

2017-11-15

Even primary diagnostic evaluation of the shoulder is a challenge for radiologists. Many imaging findings that definitely indicate abnormal findings in the untreated shoulder should be evaluated carefully in postoperative patients. Artifacts caused by implants or metal abrasion pose considerable problems in postoperative magnetic resonance imaging (MRI). Classic approaches to minimizing artifacts caused by foreign bodies include using turbo spin echo sequences, increasing bandwidth, and reducing voxel size. In recent years, several vendors have developed dedicated pulse sequences for reducing metal artifacts. Different postoperative imaging findings will be encountered, depending on the kind of surgery done. This review article describes typical postoperative MRI findings, focusing on subacromial decompression, reconstruction of the rotator cuff, labrum procedures, and biceps tenodesis. (orig.) [German] Das Schultergelenk stellt fuer jeden Radiologen bereits in der primaeren Diagnostik eine Herausforderung dar. Viele Bildbefunde, welche bei einer nicht therapierten Schulter als eindeutig pathologisch zu bewerten sind, muessen im postoperativen Setting als kritisch bewertet werden. Artefakte durch Implantate oder Metallabrieb stellen eine grosse Huerde der postoperativen Magnetresonanztomographie dar. Klassische Methoden, um Artefakte durch Fremdmaterial so gering wie moeglich zu halten, bestehen in der Anwendung von Turbo-Spin-Echo-Sequenzen sowie in der Erhoehung der Bandbreite oder der Reduktion der Voxelgroesse. Mittlerweile haben einige Anbieter jedoch spezielle Sequenzen zur Reduktion von Metallartefakten entwickelt. In Abhaengigkeit von der erfolgten Schulteroperation muessen verschiedene Bildbefunde beruecksichtigt werden. Dieser Uebersichtsartikel geht insbesondere auf die subakromiale Dekompression, die Rekonstruktion der Rotatorenmanschette, Operationen am Labrum sowie Bizepstenodesen ein und beschreibt typische postoperative Befunde. (orig.)

Pediatric intraspinal neoplasms; Paediatrische intraspinale Neoplasien

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Mueller, U.; Ahlhelm, F. [Kantonsspital Baden AG, Institut fuer Radiologie, Baden (Switzerland); Ulmer, S. [Medizinisch-Radiologisches Institut, Zuerich (Switzerland); Schlaeger, R. [Universitaetsspital Basel, Neurologische Klinik und Poliklinik, Basel (Switzerland); UCSF, Department of Neurology, San Francisco (United States)

2014-08-15

With an overall incidence of 10 % of all central nervous system tumors, spinal tumors are relatively rare in children. The majority of these tumors are astrocytomas and ependymomas (70 %) followed by rare non-glial tumor entities, such as gangliogliomas. They can be differentiated into intramedullary, extramedullary intradural and extramedullary extradural tumors according to their occurrence within the anatomical intraspinal compartments. The clinical presentation is generally unspecific. Longer lasting back pain or a gradually worsening scoliosis are often the first signs of the disease. Neurological deficits, such as gait disturbances and paresis often occur after a time delay. In rare cases increased intracranial pressure has been reported. Knowledge concerning potential organ manifestations, resulting complications and typical radiological presentation, especially in magnetic resonance imaging are mandatory for adequate diagnosis and treatment of affected patients. (orig.) [German] Spinale Tumoren umfassen bei Kindern etwa 10 % aller auftretenden Tumoren des Zentralnervensystems (ZNS) und sind damit relativ selten. Die ueberwiegende Mehrheit dieser Tumoren sind Astrozytome und Ependymome (70 %), gefolgt von selteneren nichtglialen Tumorentitaeten, wie z. B. Gangliogliomen. Differenziert werden koennen sie nach ihrem Auftreten innerhalb der anatomischen intraspinalen Kompartimente in intra- und extramedullaere sowie intra- und extradurale Tumoren. Ihre klinische Praesentation ist haeufig unspezifisch. Laenger bestehende Rueckenschmerzen oder eine progrediente Skoliose sind oft erste Hinweise auf eine Erkrankung. Neurologische Ausfallerscheinungen wie Gangstoerungen und progrediente Laehmungen treten meist zeitlich verzoegert auf. In Einzelfaellen wird ueber Hirndruckzeichen berichtet. Kenntnisse ueber die moegliche Organmanifestation, resultierende Komplikationen und die typischen radiologischen Befunde v. a. in der MRT sind entscheidend fuer die adaequate

Magnetic resonance imaging of sacroiliitis: anatomy, histological pathology, MR-morphology, and grading; Magnetresonanztomographie der Sakroiliitis: Anatomie, Pathohistologie, MR-Morphologie und Graduierung

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Hermann, K.G.A.; Fischer, T. [Institut fuer Radiologie, Charite Universitaetsmedizin Berlin (Germany); Braun, J. [Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne (Germany); Reisshauer, H. [Gemeinschaftspraxis fuer Pathologie, Neubrandenburg (Germany); Bollow, M. [Institut fuer Radiologie, Augusta-Kranken-Anstalt, Bochum (Germany)

2004-03-01

The diagnosis of spondyloarthropathy is based on radiography of the sacroiliac joints, beside the patient's history and clinical examination. In cases where the clinical examination and radiography yield discrepant findings, contrast-enhanced magnetic resonance imaging (MRI) is a sensitive modality for the diagnosis of early sacroiliitis. Knowledge of the morphologic anatomy of the sacroiliac joints and of their abnormal micro- and macroanatomy in sacroiliitis and enthesitis are helpful for interpreting MR images. Arthritis of the sacroiliac joints is characterized by subchondral sclerosis, erosions, transarticular bone bridges, accumulation of periarticular fat, juxta-articular osteitis, synovitis, capsulitis, and enthesitis. The major histologic finding in active sacroiliitis is the presence of proliferative, pannus-like connective tissue destroying cartilage and bone. This tissue contains fibroblasts and fibrocytes as well as T cells and macrophages with a shift of the CD4/CD8 ratio toward the CD4 T helper cell population. The well-established grading of MRI findings by means of a chronicity and activity index, which are determined quantitatively from dynamic MR images, is supplemented by an alternative, semiquantitative grading of activity. The following grades were defined for the short tau inversion recovery (STIR) sequence or the T1-weighted, fat-saturated spin-echo sequence for each quadrant (iliac anterior, iliac posterior, sacral anterior, sacral posterior):0: no signal increase,1: local signal increase in the joint cavity or within erosions,2: small areas of increased juxta-articular signal,3: moderate sized areas of increased juxta-articular signal,4: large areas of increased juxta-articular signal.Values of the 4 quadrants are summed to an activity score (range 0-16). The new grading system is proposed to facilitate the examination and shorten image interpretation time. (orig.) [German] Neben Anamnese und klinischer Untersuchung bildet das

Arthrographic differential diagnosis between ruptures of the anterior talofibular ligament, the joint capsule and the anterior tibiofibular ligament

International Nuclear Information System (INIS)

Moppes, F.I. van; Hoogenband, C.R. van den; Meijer, F.

1980-01-01

Aus einem Studium der Literatur, chirurgischen Befunden und Untersuchungen an Leichen kann es als unwahrscheinlich angesehen werden, dass bei einer Fussverstauchung vom Inversionstyp ein Riss des vorderen tibiofibularen Ligraments haeufig zusammen mit einem Gelenkkapselriss und einem seitlichen Baenderriss auftritt. Entgegen der Beobachtung anderer Verfasser fanden wir, dass ein Riss des vorderen tibiofularen Ligaments in keiner Weise aus dem Vorhandensein oder Nichtvorhandensein folgender arthrographischer Befunde geschlossen werden konnte: a) kontrastfreie Zone, b) tibiofibularer Rezessus, oder c) beide zusammen. Ein Gelenkkapselriss kann angenommen werden, wenn Kontrastmittel aus dem Gelenk in das weiche Gewebe austritt, ohne unterhalb oder seitlich in den Aussenknoechel zu dringen. Ein Austritt des Kontrastmittels unterhalb und seitlich des Aussenknoechels deutet auf einen Riss des vorderen tabofibularen Ligaments hin. Die anatomischen Zusammenhaenge zwischen Bandverbindung, Gelenkkapsel, tibiofibularem Rezessus und dem vorderen talofibularen Ligament wurden an Leichen und waehrend der chirurgischen Eingriffe studiert. Ausbreitung des Kontrastmittels im weichen Gewebe wird wahrscheinlich bestimmt durch die Anordnung und Beschaedigung der Weichteile und durch die Groesse des entstandenen Haematoms und folgt dem Weg des kleinsten Widerstandes. (orig.) [de

Monitoring of the coastal waters of Niedersachsen - routine tests 1998; Ueberwachung der niedersaechsischen Kuestengewaesser - Routineuntersuchungen 1998

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-11-01

Since 1994, the Niedersaechsisches Landesamt fuer Oekologie - Forschungsstelle Kueste (NLOe-FSK) has been carrying out physical-chemical and biological experiments for monitoring the coastal waters of Niedersachsen according to a concept agreed with the Niedersachsen Minister of the Environment. Owing to a lack of funds, only the first stage is being implemented at the moment (Forschungsstelle Kueste 1995a). The findings for 1994 - 1997 have been published in several reports. This is the 1998 report. [German] Seit 1994 werden vom Niedersaechsischen Landesamt fuer Oekologie - Forschungsstelle Kueste - (NLOe-FSK) physikalisch-chemische und biologische Untersuchungen zur Ueberwachung der niedersaechsischen Kuestengewaesser nach einem mit dem Niedersaechsischen Umweltministerium abgestimmten Konzept durchgefuehrt. Das Konzept enthaelt unterschiedlich umfangreiche Ueberwachungsvarianten, von denen aufgrund der geringen verfuegbaren Ressourcen derzeit ddie Ausbaustufe I, das sogenannte 'reduzierte Rumpfprogramm', verwirklicht wird (Forschungsstelle Kueste 1995a). Die in den Jahren 1994-1997 ermittelten Untersuchungsergebnisse sind in mehreren Berichten wiedergegeben (Forschungsstelle Kueste 1995b, c; 1996, 1998, 1999). Die Befunde der 'Routineuntersuchungen' des Jahres 1998 werden in dem vorliegenden Berichtsheft vorgestellt. (orig.)

Postoperative MR arthography of the shoulder joint; MR-Arthographie des Schultergelenks im postoperativen Patientenkollektiv

Energy Technology Data Exchange (ETDEWEB)

Rand, T. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria); Trattnig, S. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria); Breitenseher, M. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria); Freilinger, W. [Orthopaedisches Krankenhaus Speising (Austria); Cochole, M. [Orthopaedische Abt., Allgemein Oeffentliches Krankenhaus Amstetten (Austria); Imhof, H. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria)

1996-12-01

Indications of MR arthrography were analyzed in this prospective study. The aim was to evaluate possible advantages over conventional MRI, establish diagnostic criteria and to analyze its meaning further for the therapeutic management of postoperative patients. MR arthrography was performed in eight patients who had undergone surgical repair of rotator cuff lesions (modified Neer acromioplasty) and in six patients who had undergone arthroscopic therapy of recurrent unidirectional dislocation of the shoulder by combined arthroscopic intra- and extracapsular repair. MR investigations were performed before and after application of a contrast solution (2 mmol Gd-DTPA). All patients suffered from chronic postoperative pain. In patients with rotator cuff lesions, a partial tear could be verified in one patient and excluded in all others. In patients after arthroscopic therapy by combined intra- and extracapsular repair, a radiologically patulous-appearing capsule correlated with clinically recurrent dislocations. In all other patients diagnostic criteria, such as distribution of the intra-articular contrast solution, proliferation of scar tissue, nodular appearance of the glenohumeral ligaments and capsule thickness, correlated with a regular postoperative status. MR arthrography of the shoulder represents a promising method in the evaluation of the postoperative shoulder. It might further improve the evaluation of reactive capsule alterations, scar tissue proliferation, and the labroligamentous complex, as well as the ability to differentiate partial and complete rerupture from degenerative changes of the rotator cuff. (orig.) [Deutsch] In einer prospektiven Studie sollten die Einsatzmoeglichkeiten der MR-Arthrographie am operierten Schultergelenk erfasst werden. Ziel der Studie war einerseits eine gegenueber der konventionellen MR-Untersuchung verbesserten Diagnosestellung und andererseits die Erstellung von fuer die Rezidivdiagnostik relevanten Diagnosekriterien

Interventional MR-Mammography: manipulator-assisted large core biopsy and interstitial laser therapy of tumors of the female breast; Interventionelle MR-Mammographie: Manipulatorgestuetzte Biopsie und interstitielle Lasertherapie von Tumoren der weiblichen Brust

Energy Technology Data Exchange (ETDEWEB)

Pfleiderer, S.O.R.; Reichenbach, J.R.; Wurdinger, S.; Marx, C.; Freesmeyer, M.G.; Kaiser, W.A. [Inst. fuer Diagnostische und Interventionelle Radiologie, Friedrich-Schiller-Univ. Jena (Germany); Vagner, J.; Fischer, H. [Inst. fuer Medizintechnik und Biophysik, Forschungszentrum Karlsruhe (Germany); Schneider, A. [Klinik fuer Frauenheilkunde, Friedrich-Schiller-Univ. Jena (Germany)

2003-07-01

The present study investigated the clinical application of magnetic resonance (MR)-guided breast interventions, such as manipulator-assisted large core breast biopsy (LCBB) inside a 1.5 T whole-body magnet and MR-guided interstitial laser therapy (ILT). Sixteen patients underwent LCBB and 1 additional patient underwent 4 sessions of ILT of a recurrent undifferentiated lymph node metastasis in the axilla using a Nd-YAG laser (1064 nm). Temperature changes of the tumor tissue during ILT were monitored using phase images of a gradient echo sequence (GRE) (TR/TE/FA = 25/12/30). In 5 patients the biopsy findings were histopathologically confirmed after open surgery. In 3 patients, the biopsy missed one tubular and one ductal carcinoma; one invasive carcinoma was underestimated. Eight patients with benign findings are still in the follow-up period. The heating zone during ILT was well delineated on subtracted phase images. No severe adverse events were observed with LCBB or ILT. MR-guided breast biopsies are feasible with the manipulator system inside a whole-body 1.5 Tesla MR scanner. GRE information is suitable for therapy monitoring during ILT within the tumor. Further studies are necessary to evaluate the accuracy of the manipulator system and the efficacy of ILT in the treatment of breast lesions. (orig.) [German] Die klinische Anwendung MR-gestuetzter Interventionen an der Mamma wie die roboterassistierte Brustbiopsie innerhalb eines Ganzkoerpertomographen oder die kernspintomographisch kontrollierte interstitielle Lasertherapie (ILT) wurden untersucht. 16 Patientinnen unterzogen sich einer Brustbiopsie. Eine weitere Patientin wurde in insgesamt 4 Sitzungen mit einem Nd-YAG-Laser (1064 nm) an einem undifferenzierten axillaeren Lymphknotenrezidiv eines Mammakarzinoms behandelt. Temperaturaenderungen im Tumor waehrend der ILT wurden mit Hilfe von Phasenbildern einer Gradientenechosequenz (GRE) (TR/TE/FA = 25/12/30) visualisiert. Bei 5 Patientinnen wurde der

Patient participation in patient safety still missing: Patient safety experts' views.

Science.gov (United States)

Sahlström, Merja; Partanen, Pirjo; Rathert, Cheryl; Turunen, Hannele

2016-10-01

The aim of this study was to elicit patient safety experts' views of patient participation in promoting patient safety. Data were collected between September and December in 2014 via an electronic semi-structured questionnaire and interviews with Finnish patient safety experts (n = 21), then analysed using inductive content analysis. Patient safety experts regarded patients as having a crucial role in promoting patient safety. They generally deemed the level of patient safety as 'acceptable' in their organizations, but reported that patient participation in their own safety varied, and did not always meet national standards. Management of patient safety incidents differed between organizations. Experts also suggested that patient safety training should be increased in both basic and continuing education programmes for healthcare professionals. Patient participation in patient safety is still lacking in clinical practice and systematic actions are needed to create a safety culture in which patients are seen as equal partners in the promotion of high-quality and safe care. © 2016 John Wiley & Sons Australia, Ltd.

Acute care patients discuss the patient role in patient safety.

Science.gov (United States)

Rathert, Cheryl; Huddleston, Nicole; Pak, Youngju

2011-01-01

Patient safety has been a highly researched topic in health care since the year 2000. One strategy for improving patient safety has been to encourage patients to take an active role in their safety during their health care experiences. However, little research has shed light on how patients view their roles. This study attempted to address this deficit by inductively exploring the results of a qualitative study in which patients reported their ideas about what they believe their roles should be. Patients with an overnight stay in the previous 90 days at one of three hospitals were surveyed using a mailing methodology. Of 1,040 respondents, 491 provided an open-ended response regarding what they believe the patient role should be. Qualitative analysis found several prominent themes. The largest proportion of responses (23%) suggested that patients should follow instructions given by care providers. Other prominent themes were that patients should ask questions and become informed about their conditions and treatments, and many implied that they should expect competent care. Our results suggest that patients believe they should be able to trust that they are being provided competent care, as opposed to assuming a leadership role in their safety. Our results suggest that engaging patients in safety efforts may be complex, requiring a variety of strategies. Managers must provide environments conducive to staff and patient interactions to support patients in this effort. Different types of patients may require different engagement strategies.

Coxarthrosis - an update; Koxarthrose - ein Update

Energy Technology Data Exchange (ETDEWEB)

Imhof, H.; Noebauer-Huhmann, I.; Trattnig, S. [Medizinische Universitaet Wien, Klinik fuer Radiodiagnostik, Wien (Austria)

2009-05-15

Degenerative osteoarthritis of the hip joint (coxarthrosis) is the most common disease of the hip joint in adults. The diagnosis is based on a combination of radiographic findings and characteristic clinical symptoms. The lack of a radiographic consensus definition has seemingly resulted in a variation of the published incidences and prevalence of degenerative osteoarthritis of the hip joint. The chronological sequence of degeneration includes the following basic symptoms on conventional radiographs and CT: joint space narrowing, development of osteophytes, subchondral demineralisation/sclerosis and cyst formation, as well as loose bodies, joint malalignment and deformity. MR imaging allows additional visualization of early symptoms and/or activity signs such as cartilage edema, cartilage tears and defects, subchondral bone marrow edema, synovial edema and thickening, joint effusion and muscle atrophy. The scientific dispute concerns the significance of (minimal) joint malalignment (e.g. impingement, dysplasia etc.) and forms of malpositioning which as possible prearthrosis have a high probability of leading to degenerative osteoarthritis. Moreover, without any question, the preservation of joint containment and gender differences are important additional basic diagnostic principles, which have gained great interest in recent years. In research different MR procedures such as Na and H spectroscopy, T2*-mapping etc. with ultrahigh field MR allow cartilage metabolism and its changes in early degenerative osteoarthritis (''biochemical imaging'') to be studied. There is no doubt that even in a few years new profound knowledge is to be expected in this field. (orig.) [German] Die Hueftgelenkarthrose ist im Erwachsenenalter die haeufigste Erkrankung des Hueftgelenks. Die fehlende Konsensusdefinition dieser Erkrankung fuehrt zu einer scheinbar breiten Varianz bzgl. Inzidenz und Praevalenz. Die Diagnose wird aufgrund des radiologischen Befundes und der

Analysis of 64-row multidetector CT images for preoperative angiographic evaluation of potential living kidney donors; Analyse der mehrphasigen 64-Zeilen-Multidetektor-Computertomographie zur praeoperativen angiographischen Evaluation potenzieller Lebendnierenspender

Energy Technology Data Exchange (ETDEWEB)

Blondin, D.; Andersen, K.; Kroepil, P.; Cohnen, M.; Moedder, U.; Jung, G. [Universitaetsklinikum Duesseldorf, Institut fuer Diagnostische Radiologie, Duesseldorf (Germany); Sandmann, W. [Universitaetsklinikum Duesseldorf, Klinik fuer Gefaesschirurgie und Nierentransplantation, Duesseldorf (Germany); Ivens, K. [Universitaetsklinikum Duesseldorf, Klinik fuer Nephrologie, Duesseldorf (Germany)

2008-07-15

venoese Phase des Abdomens und eine Spaetphase nach 15 min in Low-dose-Technik fuer die CT-Urographie (CTU) durchgefuehrt. Die radiologischen Befunde wurden mit dem intraoperativen Befund oder in 2 Faellen mit der konventionellen Angiographie verglichen, ausserdem wurden Sensitivitaet, Spezifitaet, negativer und positiver Vorhersagewert ermittelt. Bei den ausgewerteten 63 LNS (31 weibliche, 32 maennliche) erreichte die CTA eine Sensitivitaet von 100% fuer die Arterien und Polarterien und 98,3% fuer die Nierenvenenanatomie. Die Low-dose-CTU erreichte ebenfalls eine Sensitivitaet von 100%. Die Ergebnisse zeigen, dass eine nichtinvasive praeoperative Planung bei potenziellen Lebendnierenspendern anhand einer 64-Zeilen-Multidetektor-CT im Sinne des 'On-stop-Shopping' zuverlaessig moeglich ist. (orig.)

Trauma and postoperative follow-up; Traumata und postoperative Folgezustaende

Energy Technology Data Exchange (ETDEWEB)

Voth, E. [Univ. Koeln (Germany). Klinik und Poliklinik fuer Nuklearmedizin

1997-10-01

Indications for the use of nuclear medicine techniques, mostly bone scintigraphy, occur in case of diagnostic problems, especially if there are discrepancies between the clinical symptoms and X-ray findings. This may happen in case of stress fractures, fractures in bones difficult to judge by X-ray imaging, and in the differentation of recent versus old fracture. A further indication for bone scanning is to assess the extent of skeletal lesions in polytrauma and in the battered child syndrome. In postoperative patients bone scanning is most frequently performed in order to assess loosening or infection of endoprosthesis. Due to bone remodelling uptake of Tc-diphosphonates varies between cemented and cementfree implants. This fact should be taken into consideration when interpreting bone scans in areas with endoprostheses. In both trauma and postoperative patients, indications for nuclear medicine imaging exist if healing is complicated. Bone scanning can be used to assess pseudoartrosis or non-union, infection, viability of grafts and bone fragments and reflex sympathetic dystrophy. In suspicious infection with positive bone scan, white blood cell or microcollid scintigraphy can be used for further differentiation. (orig./MG) [Deutsch] Indikationen zum Einsatz nuklearmedizinischer Verfahren, in der Regel der Skelettszintigraphie, ergeben sich bei diagnostischen Problemen, speziell bei Diskrepanzen zwischen der klinischen Symptomatik und dem roentgenologischen Befund. In der Traumatologie kann dies Stressfrakturen, Frakturen in roentgenologisch schwer beurteilbaren Skelettabschnitten, das Ausmass der knoechernen Verletzungen bei Polytraumata oder Kindermisshandlungen sowie die Differenzierung alte versus frische Fraktur betreffen. In der postoperativen Verlaufs- bzw. Therapiekontrolle ist die haeufigste Indikation zur Skelettszintigraphie die Frage nach Lockerung einer Endoprothese. Wegen des aus pathophysiologischen Gruenden unterschiedlichen Anreicherungsmusters

Multiparametric MRI of the prostate. Important radiological findings for urologists; Multiparametrische MRT der Prostata. Wichtige radiologische Befunde fuer den Urologen

Energy Technology Data Exchange (ETDEWEB)

Schlemmer, Heinz-Peter [Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany)

2017-08-15

High prevalence of prostate cancer with multifocality and biological heterogeneity. Insufficient conventional urological diagnostics. Discrimination between significant and insignificant cancer needed. Digital rectal examination, prostate-specific antigen (PSA) serum level, systematic transrectal ultrasound (TRUS)-guided prostate biopsy. Multiparametric magnetic resonance imaging (mpMRI) including T2-weighted (T2w), diffusion-weighted and dynamic contrast-enhanced MRI according to the prostate imaging reporting and data system (PIRADS), MR-targeted biopsy, most frequently MR/TRUS image fusion biopsy. Prostate cancer is characterized by low signal intensity on T2w MRI, restricted water diffusion and pronounced and early uptake of contrast enhancement. Sensitivity and specificity according to the current literature are ca. 80% and 90%, respectively. In cases of suspected prostate cancer, most accurate are mpMRI according to PIRADS and in cases of positive findings, MRI-targeted biopsy, most frequently as MRI/TRUS image fusion biopsy. (orig.) [German] Hohe Praevalenz des Prostatakarzinoms mit Multifokalitaet und biologischer Heterogenitaet. Unzureichende konventionelle urologische Diagnostik. Unterscheidung klinisch signifikanter von klinisch nicht signifikanten Karzinomen erforderlich. Digitale rektale Untersuchung, Serum-PSA (prostataspezifisches Antigen), transrektale Sonographie (TRUS), systematische transrektale TRUS-Biopsie. Multiparametrische Magnetresonanztomographie (mpMRT) mit T2w- und diffusionsgewichteten sowie dynamischen kontrastmittelverstaerkten T1w-Sequenzen, dem Standard nach dem Prostate Imaging Reporting and Data System (PIRADS) entsprechend. MR-unterstuetzte Biopsie, meist MR-/TRUS-Fusionsbiopsie. Prostatakarzinome sind typischerweise T2-hypointens mit eingeschraenkter Diffusion und zeigen eine rasche Kontrastmittelanflutung. Nach der Literatur betragen Sensitivitaet und Spezifitaet der mpMRT ca. 80 bzw. 90 %. Fuer die Abklaerung bei Verdacht auf ein Prostatakarzinom sollten eine mpMRT nach PIRADS-Standard und bei suspekten Befunden eine MR-unterstuetzte Biopsie erfolgen, vorzugsweise als MR-/TRUS-Fusionsbiopsie. (orig.)

Osler's disease; Morbus Osler

Energy Technology Data Exchange (ETDEWEB)

Ahlhelm, F.; Mueller, U. [Kantonsspital Baden AG, Institut fuer Radiologie, Baden (Switzerland); Lieb, J. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland); Schneider, G. [Universitaetskliniken des Saarlandes, Klinik fuer Diagnostische und Interventionelle Radiologie, Homburg/Saar (Germany); Ulmer, S. [Medizinisch-Radiologisches Institut, Zuerich (Switzerland)

2013-12-15

Osler's disease, also known as hereditary hemorrhagic telangiectasia (HHT) and Osler-Weber-Rendu syndrome, is an autosomal dominant disorder leading to abnormal blood vessel formation in the skin, mucous membranes and often in organs, such as the lungs, liver and brain (arteriovenous malformations AVM). Various types are known. Patients may present with epistaxis. Teleangiectasia can be identified by visual inspection during physical examination of the skin or oral cavity or by endoscopy. Diagnosis is made after clinical examination and genetic testing based on the Curacao criteria. Modern imaging modalities, such as computed tomography (CT) or magnetic resonance imaging (MRI) have become more important as they can depict the AVMs. Pulmonary AVMs can be depicted in CT imaging even without the use of a contrast agent while other locations including the central nervous system (CNS) usually require administration of contrast agents. Knowledge of possible clinical manifestations in various organs, possible complications and typical radiological presentation is mandatory to enable adequate therapy of these patients. Interventional procedures are becoming increasingly more important in the treatment of HHT patients. (orig.) [German] Der Mobus Osler (Synonyme: hereditaere haemorrhagische Teleangiektasie [HHT], Morbus Rendu-Osler-Weber) ist eine Multisystemerkrankung und gehoert zur Gruppe der vaskulaeren haemorrhagischen Erkrankungen. Bei der autosomal dominanten Erkrankung, die zu den haeufigsten Phakomatosen zaehlt, kann je nach Gendefekt zwischen verschiedenen Formen, die zu einer Stoerung der Blutgefaessbildung fuehren, unterschieden werden. Neben der genetischen Diagnostik und der klinischen Untersuchung sind bildgebende Verfahren entscheidend fuer die Diagnose. Klinisch stehen die Epistaxis, mukokutane Teleangiektasien und viszerale arteriovenoese Malformationen (AVM) v. a. in Lunge, Leber und Hirn sowie die Folgen dieser Gefaesspathologien wie z. B

Awake craniotomy. A patient`s perspective.

Science.gov (United States)

Bajunaid, Khalid M; Ajlan, Abdulrazag M

2015-07-01

To report the personal experiences of patients undergoing awake craniotomy for brain tumor resection. We carried out a qualitative descriptive survey of patients` experiences with awake craniotomies for brain tumor resection. The survey was conducted through a standard questionnaire form after the patient was discharged from the hospital. Of the 9 patients who met the inclusion criteria and underwent awake craniotomy, 3 of those patients reported no recollection of the operation. Five patients had auditory recollections from the operation. Two-thirds (6/9) reported that they did not perceive pain. Five patients remembered the head clamp fixation, and 2 of those patients classified the pain from the clamp as moderate. None of the patients reported that the surgery was more difficult than anticipated. Awake craniotomy for surgical resection of brain tumors was well tolerated by patients. Most patients reported that they do not recall feeling pain during the operation. However, we feel that further work and exploration are needed in order to achieve better control of pain and discomfort during these types of operations.

Achieving patient satisfaction: resolving patient complaints.

Science.gov (United States)

Oxler, K F

1997-07-01

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

Patient-centred outcomes research: perspectives of patient stakeholders.

Science.gov (United States)

Chhatre, Sumedha; Gallo, Joseph J; Wittink, Marsha; Schwartz, J Sanford; Jayadevappa, Ravishankar

2017-11-01

To elicit patient stakeholders' experience and perspectives about patient-centred care. Qualitative. A large urban healthcare system. Four patient stakeholders who are prostate cancer survivors. Experience and perspectives of patient stakeholders regarding patient-centred care and treatment decisions. Our patient stakeholders represented a diverse socio-demographic group. The patient stakeholders identified engagement and dialogue with physicians as crucial elements of patient-centred care model. The degree of patient-centred care was observed to be dependent on the situations. High severity conditions warranted a higher level of patient involvement, compared to mild conditions. They agreed that patient-centred care should not mean that patients can demand inappropriate treatments. An important attribute of patient-centred outcomes research model is the involvement of stakeholders. However, we have limited knowledge about the experience of patient stakeholders in patient-centred outcomes research. Our study indicates that patient stakeholders offer a unique perspective as researchers and policy-makers aim to precisely define patient-centred research and care.

Patients' preferences for patient-centered communication

DEFF Research Database (Denmark)

Lau, Sofie Rosenlund; Christensen, Søren Troels; Andreasen T., Jesper

2013-01-01

To investigate patients' preferences for patient-centered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone.......To investigate patients' preferences for patient-centered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone....

X-ray findings in the skeleton of the hand to prove renal osteopathy. Soft ray immersions radiography versus standard procedures; Roentgendiagnostik der renalen Osteopathie am Handskelett. Weichstrahl-Immersions-Radiographie kontra Standardtechnik

Energy Technology Data Exchange (ETDEWEB)

Pollack, T. [Radiologische Klinik, Krankenhaus Dresden-Friedrichstadt, Staedtisches Klinikum (Germany); Friedberg, R. [Radiologische Klinik, Krankenhaus Dresden-Friedrichstadt, Staedtisches Klinikum (Germany); Heinicke, H.J. [1. Medizinische Klinik, Krankenhaus Dresden-Friedrichstadt, Staedtisches Klinikum (Germany)

1994-11-01

In examinations of the hand skeleton, findings typical of renal osteopathy are much more readily revealed by soft ray immersions radiography than by images obtained using conventional techniques. In combination with microradioscopy the method is highly suitable for the primary diagnosis and follow-up of renal osteopathy. The information provided eliminates the need for examinations of other skeletal sections and thus justifies the slightly increased dose requirements. The fact that unchanged parathormone can be determined simultaneously adds to the sensitivity of this non-invasive technique. Histological assessments of the skeleton can, however, not always be avoided. (orig.) [Deutsch] Die Untersuchung des Handskeletts mit Hilfe der Weichstrahl-Immersions-Radiographie (WIR) ist fuer typische Befunde der renalen Osteopathie wesentlich sensitiver als die Aufnahmen in Standardtechnik. In Kombination mit der Mikroradioskopie ist sie fuer die roentgenologische Basisdiagnostik und Verlaufskontrolle der renalen Osteopathie sehr gut geeignet. Der Informationsgewinn und die Moeglichkeit der Einsparung von Roentgenuntersuchungen anderer Skelettabschnitte rechtfertigt den etwas hoeheren Dosisbedarf der WIR. Die gleichzeitige Bestimmung des intakten Parathormons erhoeht die Sensitivitaet der nichtinvasiven Diagnostik. Dennoch laesst sich auf eine Knochenhistologie nicht in jedem Fall verzichten. (orig.)

Zwischen Freakout und Normcore

Directory of Open Access Journals (Sweden)

Beate Großegger

2017-06-01

Full Text Available Bis Ende des 20. Jahrhunderts war Rebellion jugendkulturell ein großes Thema. Heute hat die Jugend das so genannte Establishment aus den Augen verloren; die breite Mehrheit gibt sich postheroisch, setzt auf individualitätsbezogene Werte und träumt, eingeschlossen in ihre bunten Lifestyleblasen, von einem perfekten Leben. Bezugnehmend auf aktuelle Befunde der Jugend- und Generationenforschung gibt Beate Großegger in ihrem Beitrag einen Überblick über die wichtigsten Werte- und Lifestyletrends im frühen 21. Jahrhundert und zeigt dabei, wie sehr die heutige Jugend Kind ihrer Zeit und Produkt gesellschaftlicher Rahmenbedingungen ist. Until the late 20th century rebellion was an important aspect of various youth subcultures. But today’s youth has a different mindset. The majority acts post-heroically, i.e. they rather focus on their individual, their private lifestyle than opposing against the establishment. Wrapped in their lifestyle filterbubbles, they dream of a perfect life. Based on recent youth und generation studies Beate Großegger gives an overview of the most important youth cultural trends in the fields of values and lifestyles and introduces today’s youth as a child of our times.

[Osteopathie bei gastroösophagealem Reflux mit Hiatushernie: Ein Fallbericht gemäß der CARE-Leitlinie].

Science.gov (United States)

Rotter, Gabriele; Brinkhaus, Benno

2017-01-01

Hintergrund: Das Vorhandensein einer Hiatushernie kann das Auftreten einer gastroösophagealen Refluxerkrankung (GERD) als Komplikation bedingen. Konventionelle medizinische Therapiemaßnahmen können zu unerwünschten Ereignissen und Rezidiven führen. Bisher sind die Effekte von osteopathischen Behandlungen bei Hiatushernie und GERD nicht bekannt. Fallbericht: Eine 59-jährige Patientin mit endoskopisch diagnostizierter chronischer Gastritis, GERD und Hiatushernie beklagte einen persistierenden gastroösophagealen Reflux trotz konventionell-medizinischer konservativer Therapie. Die osteopathische Diagnostik ergab eine funktionelle Störung im Bereich des Magens und der Kardia mit einer Beteiligung zugehöriger Reflexzonen. Nach einer osteopathischen Behandlung als individuelle, befundorientierte Therapie ließen die Beschwerden erheblich nach. Die Hiatushernie war nach einer dieser Behandlung endoskopisch nicht mehr nachweisbar. Schlussfolgerungen: Dieser Fallbericht schildert die Symptomreduktion einer GERD nach osteopathischer Behandlung. In der endoskopischen Folgeuntersuchung fand sich die initial diagnostizierte Hiatushernie nicht mehr, diese Befund änderung könnte jedoch auf die unterschiedlichen Untersucher zurückgeführt werden. Prospektive kontrollierte klinische Studien sind notwendig, um den Stellenwert von osteopathischen Behandlungen bei GERD mit Hiatushernie zu untersuchen. © 2017 The Author(s). Published by S. Karger GmbH, Freiburg.

Tarsaltunnel syndrome - MRI diagnosis; Tarsaltunnelsyndrom. MR-Diagnostik

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Trattnig, S. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria). Abt. fuer Osteoradiologie; Breitenseher, M. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria). Abt. fuer Osteoradiologie; Haller, J. [Radiologische Abt., Hanuschkrankenhaus, Wien (Austria)]|[Ludwig Boltzmann-Institut fuer Osteologie, Wien (Austria); Helbich, T. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria). Abt. fuer Osteoradiologie; Gaebler, C. [Universitaetsklinik fuer Unfallchirurgie, Wien (Austria); Imhof, H. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria). Abt. fuer Osteoradiologie

1995-07-01

Clinical findings and symptoms of tarsal tunnel are commonly vague and diffuse and electrodiagnostic studies do not provide definitive diagnosis. MR imaging with its excellent soft tissue contrast can demonstrate clearly the anatomy of the tarsal tunnel and its contents. MRI is able to demonstrate a space-occypyinglesion and its relationship to the posterior tibial nerve and its branches. This information aids in surgical planning by determining the extent of the decompression required. MR imaging may also be used to follow up non-surgical causes of tarsal tunnel syndrome such as tenosynovitis. (orig.) [Deutsch] Klinische Befunde und Symptomoe des Tarsaltunnelsyndroms sind haeufig diffus, und elektrodiagnostische Untersuchungen liefern keine definitive Diagnose. Die MRT mit ihrem exzellenten Weichteilkontrast erlaubt eine ausgezeichnete Darstellung der Anatomie des Tarsaltunnels und seines Inhaltes. Die MRT ermoeglicht auch die Darstellung von raumfordernden Laesionen und ihre Beziehung zum N.tibialis posterior bzw. seiner Aeste. Diese Information hilft in der chirurigschen Planung, in dem das Ausmass der notwendigen Dekompression bestimmt werden kann. Die MRT ist auch geeignet als nichtinvasive Verlaufskontrolle von Ursachen eines Tarsaltunnelsyndroms, die keinen chirugischen Eingriff erfordern wie z.B. einer Tenosynovitis. (orig.)

Spreading amelanotic malignant melanoma: A rare differential diagnosis with tumors of the glandula submandibularis; Metastasiertes amelanotisches Melanom: Eine seltene Differentialdiagnose bei Tumoren der Glandula submandibularis

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Ehrenberg, C.; Helmberger, H. [Technische Univ. Muenchen (Germany). Inst. fuer Roentgendiagnostik; Werner, M. [Institut fuer Allgemeine Pathologie und Pathologische Anatomie, Klinikum rechts der Isar, Technische Univ. Muenchen (Germany)

1998-09-01

The case reported emphasizes the importance of immediate performance of imaging scans in case of the slightest suspicion that clinical symptoms might indicate malignancy of a detected lesion. Despite the superficially only marginal macroscopic findings, MR imaging as well as the CT scans revealed an advanced, malignant process that had been spreading. Particularly the soft tissue differential diagnosis obtained with MRI yields the information required for diagnostic characterization of the space occupying tumor mass. It will however be necessary in any case to verify the diagnosis by biopsy or extirpation and cytologic examination of tissue, as the imaging methods do not always unambigiously reveal the malignant dignity of the tumor. (orig./CB) [Deutsch] Der vorliegende Fall unterstreicht die Bedeutung einer umgehend durchgefuehrten Bildgebung beim geringsten Zweifel an der Benignitaet eines klinischen Symptoms. Trotz des aeusserlich nur marginalen makroskopischen Befundes zeigt die Kernspintomographie in Uebereinstimmung mit der Computertomographie einen fortgeschrittenen, bereits abgesiedelten Prozess. Insbesondere die MRT laesst aufgrund ihrer guten Weichteildifferenzierung einen Rueckschluss auf den Gewebstyp der Raumforderung zu. Einschraenkend bleibt jedoch festzuhalten, dass die maligne Dignitaet des Tumors in beiden bildgebenden Verfahren nicht ohne weiteres erkennbar ist, so dass die Biopsie bzw. Extirpation zur Histologiegewinnung unverzichtbar ist. (orig./MG)

Der chthonische Dionysos - Zur Wirkmacht des Mythos in den Mysterien

Directory of Open Access Journals (Sweden)

Niklas Engel

2016-12-01

Full Text Available Dieser Beitrag soll aufzeigen, dass eine chthonische und eschatologische Dimension der dionysischen Göttlichkeit in verschiedenen Riten und Kulten des Gottes nachgewiesen werden kann und dabei keinesfalls mysterienexklusiv ist. Dazu soll der archäologische Befund, der Dionysos mit dem Jenseits und eschatologischen Ho nungen in Verbindung bringt, vorgestellt und untersucht werden. Darauf aufbauend soll belegt werden, dass diese jenseitige Dimension sich sowohl in Riten mit privatem Kern, hier am Beispiel der Oreibasia, als auch in Kultfeiern des ö entlichen Festkanons, wie den Anthesterien, zeigt. Abschließend soll dann Dionysos‘ Funktion in den eleusinischen Mysterien untersucht werden. This paper aims to show that a chthonic and eschatological dimension of dionysiac divinity can be found in various rites and cults of the god and that this is not exclusive for the mysteries. Recent archaeological evidence connecting Dionysos with the afterlife and eschatological expectations will be introduced and analyzed. is dimension manifests itself in rites with a private intent (e.g. the Oreibasia as well as public celebrations of the festival calendar (e.g. the Anthesteria. An analysis of Dionysos’ function in the eleusinian mysteries concludes the overview.

Patient Involvement in Patient Safety: A Qualitative Study of Nursing Staff and Patient Perceptions.

Science.gov (United States)

Bishop, Andrea C; Macdonald, Marilyn

2017-06-01

The risk associated with receiving health care has called for an increased focus on the role of patients in helping to improve safety. Recent research has highlighted that patient involvement in patient safety practices may be influenced by patient perceptions of patient safety practices and the perceptions of their health care providers. The objective of this research was to describe patient involvement in patient safety practices by exploring patient and nursing staff perceptions of safety. Qualitative focus groups were conducted with a convenience sample of nursing staff and patients who had previously completed a patient safety survey in 2 tertiary hospital sites in Eastern Canada. Six focus groups (June 2011 to January 2012) were conducted and analyzed using inductive thematic analysis. Four themes were identified: (1) wanting control, (2) feeling connected, (3) encountering roadblocks, and (4) sharing responsibility for safety. Both patient and nursing staff participants highlighted the importance of building a personal connection as a precursor to ensuring that patients are involved in their care and safety. However, perceptions of provider stress and nursing staff workload often reduced the ability of the nursing staff and patient participants to connect with one another and promote involvement. Current strategies aimed at increasing patient awareness of patient safety may not be enough. The findings suggest that providing the context for interaction to occur between nursing staff and patients as well as targeted interventions aimed at increasing patient control may be needed to ensure patient involvement in patient safety.

Incidental findings in chest X-rays; Zufallsbefunde im Roentgenthorax

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Wielpuetz, M.O.; Kauczor, H.U. [Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaet Heidelberg, Translational Lung Research Center (TLRC), Deutsches Zentrum fuer Lungenforschung (DZL), Heidelberg (Germany); Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik, Heidelberg (Germany); Weckbach, S. [Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaet Heidelberg, Translational Lung Research Center (TLRC), Deutsches Zentrum fuer Lungenforschung (DZL), Heidelberg (Germany)

2017-04-15

Conventional projection radiography (chest x-ray) is one of the most frequently requested procedures in radiology. Even though chest x-ray imaging is frequently performed in asymptomatic patients for preoperative assessment, clinically relevant incidental findings are relatively scarce. This is due to the relatively low sensitivity of chest x-rays where few clinically relevant incidental findings are to be expected, as any detectable pathologies will as a rule already be clinically symptomatic. Recommendations from relevant societies for the management of incidental findings, apart from the clarification of incidental nodules, do not exist. This review article therefore describes the most frequent and typical incidental findings of lung parenchyma (apart from pulmonary nodules), mediastinal structures including the hilum of the lungs, pleura, chest wall and major vessels. Also described are those findings which can be diagnosed with sufficient certainty from chest x-rays so that further clarification is not necessary and those which must be further clarified by multislice imaging procedures or other techniques. (orig.) [German] Eine der haeufigsten Untersuchungen in der Radiologie ist die konventionelle Projektionsradiographie des Thorax (Roentgenthorax). Auch wenn projektionsradiographische Aufnahmen im Rahmen einer praeoperativen Abklaerung haeufig als orientierende Untersuchung angefertigt werden, sind - bedingt durch die relativ geringe Sensitivitaet des Roentgenthorax - wenig klinisch relevante Zufallsbefunde zu erwarten, da nachweisbare Pathologien in der Regel bereits auch klinisch apparent sind. Empfehlungen entsprechender Fachgesellschaften zu Zufallsbefunden im Roentgenthorax jenseits der Abklaerung von Rundherden liegen nicht vor. Die vorliegende Arbeit beleuchtet daher haeufige und typische Zufallsbefunde des Lungenparenchyms (ausser den Lungenrundherden), der mediastinalen Strukturen einschliesslich der Hili, der Pleura, der Thoraxwand sowie der

SPECT in psychiatry; Die Bedeutung der Hirn-SPECT in der Psychiatrie

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Kasper, S [Universitaetsklinik fuer Psychiatrie, Wien (Austria); Gruenwald, F [Bonn Univ. (Germany). Klinik fuer Nuklearmedizin; Danos, P [Psychiatrische Universitaetsklinik, Bonn (Germany); Walter, H [Universitaetsklinik fuer Psychiatrie, Wien (Austria); Klemm, E [Bonn Univ. (Germany). Klinik fuer Nuklearmedizin; Bruecke, T [Universitaetsklinik fuer Neurologie, Wien (Austria); Podreka, I [Universitaetsklinik fuer Neurologie, Wien (Austria); Biersack, H J [Bonn Univ. (Germany). Klinik fuer Nuklearmedizin

1994-10-01

In the last fifteen years different attempts have been undertaken to understand the biological basis of major psychiatric disorders. One important tool to determine patterns of brain dysfunction is single emission computed tomography (SPECT). Whereas SPECT investigations are already a valuable diagnostic instrument for the diagnosis of dementia of the Alzheimer Type (DAT) there have not been consistent findings that can be referred to as specific for any other particular psychiatric diagnostic entity. Nevertheless, SPECT studies have been able to demonstrate evidence of brain dysfunction in patients with schizophrenia, depression, anxiety disorders, and substance abuse in which other methods showed no clear abnormality of brain function. Our manuscript reviews the data which are currently available in the literature and stresses the need for further studies, especially for prediction and monitoring psychiatric treatment modalities. (orig.) [Deutsch] In den vergangenen 15 Jahren wurde durch verschiedene methodologische Ansaetze versucht, die biologischen Ursachen psychiatrischer Erkrankungen naeher zu erforschen. Als eine bedeutende Methode hat sich dabei die Single-Photonen-Emissions-Computertomographie (SPECT) herausgestellt. Waehrend die SPECT-Untersuchungen bereits Eingang in die Routinediagnostik bei Demenzen vom Alzheimer-Typ gefunden haben, konnten fuer weitere psychiatrische Erkrankungen noch keine eindeutigen Befunde etabliert werden. Mit der SPECT-Methode ist es jedoch gelungen, funktionelle Veraenderungen des Gehirns von psychiatrischen Erkrankungen darzustellen, wie z.B. Schizophrenie, Depression, Angsterkrankungen bzw. Substanzmissbrauch. In Forschungsprotokollen wird durch die SPECT-Methode versucht, abzuklaeren, inwieweit es moeglich ist, innerhalb der Erkrankungsentitaeten psychiatrischer Erkrankungen oder auch diese uebergreifend eine Subklassifizierung zu finden und evtl. Gehirnsysteme ausfindig zu machen, die mit einer spezifischen

Diagnostic imaging of compression neuropathy; Bildgebende Diagnostik von Nervenkompressionssyndromen

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Weishaupt, D.; Andreisek, G. [Universitaetsspital, Institut fuer Diagnostische Radiologie, Zuerich (Switzerland)

2007-03-15

Compression-induced neuropathy of peripheral nerves can cause severe pain of the foot and ankle. Early diagnosis is important to institute prompt treatment and to minimize potential injury. Although clinical examination combined with electrophysiological studies remain the cornerstone of the diagnostic work-up, in certain cases, imaging may provide key information with regard to the exact anatomic location of the lesion or aid in narrowing the differential diagnosis. In other patients with peripheral neuropathies of the foot and ankle, imaging may establish the etiology of the condition and provide information crucial for management and/or surgical planning. MR imaging and ultrasound provide direct visualization of the nerve and surrounding abnormalities. Bony abnormalities contributing to nerve compression are best assessed by radiographs and CT. Knowledge of the anatomy, the etiology, typical clinical findings, and imaging features of peripheral neuropathies affecting the peripheral nerves of the foot and ankle will allow for a more confident diagnosis. (orig.) [German] Kompressionsbedingte Schaedigungen peripherer Nerven koennen die Ursache hartnaeckiger Schmerzen im Bereich des Sprunggelenks und Fusses sein. Eine fruehzeitige Diagnose ist entscheidend, um den Patienten der richtigen Therapie zuzufuehren und potenzielle Schaedigungen zu vermeiden oder zu verringern. Obschon die klinische Untersuchung und die elektrophysiologische Abklaerungen die wichtigsten Elemente der Diagnostik peripherer Nervenkompressionssyndrome sind, kann die Bildgebung entscheidend sein, wenn es darum geht, die Hoehe des Nervenschadens festzulegen oder die Differenzialdiagnose einzugrenzen. In gewissen Faellen kann durch Bildgebung sogar die Ursache der Nervenkompression gefunden werden. In anderen Faellen ist die Bildgebung wichtig bei der Therapieplanung, insbesondere dann, wenn die Laesion chirurgisch angegangen wird. Magnetresonanztomographie (MRT) und Sonographie ermoeglichen eine

Analyses of functional brain connectivity; Untersuchungen zur funktionellen Konnektivitaet des Gehirns

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Stephan, K.E.

2003-03-01

This dissertation includes two independent studies that investigate two complementary aspects of functional connectivity in the Macaque and the human brain. In the first study, a computational meta-analysis of published electrophysiological data on context-independent functional brain connectivity was conducted by means of three independent methods. The second study investigated the effects of the atypical antipsychotic substance olanzapine on the functional connectivity of the cerebellum during a simple motor task (self-paced finger tapping). Six schizophrenic patients and six control subjects matched for age and sex were investigated by functional magnetic resonance imaging (fMRI) twice. This study provided the first experimental data on the effects of atypical antipsychotic agents on functional brain connectivity and demonstrated pronounced olanzapine-dependent changes of functional couplings between cerebellum, thalamus, and prefrontal cortex. (orig.) [German] In der hier vorgelegten Arbeit werden zwei komplementaere Aspekte der funktionellen Konnektivitaet - im Gehirn des Makaken und Menschen anhand zweier separater Studien untersucht. In der ersten Studie wurde mittels dreier unabhaengiger Methoden eine Metaanalyse publizierter elektrophysiologischer Daten zur kontextunabhaengigen funktionellen Konnektivitaet des Makakenkortex durchgefuehrt. Diese Studie erbrachte damit zum ersten Mal den Nachweis einer funktionellen Small World-Netzwerkstruktur des Primatenkortex. In der zweiten Studie wurde der Effekt des atypischen Neuroleptikums Olanzapin auf die funktionelle Konnektivitaet des Zerebellums im Kontext einer einfachen motorischen Aufgabe (selbstgesteuertes Fingertrapping) untersucht. Sechs schizophrene Patienten, die Neuroleptika-naiv bzw. -entwoehnt waren, sowie sechs alters- und geschlechtsentprechende Kontrollprobanden wurden im Abstand von jeweils drei Wochen mit funktioneller Magnetresonanztomografie (fMRT) untersucht. Diese Studie lieferte die ersten

Neurosarcoidosis. Radiologe, Oct 2016, v. 56(10); Neurosarkoidose

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Reith, W.; Roumia, S.; Popp, C. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

2016-10-15

Neurosarcoidosis is a relatively rare complication of sarcoidosis that occurs in approximately 5-15 % of patients. The clinical picture is variable. Clinically, neurosarcoidosis is mostly manifested as lesions of the cranial nerves (50-70 %) and several cranial nerves are typically affected. This is the result of aseptic granulomatous basal meningitis. Intraparenchymal granulomas also occur, frequently affecting basal near-midline structures, such as the hypothalamus and pituitary glands and can lead to encephalopathy. Diagnostics are essentially performed using magnetic resonance imaging (MRI) as it can demonstrate the thickened meninges, which have a high affinity for contrast media but the results are not specific. Particularly in the absence of systemic sarcoidosis, diagnosis can be difficult. Laboratory tests are not very sensitive and specific, which makes neurosarcoidosis a diagnostic challenge. Due to the substantial morbidity of the disease, early and consistent treatment should be initiated. This is usually carried out with corticosteroids supported by immunosuppressant drugs, such as azathioprine and methotrexate. (orig.) [German] Die Neurosarkoidose ist eine seltene Komplikation der Sarkoidose, die bei ca. 5-15 % der Patienten auftritt. Das klinische Bild ist variabel. Klinisch praesentiert sich eine Neurosarkoidose am haeufigsten mit Hinnervenausfaellen (50-70 %), typischerweise sind mehrere Hirnnerven betroffen. Dies ist Folge der aseptischen basalen granulomatoesen Meningitis. Auch intraparenchymatoese Granulome kommen vor, haeufig mit Befall basaler mittelliniennaher Strukturen wie Hypothalamus und Hypophyse, die zu einer Enzephalopathie fuehren koennen. Diagnostisch wegweisend ist die MRT, welche die verdickten und stark Kontrastmittel (KM) aufnehmenden Meningen nachweisen kann, die Befunde sind allerdings nicht spezifisch. Insbesondere bei fehlender systemischen Sarkoidose ist die Diagnose schwierig. Laboruntersuchungen sind wenig sensitiv und

Clinical implications of a new TSH-receptor-antibody-assay (DYNOtest {sup trademark} TRAKhuman) in autoimmune thyroid diseases; Klinische Implikationen eines neuen TSH-Rezeptor-Antikoerper-Assays (DYNOtest {sup trademark} TRAKhuman) bei autoimmunen Schilddruesenerkrankungen

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Meller, J.; Schreivogel, I.; Becker, W. [Goettingen Univ. (Germany). Abt. fuer Nuklearmedizin; Bergmann, A.; Morgenthaler, N. [B.R.A.H.M.S Diagnostica, Berlin (Germany); Huefner, M. [Goettingen Univ. (Germany). Abt. Innere Medizin

2000-07-01

konsekutiven Patienten (IH: n=50, Autoimmunthyreoiditis/AIT: n=92) und 55 Kontrollen von denen 31 schilddruesengesund waren und 24 eine euthyreote Iodmangelstruma aufwiesen, wurden parallel mit dem DYNOtest {sup trademark} TRAKhuman-Assay und einem konventionellen RRA (TRAK-Assay {sup trademark}) untersucht. Bei allen Patienten wurden FT3, FT4 und TSH bestimmt und eine Sonographie durchgefuehrt. Ergebnisse: Der DYNOtest {sup trademark} TRAKhuman-Assay war bei der Gesamtheit der Basedow-Patienten im Nachweis von TRAKs hoch signifikant sensitiver als der konventionelle RRA (p<0,00012), insbesondere bei Patienten unter einer thyreostatischen Therapie (p<0,003), sowie bei Patienten mit AIT (p<0,003). Die meisten TRAK-positiven AITs waren hypothyreot. Je ein Patient unseres Normalkollektivs wies im DYNOtest {sup trademark} TRAKhuman- bzw. im TRAK-Assay {sup trademark} einen falsch positiven Befund auf. Somit war der neue RRA in der Spezifitaet dem konventionellen Assay nicht unterlegen. Schlussfolgerung: Bei vergleichbarer Spezifitaet stellt der Der DYNOtest {sup trademark} TRAKhuman-Assay gegenueber aelteren RRAs einen Fortschritt in der diagnostischen Abklaerung einer IH dar. (orig.)

Transfer Out Patient Not Abandon The Patient

Directory of Open Access Journals (Sweden)

Deepak Gupta

2015-12-01

Full Text Available Physician-patient relationship is unique in some aspects and not-so-unique in other aspects when compared to other human interactions. Until-unless for the sake of health promotional activities, this relationship is almost always conceived in the times of human sufferings and consequently culminated when those sufferings have subsided as well as sought out happiness has ensued/been achieved. However, not all physician-patient relationships follow the normal course and/or meet the natural ends. These abnormal relationships are not inconsequential in terms of numbers and/or their effects (short-term and long term on both patients and physicians. Every country has its own baggage in the wake of why, how and what about these abnormal ends to physician-patient relationships; however, the most common causes are the patients’ inability to pay their medical bills, the conflicting goals of physicians and their patients in regards to patients’ sufferings’ management and finally the behavioral issues (patients’ and/or physicians’ interfering these relationships. Irrespective of any cause, the physicians should never forget that the patient can always discharge their physicians and discontinue their relationship with their physicians without any reason (until unless the physicians deem those patients either incapable/non-consentable to do so and/or potential threat to their own personal safety or other people’s safety. Contrarily, physicians can also discharge patients from their care but cannot abandon these patients (1-3 which mean that physicians have to ensure their discharged patients either are referred to or have sought another physician within appropriate time frame post-relationship-discontinuation. Each country has their own medico-legal liabilities that vary in terms of penalties imposed; however, irrespective of the feared legal concerns, the physicians should not forget that ethical essence of medicine is the art of healing that

Patient-oriented health technologies: Patients' perspectives and use.

Science.gov (United States)

Bauer, Amy M; Rue, Tessa; Munson, Sean A; Ghomi, Reza Hosseini; Keppel, Gina A; Cole, Allison M; Baldwin, Laura-Mae; Katon, Wayne

2017-08-01

For patient-oriented mobile health tools to contribute meaningfully to improving healthcare delivery, widespread acceptance and use of such tools by patients are critical. However, little is known about patients' attitudes toward using health technology and their willingness to share health data with providers. To investigate primary care patients' comfort sharing health information through mobile devices, and patients' awareness and use of patient portals. Patients (n=918) who visited one of 6 primary care clinics in the Northwest US completed a survey about health technology use, medical conditions, and demographics. More patients were comfortable sharing mobile health information with providers than having third parties store their information (62% vs 30%, Somers D=.33, phigher among patients with a chronic condition (AOR= 3.18, p=0.004). Comfort, awareness, and use of health technologies were variable. Practices introducing patient-facing health technologies should promote awareness, address concerns about data security, and provide education and training, especially to older adults and those with health literacy limitations. Patient-facing health technologies provide an opportunity for delivering scalable health education and self-management support, particularly for patients with chronic conditions who are already using patient portals.

Terminally ill patients as customers: the patient's perspective.

Science.gov (United States)

Seibel, Katharina; Valeo, Sara Celestina; Xander, Carola; Adami, Sandra; Duerk, Thorsten; Becker, Gerhild

2014-01-01

Consumerism in health care defines patients as self-determined, rational customers. Yet, it is questionable whether vulnerable patients, such as the terminally ill, also fulfill these criteria. Vulnerable contexts and the patient's perspective on being a customer remain relatively unexplored. The present study addresses this research gap by analyzing terminally ill patients' views on being customers. To explore the ways in which patients in palliative care refer to themselves as patients/customers, and how the patients' concepts of self-determination are related to their attitudes toward the patient/customer role. Qualitative interviews were conducted. Data were analyzed in three steps: narrative analysis, thematic content analysis, and typology construction. Researchers recruited 25 patients via the Department of Palliative Care, University Medical Center Freiburg, Germany. In many ways, palliative patients contradict the image of a self-determined customer. The palliative patient role is characterized by the concept of relational self-determination rather than an unrestricted self-determination. Self-attribution as a customer still occurs when positively associated with a person-centered, individualized treatment. Thus, the customer and patient role overlap within the palliative care setting because of the focus on the individual. The idealized customer role cannot be arbitrarily applied to all medical fields. Palliative patients are dependent on the physician, regardless of whether the customer or patient role is preferred. Hence, self-determination must be understood in relational terms, and physicians must recognize their crucial role in promoting patients' self-determination in the context of shared decision-making.

Clinical value of FDG hybrid-PET in staging and restaging of malignant lymphoma. Compared with conventional diagnostic methods; Klinische Wertigkeit der Befunde von FDG-PET mittels Koinzidenz-Gammakamera beim Staging und Restaging maligner Lymphome. Ein Vergleich zu konventioneller Diagnostik

Energy Technology Data Exchange (ETDEWEB)

Pichler, R.; Maschek, W.; Hatzl-Griesenhofer, M.; Huber, H. [Allgemeines Krankenhaus Linz (Austria). Inst. fuer Nuklearmedizin; Wimmer, G.; Wahl, G.; Fridrik, M. [Allgemeines Krankenhaus Linz (Austria). I. Medizinische Abt.

2000-09-01

Aim of the present retrospective study was to validate the clinical value of F-18-FDG PET imaging in lymphoma patients with a dual head camera modified for coincidence detection. Staging before and after oncological treatment was compared with a conservative diagnostic approach. Methods: 48 patients (28 non-Hodgkin lymphoma, 20 Hodgkin's disease) received FDG-Hybrid-PET scans. Pretherapeutic staging was realized in 28 patients, 9 of them had control studies after they had completed therapy. Totally 29 persons were examined for posttherapeutic restaging. Computed tomography imaging and lymph node sonography was performed in all cases. Results were validated by clinical follow-up, in three cases a recidive was proven by biopsy. Results: CT and ultrasound detected 77 lesions in 28 patients compared with 100 visualized by PET, but this difference in pretherapeutic staging did not reach significance at p>0.05 by Fisher's t-test. Hybrid-PET obtained a sensitivity of 93%, a specifity of 79%, a positive of 82% and a negative predictive value of 92% for detection of residual disease. The values for CT+US were 87%, 64%, 72% and 88% respectively. Conclusion: FDG Hybrid-PET is as or even more accurate than standard morphologic diagnostic methods for prestaging in malignant lymphoma. Additionally, there is a substancial benefit for therapy monitoring of residual disease using coincidence detection PET with a 3/4-inch crystal gamma camera. (orig.) [German] Ziel der vorliegenden retrospektiven Studie war die Validierung der klinischen Wertigkeit von F-18-FDG-PET mittels Doppelkopf-Koinzidenz-Gammakamera bei Lymphompatienten. Die Ergebnisse von prae- und post-therapeutischem Staging wurden mit dem konservativ bildgebender Verfahren verglichen. Methoden: 48 Patienten (28 NHL, 20 Morbus Hodgkin) erhielten FDG-DK-PET-Untersuchungen. Ein praetherapeutisches Staging wurde bei 28 Patienten durchgefuehrt, 9 von diesen hatten weitere Kontrollstudien nach abgeschlossenem

Speech recognition: impact on workflow and report availability; Spracherkennung: Auswirkung auf Workflow und Befundverfuegbarkeit

Energy Technology Data Exchange (ETDEWEB)

Glaser, C.; Trumm, C.; Nissen-Meyer, S.; Francke, M.; Kuettner, B.; Reiser, M. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen (Germany). Institut fuer Klinische Radiologie

2005-08-01

Hauptkomponenten eines SES sind das akustische und das Sprachmodell. Merkmale kontinuierlicher SES mit Realtimeerkennung umfassen vorformulierbare Befund(bloeck)e, Standardbefundvorlagen und Sprachkommandos (Navigation im Text, Steuerung von SES und RIS). Sinnvoll fuer eine optimale Nutzung des SES-Potenzials ist die Integration von SES, RIS und PACS. Wichtige Leistungsparameter eines SES sind Befundverfuegbarkeit und Zeiteffizienz des Befundungsprozesses (Erkennungsrate, Editier- und Korrekturaufwand, Wortschatzpflege) fuer den Radiologen. In der Praxis wird die Erkennungsrate ueber die Fehlerrate (Einheit ''Wort'') abgeschaetzt. Fehlerraten liegen zwischen 4 und 28%. Etwa 20% davon sind Wortschatzfehler, die u. U. zu einer falschen Befundinterpretation fuehren koennen. Sie unterstreichen die Notwendigkeit einer sorgfaeltigen Textkorrektur und Wortschatzpflege. Die Einfuehrung eines SES erbringt eine drastische Verbesserung der Befundverfuegbarkeit. Dagegen nimmt der individuelle aerztliche Zeitbedarf bei digitaler Befunderstellung um ca. 20-25% (Projektionsradiographie, CR) bzw. ca. 30% (CT, MRT) zu. Die Entlastung des Schreibbueros (Hintergrunddiktat) haengt von dessen Qualifikation ab. Das Onlinediktat fuehrt zu einer Umverteilung von Arbeitsschritten vom Schreibbuero auf den Befunder. (orig.)

MR-imaging of the breast at 0.5 Tesla: menstrual-cycle dependency of parenchymal contrast enhancement in healthy volunteers with oral contraceptive use?; MR-Mammographie bei 0,5 Tesla: Menstruationszyklusabhaengigkeit der Kontrastmittelanreicherung unter hormoneller Kontrazeption?

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Lorenzen, J.; Welger, J.; Krupski, G.; Adam, G. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany); Lisboa, B.W. [Klinik und Poliklinik fuer Frauenheilkunde und Geburtshilfe, Universitaetsklinikum Hamburg-Eppendorf (Germany)

2003-04-01

(Zyklustag 21 - 2). Alle Probandinnen nahmen regelmaessig orale Kontrazeptiva fuer mindestens 6 Monate ein. Die Untersuchungen erfolgten an einem 0,5 Tesla Magneten unter Verwendung einer 3D-Gradientenechosequenz mit Anfertigung von Subtraktionsaufnahmen der Kontrastmittelserie. Wir untersuchten die Anzahl der anreichernden Herde sowie die Kontrastmittelaufnahme des Brustdruesenparenchyms waehrend der verschiedenen Zyklusphasen. Ergebnisse: Bei nur zwei der untersuchten 17 Probandinnen fand sich je ein umschrieben anreichernder Herd, der in der Auswertung des zeitlichen Verlaufs der Kontrastmittelaufnahme einen nicht suspekten Befund ergab (< 80% initialer Signalanstieg nach Kontrastmittelgabe, kein Nachweis eines sogenannten ''wash-out''-Phaenomens). Eine ergaenzende Ultraschalluntersuchung ergab einen unauffaelligen Befund. Die Kontrastmittelaufnahme im Brustparenchym waehrend der Zyklustage 7 - 14 (mittlere relative Kontrastmittelaufnahme: 0,12-0,26, 1 - 9 Minuten nach Kontrastmittelgabe) unterschied sich dabei nicht signifikant (p = 0,2209; Wilcoxon signed rank test) von dem perimenstruellen Zeitraum der Tage 21 - 2 (Mittelwert: 0,13-0,32). Schlussfolgerung: Eine Zyklusabhaengigkeit der Kontrastmittelaufnahme des Brustparenchyms unter oraler Kontrazeption ist nicht nachweisbar. (orig.)

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

Science.gov (United States)

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

2015-01-01

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

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

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Armitage Gerry

2011-05-01

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

Patient-centred Prevention among PAD Patients

DEFF Research Database (Denmark)

Pii, Kathrine Hoffmann

2015-01-01

Intro: This paper discusses a central professional dilemma in patient-centred education: on one hand the concern for ensuring patients autonomy and right to make their own decisions regarding their treatment and, on the other hand, a concern for getting patients to make the “right” decisions......-centredness is thus promoted as a way to organize health more effectively (in terms of cost and treatment outcomes) and as a way to ensure patients’ autonomy and fundamental right to make their own decisions regarding their treatment. Critical voices within social and nursing theory have however argued....... The paper shows that the programme’s attempt to facilitate that patients make their “own” decision is challenged by patients who understand the preventive programme in relational terms and even demand more intervention from the professionals in terms of expert advice, involvement, and discipline. Conclusion...

Preoperative patient education: evaluating postoperative patient outcomes.

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Meeker, B J

1994-04-01

Preoperative teaching is an important part of patient care and can prevent complications, as well as promote patient fulfillment during hospitalization. A study was conducted at Alton Ochsner Medical Foundation in New Orleans, LA, in 1989, to determine the impact of a preoperative teaching program on the incidence of postoperative atelectasis and patient satisfaction. Results showed no significant difference of postoperative complications and patient gratification after participating in a structured preoperative teaching program. As part of this study, it was identified that a patient evaluation tool for a preoperative teaching class needed to be developed. The phases of this process are explained in the following article.

A prospective, double-blind study of prophylaxis of radioxerostomia by coumarin/troxerutine in patients with head and neck cancer; Prospektive, doppelblinde Therapiestudie zur Prophylaxe der Radioxerostomie durch Cumarin/Troxerutin bei Patienten mit Kopf-Hals-Karzinomen

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Groetz, K.A.; Al-Nawas, B.; Wagner, W. [Universitaetsklinik fuer Mund-, Kiefer- und Gesichtschirurgie, Mainz (Germany); Henneicke-von Zepelin, H.H.; Wuestenberg, P.; Naser-Hijazi, B. [Schaper und Bruemmer, Salzgitter (Germany). Hauptbereich Medizin; Kohnen, R. [Institute for Medical Research Management and Biometrics, Nuernberg (Germany); Bockisch, A. [Universitaetsklinik und Poliklinik fuer Nuklearmedizin, Essen (Germany); Kutzner, J. [Universitaetsklinik und Poliklinik fuer Radiologie, Mainz (Germany); Belz, G.G. [Zentrum fuer Kardiovaskulaere Pharmakologie, Mainz (Germany)

1999-08-01

Aim: Prospective, randomized placebo-controlled double-blind study to prove the efficacy of Coumarin/Troxerutine (Venalot {sup trademark} Depot) for protection of salivary glands during a head and neck irradiation. Patients and Method: Forty-eight radiotherapy patients (60 Gy) with head and neck cancer were included in this trial. During radiotherapy the salivary glands were located in the core irradiation field. Primary efficacy parameters were sialometry, quantitative salivary gland scientigraphy and clinical evaluation of early effects of radiotherapy (RTOG-score). All data were collected at 6 assessments: 1 week pre-radiation (U1), at start (U2), half time (U3) and end (U4) of irradiation, 8 days (U5) and 28 days (U6) after the end of irradiation. Results: Twenty-three patients (11 verum, 12 placebo) completed the study with all assessments. Sialometrically, all patients were severely (half of radiotherapy) or completely (end of radiotherapy) xerostomatic. In a global efficacy measure according to O'Brien combining scintigraphy and RTOG there was a tendency for a higher efficacy of verum compared to placebo (p=0.068). After start of irradiation therapy, the RTOG-score showed continuously and significantly lower early radiation effects under verum than under placebo (U3 vs U6: p<0.05, area under curve: p=0.032). The scintigraphically determined excretion fraction was slightly less impaired in the verum group compared to the placebo treatment (p=0.12). There was no difference in drug safety between placebo and verum for adverse events, changes in the activity of liver enzymes and for global impression of tolerability. Concluions: The results give support for an advantageous effect of Venalot {sup trademark} Depot in the treatment of radiogenic sialadenitis and mucositis. In even a small number of evaluable patients, early clinical effects of irradiation (RTOG-score) were less pronounced in the active treatment group than in the placebo group, but the sample

Dentist–patient communication: what do patients and dentists remember following a consultation? Implications for patient compliance

Directory of Open Access Journals (Sweden)

Misra S

2013-06-01

Full Text Available Sara Misra, Blánaid Daly, Stephen Dunne, Brian Millar, Mark Packer, Koula AsimakopoulouDental Institute, King's College London, London, UKBackground: There is a lack of information about the extent to which patients recall key facts of dental consultations. Forgetting health advice undermines adherence with such instructions and is a potential problem. This study assessed the quantity and type of information recalled in a dental consultation, dentist–patient agreement over the contents of the consultation, and the relationship of such recall with patient satisfaction.Methods: Using a cross-sectional design, questionnaire data were obtained from patients recruited through a letter and presenting for a routine dental consultation. General issues discussed, specific information about oral health given, dentist-performed procedures, and agreed future actions were reported independently in writing, by patients and also by the treating dentist immediately postconsultation. Additionally, patients completed a dental visit satisfaction questionnaire.Results: Responses (n = 26, 55% response rate were content-analyzed, and data on the number and type of information that was recalled were obtained. Interrater reliability was established. Inferential testing showed differences in dentist–patient recall, dentist–patient agreement, and the association between patient recall and satisfaction. Dentists recalled more information than patients (P = 0.001. Dentists further reported giving more dental health education (P = 0.006 and discussing more future actions (P = 0.002 than patients actually remembered. Technical (eg, crowns/bridges rather than psychosocial (eg, pain/embarrassment issues were reported more often (P = 0.001 by both dentists and patients. Dentist–patient agreement over issues discussed and procedures performed was higher (kappa = 0.210–0.310 than dental health education agreement and agreed future actions (kappa = 0.060–0.110. There

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

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Pors, Anja Svejgaard

2016-01-01

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

Patient satisfaction

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Bhanu Prakash

2010-01-01

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

Patient satisfaction.

Science.gov (United States)

Prakash, Bhanu

2010-09-01

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

Patients with epilepsy and patients with psychogenic non-epileptic seizures

DEFF Research Database (Denmark)

Turner, Katherine; Piazzini, Ada; Chiesa, Valentina

2011-01-01

and neuropsychological functions among patients with PNES, patients with epilepsy associated with PNES and patients with epilepsy. METHODS: We evaluated 66 consecutive in-patients with video-EEG recordings: 21 patients with epilepsy, 22 patients with PNES and 10 patients with epilepsy associated with PNES; 13 patients....... We observed fewer mood and anxiety disorders in patients with PNES compared with those with epilepsy. We did not find statistically significant differences in neuropsychological profiles among the 3 patient groups. CONCLUSION: This study can help to contribute to a better understanding of the impact...

Rezension von: Julia Reuter, Paula-Irene Villa (Hg.: Postkoloniale Soziologie. Empirische Befunde, theoretische Anschlüsse, politische Intervention. Bielefeld: transcript Verlag 2010.

Directory of Open Access Journals (Sweden)

Ruth Streicher

2010-05-01

Full Text Available Welche Inspirationen und Anforderungen ergeben sich aus dem Projekt der ‚Dekolonisierung‘ der Soziologie auf der theoretischen, konzeptionellen und empirischen Ebene für die deutsche soziologische Debatte? Die im Band versammelten Beiträge bieten erste Versuche zur Beantwortung dieser Fragen. Während Selbstreflexivität großgeschrieben wird, mangelt es auch diesem Band noch an empirischer Fundierung der postkolonialen Kritik.

Effects of the Smartphone Application "Safe Patients" on Knowledge of Patient Safety Issues Among Surgical Patients.

Science.gov (United States)

Cho, Sumi; Lee, Eunjoo

2017-12-01

Recently, the patient's role in preventing adverse events has been emphasized. Patients who are more knowledgeable about safety issues are more likely to engage in safety initiatives. Therefore, nurses need to develop techniques and tools that increase patients' knowledge in preventing adverse events. For this reason, an educational smartphone application for patient safety called "Safe Patients" was developed through an iterative process involving a literature review, expert consultations, and pilot testing of the application. To determine the effect of "Safe Patients," it was implemented for patients in surgical units in a tertiary hospital in South Korea. The change in patients' knowledge about patient safety was measured using seven true/false questions developed in this study. A one-group pretest and posttest design was used, and a total of 123 of 190 possible participants were tested. The percentage of correct answers significantly increased from 64.5% to 75.8% (P effectively improve patients' knowledge of safety issues. This will ultimately empower patients to engage in safe practices and prevent adverse events related to surgery.

Patients for patient safety in China: a cross sectional study.

Science.gov (United States)

Zhang, Qiongwen; Li, Yulin; Li, Jing; Mao, Xuanyue; Zhang, Lijuan; Ying, Qinghua; Wei, Xin; Shang, Lili; Zhang, Mingming

2012-02-01

To investigate the baseline status of patients' awareness, knowledge, and attitudes to patient safety in China, and to determine the factors that influence patients' involvement in patient safety. We conducted a cross sectional survey using questionnaires adapted from recent studies on patient safety from outside China. The items included medical errors, infection, medication safety, and other aspects of patient safety. The questionnaire included 17 items and 5 domains. The survey was conducted between Jan. 2009 and Dec. 2010 involving 1000 patients from ten grade-A hospitals in seven provinces or cities in China. Most patients from the surgery departments completed the questionnaires voluntarily and anonymously. Five reviewers independently input the data into Microsoft Excel 2003, and the data were double-checked. Data were analyzed using SPSS 15.0 software for differences in the perceptions and attitudes of patients toward patient safety among different genders, ages, and regions. We distributed 1000 questionnaires and collected 959 completed questionnaires (response rate: 96%). Among the respondents, 58% of patients did not know what medical error is. Sixty-five percent of patients wanted disclosure of all medical errors. After errors occurred, 58% of patients wanted explanations of all possible harms that had resulted. Among 187 patients who had experienced medical errors, 83% of patients had sought appropriate legal action. About 52% of patients understood hospital infection, but 28% patients did not know that infections could occur in hospital. Seventy-eight percent of patients thought that medical staff should wash their hands before examining patients. More than half of the patients (68%) were willing to remind the staff of hygiene if they saw unsanitary conditions in a health clinic. Only 14% of patients knew the side effects of medications that they took. The majority of patients surveyed expressed willingness to contribute to patient safety, but their

Patient perspectives of patient-controlled analgesia (PCA) and methods for improving pain control and patient satisfaction.

Science.gov (United States)

Patak, Lance S; Tait, Alan R; Mirafzali, Leela; Morris, Michelle; Dasgupta, Sunavo; Brummett, Chad M

2013-01-01

This study aimed to (1) identify patient-controlled analgesia (PCA) attributes that negatively impact patient satisfaction and ability to control pain while using PCA and (2) obtain data on patient perceptions of new PCA design features. We conducted a prospective survey study of postoperative pain control among patients using a PCA device. The survey was designed to evaluate patient satisfaction with pain control, understanding of PCA, difficulties using PCA, lockout-period management, and evaluation of new PCA design features. A total of 350 eligible patients completed the survey (91%). Patients who had difficulties using PCA were less satisfied (P PCA. Forty-nine percent of patients reported not knowing if they would receive medicine when they pushed the PCA button, and of these, 22% believed that this uncertainty made their pain worse. The majority of patients preferred the proposed PCA design features for easier use, including a light on the button, making it easier to find (57%), and a PCA button that vibrates (55%) or lights up (70%), alerting the patient that the PCA pump is able to deliver more medicine. A majority of patients, irrespective of their satisfaction with PCA, preferred a new PCA design. Certain attributes of current PCA technology may negatively impact patient experience, and modifications could potentially address these concerns and improve patient outcomes.

PET in diagnosing exocrine pancreatic cancer; PET bei Tumoren des exokrinen Pankreas

Energy Technology Data Exchange (ETDEWEB)

Bares, R.; Besenfelder, H.; Dohmen, B.M. [Abt. Nuklearmedizin, Radiologische Klinik des Universitaetsklinikums Tuebingen (Germany)

2003-06-01

Despite dramatic improvements in diagnostic imaging (ultrasonography, in particular endoscopic ultrasound, CT, MRI) treatment results of pancreatic cancer are still poor. Due to the lack of early symptoms, most tumors are diagnosed at an advanced stage of disease which excludes curative surgical treatment. FDG-PET has been shown to be effective in detecting pancreatic cancer as well as differentiating benign from malignant pancreatic tumors. Results might be further improved by applying quantitative analyses, in particular kinetic modelling of FDG metabolism. Nevertheless false negative as well as false positive findings may occur. Small lesions (lymphnode or liver metastases < 1 cm) might be missed, furthermore hyperglycemia often present in patients with pancreatic disease might reduce tumor uptake and subsequently tumor detectability by PET. False positive findings were reported in active pancreatitis and some benign tumors. Although PET proved to be superior to CT or ERCP in detecting cancer, clinical relevance of PET is limited due to the absence of therapeutic consequences to be derived from PET. As a consequence PET should only be used in patients with equivocal findings of morphological imaging (CT, ERCP) who are potential candidates for surgical treatment. (orig.) [German] Trotz verbesserter diagnostischer Moeglichkeiten (endoskopischer Ultraschall, Spiral-CT, MRT) sind die Behandlungsergebnisse bei Tumoren des exokrinen Pankreas nach wie vor unbefriedigend. Aufgrund der spaet einsetzenden klinischen Symptomatik wird die Diagnose meist erst bei lokaler Inoperabilitaet gestellt. Die FDG-PET has sich sowohl im Nachweis von Pankreaskarzinomen als auch bei der Differenzialdiagnose pankreatischer Raumforderungen bewaehrt und den etablierten bildgebenden Verfahren (Ultraschall, CT) als ueberlegen erwiesen. Weitere Verbesserungen erscheinen durch absolute Quantifizierung der FDG-Kinetik moeglich. Dennoch koennen falsch negative wie auch falsch positive Ergebnisse

Patient-centered care requires a patient-oriented workflow model.

Science.gov (United States)

Ozkaynak, Mustafa; Brennan, Patricia Flatley; Hanauer, David A; Johnson, Sharon; Aarts, Jos; Zheng, Kai; Haque, Saira N

2013-06-01

Effective design of health information technology (HIT) for patient-centered care requires consideration of workflow from the patient's perspective, termed 'patient-oriented workflow.' This approach organizes the building blocks of work around the patients who are moving through the care system. Patient-oriented workflow complements the more familiar clinician-oriented workflow approaches, and offers several advantages, including the ability to capture simultaneous, cooperative work, which is essential in care delivery. Patient-oriented workflow models can also provide an understanding of healthcare work taking place in various formal and informal health settings in an integrated manner. We present two cases demonstrating the potential value of patient-oriented workflow models. Significant theoretical, methodological, and practical challenges must be met to ensure adoption of patient-oriented workflow models. Patient-oriented workflow models define meaningful system boundaries and can lead to HIT implementations that are more consistent with cooperative work and its emergent features.

Cardiac patients' perception of patient-centred care: a qualitative study.

Science.gov (United States)

Esmaeili, Maryam; Cheraghi, Mohammad A; Salsali, Mahvash

2016-03-01

The aim of this study was to explore cardiac patients' perception of patient-centred care. Despite patient's importance in the process of care, less attention has been paid to experiences and expectations of patients in definitions of patient-centred care. As patients are an important element in process of patient-centred care, organizing care programs according to their perceptions and expectations will lead to enhanced quality of care and greater patient satisfaction. This study is a descriptive qualitative study. Content analysis approach was performed for data analysis. Participants were 18 cardiac patients (10 women and 8 men) hospitalized in coronary care units of teaching hospitals affiliated to Tehran University of Medical Sciences. We collected the study data through conducting personal face-to-face semi-structured interviews. The participants' perceptions of patient-centred care fell into three main themes including managing patients uncertainty, providing care with more flexibility and establishing a therapeutic communication. The second theme consisted of two sub-themes: empathizing with patients and having the right to make independent decisions. Receiving patient-centred care is essential for cardiac patients. Attention to priorities and preferences of cardiac patients and making decisions accordingly is among effective strategies for achieving patient-centred care. Cardiac care unit nurses ought to be aware that in spite of technological developments and advances, it is still important to pay attention to patients' needs and expectations in order to achieve patient satisfaction. In planning care programs, they should consider accountability towards patients' needs, flexibility in process of care and establishing medical interactions as an effective strategy for improving quality of care. © 2014 British Association of Critical Care Nurses.

[Differences in attitude toward patient-centeredness in patients and physicians].

Science.gov (United States)

Kim, Min-Jeong

2013-06-01

There have been studies on the patient-centeredness of medical students and physicians in South Korea, but no result has presented the patient-centered attitude of patients and doctors. So, this study intended to compare the attitudes of patients and doctors toward the roles that patients and physicians should play in the health care process. One hundred and fifteen doctors and 264 patients participated in this survey using a structured questionnaire, including sociodemographic data and Patient Practitioner Orientation Scale (PPOS). The PPOS comprises sharing (sharing information, take part in decision making) and caring (respecting one's feelings, interpersonal relationships) subscales. The PPOS scores of the doctors and patient were 3.02 and 3.20. In detail, the doctors' sharing and caring scores were and 3.02 and 3.48, and the those of patients were 3.14 and 3.12, respectively. This results are enough to demonstrate that patients are likely to be patient-centered with regard to sharing and that doctors tend to be patient-centered in terms of caring. The patients' desire to obtain medical information and take part in decision making (sharing) are greater than those of doctors. Doctors had more patient-centered attitude than patients in terms of respects for one's feelings and interpersonal relationships (caring).

Patient activation and use of an electronic patient portal.

Science.gov (United States)

Ancker, Jessica S; Osorio, Snezana N; Cheriff, Adam; Cole, Curtis L; Silver, Michael; Kaushal, Rainu

2015-01-01

Electronic patient portals give patients access to personal medical data, potentially creating opportunities to improve knowledge, self-efficacy, and engagement in healthcare. The combination of knowledge, self-efficacy, and engagement has been termed activation. Our objective was to assess the relationship between patient activation and outpatient use of a patient portal. Survey. A telephone survey was conducted with 180 patients who had been given access to a portal, 113 of whom used it and 67 of whom did not. The validated patient activation measure (PAM) was administered along with questions about demographics and behaviors. Portal users were no different from nonusers in patient activation. Portal users did have higher education level and more frequent Internet use, and were more likely to have precisely 2 prescription medications than to have more or fewer. Patients who chose to use an electronic patient portal were not more highly activated than nonusers, although they were more educated and more likely to be Internet users.

[Student patient relationship from the patient's point of view].

Science.gov (United States)

Beca, Juan Pablo; Browne, Francisca; Valdebenito, Carolina; Bataszew, Alexander; Martínez, María José

2006-08-01

Patients are becoming increasingly active in their relationship with medical professionals. Their relationship with medical students needing to learn clinical skills, may be specially problematic if patients are not willing to accept their involvement in the medical team. To examine patient's perceptions of their relation with medical students and their agreement to let students be part of the treating team. Qualitative study using taped semi-structured interviews addressed to inpatients from one public and one private hospital in Chile. Both groups of patients acknowledged that students dedicated more time to them, but they expressed their preference to limit student's participation to clinical history taking and physical examination. They also expected them to be observers rather than actors. Patients from the private hospital emphasized that only one student per instructor should participate in their care. Patients from the public hospital were more compliant about student's participation. The right to refuse students' involvement in their care was clearly known by all patients from the private system and by most patients from the public hospital. Patients in Chilean public and private hospitals were in general positive regarding student's participation in their care. Students' clinical practice ought to strictly respect patients's rights, and patients should be considered volunteers who generously agree to cooperate with the education of medical students.

Patient satisfaction and positive patient outcomes in ambulatory anesthesia

Directory of Open Access Journals (Sweden)

Shah U

2015-04-01

Full Text Available Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA. Patient satisfaction is a complex concept that is influenced by multiple factors. A patient's viewpoint and knowledge plays an influential role in patient satisfaction with ambulatory surgery. Medical optimization and psychological preparation of the patient plays a pivotal role in the success of ambulatory surgery. Postoperative pain, nausea, and vomiting are the most important symptoms for the patient and can be addressed by multimodal drug regimens. Shared decision making, patient–provider relationship, communication, and continuity of care form the main pillars of patient satisfaction. Various psychometrically developed instruments are available to measure patient satisfaction, such as the Iowa Satisfaction with Anesthesia Scale and Evaluation du Vecu de I'Anesthesie Generale, but none have been developed specifically for ambulatory surgery. The ASA has made recommendations for data collection for patient satisfaction surveys and emphasized the importance of reporting the data to the Anesthesia Quality Institute. Future research is warranted to develop a validated tool to measure patient satisfaction in ambulatory surgery. Keywords: patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

Patient participation in patient safety and nursing input - a systematic review.

Science.gov (United States)

Vaismoradi, Mojtaba; Jordan, Sue; Kangasniemi, Mari

2015-03-01

This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Systematic review using integrative methods. Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: "patient", "healthcare provider", "task", "work environment", "organisation & management". We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Patients have a significant role to play in enhancing their own safety while receiving hospital care. This

One decade of functional imaging in schizophrenia research. From visualisation of basic information processing steps to molecular brain imaging; Zehn Jahre funktionelle Magnetresonanztomographie in der Schizophrenieforschung. Von der Abbildung einfacher Informationsverarbeitungsprozesse zur molekulargenetisch orientierten Bildgebung

Energy Technology Data Exchange (ETDEWEB)

Tost, H. [Zentralinstitut fuer Seelische Gesundheit, NMR-Forschung in der Psychiatrie (Germany); Zentralinstitut fuer Seelische Gesundheit, NMR-Forschung in der Psychiatrie, Mannheim (Germany); Meyer-Lindenberg, A. [Genes, Neuroimaging Core Facility and Unit on Integrative Neuroimaging, Cognition and Psychosis Program, National Institute of Mental Health (United States); Ruf, M.; Demirakca, T.; Grimm, O.; Henn, F.A.; Ende, G. [Zentralinstitut fuer Seelische Gesundheit, NMR-Forschung in der Psychiatrie (Germany)

2005-02-01

Modern neuroimaging techniques such as magnetic resonance imaging (MRI) and positron emission tomography (PET) have contributed tremendously to our current understanding of psychiatric disorders in the context of functional, biochemical and microstructural alterations of the brain. Since the mid-nineties, functional MRI has provided major insights into the neurobiological correlates of signs and symptoms in schizophrenia. The current paper reviews important fMRI studies of the past decade in the domains of motor, visual, auditory, attentional and working memory function. Special emphasis is given to new methodological approaches, such as the visualisation of medication effects and the functional characterisation of risk genes. (orig.) [German] Bildgebende Verfahren wie die Magnetresonanz- und Positronenemissionstomographie haben entscheidend dazu beigetragen, dass psychiatrische Erkrankungen heutzutage im Kontext funktioneller, biochemischer und feinstruktureller Veraenderungen des Gehirns verstanden werden. Im Bereich der Schizophrenieforschung gibt insbesondere die funktionelle Magnetresonanztomographie seit Mitte der 90er-Jahre wichtige Einblicke in die neurobiologischen Grundlagen schizophrener Defizitbereiche. Die vorliegende Arbeit stellt die wichtigsten fMRT-Befunde der letzten Dekade in den Bereichen Psychomotorik, visuelle bzw. akustische Informationsverarbeitung, Aufmerksamkeit und Arbeitsgedaechtnis vor. Die Betrachtung erfolgt dabei unter der besonderen Beruecksichtigung aktueller methodischer Ansaetze wie der Darstellung von Therapieeffekten und der funktionellen Charakterisierung psychiatrischer Risikogene. (orig.)

Patients' and healthcare workers' perceptions of a patient safety advisory.

Science.gov (United States)

Schwappach, David L B; Frank, Olga; Koppenberg, Joachim; Müller, Beat; Wasserfallen, Jean-Blaise

2011-12-01

To assess patients' and healthcare workers' (hcw) attitudes and experiences with a patient safety advisory, to investigate predictors for patients' safety-related behaviors and determinants for staff support for the advisory. Cross-sectional surveys of patients (n= 1053) and hcw (n= 275). Three Swiss hospitals. Patients who received the safety advisory and hcw caring for these patients. Patient safety advisory disseminated to patients at the study hospitals. Attitudes towards and experiences with the advisory. Hcw support for the intervention and patients' intentions to apply the recommendations were modelled using regression analyses. Patients (95%) and hcw (78%) agreed that hospitals should educate patients how to prevent errors. Hcw and patients' evaluations of the safety advisory were positive and followed a similar pattern. Patients' intentions to engage in safety were significantly predicted by behavioral control, subjective norms, attitudes, safety behaviors during hospitalization and experiences with taking action. Hcw support for the campaign was predicted by rating of the advisory (Odds ratio (OR) 3.4, confidence interval (CI) 1.8-6.1, Ppatients (OR 1.9, CI 1.1-3.3, P= 0.034) and experience of unpleasant situations (OR 0.6, CI 0.4-1.0, P= 0.035). The safety advisory was well accepted by patients and hcw. To be successful, the advisory should be accompanied by measures that target norms and barriers in patients, and support staff in dealing with difficult situations.

Patient information in radiooncology. Results of a patient survey

International Nuclear Information System (INIS)

Schaefer, C.; Dietl, B.; Putnik, K.; Altmann, D.; Herbst, M.; Marienhagen, J.

2002-01-01

Background: As a result of increased interest and public demand, providing patients with adequate information about radiooncology has become more and more difficult for the doctor. Insufficient patient information can not only cause anxiety for the patient, but can also lead to legal action against the physician. In order to gain a deeper insight into our clinical practice of providing patient information, we developed a special questionnaire. We describe our first experiences in using this questionnaire at our institute. Patients and methods: We examine the amount of information and level of satisfaction, as well as the agreement of assessment between patient and physician after the provision of standard patient information before and at the end of radiotherapy. 51 consecutive patients were interviewed with a newly designed questionnaire. The first questioning with 13 items was carried out before radiotherapy and the second with ten items was done at the end of treatment. Sum scores for information and satisfaction were defined and agreement was measured by the weighted κ coefficient. Results: Global level of information and satisfaction was good, and a significant increase in information level and a significant decline in satisfaction were seen between questionnaire 1 and 2. Agreement between patient and physician was fair, for example intent of treatment resulted in a κ coefficient of 0.34, and poor for the doctor's role with a κ coefficient of -0.002. Only 52% of the patients who received palliative radiotherapy rated correctly the non-curative intent of treatment, whereas 86% of the patients who received curative radiotherapy made a correct statement. Before radiotherapy, emotional state was often both negatively and positively assessed by the patients. Conclusion: Our short questionnaire is simple and easy to understand. It provides insights into patient information with respect to assessment of the information, satisfaction level, and agreement between

Chronic lead intoxication; Chronische Bleiintoxikation

Energy Technology Data Exchange (ETDEWEB)

Wieseler, B.; Leng, G. [Duesseldorf Univ. (Germany). Inst. fuer Hygiene; Lenz, S.; Schultz, C. [Klinikum Remscheid GmbH, Remscheid (Germany); Wilhelm, M. [Bochum Univ. (Germany). Inst. fuer Hygiene, Sozial- und Umweltmedizin

1999-02-01

The case of a female 68 years old patient is described. Here, a chronic lead intoxication was diagnosed after a two year old medical history with increasing attacks of colic-like abdominal pain often described as life-threatening. After repeated hospitalizations and intensive search for the cause of the symptoms, porphyria and anemia was found to be a sign of a chronic lead poisoning. The blood lead concentrations were always about a level of 600 {mu}g/L. The source of exposure could not be found by now. Neither home inspection nor environmental investigations have shown a recent source of lead intake by the patient. However, a possible occupational source of lead exposure at a blast furnace was established by anamnesis for 1952 to 1962. Thus, osteoporosis induced lead mobilisation was suspected. Noticeable are the results of the six abdominal survey radiographies taken during hospitalization within one year; three radiographies were taken following clinical admission and three before discharge of the patient. In comparison, the course shows a chronic relapsing alimentary supply from metallic particles of unknown genesis. The patient was treated with the sodium salt of 2,3-dimercapto-1-propansulfonic acid (DMPS, Dimaval{sup TM}). She was free of complain afterwards. Following therapy, the blood lead concentrations fell under a level of 400 {mu}m/L, but after several weeks the lead level raised up to the original level of 600 {mu}g/L. (orig.) [Deutsch] Es wird eine 68jaehrige Patientin vorgestellt, bei der nach fast zweijaehriger Krankengeschichte, die gekennzeichnet war durch rezidivierende, teils als lebensbedrohlich geschilderte Bauchkoliken, eine chronische Bleiintoxikation diagnostiziert wurde. Erst nach wiederholten stationaeren Krankenhausaufenthalten mit intensiver Suche nach der Krankheitsursache wurden das Krankheitsbild und die Laborwerte durch Zusatzuntersuchungen ergaenzt, so dass sich in der festgestellten Porphyrie und Anaemie die Diagnose der

Lymph scintigraphy and pre- and intraoperative gamma probe measurements for localization of sentinel lymph nodes (SLN) in breast cancer; Lymphszintigraphie sowie prae- und intraoperative Sondenmessung zur Darstellung des Sentinel Lymph Node (SLN) beim Mammakarzinom

Energy Technology Data Exchange (ETDEWEB)

Brenner, W.; Czech, N.; Felde, U. zum; Kampen, W.U.; Henze, E. [Kiel Univ. (Germany). Klinik fuer Nuklearmedizin; Ostertag, H. [Kiel Univ. (Germany). Klinik fuer Gynaekologie und Geburtshilfe; Klutmann, S.; Bohuslavizki, K.H. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin; Luettges, J.; Sprenger, A. [Kiel Univ. (Germany). Inst. fuer Allgemeine und Pathologische Anatomie

2000-05-01

Aim of this study was to prove the clinical value of nuclear medicine procedures to detect the sentinel lymph node (SLN) for SLN biopsy. Methods: In 132 patients with breast cancer we performed lymph scintigraphy of the breast as well as both pre- and intraoperative gamma probe measurements correlating the results with the findings of histopathology. Results: SLN were detectable in 62 of 110 patients according to a sensitivity of 56% when scanning was performed only at 1-2 h p.i. while the sensitivity increased to 86% (19 of 22 pts.) if sequential images were acquired up to 2 h p.i. One or more SLN were identified by a handheld gamma probe transcutaneously prior to surgery in 96% (113 of 118 pts.) of the patients who showed up with no clinically suspected lymph node metastases. Intraoperatively, in additionally 2 patients the SLN could be found resulting in a sensitivity of 97% (115 of 118 pts.). In only 3 patients with clinically no tumor spread to axillary lymph nodes no SLN could be identified by the probe. Skip lesions, i.e. lymph node metastases in patients with tumorfree SLN, occurred in 2 cases: Due to SLN biopsy in these patients lymph node staging was false negative compared to conventional staging by means of axillary lymph node dissection. Conclusion: The results demonstrate a high preoperative detection rate of SLN in patients with breast cancer using lymph scintigraphy and gamma probe measurements. Thus, nuclear medicine is capable of providing the basic requirements for SLN biopsy in the daily routine. (orig.) [German] Ziel der vorliegenden Arbeit im Vorfeld einer geplanten Multicenterstudie zur Wertigkeit der Sentinel-Lymphknoten (SLN) Biopsie war, die Zuverlaessigkeit der SLN-Detektion mit nuklearmedizinischen Methoden im klinischen Routinebetrieb zu ueberpruefen. Methoden: Bei 132 Patientinnen mit stanzbioptisch gesichertem Mammakarzinom fuehrten wir eine Lymphszintigraphie der Brust sowie eine prae- und intraoperative Gammasondenmessung durch und

Patient participation in transitional care of older patients

OpenAIRE

Dyrstad, Dagrunn Nåden

2016-01-01

PhD thesis in Health, medicine and welfare Background: Older patients often have several health challenges, with multiple medications, which leads to a need of treatment and care from diverse healthcare services. These patients are often in need of transitions from different levels of care, specifically during hospital admission and discharge. Patient participation is highlighted and stated in patients’ rights and healthcare directives, with patients being informed and involved in all trea...

Does patient satisfaction affect patient loyalty?

Science.gov (United States)

Kessler, Daniel P; Mylod, Deirdre

2011-01-01

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

Using patient acuity data to manage patient care outcomes and patient care costs.

Science.gov (United States)

Van Slyck, A; Johnson, K R

2001-01-01

This article describes actual reported uses for patient acuity data that go beyond historical uses in determining staffing allocations. These expanded uses include managing patient care outcomes and health care costs. The article offers the patient care executive examples of how objective, valid, and reliable data are used to drive approaches to effectively influence decision making in an increasingly competitive health care environment.

Can "patient keeper" help in-patients?

Science.gov (United States)

Al-Hinnawi, M F

2009-06-01

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

The relationship between physician humility, physician-patient communication, and patient health.

Science.gov (United States)

Ruberton, Peter M; Huynh, Ho P; Miller, Tricia A; Kruse, Elliott; Chancellor, Joseph; Lyubomirsky, Sonja

2016-07-01

Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical visit. Primary care physician-patient interactions (297 patients across 100 physicians) were rated for the physician's humility and the effectiveness of the physician-patient communication. Additionally, patients reported their overall health and physicians and patients reported their satisfaction with the interaction. Within-physician fluctuations in physician humility and self-reported patient health positively predicted one another, and mean-level differences in physician humility predicted effective physician-patient communication, even when controlling for the patient's and physician's satisfaction with the visit and the physician's frustration with the patient. The results suggest that humble, rather than paternalistic or arrogant, physicians are most effective at working with their patients. Interventions to improve physician humility may promote better communication between health care providers and patients, and, in turn, better patient outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Using Patient Portals to Increase Engagement in Patients with Cancer.

Science.gov (United States)

Rodriguez, Elizabeth S

2018-04-03

To review patient portals which serve as a tool for patient engagement by increasing access to electronic health care information and expanding ways to communicate with health care providers. Reviews of the literature and first-hand experience. Meaningful Use requirements propelled the design and development of patient portals in recent years. Patient engagement in oncology can improve quality of life and outcomes. Oncology nurses facilitate patient adoption of patient portals and support usage. Patient education helps manage communication expectations and understanding of online medical information. Copyright © 2018 Elsevier Inc. All rights reserved.

Patient-Centeredness as Physician Behavioral Adaptability to Patient Preferences.

Science.gov (United States)

Carrard, Valérie; Schmid Mast, Marianne; Jaunin-Stalder, Nicole; Junod Perron, Noëlle; Sommer, Johanna

2018-05-01

A physician who communicates in a patient-centered way is a physician who adapts his or her communication style to what each patient needs. In order to do so, the physician has to (1) accurately assess each patient's states and traits (interpersonal accuracy) and (2) possess a behavioral repertoire to choose from in order to actually adapt his or her behavior to different patients (behavioral adaptability). Physician behavioral adaptability describes the change in verbal or nonverbal behavior a physician shows when interacting with patients who have different preferences in terms of how the physician should interact with them. We hypothesized that physician behavioral adaptability to their patients' preferences would lead to better patient outcomes and that physician interpersonal accuracy was positively related to behavioral adaptability. To test these hypotheses, we recruited 61 physicians who completed an interpersonal accuracy test before being videotaped during four consultations with different patients. The 244 participating patients indicated their preferences for their physician's interaction style prior to the consultation and filled in a consultation outcomes questionnaire directly after the consultation. We coded the physician's verbal and nonverbal behavior for each of the consultations and compared it to the patients' preferences to obtain a measure of physician behavioral adaptability. Results partially confirmed our hypotheses in that female physicians who adapted their nonverbal (but not their verbal) behavior had patients who reported more positive consultation outcomes. Moreover, the more female physicians were accurate interpersonally, the more they showed verbal and nonverbal behavioral adaptability. For male physicians, more interpersonal accuracy was linked to less nonverbal adaptability.

Patient opinion

DEFF Research Database (Denmark)

Zurita, Laura; Nøhr, Christian

2004-01-01

The paper is based upon a case study and aims to provide information abouit patients values and communication that will be useful in the design of more patient friendly health system.......The paper is based upon a case study and aims to provide information abouit patients values and communication that will be useful in the design of more patient friendly health system....

Remote Patient Management for Home Dialysis Patients

Directory of Open Access Journals (Sweden)

Eric L. Wallace

2017-11-01

Full Text Available Remote patient management (RPM offers renal health care providers and patients with end-stage kidney disease opportunities to embrace home dialysis therapies with greater confidence and the potential to obtain better clinical outcomes. Barriers and evidence required to increase adoption of RPM by the nephrology community need to be clearly defined. Ten health care providers from specialties including nephrology, cardiology, pediatrics, epidemiology, nursing, and health informatics with experience in home dialysis and the use of RPM systems gathered in Vienna, Austria to discuss opportunities for, barriers to, and system requirements of RPM as it applies to the home dialysis patient. Although improved outcomes and cost-effectiveness of RPM have been demonstrated in patients with diabetes mellitus and heart disease, only observational data on RPM have been gathered in patients on dialysis. The current review focused on RPM systems currently in use, on how RPM should be integrated into future care, and on the evidence needed for optimized implementation to improve clinical and economic outcomes. Randomized controlled trials and/or large observational studies could inform the most effective and economical use of RPM in home dialysis. These studies are needed to establish the value of existing and/or future RPM models among patients, policy makers, and health care providers.

Emerging versions of patient involvement with Patient Reported Outcomes

DEFF Research Database (Denmark)

Langstrup, Henriette

It is a central argument in the growing Danish PRO-arena, that a large-scale collection of PRO from patients in the Danish Healthcare system will pave the way for more genuine patient involvement in clinical decision-making, quality management and governance of the health services. In this paper I...... discuss how patient involvement is being (re)configured when increasingly connected to national visions of participatory healthcare. A central discussion centers on ‘meaningful use’ of patient-generated data promoting patients’ expectations and experiences as a criterion for how to proceed...... with the national use of PRO. But how do assumptions of what constitutes meaning for patients interact with the kinds of roles that patients are expected to take on with PROtools? What forms of participation are assumed to be meaningful and thus good and which are not? In sketching emerging versions of patient...

Communication and patient participation influencing patient recall of treatment discussions.

Science.gov (United States)

Richard, Claude; Glaser, Emma; Lussier, Marie-Thérèse

2017-08-01

Patient recall of treatment information is a key variable towards chronic disease (CD) management. It is unclear what communication and patient participation characteristics predict recall. To assess what aspects of doctor-patient communication predict patient recall of medication information. To describe lifestyle treatment recall, in CD primary care patients. Observational study within a RCT. Community-based primary care (PC) practices. Family physicians (n=18): practicing >5 years, with a CD patient caseload. Patients (n=159): >40 years old, English speaking, computer literate, off-target hypertension, type II diabetes and/or dyslipidaemia. Patient characteristics: age, education, number of CDs. Information characteristics: length of encounter, medication status, medication class. Communication variables: socio-emotional utterances, physician dominance and communication control scores and PACE (ask, check and express) utterances, measured by RIAS. Number of medication themes, dialogue and initiative measured by MEDICODE. Recall of CD, lifestyle treatment and medication information. Frequency of lifestyle discussions varied by topic. Patients recalled 43% (alcohol), 52% (diet) to 70% (exercise) of discussions. Two and a half of six possible medication themes were broached per medication discussion. Less than one was recalled. Discussing more themes, greater dialogue and patient initiative were significant predictors of improved medication information recall. Critical treatment information is infrequently exchanged. Active patient engagement and explicit conversations about medications are associated with improved treatment information recall in off-target CD patients followed in PC. Providers cannot take for granted that long-term off-target CD patients recall information. They need to encourage patient participation to improve recall of treatment information. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Importance of doctor-patient relationship for patient adherence with medication regimes

DEFF Research Database (Denmark)

Sokolowski, Ineta; Vedsted, Peter

Aim: It has been supposed that the relation between the doctor and the patient has implications for the adherence to medication. This study explores the effect of patient reported doctor-patient relationship on patient adherence with medication regiments. Methods: Design: Prospective cohort study...... practices. Doctor-patient relationship was measured from The Danish version of the 23-item EUROPEP questionnaire measuring patient evaluation of general practice. From the register data on prescriptions we drew all subsidised drugs redeemed at pharmacies for each patient in 2002-2005. Patients, who did...... was measured as secondary non-compliance and as persistence. The incidence rate ratio of non-adherence was calculated for different levels of the patient evaluated doctor-patient-relationship. Results: A total of 482 patients started new treatment of which 98 were non-compliant and 7 were censored. This study...

Patient satisfaction with doctor-patient interactions: a mixed methods study among diabetes mellitus patients in Pakistan.

Science.gov (United States)

Jalil, Aisha; Zakar, Rubeena; Zakar, Muhammad Zakria; Fischer, Florian

2017-02-21

Patient satisfaction with doctor-patient interactions is an indicator of physicians' competence. The satisfaction of diabetes patients is rarely studied in public diabetes clinics of Pakistan. Thus, this study aims to analyse the association between patient satisfaction and five dimensions of medical interaction: technical expertise, interpersonal aspects, communication, consultation time, and access/availability. A cross-sectional mixed methods study was conducted during July and August 2015 in the largest public diabetes outpatient clinic in Punjab province. We used the criterion sampling method to identify 1164 patients who: (i) were adult (18 years and above), (ii) had diabetes mellitus, (iii) had made at least three previous visits to the same clinic. The data was collected through face-to-face interviews. The structured part of the questionnaire was based on demographic characteristics and the Patient Satisfaction Questionnaire (PSQ-III). We translated the questionnaire into Urdu and pretested it with 25 patients in a similar context. Data storage and analysis were carried out using SPSS (version 22.0). Bivariate analyses and multinomial logistic regression model were used to generate the quantitative findings. Out of the 1164 eligible patients approached for interviews, 1095 patients completed the structured questionnaire and 186 respondents provided qualitative information in comments section. We conducted a thematic content analysis of qualitative responses in order to explain the quantitative findings. Demographic characteristics such as gender, education and occupation were significantly associated with the levels of patient satisfaction. The dimensions of doctor-patient interaction were significantly associated with patient satisfaction: technical expertise (OR = .87; 95% CI = .84-.91), interpersonal aspects (OR = .82; 95% CI = .77-.87), communication (OR = .83; 95% CI = .78-.89), time dimension (OR = .90; 95% CI = .81

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

Science.gov (United States)

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

2015-01-01

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

Clinical use of patient decision-making aids for stone patients.

Science.gov (United States)

Lim, Amy H; Streeper, Necole M; Best, Sara L; Penniston, Kristina L; Nakada, Stephen Y

2017-08-01

Patient decision-making aids (PDMAs) help patients make informed healthcare decisions and improve patient satisfaction. The utility of PDMAs for patients considering treatments for urolithiasis has not yet been published. We report our experience using PDMAs developed at our institution in the outpatient clinical setting in patients considering a variety of treatment options for stones. Patients with radiographically confirmed urolithiasis were given PDMAs regarding treatment options for their stone(s) based on their clinical profile. We assessed patients' satisfaction, involvedness, and feeling of making a more informed decision with utilization of the PDMAs using a Likert Scale Questionnaire. Information was also collected regarding previous stone passage, history and type of surgical intervention for urolithiasis, and level of education. Patients (n = 43; 18 males, 23 females and two unknown) 53 +/- 14years old were included. Patients reported that they understood the advantages and disadvantages outlined in the PDMAs (97%), that the PDMAs helped them make a more informed decision (83%) and felt more involved in the decision making process (88%). Patients reported that the aids were presented in a balanced manner and used up-to-date scientific information (100%, 84% respectively). Finally, a majority of the patients prefer an expert's opinion when making a treatment decision (98%) with 73% of patients preferring to form their own opinion based on available information. Previous stone surgery was associated with patients feeling more involved with the decision making process (p = 0.0465). PDMAs have a promising role in shared decision-making in the setting of treatment options for nephrolithiasis.

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.

Patient-centered medical homes for patients with disabilities.

Science.gov (United States)

Hernandez, Brigida; Damiani, Marco; Wang, T Arthur; Driscoll, Carolyn; Dellabella, Peter; LePera, Nicole; Mentari, Michael

2015-01-01

The patient-centered medical home is an innovative approach to improve health care outcomes. To address the unique needs of patients with intellectual and developmental disabilities (IDDs), a large health care provider reevaluated the National Committee for Quality Assurance's 6 medical home standards: (a) enhance access and continuity, (b) identify and manage patient populations, (c) plan and manage care, (d) provide self-care and community support, (e) track and coordinate care, and (f) measure and improve performance. This article describes issues to consider when serving patients with IDDs.

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

Science.gov (United States)

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

2013-01-01

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

Patient satisfaction after receiving dental treatment among patients ...

African Journals Online (AJOL)

Background: Patient satisfaction is one of the indicators of the quality of care. Therefore it is one of the tools for evaluating the quality of care. Aim: To determine patient satisfaction after receiving dental treatment among patients attending public dental clinics in Dar-Es-Salaam. Material and methods: Five public dental clinics ...

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

Science.gov (United States)

Henriksen, Ann-Helen; Ringsted, Charlotte

2011-09-01

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

Patient-centered communication strategies for patients with aphasia: discrepancies between what patients want and what physicians do.

Science.gov (United States)

Morris, Megan A; Clayman, Marla L; Peters, Kaitlin J; Leppin, Aaron L; LeBlanc, Annie

2015-04-01

Communication during clinical encounters can be challenging with patients with communication disabilities. Physicians have the potential to positively affect the encounter by using communication strategies that engage the patient in patient-centered communication. We engaged patients and their physicians in defining their preferences for patient-centered communication strategies, then evaluated the use of the identified strategies during observed clinical encounters. We video-recorded 25 clinical encounters with persons with aphasia. All encounters were previously scheduled with community physicians and a companion was present. Following each encounter, physicians completed a brief questionnaire and the person with aphasia and his or her companion participated in a video elicitation interview. While many of the communication strategies identified and described by physicians, patients and companions were similar, patients and companions identified three additional key communication strategies. These strategies included (1) using visual aids, (2) writing down key words while speaking, and (3) using gestures. In the video recorded clinical encounters, no physicians wrote down key words while speaking and only one used a visual aid during the clinical encounter. The frequency with which physicians used gestures varied greatly, even within the same patient, suggesting the use of gestures was independent of patient or companion characteristics. To maximize patient-centered communication with patients with communication disabilities, physicians should use "disability-specific" communication strategies. Our study suggests that physicians should routinely ask patients and companions about communication preferences and then incorporate identified communication strategies into their communication style. Copyright © 2015 Elsevier Inc. All rights reserved.

Patient delay and associated factors among breast cancer patients

International Nuclear Information System (INIS)

Khan, M.A.; Khan, M.I.; Andleeb, U.

2015-01-01

Objectives: To stratify patients into various stages, calculate average patient delay and study various causes of delay to presentation. Methodology: This was a one year hospital based cross sectional study at Khyber Teaching Hospital, using non probability consecutive sampling. A simplified staging was used for this study; Early (Stage I), Intermediate (Stage II, III), and Late (Stage IV). A patient was labelled delay when >3 months had elapsed between first symptom perception and first doctor consultation. Results: 80 patients were included with age 21-80 years (mean 45.28+-13.15). 80% of the patients were married, 76.3% (n=61/80) were poor with annual income of <500 US $, 85% of patients were illiterate. The participants from Rural and Urban areas were similar (37 % vs 31%); 15% were from Afghanistan. 80% patients presented with a delay of >3 months. Most common cause of delay was false symptom interpretation in 25.3% (n=17) patients. Conclusion: Late clinical presentation is because of lack of health education, unawareness, misconceptions about treatment and strong belief in traditional medicine resulting in advanced disease. This is worsened by poverty and unavailability of health care services especially in rural areas. (author)

Ambulatory orthopaedic surgery patients' emotions when using different patient education methods.

Science.gov (United States)

Heikkinen, Katja; Salanterä, Sanna; Leppänen, Tiina; Vahlberg, Tero; Leino-Kilpi, Helena

2012-07-01

A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods.

Medication adherence in type 2 diabetes patients: study of patients ...

African Journals Online (AJOL)

Medication adherence in type 2 diabetes patients: study of patients in ... impact of medication adherence on the clinical outcomes of type 2 diabetes patients at ... the review of case notes of one-hundred and fifty two randomly selected patients.

The importance of patient-centered care for various patient groups.

NARCIS (Netherlands)

Boer, D. de; Delnoij, D.; Rademakers, J.

2013-01-01

Objectives: To assess differences in the importance ascribed to patient-centered care between various patient groups and demographic groups. Methods: Survey data collected using questionnaires were analyzed for patients that underwent hip or knee surgery (n=214), patients suffering from rheumatoid

Communication Skills in Patient-Doctor Interactions: Learning from Patient Complaints

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Janine W.Y. Kee

2018-06-01

Full Text Available Purpose: Despite communication skills training in medical school, junior doctors continue to demonstrate poor patient-doctor communication skills, where patient unhappiness from the encounter often manifests as patient complaints. We sought to identify crucial communication skills that should be incorporated in the communications curriculum by learning from patient complaints, to explore how the communication lapses occur. Method: 38 cases of anonymized negative patient feedback about junior doctors were analysed using qualitative content analysis. A two-step fine-coding system involving four researchers was employed. Results: Four main themes of communication errors were identified, namely: non-verbal (eye contact, facial expression and paralanguage, verbal (active listening and inappropriate choice of words, and content (poor quantity and quality of information provided; and poor attitudes (lack of respect and empathy. Discussion: Patient-doctor communication is a complex interpersonal interaction that requires an understanding of each party׳s emotional state. We identified important but overlooked communication lapses such as non-verbal paralinguistic elements that should be incorporated into communications curriculum, with an emphasis on dialectical learning. These include integrating these findings into a simulation-based communications module for training doctors at a post-graduate level as well as monitoring and analyzing patient complaints regularly to iteratively update the content of the training module. Beyond these skills training, there is also a need to highlight negative emotions of doctors in future research, as it influences their communication patterns and attitudes towards patients, ultimately shaping how patients perceive them. Keywords: Communication skills training, Patient complaints, Patient negative feedback, Patient-Doctor communication, Residency training

Transforming Patient Value: Comparison of Hospital, Surgical, and General Surgery Patients.

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Pitt, Henry A; Tsypenyuk, Ella; Freeman, Susan L; Carson, Steven R; Shinefeld, Jonathan A; Hinkle, Sally M; Powers, Benjamin D; Goldberg, Amy J; DiSesa, Verdi J; Kaiser, Larry R

2016-04-01

Patient value (V) is enhanced when quality (Q) is increased and cost (C) is diminished (V = Q/C). However, calculating value has been inhibited by a lack of risk-adjusted cost data. The aim of this analysis was to measure patient value before and after implementation of quality improvement and cost reduction programs. Multidisciplinary efforts to improve patient value were initiated at a safety-net hospital in 2012. Quality improvement focused on adoption of multiple best practices, and minimizing practice variation was the strategy to control cost. University HealthSystem Consortium (UHC) risk-adjusted quality (patient mortality + safety + satisfaction + effectiveness) and cost (length of stay + direct cost) data were used to calculate patient value over 3 fiscal years. Normalized ranks in the UHC Quality and Accountability Scorecard were used in the value equation. For all hospital patients, quality scores improved from 50.3 to 66.5, with most of the change occurring in decreased mortality. Similar trends were observed for all surgery patients (42.6 to 48.4) and for general surgery patients (30.9 to 64.6). For all hospital patients, cost scores improved from 71.0 to 2.9. Similar changes were noted for all surgical (71.6 to 27.1) and general surgery (85.7 to 23.0) patients. Therefore, value increased more than 30-fold for all patients, 3-fold for all surgical patients, and almost 8-fold for general surgery patients. Multidisciplinary quality and cost efforts resulted in significant improvements in value for all hospitalized patients as well as general surgery patients. Mortality improved the most in general surgery patients, and satisfaction was highest among surgical patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Das Konzept des 'Medialen Habitus'

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Sven Kommer

2013-12-01

Full Text Available Sven Kommer fragt in seinem Beitrag, inwieweit das Habitus-Konzept als Erklärungsmuster für die beobachtbare Zementierung sozialer Ungleichheit im Schulsystem greift. Dabei konstatiert der Beitrag, dass alle an der Weiterschreibung des Habitus-Konzepts beteiligten AutorInnen sich darin einig sind, dass es wichtige Beiträge für die Selbst-Aufklärung einer weitestgehend mediatisierten Gesellschaft leistet. Der Artikel geht dabei – auch angesichts der PISA-Studien – von dem empirischen Befund aus, dass die individuelle Ausprägung der Medienkompetenz aufs engste mit den Ressourcen des Elternhauses verbunden ist und sich dabei die elterlichen Formen der Medienerziehung unübersehbar mit den aktuellen medialen Handlungspraxen verbinden. Dieser Befund deckt sich auf weite Strecken auch mit den Ergebnissen der Bildungssoziologie Pierre Bourdieus, weshalb die Diskussionen zum medialen Habitus im Rahmen dieser Ausführungen auch mit empirischen Argumenten unterfüttert werden. Ganz in diesem Sinne arbeitet der Artikel auch heraus, dass die aus dem Kontext der Cultural Studies stammenden Thesen zur Nivellierung kultureller Milieu-Unterschiede wenig empirisch fundiert sind. Der Artikel betont dahingehend, dass hier eine unreflektierte Infiltration durch genuin neoliberales Gedankengut vorliegt, da mit ihr auch die Annahme einer "freien Wahl" von Lebensweg, Milieuzugehörigkeit oder Gender verbunden werden kann. Dabei wir auch eingehend der "Clash of Habitus" diskutiert, der zwischen Lehrenden und Lernenden stattfindet und das Augenmerk ein Mal mehr auf die Tatsache lenkt, das unser Bildungssystem auf dieser pädagogisch relevanten Ebene durch soziale Ungleichheiten gekennzeichnet ist. In his essay, Sven Kommer questions whether the notion of habitus is suitable to support the understanding of the obvious consolidation of inequality in the school system. He shows that all authors active in the continued use of the notion of habitus agree that it

Diagnostic work-up of pulmonary nodules. Management of pulmonary nodules detected with low-dose CT screening; Abklaerung von Lungenrundherden. Management durch Frueherkennungsuntersuchungen detektierter pulmonaler Rundherde

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Wormanns, D. [Evangelische Lungenklinik Berlin, Berlin (Germany)

2016-09-15

Pulmonary nodules are the most frequent pathological finding in low-dose computed tomography (CT) scanning for early detection of lung cancer. Early stages of lung cancer are often manifested as pulmonary nodules; however, the very commonly occurring small nodules are predominantly benign. These benign nodules are responsible for the high percentage of false positive test results in screening studies. Appropriate diagnostic algorithms are necessary to reduce false positive screening results and to improve the specificity of lung cancer screening. Such algorithms are based on some of the basic principles comprehensively described in this article. Firstly, the diameter of nodules allows a differentiation between large (>8 mm) probably malignant and small (<8 mm) probably benign nodules. Secondly, some morphological features of pulmonary nodules in CT can prove their benign nature. Thirdly, growth of small nodules is the best non-invasive predictor of malignancy and is utilized as a trigger for further diagnostic work-up. Non-invasive testing using positron emission tomography (PET) and contrast enhancement as well as invasive diagnostic tests (e.g. various procedures for cytological and histological diagnostics) are briefly described in this article. Different nodule morphology using CT (e.g. solid and semisolid nodules) is associated with different biological behavior and different algorithms for follow-up are required. Currently, no obligatory algorithm is available in German-speaking countries for the management of pulmonary nodules, which reflects the current state of knowledge. The main features of some international and American recommendations are briefly presented in this article from which conclusions for the daily clinical use are derived. (orig.) [German] Lungenrundherde sind die haeufigsten pathologischen Befunde bei Untersuchungen mit der Niedrigdosis-CT zur Lungenkrebsfrueherkennung. Fruehstadien des Lungenkarzinoms manifestieren sich meist als Rundherd

[Influence of patients' attitude on doctors' satisfaction with the doctor-patient relationship].

Science.gov (United States)

Xie, Zheng; Qiu, Ze-qi; Zhang, Tuo-hong

2009-04-18

To describe the doctors' satisfaction of the doctor-patient relationship and find out the influencing factors of the patients, gathering evidence to improve the doctor-patient relationship. This study was a cross-sectional study, in which doctors and nurses in 10 hospitals of Beijing, Shandong and Chongqing were surveyed with structured questionnaires and in-depth interviews. The mean score of the doctors' satisfaction of the doctor-patient relationship was 59.97, which was much lower than the patients'. The patients' socio-demographic characteristics, social economic status (SES) and behavior characteristics influence the interaction of the doctors and the patients. The doctors' satisfaction of the doctor-patient relationship was influenced by the patients' trust. The doctors' perspective is helpful to define the tension and the cause of the doctor-patient relationship. The patients' characteristics have important influence on the doctor-patient relationship. It's necessary to take action on the patients to improve the doctor-patient relationship.

Autoantibody signature differentiates Wilms tumor patients from neuroblastoma patients.

Directory of Open Access Journals (Sweden)

Jana Schmitt

Full Text Available Several studies report autoantibody signatures in cancer. The majority of these studies analyzed adult tumors and compared the seroreactivity pattern of tumor patients with the pattern in healthy controls. Here, we compared the autoimmune response in patients with neuroblastoma and patients with Wilms tumor representing two different childhood tumors. We were able to differentiate untreated neuroblastoma patients from untreated Wilms tumor patients with an accuracy of 86.8%, a sensitivity of 87.0% and a specificity of 86.7%. The separation of treated neuroblastoma patients from treated Wilms tumor patients' yielded comparable results with an accuracy of 83.8%. We furthermore identified the antigens that contribute most to the differentiation between both tumor types. The analysis of these antigens revealed that neuroblastoma was considerably more immunogenic than Wilms tumor. The reported antigens have not been found to be relevant for comparative analyses between other tumors and controls. In summary, neuroblastoma appears as a highly immunogenic tumor as demonstrated by the extended number of antigens that separate this tumor from Wilms tumor.

The evolving concept of "patient-centeredness" in patient-physician communication research.

Science.gov (United States)

Ishikawa, Hirono; Hashimoto, Hideki; Kiuchi, Takahiro

2013-11-01

Over the past few decades, the concept of "patient-centeredness" has been intensively studied in health communication research on patient-physician interaction. Despite its popularity, this concept has often been criticized for lacking a unified definition and operationalized measurement. This article reviews how health communication research on patient-physician interaction has conceptualized and operationalized patient-centered communication based on four major theoretical perspectives in sociology (i.e., functionalism, conflict theory, utilitarianism, and social constructionism), and discusses the agenda for future research in this field. Each theory addresses different aspects of the patient-physician relationship and communication from different theoretical viewpoints. Patient-centeredness is a multifaceted construct with no single theory that can sufficiently define the whole concept. Different theoretical perspectives of patient-centered communication can be selectively adopted according to the context and nature of problems in the patient-physician relationship that a particular study aims to explore. The present study may provide a useful framework: it offers an overview of the differing models of patient-centered communication and the expected roles and goals in each model; it does so toward identifying a communication model that fits the patient and the context and toward theoretically reconstructing existing measures of patient-centered communication. Furthermore, although patient-centered communication has been defined mainly from the viewpoint of physician's behaviors aimed at achieving patient-centered care, patient competence is also required for patient-centered communication. This needs to be examined in current medical practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Stereotactic vacuum core biopsy of clustered microcalcifications classified as BI-RADS{sup TM} type 3; Stereotaktische Vakuumstanzbiopsie zur Abklaerung von gruppiertem Mikrokalk der Kategorie BI-RADS{sup TM} 3

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Obenauer, S.; Fischer, U.; Baum, F.; Dammert, S.; Grabbe, E. [Goettingen Univ. (Germany). Abt. fuer Roentgendiagnostik; Fuezesi, L. [Goettingen Univ. (Germany). Zentrum Pathologie

2001-08-01

Purpose: Evaluation of stereotactic vacuum core biopsy of clustered microcalcifications categorized as BI-RADS{sup TM} 3. Material and methods: 86 patients with microcalcification BI-RADS{sup TM} 3 (probably benign, <3% malignant) underwent a stereotactic vacuum core biopsy (Mammotome, Fa. Ethicon Endo-Surgery Breast Care) using a digital stereotactic unit (Mammotest, Fa. Fischer Imaging). The removal of the calcifications was judged by two radiologists in consensus and classified as complete (100%), major (55-99%) or incomplete (<50%). Results: 4/86 patients could not be evaluated by vacuum core biopsy due to the localization of the microcalcifications close to the skin or lack of detection. In 40/82 cases a complete, in 38/82 a major, and in 4/82 an incomplete removal was achieved. Histology revealed 67 cases of fibrocystic changes, 4 papillomas, 4 fibroadenomas, 4 cases of atypical ductal hyperplasia (ADH), and 3 ductal carcinomas in situ (DCIS), one of these with a minimal-invasive tumor component. Patients with ADH were advised to undergo surgical biopsy. Histology revealed complete removal. 7 patients had complications or side-effects. Conclusions: Percutaneous vacuum core biopsy is a reliable minimal-invasive diagnostic method to come to the final diagnosis in patients with clustered microcalcifications categorized BI-RADS{sup TM} 3. However, if malignancy is proven (about 4% of our cases) an open biopsy is necessary. (orig.) [German] Zielsetzung: Evaluation der stereotaktischen Vakuumstanzbiopsie bei gruppierten Mikrokalzifikationen vom Typ BI-RADS{sup TM}3. Material und Methodik: Gruppiert angeordneter Mikrokalk der Kategorie BI-RADS{sup TM} 3 (wahrscheinlich benigne, <3% maligne) wurde bei 86 Patientinnen mit einer stereotaktischen Vakuumstanzbiopsie (Mammotome{sup circledR}, Fa. Ethicon Endo-Surgery Breast Care) an einem digitalen Stereotaxietisch (Mammotest, Fa. Fischer Imaging) abgeklaert. Das Ausmass der bioptisch entfernten Kalizifkationen wurde von

Spondylolysis in adolescents: the diagnostic value of MRI; Die Spondylolyse im Stadium der Entstehung: Diagnostischer Beitrag der MRT

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Staebler, A.; Steinborn, M.; Matzko, M.; Reiser, M. [Klinikum Grosshadern, Muenchen (Germany). Inst. fuer Radiologische Diagnostik; Paulus, R.; Bosch, R. [Muenchen Univ. (Germany). Orthopaedische Klinik

2000-01-01

Purpose: To assess the value of MR imaging in demonstrating ongoing spondylolysis in adolescents. Methods: MRI was performed in 9 juvenile patients (3 female, 6 male aged 8-16 years; mean 12.5 y) with pain during hyperextension. In 6 patients a CT scan and in 5 a plain film was available. Results: In all patients bone marrow edema was found in the pars interarticularis and the pedicle, which was bilateral in 4 patients. In 7/9 cases the L5 vertebra was affected, in 2/9 cases spondylolysis was found in L4. In 3 cases the edema reached the middle third of the vertebral body and a tumor was suspected. In all CT scans a bilateral incomplete or complete cleft in the pars interarticularis was found. In 4/6 CT-scans a sclerosis was seen in the area of the bone marrow edema. Only in 1/5 pain films was there a suspicion for a spondylolysis, four examinations were completely normal. Conclusions: To eliminate underlying causal conditions of spondylolysis and to install specific therapy, early diagnosis is mandatory. MR imaging should be the first and only imaging modality in young patients with low back pain during and after exercise and pain with hyperextension. Bone scans and CT scans should be avoided due to irradiation, plain films usually do not reveal pathological findings in developing spondylolysis. (orig.) [German] Ziel: Darstellung der Wertigkeit der MR-Tomographie in der Diagnostik der Spondylolyse im Stadium der Entstehung. Methoden: 9 sportlich, aktive jugendliche Patienten im Alter von 8-16 Jahren (Durchschnitt 12,5 Jahre) mit Rueckenschmerzen bei der Hyperextension wurden MR-tomographisch untersucht. In 6 Faellen lag eine CT, in 5 Faellen Roentgenaufnahmen vor. Ergebnisse: Bei den 9 Jugendlichen wurden Knochenmarkoedeme in der Pars interarticularis und den Bogenwurzeln nachgewiesen, die in 4 Patienten beidseitig vorhanden waren. In 7/9 Faellen war LWK 5 betroffen, in 2/9 LWK 4. In 3 Faellen reichte das Oedem in die Wirbelkoerper, bei 2 Patienten bestand

Ensuring a proactive, evidence-based, patient safety approach to patient assessment.

Science.gov (United States)

Considine, Julie; Currey, Judy

2015-01-01

To argue that if all nurses were to adopt the primary survey approach (assessment of airway, breathing, circulation and disability) as the first element of patient assessment, they would be more focused on active detection of clinical deterioration rather than passive collection of patient data. Nurses are the professional group that carry the highest level of responsibility for patient assessment, accurate data collection and interpretation. The timely recognition of, and response to deteriorating patients, is dependent on the measurement and interpretation of pertinent physiological data by nurses. Discursive paper. Traditionally taught and commonly used approaches to patient assessment such as 'vital signs' and 'body systems' are not evidence-based nor framed in patient safety. The primary survey approach as the first element in patient assessment has three major advantages: (1) data are collected according to clinical importance; (2) data are collected using the same framework as most organisation's rapid response system activation criteria; and (3) the primary survey acts as a patient safety checklist, thereby decreasing the risk of failure to recognise, and therefore respond to, deteriorating patients. The vital signs and body systems approaches to patient assessment have significant limitations in identifying clinical deterioration. The primary survey approach provides nurses with a consistent, evidence-based and sequenced approach to patient assessment in every clinical setting. All nurses should use a primary survey approach as the first element of patient assessment in every patient encounter as a patient safety strategy. © 2014 John Wiley & Sons Ltd.

Labelling patients

International Nuclear Information System (INIS)

Strudwick, R.M.

2016-01-01

This article looks at how diagnostic radiographers label their patients. An ethnographic study of the workplace culture in one diagnostic imaging department was undertaken using participant observation for four months and semi-structured interviews with ten key informants. One of the key themes; the way in which radiographers label their patients, is explored in this article. It was found from the study that within the department studied the diagnostic radiographers labelled or categorised their patients based on the information that they had. This information is used to form judgements and these judgements were used to assist the radiographers in dealing with the many different people that they encountered in their work. This categorisation and labelling of the patient appears to assist the radiographer in their decision-making processes about the examination to be carried out and the patient they are to image. This is an important aspect of the role of the diagnostic radiographer. - Highlights: • I have studied the culture in one imaging department. • Radiographers label or categorise their patients. • These labels/categories are used to manage the patient. • This is an important aspect of the way in which radiographers work.

Review: Joachim R. Höflich (2003. Mensch, Computer und Kommunikation. Theoretische Verortungen und empirische Befunde [Man, Computer, Communication. Theoretical Positions and Empirical Findings

Directory of Open Access Journals (Sweden)

Jan Schmidt

2004-05-01

Full Text Available Joachim R. HÖFLICH presents a theory of the institutionalization of computer-mediated communication that centers on the user and his/her expectations. "Computer frames", consisting of rules and routines for the appropriate use of a medium and its applications as a tool for information, public discussion or interpersonal communication, structure the single usage episodes as well as the users' expectations. Drawing on a variety of data on the development of the Newspaper-Mailbox "Augsburg Newsline" in the Mid-Nineties, HÖFLICH demonstrates the usefulness of his conceptual framework for empirical analysis. His book is, therefore, a valuable contribution to the field of online research in social and communication science alike. URN: urn:nbn:de:0114-fqs040297

Therapeutic options in chronic heart failure. Findings on chest X-ray; Nicht medikamentoese Therapieoptionen der chronischen Herzinsuffizienz. Befunde in der Projektionsradiografie des Thorax

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Granitz, M.R.; Meissnitzer, T.; Meissnitzer, M.W.; Hergan, K.; Altenberger, J.; Granitz, C. [Uniklinikum Salzburg - Landeskrankenhaus (Austria)

2016-05-15

The contribution covers drugless therapeutic options for chronic heart failure: the implantable cardioverter/defibrillator (ICD), the cardiac resynchronization therapy (CRT), the interventional catheter treatment of functional mitral insufficiency, and mechanical heart supporting systems and heart transplantation.

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

Patient involvement in blood transfusion safety: patients' and healthcare professionals' perspective.

Science.gov (United States)

Davis, R; Murphy, M F; Sud, A; Noel, S; Moss, R; Asgheddi, M; Abdur-Rahman, I; Vincent, C

2012-08-01

Blood transfusion is one of the major areas where serious clinical consequences, even death, related to patient misidentification can occur. In the UK, healthcare professional compliance with pre-transfusion checking procedures which help to prevent misidentification errors is poor. Involving patients at a number of stages in the transfusion pathway could help prevent the occurrence of these incidents. To investigate patients' willingness to be involved and healthcare professionals' willingness to support patient involvement in pre-transfusion checking behaviours. A cross-sectional design was employed assessing willingness to participate in pre-transfusion checking behaviours (patient survey) and willingness to support patient involvement (healthcare professional survey) on a scale of 1-7. One hundred and ten patients who had received a transfusion aged between 18 and 93 (60 male) and 123 healthcare professionals (doctors, nurses and midwives) involved in giving blood transfusions to patients. Mean scores for patients' willingness to participate in safety-relevant transfusion behaviours and healthcare professionals' willingness to support patient involvement ranged from 4.96-6.27 to 4.53-6.66, respectively. Both groups perceived it most acceptable for patients to help prevent errors or omissions relating to their hospital identification wristband. Neither prior experience of receiving a blood transfusion nor professional role of healthcare staff had an effect on attitudes towards patient participation. Overall, both patients and healthcare professionals view patient involvement in transfusion-related behaviours quite favourably and appear in agreement regarding the behaviours patients should adopt an active role in. Further work is needed to determine the effectiveness of this approach to improve transfusion safety. © 2012 The Authors. Transfusion Medicine © 2012 British Blood Transfusion Society.

Communicating with patients

Science.gov (United States)

... Ask your patients about their outlooks, attitudes, and motivations. Learn the patient's perspective. Talk to the patient ... beliefs. This will help you understand the patient's motivation and let you plan the best ways to ...

Patient/Family Education for Newly Diagnosed Pediatric Oncology Patients.

Science.gov (United States)

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

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

Patient-controlled hospital admission for patients with severe mental disorders

DEFF Research Database (Denmark)

Thomsen, Christoffer Torgaard; Benros, Michael Eriksen; Hastrup, Lene Halling

2016-01-01

INTRODUCTION: Patient-controlled hospital admission for individuals with severe mental disorders is a novel approach in mental healthcare. Patients can admit themselves to a hospital unit for a short stay without being assessed by a psychiatrist or contacting the emergency department. Previous...... studies assessing the outcomes of patient-controlled hospital admission found trends towards reduction in the use of coercive measures and length of hospital stay; however, these studies have methodological shortcomings and small sample sizes. Larger studies are needed to estimate the effect of patient-controlled...... hospital admission on the use of coercion and of healthcare services. DESIGN AND METHODS: We aim to recruit at least 315 patients who are offered a contract for patient-controlled hospital admissions in eight different hospitals in Denmark. Patients will be followed-up for at least 1 year to compare...

Patterns of Physician-Patient Communication Associated with Patient Satisfaction.

Science.gov (United States)

Williams, M. Lee; Clampitt, Phillip G.

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

Perception of patients accessing out- patient pharmacy on the ...

African Journals Online (AJOL)

Conclusion: Patients' overall perception of pharmacy services was above average. There is need for improvement in the quality of services, especially in the availability of essential drugs at competitive prices and provision of adequate counselling and drug information services to patients. Keywords: Patient satisfaction, ...

'What do patients want?' Tailoring medicines information to meet patients' needs.

Science.gov (United States)

Young, Amber; Tordoff, June; Smith, Alesha

2017-11-01

Medicines information leaflets can equip patients to be in control of their own healthcare and support the safe and effective use of medicines. The design and content of leaflets influences patients' willingness to read them, and poor examples can cause patient confusion and anxiety. Researchers examined the literature over the past 8 years to determine the content and design of medicine information leaflets that patients prefer in order to read, understand, and use them effectively. It was found that existing leaflets do not meet patients' needs and appear ineffective. Leaflets lack the information patients seek and may contain non-essential material, affecting patients' perception of, and willingness to read them. Additionally, the acceptable leaflet length varies between patients. Application of good design principles improves readability, comprehension, and ability to locate information. Medicine information leaflets must meet patients' needs and be well designed. Tailoring information leaflets to patient characteristics and requirements would enhance effectiveness. Passive provision of pre-printed leaflets is outdated, unvalued and ineffective. Using automated computer systems for leaflet tailoring with the ability to further adapt patients' information might be the best way forward. Copyright © 2016 Elsevier Inc. All rights reserved.

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

Science.gov (United States)

Towle, Angela; Godolphin, William

2013-01-01

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

Patient Compliance With Electronic Patient Reported Outcomes Following Shoulder Arthroscopy.

Science.gov (United States)

Makhni, Eric C; Higgins, John D; Hamamoto, Jason T; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

2017-11-01

To determine the patient compliance in completing electronically administered patient-reported outcome (PRO) scores following shoulder arthroscopy, and to determine if dedicated research assistants improve patient compliance. Patients undergoing arthroscopic shoulder surgery from January 1, 2014, to December 31, 2014, were prospectively enrolled into an electronic data collection system with retrospective review of compliance data. A total of 143 patients were included in this study; 406 patients were excluded (for any or all of the following reasons, such as incomplete follow-up, inaccessibility to the order sets, and inability to complete the order sets). All patients were assigned an order set of PROs through an electronic reporting system, with order sets to be completed prior to surgery, as well as 6 and 12 months postoperatively. Compliance rates of form completion were documented. Patients who underwent arthroscopic anterior and/or posterior stabilization were excluded. The average age of the patients was 53.1 years, ranging from 20 to 83. Compliance of form completion was highest preoperatively (76%), and then dropped subsequently at 6 months postoperatively (57%) and 12 months postoperatively (45%). Use of research assistants improved compliance by approximately 20% at each time point. No differences were found according to patient gender and age group. Of those completing forms, a majority completed forms at home or elsewhere prior to returning to the office for the clinic visit. Electronic administration of PRO may decrease the amount of time required in the office setting for PRO completion by patients. This may be mutually beneficial to providers and patients. It is unclear if an electronic system improves patient compliance in voluntary completion PRO. Compliance rates at final follow-up remain a concern if data are to be used for establishing quality or outcome metrics. Level IV, case series. Copyright © 2017 Arthroscopy Association of North

Participation in online patient support groups endorses patients' empowerment

NARCIS (Netherlands)

van Uden-Kraan, C. F.; Drossaert, Constance H C; Taal, E; Seydel, E. R.; van de Laar, Mart A F J

Objective: Although much has been expected of the empowering effect of taking part in online patient support groups, there is no direct evidence thus far for the effects of participation on patient empowerment. Hence our exploring to what extent patients feel empowered by their participation in

Patient Safety Culture

DEFF Research Database (Denmark)

Kristensen, Solvejg

of health care professional’s behaviour, habits, norms, values, and basic assumptions related to patient care; it is the way things are done. The patient safety culture guides the motivation, commitment to and know-how of the safety management, and how all members of a work place interact. This thesis......Patient safety is highly prioritised in the Danish health care system, never the less, patients are still exposed to risk and harmed every day. Implementation of a patient safety culture has been suggested an effective mean to protect patients against adverse events. Working strategically...

Long-term graft and patient survival following renal transplantation in diabetic patients

DEFF Research Database (Denmark)

Rømming Sørensen, Vibeke; Schwartz Sørensen, Søren; Feldt-Rasmussen, Bo

2006-01-01

. The groups were similar with respect to age and sex. RESULTS: The patient survival rates (diabetic versus non-diabetic patients) were 88% vs 91% (p=NS) at 1 year, 68% vs 73% (p=NS) at 5 years and 31% vs 52% (pnon-diabetic patients) were 72% vs 72...... patients, 55% were smokers. Among the diabetic patients, graft and patient survival were independent of smoking habits, blood pressure, HbA1c and total cholesterol. CONCLUSIONS: Graft survival was similar in diabetic and non-diabetic patients. For the first 5 years following renal transplantation......OBJECTIVE: To study long-term graft and patient survival following renal transplantation in diabetic and non-diabetic patients. MATERIAL AND METHODS: Over the time period 1985-99, 498 transplantations in 399 non-diabetic patients and 68 transplantations in 62 diabetic patients were performed...

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.

Improving stroke patients' care: a patient held record is not enough

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Lampe Fiona

2001-03-01

Full Text Available Abstract Background Stroke patients' care in hospital tends to be poorly organised, with poor communication and a lack of information being frequent sources of complaint. The purpose of this study was to evaluate whether a patient-held record (PHR would result in greater patient satisfaction and better care planning for stroke patients. Methods A time series control (6 months - intervention (8 months - control (6 months was used among London teaching hospital general medical and geriatric medicine inpatient wards. All stroke patients admitted to the wards during the intervention phase received a PHR and were instructed in its use. Demographic, stroke severity, social factors and outcomes were collected from all stroke patients during all phases of the study. Results Of 252 stroke patients aged 46 to 98 years entered into the study, by six months after admission 118 (46.8% had died. PHR and control group patients were well matched in terms of socio-demographic characteristics and pre-stroke ability. At six months after admission, 119 (97% patients responded to the questionnaire. Just over half (56%, 13 of intervention group patients recalled receiving a PHR. Of those patients, 59% reported reading the PHR, 27% had lost their PHR, and two-thirds said they had difficulties encouraging staff to write in the PHR. Half felt that possession of the PHR was more trouble than it was worth. PHR group patients were more satisfied with the recovery they had made (79% vs. 59%, p=0.04, but felt less able to talk to staff about their problems (61% vs. 82%, p=0.02. PHR group patients reported receiving fewer explanations about their condition (18% vs. 33%, p=0.12 and treatment (26% vs. 45%, p=0.07, and were more afraid of asking doctors questions (21% vs. 4%, p=0.01 than controls. PHR group patients were no better prepared for hospital discharge than control group patients, and both groups were ill-informed about services and benefits that might have helped

Provider and patient perception of psychiatry patient health literacy

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Bacon O

2017-06-01

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

Quality of life in patients with dental conditions: comparing patients' and providers' evaluation.

Science.gov (United States)

Sampogna, F; Johansson, V; Axtelius, B; Abeni, D; Söderfeldt, B

2009-12-01

To measure the agreement between patients and their caregivers in evaluating patients' oral quality of life. Cross-sectional study. Data collected in four Swedish dental clinics in 2004. Consecutive patients. Data were completed for 444 patients. Fifteen dentists and 12 dental hygienists agreed to participate. For each patient, the patient him/herself and his/her caregiver completed the 14-item Oral Health Impact Profile (OHIP-14), a specific instrument used to measure quality of life in oral conditions, with higher scores indicating a worse quality of life. Information on personal and clinical characteristics of patients were also collected. Median OHIP-14 scores given by caregivers and patients were calculated and compared in different subgroups of patients. Cohen's kappa was calculated to measure the agreement between the evaluation of patients and caregivers. OHIP-14 scores median values were 3.0 among patients and 9.0 among caregivers. Caregivers always gave a higher score than patients, especially in older patients and patients with lower education. The concordance between patients' and caregivers' evaluation was very low (for different OHIP-14 cutoffs: Cohen's kappa from 0.10 to 0.15). In this study, great discrepancies were observed between patients and caregivers in the evaluation of patients' oral quality of life, with caregivers overestimating the burden of dental conditions on patients. It is important to improve patient-caregiver communication, in order to increase patient satisfaction and provide better care. A good patient-caregiver relationship is essential for the patients' well-being and their adherence to treatment.

NESB patients.

Science.gov (United States)

Charles, Janice; Britt, Helena; Fahridin, Salma

2010-04-01

General practitioner consultations with patients of non-English speaking background (NESB) account for one in 10 encounters recorded in the BEACH (Bettering the Evaluation and Care of Health) program (NESB is defined as patients who reported that their primary language spoken at home is not English). We present a descriptive comparison of consultations with NESB and English speaking patients recorded between April 2007 and March 2009. Indigenous persons were excluded from the analysis to give a clearer picture of NESB patients of non- Australian origin. Only statistically significant differences with nonoverlapping 95% confidence intervals are reported.

Patients Provide Recommendations for Improving Patient Satisfaction.

Science.gov (United States)

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

2016-04-01

National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

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

Science.gov (United States)

Bhakta, Hemangini C; Marco, Catherine A

2014-04-01

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

Doctor-patient communication and cancer patients' quality of life and satisfaction

NARCIS (Netherlands)

Ong, L. M.; Visser, M. R.; Lammes, F. B.; de Haes, J. C.

2000-01-01

In this study, the relationship between (a) doctor's and patients' communication and (b) doctors' patient-centredness during the oncological consultation and patients' quality of life and satisfaction was examined. Consultations of 96 consecutive cancer patients were recorded and content analysed by

A good patient?

DEFF Research Database (Denmark)

Campbell, Catherine; Scott, Kerry; Skovdal, Morten

2015-01-01

, physical cleanliness, honesty, gratitude and lifestyle adaptations (taking pills correctly andcoming to the clinic when told). As healthcare workers may decide to punish patients who do not live up the‘good patient persona’, many patients seek to perform within the confines of the ‘good patient persona...

Interrelation between Patient Satisfaction and Patient-Provider Communication in Diabetes Management

Directory of Open Access Journals (Sweden)

Ayse Basak Cinar

2014-01-01

Full Text Available The present study aims to assess how patient satisfaction with medical provider-patient communication can affect oral health, diabetes, and psychobehavioural measures among type 2 diabetes (T2DM patients. It is part of a prospective intervention study among randomly selected T2DM patients, in Turkey. The data analyzed were Community Periodontal Need Index (CPI, HbA1c, patient satisfaction with communication, and psychobehavioural variables. Data was collected initially and at the end of the intervention. The participants were allocated to either health coaching (HC or health education (HE. At baseline, there were no statistical differences between the HC and the HE groups on any of the measures (P>0.05. Patients in both the HC and the HE groups had low satisfaction with communication. At postintervention, the increase in patient satisfaction with communication in the HC group was significantly higher than that in the HE group (P=0.001. Principal component analysis revealed that patient satisfaction with communication shared the same cluster with clinical measures (CPI and HbA1c and quality of life in the HC group. In conclusion, the present study showed, to our knowledge for the first time, that overall patient satisfaction with medical care provider-patient communication, empowered by HC approach, was interrelated with well-being of T2DM patients, in terms of psychobehavioural and clinical measures.

Displacing the patient

DEFF Research Database (Denmark)

Pors, Anja Svejgaard

2014-01-01

is not only about disease treatment, but also about ‘information treatment’ for the purpose of increasing patient satisfaction at the hospital. The goal of patient satisfaction addresses both a care-oriented approach to the patient and also deploys market perceptions of patients as homogeneous target groups...... for which information can be standardized. In the latter approach (market orientation), the patient is also a resource for organizational development. Overall, the strategy presents an information-pursuing patient figure that makes it possible to streamline the organization's care orientation on market......Over the past decade, patient communication has become a strategic priority in Danish public hospitals: communication is a focal point of policies, plans and daily work practices. Hospitals today create communication strategies and build communication departments to improve communication...

Dentist-Patient Relationship

Directory of Open Access Journals (Sweden)

Gheorghe Raftu

2016-01-01

In the dentist-patient relationship confidence comes from the assurance that personal information(belonging to the patient will remain confidential; this is in the interest of the patient and the patient'sautonomy is recognized. There were presented several behavioral types which can lead to a physicianpatientrelationship, based on trust.

Implementing Patient Family-Centered Care Grand Rounds Using Patient/Family Advisor Narratives

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Maureen B Fagan DNP, MHA, FNP-BC

2015-11-01

Full Text Available With the emerging trend of patient family–centered care in health care, it is essential that physicians be exposed to patient and family perspectives of care during medical education and training. Grand Rounds provides an ideal format for physicians to learn about patient family–centered care. At Brigham and Women’s Hospital, we sought to bring the voice of the patient to Patient Family–Centered Grand Rounds in order to expose clinicians to rich narratives describing the medical care received by patients/families and to ultimately change physician practice to reflect patient family–centered principles. We conducted a clinician survey and found promising results indicating that patient/family narratives can be effective at educating physicians about patient family–centered care.

Study of Knowledge and Practice of Patient Self directed Care among Diabetics Patients

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Z. Abedini

2008-07-01

Full Text Available Background and ObjectivesDiabetic patients play the main role in the management of their disease. Adequate knowledge of this disease state and self directed patient care will improve the health of these patients. Some studies have indicated a high prevalence of diabetes complication are due to the lack of knowledge of self directed patient care and practice in diabetic patient group. The objective of this study is to measure the knowledge level of self directed patient care and practice in order to evaluate their effects on improvement of diabetic patients' health in the city of Qom, Iran.MethodsIn this cross sectional study 1004 patients with diabetes participated (During year 2006. Data were collected from patients of General Hospital metabolism and endocrine research center.An interviewing method was used to asses the demographics data, history of disease, and knowledge of self directed patient care in these patients. Data were analyzed using a descriptive statistic, chi-square, and Pearson correlation coefficient, and SPSS software.ResultsOut of 1004 observed case, 154 patients were with Diabetes type I and 850 patients with Diabetes type II. The knowledge of self directed patient care and practice level of with both types of diabetes were determined to be mostly at an intermediate level. In type I diabetic patients there was a significant relation between knowledge level of self directed patient care and gender of the patients (P=0.01. Also, there was a significant correlation between practice and age (P=0.03(, and economical status (P=0.06 of the patients. In type II diabetic patients there was a significant relation between knowledge level of self directed patient care and educational level (P=0.00(, and economical status (P=0.01 of the patients. The practice level of self directed patient care was significantly related to economical status (p=0.03 in this group of patients. ConclusionThese results indicate that an increase in knowledge

Patient-Ventilator Dyssynchrony

Directory of Open Access Journals (Sweden)

Elvira-Markela Antonogiannaki

2017-11-01

Full Text Available In mechanically ventilated patients, assisted mechanical ventilation (MV is employed early, following the acute phase of critical illness, in order to eliminate the detrimental effects of controlled MV, most notably the development of ventilator-induced diaphragmatic dysfunction. Nevertheless, the benefits of assisted MV are often counteracted by the development of patient-ventilator dyssynchrony. Patient-ventilator dyssynchrony occurs when either the initiation and/or termination of mechanical breath is not in time agreement with the initiation and termination of neural inspiration, respectively, or if the magnitude of mechanical assist does not respond to the patient’s respiratory demand. As patient-ventilator dyssynchrony has been associated with several adverse effects and can adversely influence patient outcome, every effort should be made to recognize and correct this occurrence at bedside. To detect patient-ventilator dyssynchronies, the physician should assess patient comfort and carefully inspect the pressure- and flow-time waveforms, available on the ventilator screen of all modern ventilators. Modern ventilators offer several modifiable settings to improve patient-ventilator interaction. New proportional modes of ventilation are also very helpful in improving patient-ventilator interaction.

MRI of the hyaline knee joint cartilage. Animal experimental and clinical studies; MRT des hyalinen Kniegelenkknorpels. Tierexperimentelle und klinische Untersuchungen

Energy Technology Data Exchange (ETDEWEB)

Adam, G. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik; Prescher, A. [Technische Hochschule Aachen (Germany). Inst. fuer Anatomie; Nolte-Ernsting, C. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik; Buehne, M. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik; Scherer, K. [Technische Hochschule Aachen (Germany). Inst. fuer Versuchstierkunde; Kuepper, W. [Technische Hochschule Aachen (Germany). Inst. fuer Versuchstierkunde; Guenther, R.W. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik

1994-02-01

The value of MR imaging for the detection of hyaline cartilage lesions using 2-D spin-echo and 3-D gradient-echo imaging was evaluated in an animal experiment in 10 dogs and in a clinical study in 30 patients. MR imaging findings were compared with histopathological and arthroscopy findings, respectively. Using MRI neither grade I nor grade II hyaline cartilage lesions were detectable. In the animal experiments 77% of grade III lesions and all the grade IV lesions were seen. However, in the clinical study only about the half of grade III and IV lesions were detected. 3-D gradient-echo MR imaging was superior to 2-D spin-echo imaging (p<0.001), while 3-D FLASH and 3-D FISP did not differ significantly in the detection rate (p<0.34). 3-D gradient-echo MR imaging seems to be the best method for the delineation of high grade cartilage lesions. However, early stages of cartilage degeneration are invisible even with this imaging modality. (orig.) [Deutsch] Die Wertigkeit der MRT in der Erfassung von Knorpellaesionen mit 2-D-Spin-Echo- und 3-D-Grafienten-Echo-Sequenzen wurde in einer tierexperimentellen Untersuchung an 10 Hunden sowie in einer klinischen Studie an 30 Patienten ueberprueft. Die kernspintomographischen Ergebnisse wurden mit dem pathologisch-anatomischen Befund bzw. der Arthroskopie verglichen. MR-tomographisch konnten weder Grad-I- noch Grad-II-Knorpellaesionen erfasst werden. Die Erkennbarkeitsrate der Grad-III- und -IV-Laesionen lag fuer die tierexperimentellen Untersuchungen bei 77 bzw. 100%, waehrend klinisch nur etwa 50% dieser Veraenderungen erkannt werden konnten. Dabei waren die 3-D-Gradienten-Echo-Sequenzen den 2-D-Spin-Echo-Sequenzen signifikant ueberlegen (p<0,001), waehrend sich die 3-D-Gradienten-Echo-Sequenzen FISP und FLASH nicht voneinander unterschieden (p<0,34). Derzeit muessen die 3-D-Gradienten-Echo-Sequenzen als die beste Methode zur Erfassung hoehergradiger Knorpellaesionen angesehen werden. Fruehe Stadien der Knorpelschaedigung sind

The importance of risk models for management of pulmonary nodules; Die Bedeutung von Risikomodellen fuer das Management pulmonaler Rundherde

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Prosch, H.; Baltzer, P. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

2014-05-15

Pulmonary nodules are a frequent finding in computed tomography (CT) investigations. Further diagnostic work-up of detected nodules mainly depends on the so-called pre-test probability, i.e. the probability that the nodule is malignant or benign. The pre-test probability can be calculated by combining all relevant information, such as the age and the sex of the patient, the smoking history, and history of previous malignancies, as well as the size and CT morphology of the nodule. If additional investigations are performed to further investigate the nodules, all results must be interpreted taking into account the pre-test probability and the test performance of the investigation in order to estimate the post-test probability. In cases with a low pre-test probability, a negative result from an exact test can exclude malignancies but a positive test cannot prove malignancy in such a setting. In cases with a high pre-test probability, a positive test result can be considered as proof of malignancy but a negative test result does not exclude malignancy. (orig.) [German] Pulmonale Rundherde sind ein haeufiger Befund bei CT-Untersuchungen des Thorax. Die weiterfuehrende Abklaerung der gefunden Rundherde haengt im Wesentlichen von der so genannten Vortestwahrscheinlichkeit ab, der Wahrscheinlichkeit ob der Rundherd maligne ist oder nicht. Diese Vortestwahrscheinlichkeit laesst sich durch die Kombination aller relevanten Vorinformationen wie Alter und Geschlecht des Patienten, Raucheranamnese, Tumoranamnese, Groesse und CT-Morphologie des Rundherdes genau berechnen oder intuitiv abschaetzen. Werden weiterfuehrende Untersuchungen zur Abklaerung des Rundherdes durchgefuehrt, ist das Ergebnis dieser Untersuchung, die Nachtestwahrscheinlichkeit fuer das Vorliegen von Malignitaet, in Abhaengigkeit von der Vortestwahrscheinlichkeit und der Testguete der Untersuchung zu interpretieren. Waehrend ein genauer Test im Falle niedriger Vortestwahrscheinlichkeiten Malignitaet mit

Imaging of hip joint arthroplasty; Bildgebung bei Hueftgelenkendoprothesen

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Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C. [Univ.-Klinik fuer Radiodiagnostik, Medizinische Universitaet Wien, Abteilung fuer Neuroradiologie und Muskuloskelettale Radiologie, Wien (Austria)

2009-05-15

The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [German] Dem Hueftgelenk als groesstem Gelenk des menschlichen Koerpers kommt eine besondere Bedeutung in der muskuloskelettalen Radiologie zu. Entsprechend wichtig ist auch die radiologische Beurteilung von Hueftgelenkendoprothesen, die z. B. infolge degenerativer Gelenkerkrankungen, einer Hueftkopfnekrose oder einer Fraktur eingesetzt werden. Die Projektionsradiographie ist weiterhin die primaere Modalitaet zur Beurteilung von Hueftgelenkendoprothesen, direkt postoperativ und zur laengerfristigen Verlaufskontrolle. Diese Methode erlaubt in der Mehrzahl der Faelle eine suffiziente Antwort auf die Frage nach Lockerung, periprothetischer Fraktur oder Prothesenmaterialbruch, Luxation, Infektion und Weichteilkalzifikation

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.

Quality of doctor-patient communication through the eyes of the patient: variation according to the patient's educational level.

Science.gov (United States)

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

2015-10-01

Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In this study we describe patients' perspective in doctor-patient communication according to their educational level, and to what extent these perspectives lean towards the expert opinion on doctor-patient communication. In a multi-center study (Belgium, The Netherlands, UK and Italy), focus group discussions were organised using videotaped medical consultations. A mixed methods approach was used to analyse the data. Firstly, a difference in perspective in communication style was found between the lower educated participants versus the middle and higher educated participants. Secondly, lower educated participants referred positively most to aspects related to the affective/emotional area of the medical consultation, followed by the task-oriented/problem-focused area. Middle and higher educated participants positively referred most to the task-oriented/problem-focused area. The competency of the physician was an important category of communication for all participants, independent of social background. The results indicate that the preferences of lower educated participants lean more towards the expert opinion in doctor-patient communication than the middle and higher educated participants. Patients' educational level seems to influence their perspective on communication style and should be taken into account by physicians. Further quantitative research is needed to confirm these results.

Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases.

Science.gov (United States)

Cukor, Daniel; Cohen, Lewis M; Cope, Elizabeth L; Ghahramani, Nasrollah; Hedayati, S Susan; Hynes, Denise M; Shah, Vallabh O; Tentori, Francesca; Unruh, Mark; Bobelu, Jeanette; Cohen, Scott; Dember, Laura M; Faber, Thomas; Fischer, Michael J; Gallardo, Rani; Germain, Michael J; Ghahate, Donica; Grote, Nancy; Hartwell, Lori; Heagerty, Patrick; Kimmel, Paul L; Kutner, Nancy; Lawson, Susan; Marr, Lisa; Nelson, Robert G; Porter, Anna C; Sandy, Phillip; Struminger, Bruce B; Subramanian, Lalita; Weisbord, Steve; Young, Bessie; Mehrotra, Rajnish

2016-09-07

Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases. Copyright © 2016 by the American Society of Nephrology.

Organizing Patient Involvement

DEFF Research Database (Denmark)

Brehm Johansen, Mette

hospitals. During the last 25 years, patient involvement and quality improvement have become connected in Danish healthcare policy. However, the ideal of involving patients in quality improvement is described in very general terms and with only few specific expectations of how it is to be carried out...... in practice, as I show in the thesis. In the patient involvement literature, the difficulties of getting patient involvement in quality improvement to have in an impact on the planning and development of healthcare services is, for example, ascribed to conceptual vagueness of patient involvement, differences...... in perspectives, values and understandings between patients and healthcare professionals, or the lack of managerial attention and prioritization....

Patient Satisfaction in Obstetrics and Gynecology: Individualized Patient-centered Communication

OpenAIRE

John Yeh; Eryn E. Nagel

2010-01-01

Background Patient satisfaction is becoming an increasingly prevalent topic in medicine, but little is known about patient satisfaction in women's health and other specialties. We review current methods of improving patient satisfaction in the field of obstetrics and gynecology with the intent to increase patient satisfaction even further by enhancing and combining previously used strategies. Methods A search from inception to June 2010 for electronic literature was performed using Medline. T...

Role of effective nurse-patient relationships in enhancing patient safety.

Science.gov (United States)

Conroy, Tiffany; Feo, Rebecca; Boucaut, Rose; Alderman, Jan; Kitson, Alison

2017-08-02

Ensuring and maintaining patient safety is an essential aspect of care provision. Safety is a multidimensional concept, which incorporates interrelated elements such as physical and psychosocial safety. An effective nurse-patient relationship should ensure that these elements are considered when planning and providing care. This article discusses the importance of an effective nurse-patient relationship, as well as healthcare environments and working practices that promote safety, thus ensuring optimal patient care.

chemotherapy patients

Directory of Open Access Journals (Sweden)

Katarzyna Augustyniuk

2016-02-01

Full Text Available Background . Complementary and alternative medicine (CAM practices for cancer have become popular among oncology patients. An increasing interest in alternative medicine can be explained by the inefficiency of conventional treatment, dissatisfaction with treating patients like objects, and the will to use all available treatment methods. Objectives . The authors assessed how often patients use CAM methods, and which of them are most popular. Material and methods . The study was conducted in Military Hospital no. 109 and the Independent Public Clinical Hospital no. 1 in Szczecin among 100 chemotherapy patients. This survey-based study was performed using an original questionnaire. Results. Most respondents (68% did not use alternative methods to fight the disease. The most popular treatment methods were: herbal medicine (50%, alternative medicine preparations (38% and diet (25%, and the least common: hypnosis (3% and aromatherapy (3%. Analyzed sociodemographic factors had no effects on a choice of a CAM method. Patients obtained information about CAM methods mainly from the Internet (40%, medical staff (37% and literature (31%. Conclusions . 1. Using CAM by patients receiving chemotherapy for neoplasms is quite a common phenomenon. 2. CAM were more often chosen by women. Neither the duration of the disease nor sociodemographic data had effects on making the decision to use CAM methods. 3. The most popular CAM were: herbal medicine, alternative medicine preparations, and diet. 4. Cancer patients should receive special support from nurses and doctors as well as other members of the therapeutic team. Oncology patients should never be left on their own so that they were forced to seek help and support in therapies unconfirmed by scientific investigation.

Patient perception and the barriers to practicing patient-centered communication: A survey and in-depth interview of Chinese patients and physicians.

Science.gov (United States)

Ting, Xu; Yong, Bao; Yin, Liang; Mi, Tian

2016-03-01

To investigate patient perceptions of patient-centered communication (PCC) in doctor-patient consultations and explore barriers to PCC implementation in China. This study was conducted in public teaching hospital in Guiyang, Guizhou, China. In Phase 1, patient attitudes to PCC were quantitatively assessed in 317 outpatients using modified Patient-Practitioner Orientation Scale (PPOS). In Phase 2, we conducted in-depth interviews with 20 outpatients to explore their views on PCC and expose potential barriers to PCC implementation. Participants communicated "patient-centered" preferences, particularly with regard to their doctors' empathy, communication skills, time and information sharing. Patients were more concerned about doctors exhibiting caring perspective than power sharing. Younger and highly educated patients were more likely to prefer PCC and highly educated patients paid more attention to power sharing. Several factors including inadequate time for PCC resulting from doctors' high patient-load, doctor-patient communication difficulties and excessive treatment due to inappropriate medical payment system affected PCC implementation in China. Patients expressed moderate enthusiasm for PCC in China. They expressed strong preferences concerning physician respect for patient perspective, but less concern for power sharing. Government should improve health care system by implementing PCC in daily healthcare practice to improve patient awareness and preferences. Copyright © 2016. Published by Elsevier Ireland Ltd.

Display methods of electronic patient record screens: patient privacy concerns.

Science.gov (United States)

Niimi, Yukari; Ota, Katsumasa

2013-01-01

To provide adequate care, medical professionals have to collect not only medical information but also information that may be related to private aspects of the patient's life. With patients' increasing awareness of information privacy, healthcare providers have to pay attention to the patients' right of privacy. This study aimed to clarify the requirements of the display method of electronic patient record (EPR) screens in consideration of both patients' information privacy concerns and health professionals' information needs. For this purpose, semi-structured group interviews were conducted of 78 medical professionals. They pointed out that partial concealment of information to meet patients' requests for privacy could result in challenges in (1) safety in healthcare, (2) information sharing, (3) collaboration, (4) hospital management, and (5) communication. They believed that EPRs should (1) meet the requirements of the therapeutic process, (2) have restricted access, (3) provide convenient access to necessary information, and (4) facilitate interprofessional collaboration. This study provides direction for the development of display methods that balance the sharing of vital information and protection of patient privacy.

Codification of patients' rights in Poland--the Patients' Rights Act 2008.

Science.gov (United States)

Bosek, Leszek; Pawliczak, Jakub

2010-09-01

The Act of 6 November 2008 on Patients' Rights and the Commissioner for Patients' Rights collect and safeguard patients' basic rights as well as provide, for the first time in Poland, an original concept for patients' collective rights. In addition, the new Act stipulates the specific mechanism for protecting patients' rights by the newly established body called the Commissioner for Patients' Rights. Polish reform of medical law will undoubtedly contribute to the expected ratification of the Convention on Human Rights and Biomedicine. However, the nature of codified rights is relatively abstract, and the Act cannot be read without reference to legislation related to physicians and health care institutions.

Medical terminology in online patient-patient communication: evidence of high health literacy?

Science.gov (United States)

Fage-Butler, Antoinette M; Nisbeth Jensen, Matilde

2016-06-01

Health communication research and guidelines often recommend that medical terminology be avoided when communicating with patients due to their limited understanding of medical terms. However, growing numbers of e-patients use the Internet to equip themselves with specialized biomedical knowledge that is couched in medical terms, which they then share on participatory media, such as online patient forums. Given possible discrepancies between preconceptions about the kind of language that patients can understand and the terms they may actually know and use, the purpose of this paper was to investigate medical terminology used by patients in online patient forums. Using data from online patient-patient communication where patients communicate with each other without expert moderation or intervention, we coded two data samples from two online patient forums dedicated to thyroid issues. Previous definitions of medical terms (dichotomized into technical and semi-technical) proved too rudimentary to encapsulate the types of medical terms the patients used. Therefore, using an inductive approach, we developed an analytical framework consisting of five categories of medical terms: dictionary-defined medical terms, co-text-defined medical terms, medical initialisms, medication brand names and colloquial technical terms. The patients in our data set used many medical terms from all of these categories. Our findings suggest the value of a situated, condition-specific approach to health literacy that recognizes the vertical kind of knowledge that patients with chronic diseases may have. We make cautious recommendations for clinical practice, arguing for an adaptive approach to medical terminology use with patients. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

When doctor becomes patient: challenges and strategies in caring for physician-patients.

Science.gov (United States)

Domeyer-Klenske, Amy; Rosenbaum, Marcy

2012-01-01

The current study was aimed at exploring the challenges that arise in the doctor-patient relationship when the patient is also a physician and identifying strategies physicians use to meet these challenges. No previous research has systematically investigated primary care physicians' perspectives on caring for physician-patients. Family medicine (n=15) and general internal medicine (n=14) physicians at a large Midwestern university participated in semi-structured interviews where they were asked questions about their experiences with physician-patients and the strategies they used to meet the unique needs of this patient population. Thematic analysis was used to identify common responses. Three of the challenges most commonly discussed by physician participants were: (1) maintaining boundaries between relationships with colleagues or between roles as physician/colleague/friend, (2) avoiding assumptions about patient knowledge and health behaviors, and (3) managing physician-patients' access to informal consultations, personal test results, and opinions from other colleagues. We were able to identify three main strategies clinicians use in addressing these perceived challenges: (1) Ignore the physician-patient's background, (2) Acknowledge the physician-patient's background and negotiate care, and (3) Allow care to be driven primarily by the physician-patient. It is important that primary care physicians understand the challenges inherent in treating physicians and develop a strategy with which they are comfortable addressing them. Explicitly communicating with the physician-patient to ensure boundaries are maintained, assumptions about the physician-patient are avoided, and physician-patient access is properly managed are key to providing quality care to physician-patients.

Patient Satisfaction with Collection of Patient-Reported Outcome Measures in Routine Care.

Science.gov (United States)

Recinos, Pablo F; Dunphy, Cheryl J; Thompson, Nicolas; Schuschu, Jesse; Urchek, John L; Katzan, Irene L

2017-02-01

Systematic collection of patient-reported outcome measures (PROMs) during ambulatory clinic visits can enhance communication between patient and provider, and provide the ability to evaluate outcomes of care. Little is known about patient satisfaction of PROM data collection in routine clinical care. To evaluate patient reaction to the routine collection of PROMs in the ambulatory setting. Before all ambulatory clinic visits at our neurological institute, patients electronically complete health status questionnaires. We administered an 8-question patient satisfaction survey to a sample of patients seen across the institute after their clinical visit. Of 343 patients approached, 323 agreed to participate. The majority responded that the questionnaire system was easy to use, was an appropriate length, and benefited their care overall (strongly agree or agree = 92.3%, 87.6%, and 77.3%, respectively). Provider review of the PROMs with the patient during the clinic visit was associated with significantly higher positive responses to all questions, even those regarding logistical aspects of the collection process. There were significant age and race differences in response to perceived benefit: those in the Black/other race category had a markedly lower probability of viewing the process favorably with increasing age. Systematic collection of PROMs via an electronic questionnaire appears to be well accepted by patients. A minority of patients did not feel the questionnaire content applied to their appointment or that the system was a beneficial feature of the clinical practice. The provider can significantly improve the patient's perception of PROM collection and the patient-physician encounter by reviewing the questionnaire results with the patient.

High patient satisfaction after secondary rhinoplasty in cleft lip patients

NARCIS (Netherlands)

Hens, Greet; Picavet, Valerie A.; Poorten, Vincent Vander; Schoenaers, Joseph; Jorissen, Mark; Hellings, Peter W.

2011-01-01

We surveyed the subjective outcome of secondary rhinoplasty in cleft lip patients. Questionnaires were sent to 38 patients who had undergone a secondary rhinoplasty. A total of 30 questionnaires were returned and analyzed. Patients were asked to score their preoperative and postoperative nasal

ANEMIA IN HEMODIALYSIS PATIENTS: DIABETIC VS NON DIABETIC PATIENTS

Directory of Open Access Journals (Sweden)

SH SHAHIDI

2002-12-01

Full Text Available Introduction. One of the characteristic signs of uremic syndrome is anemia. One of major factors that affects on severity of anemia in ESRD is underlying diseas. The porpuse of this study is to compaire anemia between diabetic and non diabetic ESRD patients. Methods. In a case control study we compared the mean valuse of Hb, Het, MCV, MCH, MCHC, BUN, Cr and duration of dialysis between diabetic and nondiabetic patients on chronic hemodialyis. some variables (such as age, sex, use of erythropoietin, nonderolone decaonats, folic acid, ferrous sulfate, transfusion and blood loss in recent three months and acquired kidney cysts were matched between cases and controls. Results. Means of Hb were 9±1.3 and 8 ± 1.7 in diabetic and non diabetic patients (P<0.05. Mean corposcular volume in diabetic patients (91±3.1 fl was more higher than non diabetic ones (87.1 ± 8.9 (P < 0.05. Other indices had no differences between two groups (P > 0.05. Discussion. Severity of anemia in patients with diabetic nephropathy is milder that other patients with ESRD. So, Anemia as an indicator of chronocity of renal disease in diabetics is missleading.

Outpatient management of intensively treated acute leukemia patients-the patients' perspective

DEFF Research Database (Denmark)

Jepsen, Lene Østergaard; Høybye, Mette Terp; Hansen, Dorte Gilså

2016-01-01

, responsibility and the home were performed. Twenty-two patients were interviewed the first time, and 15 of these were interviewed the second time. The data were analyzed in an everyday life relational perspective. RESULTS: Outpatient management facilitates time to be administrated by the patients and thereby...... the possibility of maintaining everyday life, which was essential to the patients. The privacy ensured by the home was important to patients, and they accepted the necessary responsibility that came with it. However, time spent together with fellow patients and their relatives was an important and highly valued...... part of their social life. CONCLUSIONS: Approached from the patient perspective, outpatient management provided a motivation for patients as it ensured their presence at home and provided the possibility of taking part in everyday life of the family, despite severe illness and intensive treatment...

Displacing the patient

DEFF Research Database (Denmark)

Pors, Anja Svejgaard

a care-oriented approach to the patient and also deploys market perceptions of patients as homogeneous target groups to which information can be standardized. In the latter approach (market orientation), the patient is also a resource for organizational development. Overall, the strategy presents...... an information-pursuing patient figure making it possible to streamline the organization's care orientation on market conditions. In contrast to a dichotomy of care and market as mutually exclusive (Mol 2008), care and market appear to be intertwined in political patient figures through which the organization...

Transforming consumer health informatics through a patient work framework: connecting patients to context.

Science.gov (United States)

Valdez, Rupa S; Holden, Richard J; Novak, Laurie L; Veinot, Tiffany C

2015-01-01

Designing patient-centered consumer health informatics (CHI) applications requires understanding and creating alignment with patients' and their family members' health-related activities, referred to here as 'patient work'. A patient work approach to CHI draws on medical social science and human factors engineering models and simultaneously attends to patients, their family members, activities, and context. A patient work approach extends existing approaches to CHI design that are responsive to patients' biomedical realities and personal skills and behaviors. It focuses on the embeddedness of patients' health management in larger processes and contexts and prioritizes patients' perspectives on illness management. Future research is required to advance (1) theories of patient work, (2) methods for assessing patient work, and (3) techniques for translating knowledge of patient work into CHI application design. Advancing a patient work approach within CHI is integral to developing and deploying consumer-facing technologies that are integrated with patients' everyday lives. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com. For numbered affiliations see end of article.

Assessing patient dose in interventional fluoroscopy using patient-dependent hybrid phantoms

Science.gov (United States)

Johnson, Perry Barnett

Interventional fluoroscopy uses ionizing radiation to guide small instruments through blood vessels or other body pathways to sites of clinical interest. The technique represents a tremendous advantage over invasive surgical procedures, as it requires only a small incision, thus reducing the risk of infection and providing for shorter recovery times. The growing use and increasing complexity of interventional procedures, however, has resulted in public health concerns regarding radiation exposures, particularly with respect to localized skin dose. Tracking and documenting patient-specific skin and internal organ dose has been specifically identified for interventional fluoroscopy where extended irradiation times, multiple projections, and repeat procedures can lead to some of the largest doses encountered in radiology. Furthermore, inprocedure knowledge of localized skin doses can be of significant clinical importance to managing patient risk and in training radiology residents. In this dissertation, a framework is presented for monitoring the radiation dose delivered to patients undergoing interventional procedures. The framework is built around two key points, developing better anthropomorphic models, and designing clinically relevant software systems for dose estimation. To begin, a library of 50 hybrid patient-dependent computational phantoms was developed based on the UF hybrid male and female reference phantoms. These phantoms represent a different type of anthropomorphic model whereby anthropometric parameters from an individual patient are used during phantom selection. The patient-dependent library was first validated and then used in two patient-phantom matching studies focused on cumulative organ and local skin dose. In terms of organ dose, patient-phantom matching was shown most beneficial for estimating the dose to large patients where error associated with soft tissue attenuation differences could be minimized. For small patients, inherent difference

Neuropathic pain in patients with spinal cord injury: report of 213 patients.

Science.gov (United States)

Teixeira, Manoel Jacobsen; Paiva, Wellingson Silva; Assis, Maruska Salles; Fonoff, Erich Talamoni; Bor-Seng-Shu, Edson; Cecon, Angelo Daros

2013-09-01

Management of neuropathic pain following spinal cord injury (SCI) can be a frustrating experience for patients since it poses a therapeutic challenge. In this article the authors describe the clinical characteristics of a group of patients with pain after spinal cord injury. In this retrospective study, 213 patients with SCI and neuropathic pain were assessed. We analyzed clinical characteristics, treatment options, and pain intensity for these patients. The main cause of SCI was spine trauma, which occurred in 169 patients, followed by tumors and infection. Complete lesions were verified in 144 patients. In our study, patients with traumatic SCI and partial lesions seem to be presented with more intense pain; however, this was not statistically significant. Neuropathic pain is a common complaint in patients with SCI and presents a treatment challenge. Knowledge of the clinical characteristics of this group of patients may help determine the best approach to intervention.

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...

Audiology patient fall statistics and risk factors compared to non-audiology patients.

Science.gov (United States)

Criter, Robin E; Honaker, Julie A

2016-10-01

To compare fall statistics (e.g. incidence, prevalence), fall risks, and characteristics of patients who seek hearing healthcare from an audiologist to individuals who have not sought such services. Case-control study. Two groups of community-dwelling older adult patients: 25 audiology patients aged 60 years or older (M age: 69.2 years, SD: 4.5, range: 61-77) and a control group (gender- and age-matched ±2 years) of 25 non-audiology patients (M age: 69.6, SD: 4.7, range: 60-77). Annual incidence of falls (most recent 12 months) was higher in audiology patients (68.0%) than non-audiology patients (28.0%; p = .005). Audiology patients reported a higher incidence of multiple recent falls (p =.025) and more chronic health conditions (p = .028) than non-audiology patients. Significantly more audiology patients fall on an annual basis than non-audiology patients, suggesting that falls are a pervasive issue in general hearing clinics. Further action on the part of healthcare professionals providing audiologic services may be necessary to identify individuals at risk for falling.

Patient satisfaction among Spanish-speaking patients in a public health setting.

Science.gov (United States)

Welty, Elisabeth; Yeager, Valerie A; Ouimet, Claude; Menachemi, Nir

2012-01-01

Despite the growing literature on health care quality, few patient satisfaction studies have focused upon the public health setting; where many Hispanic patients receive care. The purpose of this study was to examine the differences in satisfaction between English and Spanish-speaking patients in a local health department clinical setting. We conducted a paper-based satisfaction survey of patients that visited any of the seven Jefferson County Department of Health primary care centers from March 19 to April 19, 2008. Using Chi-squared analyses we found 25% of the Spanish-speaking patients reported regularly having problems getting an appointment compared to 16.8% among English-speakers (p speaking patients controlling for center location, purpose of visit, and time spent waiting. Specifically, Spanish speaking patients were more likely to report problems getting an appointment and less likely to report having their medical problems resolved when leaving their visit as compared to those who spoke English. Findings presented herein may provide insight regarding the quality of care received, specifically regarding patient satisfaction in the public health setting. © 2011 National Association for Healthcare Quality.

Involving patients in patient safety programmes: A scoping review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care.

Science.gov (United States)

Trier, Hans; Valderas, Jose M; Wensing, Michel; Martin, Helle Max; Egebart, Jonas

2015-09-01

Patient involvement has only recently received attention as a potentially useful approach to patient safety in primary care. To summarize work conducted on a scoping review of interventions focussing on patient involvement for patient safety; to develop consensus-based recommendations in this area. Scoping review of the literature 2006-2011 about methods and effects of involving patients in patient safety in primary care identified evidence for previous experiences of patient involvement in patient safety. This information was fed back to an expert panel for the development of recommendations for healthcare professionals and policy makers. The scoping review identified only weak evidence in support of the effectiveness of patient involvement. Identified barriers included a number of patient factors but also the healthcare workers' attitudes, abilities and lack of training. The expert panel recommended the integration of patient safety in the educational curricula for healthcare professionals, and expected a commitment from professionals to act as first movers by inviting and encouraging the patients to take an active role. The panel proposed a checklist to be used by primary care clinicians at the point of care for promoting patient involvement. There is only weak evidence on the effectiveness of patient involvement in patient safety. The recommendations of the panel can inform future policy and practice on patient involvement in safety in primary care.

Testing of a Model with Latino Patients That Explains the Links Among Patient-Perceived Provider Cultural Sensitivity, Language Preference, and Patient Treatment Adherence.

Science.gov (United States)

Nielsen, Jessica D Jones; Wall, Whitney; Tucker, Carolyn M

2016-03-01

Disparities in treatment adherence based on race and ethnicity are well documented but poorly understood. Specifically, the causes of treatment nonadherence among Latino patients living in the USA are complex and include cultural and language barriers. The purpose of this study was to examine whether patients' perceptions in patient-provider interactions (i.e., trust in provider, patient satisfaction, and patient sense of interpersonal control in patient-provider interactions) mediate any found association between patient-perceived provider cultural sensitivity (PCS) and treatment adherence among English-preferred Latino (EPL) and Spanish-preferred Latino (SPL) patients. Data from 194 EPL patients and 361 SPL patients were obtained using questionnaires. A series of language-specific structural equation models were conducted to test the relationship between patient-perceived PCS and patient treatment adherence and the examined mediators of this relationship among the Latino patients. No significant direct effects of patient-perceived PCS on general treatment adherence were found. However, as hypothesized, several significant indirect effects emerged. Preferred language appeared to have moderating effects on the relationships between patient-perceived PCS and general treatment adherence. These results suggest that interventions to promote treatment adherence among Latino patients should likely include provider training to foster patient-defined PCS, trust in provider, and patient satisfaction with care. Furthermore, this training needs to be customized to be suitable for providing care to Latino patients who prefer speaking Spanish and Latino patients who prefer speaking English.

Current status of patient-controlled analgesia in cancer patients.

Science.gov (United States)

Ripamonti, C; Bruera, E

1997-03-01

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

Cultural competence: reflections on patient autonomy and patient good.

Science.gov (United States)

Leever, Martin G

2011-07-01

Terms such as 'cultural competence' and 'transcultural nursing' have comfortably taken their place in the lexicon of health care. Their high profile is a reflection of the diversity of western societies and health care's commitment to provide care that is responsive to the values and beliefs of all who require treatment. However, the relationship between cultural competence and familiar ethical concepts such as patient autonomy has been an uneasy one. This article explores the moral foundations of cultural competence, ultimately locating them in patient autonomy and patient good. The discussion of patient good raises questions about the moral relevance of a value's rootedness in a particular culture. I argue that the moral justification for honoring cultural values has more to do with the fact that patients are strongly committed to them than it does with their cultural rootedness. Finally, I suggest an organizational approach to cultural competence that emphasizes overall organizational preparedness.

Neuropathic pain in patients with spinal cord injury: report of 213 patients

Directory of Open Access Journals (Sweden)

Manoel Jacobsen Teixeira

2013-09-01

Full Text Available Objective Management of neuropathic pain following spinal cord injury (SCI can be a frustrating experience for patients since it poses a therapeutic challenge. In this article the authors describe the clinical characteristics of a group of patients with pain after spinal cord injury. Methods In this retrospective study, 213 patients with SCI and neuropathic pain were assessed. We analyzed clinical characteristics, treatment options, and pain intensity for these patients. Results The main cause of SCI was spine trauma, which occurred in 169 patients, followed by tumors and infection. Complete lesions were verified in 144 patients. In our study, patients with traumatic SCI and partial lesions seem to be presented with more intense pain; however, this was not statistically significant. Conclusions Neuropathic pain is a common complaint in patients with SCI and presents a treatment challenge. Knowledge of the clinical characteristics of this group of patients may help determine the best approach to intervention.

[Doctor-Patient Communication Training in Simulated Situations: Emotions and Perceptions of Simulated Patients during Patient-Centered Conversations].

Science.gov (United States)

Butollo, Maria Asisa; Holzinger, Anita; Wagner-Menghin, Michaela

2018-04-13

The use of simulated patients (SPs) for doctor-patient communication training has been established in medical curricula as an important didactic method. The study addresses the question, if patients' emotions and perceptions are represented adequately in patient-centered communication. 22 of 37 SPs of the Medical University of Vienna (12 women, 10 men) were asked openly about their feelings after having acted as an SP in a semi-structured interview, which employed the Critical Incident Technique. The interviews were recorded, transcribed, separated into situational analysis units und analyzed deductively; we used the evidence based qualities of patient-centered communication and the "Nationaler Kompetenzbasierter Lernzielkatalog Medizin" as a guideline. Out of 192 analysis units, 67 were evaluated as positive and 125 as negative. The SPs reported positive feelings, such as perceiving "stability and trust in relationships" (22%), perception of congruence (15%), acceptance (27%) and empathy (36%). As to negative feelings, SPs reported "perceiving instability" (18%), "incongruence" (11%), "lack of acceptance" (40%) and "lack of empathy" (30%). Additionally, 50% of SPs were positively affected when observing students' learning success. When SPs perceived patient-centered communication, they reported positive emotions. A lack of patient centeredness, on the contrary, provoked negative emotions. An empathic attitude, as well as a "lack of acceptance" with contrary effects had the strongest influence on the SPs' mental state. The reaction of SPs to patient centeredness is sufficiently authentic to reach learning objectives, however it is also affected by reactions of SPs to the learning success of students, which is irrelevant for the real-life doctor-patient interaction. SP reactions are affected by students' attitudes. Students should therefore be prepared well before interacting with SPs in a roleplay setting. While SPs' behavior is authentic in patient

Patients' and family members' views on patient-centered communication during cancer care.

Science.gov (United States)

Mazor, Kathleen M; Beard, Reneé L; Alexander, Gwen L; Arora, Neeraj K; Firneno, Cassandra; Gaglio, Bridget; Greene, Sarah M; Lemay, Celeste A; Robinson, Brandi E; Roblin, Douglas W; Walsh, Kathleen; Street, Richard L; Gallagher, Thomas H

2013-11-01

To explore patients' and family members' views on communication during cancer care and to identify those aspects of clinician-patient communication which were most important to patients and family members. We conducted a secondary data analysis of qualitative data from 137 patients with cancer and family members of patients with cancer. We used a modified version of the constant comparative method and coding paradigm of grounded theory. Patients want sensitive, caring clinicians who provide information that they need, when they need it, in a way that they can understand; who listen and respond to questions and concerns, and who attempt to understand the patient's experience. Effective information exchange and a positive interpersonal relationship with the clinician were of fundamental importance to patients and family members. These were interrelated; for instance, failure to provide information a patient needed could damage the relationship, whereas excellent listening could foster the relationship. Information exchange and relationship were also integral to decision-making, managing uncertainty, responding to emotions, and self-management. Clinicians who were responsive to patients' needs beyond the immediate medical encounter were valued. The complexity of cancer care today suggests that efforts to improve communication must be multilevel, acknowledging and addressing patient, clinician, organizational and policy barriers, and facilitators. Measurement tools are needed to assess cancer patients' and family members' experiences with communication over the course of cancer care to provide meaningful, actionable feedback to those seeking to optimize their effectiveness in communicating with patients with cancer. Copyright © 2013 John Wiley & Sons, Ltd.

Use of a Dog Visitation Program to Improve Patient Satisfaction in Trauma Patients.

Science.gov (United States)

Stevens, Penelope; Kepros, John P; Mosher, Benjamin D

Clinical staff members all recognize the importance of attaining high patient satisfaction scores. Although there are many variables that contribute to patient satisfaction, implementation of a dog visitation program has been shown to have positive effects on patient satisfaction in total joint replacement patients. This innovative practice had not previously been studied in trauma patients. The purpose of this quasi-experimental study was to determine whether dog visitation to trauma inpatients increased patient satisfaction scores with the trauma physicians. A team consisting of a dog and handler visited 150 inpatients on the trauma service. Patient satisfaction was measured using a preexisting internal tool for patients who had received dog visitation and compared with other trauma patients who had not received a visit. This study demonstrated that patient satisfaction on four of the five measured scores was more positive for the patients who had received a dog visit.

Patient life in hospital

DEFF Research Database (Denmark)

Ludvigsen, Mette Spliid

Patient life in hospital.A qualitative study of informal relationships between hospitalised patients Introduction Within a patientology framework, this PhD dissertation is about an empirical study on patient life that provides insight into the nature of informal relationships between patients...... are created through stories about three roughly framed aspects of hospitalisation: A. Being together with fellow patients entails a constant dilemma, B. Relationships between patients are restricted and extended and C. Shifting perspectives in solidarity. Conclusion Patients' hospitalisation is strongly...

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

Comparing thrombin generation in patients with hemophilia A and patients on vitamin K antagonists.

Science.gov (United States)

de Koning, M L Y; Fischer, K; de Laat, B; Huisman, A; Ninivaggi, M; Schutgens, R E G

2017-05-01

Essentials It is unknown if hemophilia patients with atrial fibrillation need anticoagulation. Endogenous thrombin potentials (ETP) in hemophilia patients and patients on coumarins were compared. Severe hemophilia patients had comparable ETP to therapeutic international normalized ratio (INR). In non-severe hemophilia, 33% had higher ETP than therapeutic INR and may need anticoagulation. Click to hear Dr Negrier's perspective on global assays for assessing coagulation SUMMARY: Background It is unknown whether patients with hemophilia A with atrial fibrillation require treatment with vitamin K antagonists (VKAs) to the same extent as the normal population. Objective To compare hemostatic potential in hemophilia patients and patients on VKAs using thrombin generation (TG). Methods In this cross-sectional study, TG, initiated with 1pM tissue factor, was measured in 133 patients with severe (FVIII hemophilia A, 97 patients on a VKA with an international normalized ratio (INR) ≥ 1.5 and healthy controls. Endogenous thrombin potential (ETP) (nm*min) was compared according to FVIII level (hemophilia patients and patients on VKAs had lower median ETPs at 304 (196-449) and 176 (100-250), respectively. ETP was quite similar in severe hemophilia patients (185 [116-307]) and patients with a therapeutic INR (156 [90-225]). Compared with patients with therapeutic INR, ETP in patients with FVIII 1-19% and patients with FVIII 20-50% was higher at 296 (203-430) and 397 (219-632), respectively. All patients with therapeutic INR had an ETP hemophilia patients, 70% of patients with FVIII 1-19% and 52% of patients with FVIII 20-50% had an ETP hemophilia patients, TG was comparable to that in patients with a therapeutic INR. In one-third of non-severe hemophilia patients, TG was higher. These results suggest that anticoagulation therapy should be considered in a substantial proportion of non-severe hemophilia patients. © 2017 International Society on Thrombosis and Haemostasis.

Can patients report patient safety incidents in a hospital setting? A systematic review.

Science.gov (United States)

Ward, Jane K; Armitage, Gerry

2012-08-01

Patients are increasingly being thought of as central to patient safety. A small but growing body of work suggests that patients may have a role in reporting patient safety problems within a hospital setting. This review considers this disparate body of work, aiming to establish a collective view on hospital-based patient reporting. This review asks: (a) What can patients report? (b) In what settings can they report? (c) At what times have patients been asked to report? (d) How have patients been asked to report? 5 databases (MEDLINE, EMBASE, CINAHL, (Kings Fund) HMIC and PsycINFO) were searched for published literature on patient reporting of patient safety 'problems' (a number of search terms were utilised) within a hospital setting. In addition, reference lists of all included papers were checked for relevant literature. 13 papers were included within this review. All included papers were quality assessed using a framework for comparing both qualitative and quantitative designs, and reviewed in line with the study objectives. Patients are clearly in a position to report on patient safety, but included papers varied considerably in focus, design and analysis, with all papers lacking a theoretical underpinning. In all papers, reports were actively solicited from patients, with no evidence currently supporting spontaneous reporting. The impact of timing upon accuracy of information has yet to be established, and many vulnerable patients are not currently being included in patient reporting studies, potentially introducing bias and underestimating the scale of patient reporting. The future of patient reporting may well be as part of an 'error detection jigsaw' used alongside other methods as part of a quality improvement toolkit.

Self-transcendence and nurse-patient interaction in cognitively intact nursing home patients.

Science.gov (United States)

Haugan, Gørill; Rannestad, Toril; Hanssen, Brith; Espnes, Geir A

2012-12-01

The aim of this study was to test whether nurse-patient interaction affects cognitively intact nursing home patients' interpersonal and intrapersonal self-transcendence, as well as testing the psychometric properties of the Nurse-Patient Interaction Scale (NPIS). Self-transcendence is considered a spiritual developmental process of maturity in adulthood, and a vital resource of well-being at the end of life. The concept of self-transcendence has previously been explored in various populations, yet the nurse-patient interactions' potential influence on self-transcendence in nursing home patients has not been published previously. A cross-sectional design employing the Self-Transcendence Scale and the NPIS was adopted. A sample of 202 cognitively well-functioning nursing home patients in Norway was selected. The statistical analyses were carried out using lisrel 8.8 and structural equation modelling. Structural equation modelling-analysis indicates statistical significant effect of nurse-patient interaction on the patients' self-transcendence. Direct influence on the intrapersonal and indirect influence on the interpersonal self-transcendence aspects was disclosed. Nurse-patient interaction significantly affected both interpersonal and intrapersonal self-transcendence among cognitively intact nursing home patients. Hence, facilitating caring interventions can be significantly beneficial to older patients' self-transcendence and thereby well-being, both emotional and physical. Caring behaviour signifies the vital and ultimate qualitative nursing behaviour, which promotes self-transcendence and thereby well-being. These findings are important for clinical nursing that intends to increase patients' well-being. © 2012 Blackwell Publishing Ltd.

Patient perceptions of text-messages, email, and video in dermatologic surgery patients.

Science.gov (United States)

Hawkins, Spencer D; Barilla, Steven; Williford, Phillip Williford M; Feldman, Steven R; Pearce, Daniel J

2017-04-14

We developed dermatology patient education videos and a post-operative text message service that could be accessed universally via web based applications. A secondary outcome of the study was to assess patient opinions of text-messages, email, and video in the health care setting which is reported here. An investigator-blinded, randomized, controlled intervention was evaluated in 90 nonmelanoma MMS patients at Wake Forest Baptist Dermatology. Patients were randomized 1:1:1:1 for exposure to: 1) videos with text messages, 2) videos only, 3) text messages-only, or 4) standard of care. Assessment measures were obtained by the use of REDCap survey questions during the follow up visit. 1) 67% would like to receive an email with information about the procedure beforehand 2) 98% of patients reported they would like other doctors to use educational videos as a form of patient education 3) 88% of our patients think it is appropriate for physicians to communicate to patients via text message in certain situations. Nearly all patients desired physicians to use text-messages and video in their practice and the majority of patients preferred to receive an email with information about their procedure beforehand.

Forest report 2012 for Baden-Wuerttemberg; Waldzustandsbericht 2012 fuer Baden-Wuerttemberg

Energy Technology Data Exchange (ETDEWEB)

Meining, Stefan [Buero fuer Umweltueberwachung, Freiburg (Germany); Wilpert, Klaus v.; Schaeffer, Juergen; Hartmann, Peter; Schumacher, Joerg; Delb, Horst [Forstliche Versuchs- und Forschungsanstalt Baden-Wuerttemberg, Freiburg im Breisgau (Germany); Augustin, Nicole [Bath Univ. (United Kingdom)

2012-07-01

The Forest State Report 2012 systematically records the health status of the forest resources in the country on a scientific basis. Environmental information is measured, recorded and evaluated in the context of forest environmental monitoring using a measuring network. More than a third of the forest area has suffered significant damage. The share of undamaged forest areas has declined by almost one third to 26 percent since last year. Compared to the previous year, the crown damage increased by an average of 2.5 percentage points. More important, however, is the fact that for the two main tree species spruce and beech since the turn of the millennium, there has been a marked increase in the damage intensity for all age groups. [German] Der Waldzustandsbericht 2012 erfasst auf wissenschaftlicher Basis systematisch den Gesundheitszustand der Waldbestaende im Land. Im Rahmen des Forstlichen Umweltmonitorings werden mit Hilfe eines Messnetzes Umweltinformationen gemessen, erfasst und ausgewertet. Ueber ein Drittel der Waldflaeche weist deutliche Schaeden auf. Der Anteil der ungeschaedigten Waldflaechen ist seit dem letzten Jahr um fast ein Drittel auf 26 Prozent zurueckgegangen. Die Kronenschaeden haben gegenueber dem Vorjahr um durchschnittlich 2,5 Prozentpunkte zugenommen. Wichtiger ist jedoch der Befund, dass fuer die beiden Hauptbaumarten Fichte und Buche seit der Jahrtausendwende ein deutlicher Anstieg der Schadensintensitaet fuer alle Altersklassen zu beobachten ist.

Geomicrobiological analysis of highly mineralized geothermal waters as a contribution to the optimum use of geothermal energy; Geomikrobiologische Forschungsarbeiten an hochmineralisierten Tiefenwaessern als Beitrag zur optimalen Nutzung geothermischer Energie

Energy Technology Data Exchange (ETDEWEB)

Koehler, M; Voelsgen, F; Hofmann, K; Bochning, S [URST Umwelt- und Rohstoff-Technologie, Greifswald (Germany); Keller, T [Geothermie Neubrandenburg GmbH (Germany)

1997-12-01

In the context of a BMBF-funded project for Mecklenburg-Vorpommern, `Geomicrobiological analysis of geothermal waters used for energy generation`, the authors continued the series of microbiological analyses of the thermal water of the geothermal heating station at Neustadt-Glewe beyond full commissioning of the plant in April 1995. Their activities also included performance of model experiments for examination of the conditions causing massive development of microorganisms in the aquifer or in the thermal water loops of the heating station. The experimental results show that compliance with the findings and recommended operational measures will guarantee long-term operating stability of the heating station. However, in-service microbiological monitoring routines are required in order to early detect and prevent unwanted processes in the thermal water system. (orig.) [Deutsch] Im Rahmen des vom BMBF gefoerderten Projektes `Geomikrobiologische Untersuchungen an geothermisch genutzten Tiefenwaessern Nordostdeutschlands` (Mecklenburg-Vorpommern) haben wir uns auch nach voller Inbetriebnahme des Erdwaerme-Heizwerkes Neustadt-Glewe (April 1995) auf die mikrobiologische Analyse des Thermalwassers konzentriert. Darueber hinaus wurde in Modellversuchen geprueft, unter welchen Bedingungen eine Massenentwicklung von Mikroorganismen im Aquifer bzw. Thermalwasserkreislauf moeglich ist. Die Versuche haben gezeigt, dass unter Beachtung der erzielten Befunde bei sachgemaesser Betriebsfuehrung die Langzeitstabilitaet der Anlage gewaehrleistet ist. Jedoch sind mikrobiologische Betriebskontrollen unerlaesslich, um unerwuenschte Prozesse im Thermalwassersystem rechtzeitig erkenn en und verhindern zu koennen. (orig.)

Differential diagnosis in pediatric radiology. Vol. 1. Skull, spine, skeleton; Differentialdiagnostik in der paediatrischen Radiologie. Bd. 1. Schaedel, Wirbelsaeule, Skelett

Energy Technology Data Exchange (ETDEWEB)

Ebel, K D [ed.; Willich, E [ed.; Richter, E [ed.; Benz-Bohm, G; Bliesener-Harzheim, J A; Ebel, K D; Oestreich, A E; Reinwein, H; Schaper, J; Schumacher, R; Stoever, B

1995-06-01

The book presents in-depth material covering the full scope of tasks and problems of differential diagnostic radiology in children. The particular approach chosen by the authors provides information that will solve even the most difficult cases, guiding the reader on his way from radiographic findings to appropriate diagnosis. All radiographic findings have been characterized and classified and put into a tabulated system relating them to the relevant differential diagnosis. The system of reference adopted specifies a given lesion or disease by reference to the most significant diagnostic keywords obtained from anamnesis, clinical data, and further diagnostic evaluation. The tentative diagnosis is taken as the basis for further specification illustrated by the characteristic X-ray pictures and full-text descriptions. Almost all diagnoses are accompanied by a comprehensive image documentation obtained by all currently available imaging methods. (MG) [Deutsch] Das vorliegende Buch gibt einen kompletten Ueberblick ueeber die gesamte Bandbreite der Differentialdiagnostik in der Paediatrischen Radiologie und soll so auch in schwierigen Faeellen den Weg vom Roentgensymptom zur Diagnose ermoeglichen. Alle relevanten Roentgensymptome werden systematisch charakterisiert und die entsprechenden Differentialdiagnosen tabellarisch zusammengestellt. Jede Erkrankung wird durch Verweise auf die wichtigsten differentialdiagnostischen Stichworte aus Anamnese, Klinik und weiterfuehrende Diagnostik naeher eingegrenzt. Ausgehend von der Verdachtsdiagnose werden wegweisende Roentgenbefunde in Wort und Bild dargestellt. Fast alle erwaehnten Befunde werden durch Abbildungen unter Beruecksichtigung aller moderner bildgebenden Verfahren dokumentiert. (MG)

Factors Associated With Patient-perceived Hoarseness in Spasmodic Dysphonia Patients.

Science.gov (United States)

Hu, Amanda; Hillel, Al; Meyer, Tanya

2016-11-01

The American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines on Hoarseness distinguishes between hoarseness, which is a symptom perceived by the patient, and dysphonia, which is a diagnosis made by the clinician. Our objective was to determine factors that are associated with patient-perceived hoarseness in spasmodic dysphonia (SD) patients. Retrospective study. Adductor SD patients who presented for botulinum toxin injections from September 2011 to June 2012 were recruited. The main outcome variable, Voice Handicap Index-10 (VHI-10), was used to quantify patient-perceived hoarseness. Clinical data, Hospital Anxiety and Depression Scale (HADS), and VHI-10 were collected. Clinician-perceived dysphonia was measured by a speech-language pathologist with Consensus Auditory Perceptual Evaluation of Voice (CAPE-V). Statistical analysis included univariate analyses and multiple linear regression. One hundred thirty-nine SD patients had VHI-10 score of 26.0 ± 7.2 (mean ± standard deviation), disease duration of 10.5 + 7.0 years, CAPE-V overall score of 43.2 ± 21.8, HADS anxiety score of 6.7 ± 3.8, and HADS depression score of 3.6 ± 2.8. In univariate analyses, there were positive correlations (P dysphonia are associated with higher levels of patient-perceived hoarseness in SD patients. Hoarseness is a very personal symptom. Multiple factors determine its self-perception. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

The Relationships Between Doctor-Patient Affectionate Communication and Patient Perceptions and Outcomes.

Science.gov (United States)

Hesse, Colin; Rauscher, Emily A

2018-02-20

The current article combines the literature on doctor-patient communication and affectionate communication. Using Affection Exchange Theory (AET), the study predicts that the need for affection and the benefits of affectionate communication translate to the doctor-patient setting, proposing a series of relationships from both perceived doctor affectionate communication and affection deprivation to several patient outcome variables (patient perception of the doctor, patient communication with the doctor, and patient satisfaction/adherence). The results strongly supported the predictions for both affectionate communication and affection deprivation, with affectionate communication positively relating to most outcome measures and affection deprivation negatively relating to most outcome measures. Affection deprivation served as a moderator for the relationship between provider competence and patient satisfaction, although affectionate communication moderated the relationship between provider competence and patient adherence. Implications and possible directions for future research are discussed.

Patient data and patient rights: Swiss healthcare stakeholders' ethical awareness regarding large patient data sets - a qualitative study.

Science.gov (United States)

Mouton Dorey, Corine; Baumann, Holger; Biller-Andorno, Nikola

2018-03-07

There is a growing interest in aggregating more biomedical and patient data into large health data sets for research and public benefits. However, collecting and processing patient data raises new ethical issues regarding patient's rights, social justice and trust in public institutions. The aim of this empirical study is to gain an in-depth understanding of the awareness of possible ethical risks and corresponding obligations among those who are involved in projects using patient data, i.e. healthcare professionals, regulators and policy makers. We used a qualitative design to examine Swiss healthcare stakeholders' experiences and perceptions of ethical challenges with regard to patient data in real-life settings where clinical registries are sponsored, created and/or used. A semi-structured interview was carried out with 22 participants (11 physicians, 7 policy-makers, 4 ethical committee members) between July 2014 and January 2015. The interviews were audio-recorded, transcribed, coded and analysed using a thematic method derived from Grounded Theory. All interviewees were concerned as a matter of priority with the needs of legal and operating norms for the collection and use of data, whereas less interest was shown in issues regarding patient agency, the need for reciprocity, and shared governance in the management and use of clinical registries' patient data. This observed asymmetry highlights a possible tension between public and research interests on the one hand, and the recognition of patients' rights and citizens' involvement on the other. The advocation of further health-related data sharing on the grounds of research and public interest, without due regard for the perspective of patients and donors, could run the risk of fostering distrust towards healthcare data collections. Ultimately, this could diminish the expected social benefits. However, rather than setting patient rights against public interest, new ethical approaches could strengthen both

Identifying Patients at Risk and Patients in Need

DEFF Research Database (Denmark)

Schmidt, Thomas

2015-01-01

korttidssengeafsnit. Det viser sig at sygeplejerskernes anvendelse af patientmonitoreringsudstyret afhænger af tidspunkt på døgnet, og i hvilken sammenhæng systemet bruges. Behandling af patienter er udfordret af hvordan information indhentes og deles imellem klinikerne. Hyppigheden hvormed patienter monitoreres...

A Patient-Specific Airway Branching Model for Mechanically Ventilated Patients

Directory of Open Access Journals (Sweden)

Nor Salwa Damanhuri

2014-01-01

Full Text Available Background. Respiratory mechanics models have the potential to guide mechanical ventilation. Airway branching models (ABMs were developed from classical fluid mechanics models but do not provide accurate models of in vivo behaviour. Hence, the ABM was improved to include patient-specific parameters and better model observed behaviour (ABMps. Methods. The airway pressure drop of the ABMps was compared with the well-accepted dynostatic algorithm (DSA in patients diagnosed with acute respiratory distress syndrome (ARDS. A scaling factor (α was used to equate the area under the pressure curve (AUC from the ABMps to the AUC of the DSA and was linked to patient state. Results. The ABMps recorded a median α value of 0.58 (IQR: 0.54–0.63; range: 0.45–0.66 for these ARDS patients. Significantly lower α values were found for individuals with chronic obstructive pulmonary disease (P<0.001. Conclusion. The ABMps model allows the estimation of airway pressure drop at each bronchial generation with patient-specific physiological measurements and can be generated from data measured at the bedside. The distribution of patient-specific α values indicates that the overall ABM can be readily improved to better match observed data and capture patient condition.

[Verbal patient information through nurses--a case of stroke patients].

Science.gov (United States)

Christmann, Elli; Holle, Regina; Schüssler, Dörte; Beier, Jutta; Dassen, Theo

2004-06-01

The article represents results of a theoretical work in the field of nursing education, with the topic: Verbal Patient Information through Nurses--A Case of Stroke Patients. The literature review and analysis show that there is a shortage in (stroke) patient information generally and a lack of successful concepts and strategies for the verbal (stroke) patient information through nurses in hospitals. The authors have developed a theoretical basis for health information as a nursing intervention and this represents a model of health information as a "communicational teach-and-learn process", which is of general application to all patients. The health information takes place as a separate nursing intervention within a non-public, face-to-face communication situation and in the steps-model of the nursing process. Health information is seen as a learning process for patients and nurses too. We consider learning as information production (constructivism) and information processing (cognitivism). Both processes are influenced by different factors and the illness-situation of patients, personality information content and the environment. For a successful health information output, it is necessary to take care of these aspects and this can be realized through a constructivational understanding of didactics. There is a need for an evaluation study to prove our concept of health information.

Validation of self assessment patient knowledge questionnaire for heart failure patients.

Science.gov (United States)

Lainscak, Mitja; Keber, Irena

2005-12-01

Several studies showed insufficient knowledge and poor compliance to non-pharmacological management in heart failure patients. Only a limited number of validated tools are available to assess their knowledge. The aim of the study was to test our 10-item Patient knowledge questionnaire. The Patient knowledge questionnaire was administered to 42 heart failure patients from Heart failure clinic and to 40 heart failure patients receiving usual care. Construct validity (Pearson correlation coefficient), internal consistency (Cronbach alpha), reproducibility (Wilcoxon signed rank test), and reliability (chi-square test and Student's t-test for independent samples) were assessed. Overall score of the Patient knowledge questionnaire had the strongest correlation to the question about regular weighing (r=0.69) and the weakest to the question about presence of heart disease (r=0.33). There was a strong correlation between question about fluid retention and questions assessing regular weighing, (r=0.86), weight of one litre of water (r=0.86), and salt restriction (r=0.57). The Cronbach alpha was 0.74 and could be improved by exclusion of questions about clear explanation (Chronbach alpha 0.75), importance of fruit, soup, and vegetables (Chronbach alpha 0.75), and self adjustment of diuretic (Chronbach alpha 0.81). During reproducibility testing 91% to 98% of questions were answered equally. Patients from Heart failure clinic scored significantly better than patients receiving usual care (7.9 (1.3) vs. 5.7 (2.2), p<0.001). Patient knowledge questionnaire is a valid and reliable tool to measure knowledge of heart failure patients.

Patient empowerment, patient participation and patient-centeredness in hospital care : A concept analysis based on a literature review

NARCIS (Netherlands)

Castro, E.M.; van Regenmortel, T.; Vanhaecht, K.; Sermeus, W.; van Hecke, A.

2016-01-01

Objectives The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Although these concepts have been discussed for a number of years, their exact

Displacing the Patient

DEFF Research Database (Denmark)

Pors, Anja Svejgaard

as an affective care recipient, as a citizen with rights and as an individual need-oriented user on the one hand. On the other hand, the goal of patient satisfaction also deploys market perceptions of patients as homogeneous target groups to which information can be standardised. In the latter (market orientation......), the patient is also a resource for organizational development and a customer with consumer behavior. Overall, the strategy presents an information-pursuing patient figure making it possible to streamline the organization's care orientation on market conditions. In contrast to Annemarie Mol’s dichotomy of care......The analysis is based on an empirical study of a hospital’s communication strategy entitled: 'The Perspective of the Patient'. The paper asks how the strategy organizes communication work as situated displacements of the patient. Based on methodological elements from situational analysis (Clarke...

Survey of a community-based infusion program for Australian patients with rheumatoid arthritis requiring treatment with tocilizumab: patient characteristics and drivers of patient satisfaction and patient-perceived benefits and concerns

Directory of Open Access Journals (Sweden)

Voight L

2012-04-01

Full Text Available Louisa VoightCoast Joint Care, Maroochydore, Queensland, AustraliaBackground: Tocilizumab is an effective therapy for patients with moderate to severe rheumatoid arthritis that is administered by infusion over one hour every 4 weeks. The community-based infusion (ACTiv program was introduced to Australia in August 2010 to provide accessible and convenient treatment for patients with rheumatoid arthritis who require tocilizumab. The primary objectives of this study were to determine the characteristics of patients in the ACTiv program, patient satisfaction, and patient-perceived benefits and concerns with the ACTiv program, and drivers of patient satisfaction and patient-perceived benefits and concerns.Methods: A voluntary self-administered survey was given to all 608 patients in the ACTiv program between January 27, 2011 and March 31, 2011.Results: A total of 351 surveys were returned completed, giving a response rate of 58% (351/608. Most patients in the ACTiv program were women aged 40–64 years, with a mean disease duration of 13.7 years and moderate disability, who had been in the ACTiv program for ≥5 months. Most patients (88%, 302/342 were either very satisfied or satisfied with the ACTiv program and believed that they were very unlikely or somewhat unlikely to switch from the ACTiv program (64%, 214/335. The most important benefit was the reassurance of receiving treatment from a trained nurse in a professional medical environment (33%, 102/309. The most important concern was the fear of side effects (48%, 134/280. The main drivers of patient satisfaction and patient-perceived benefits and concerns of patients were health profile, previous medication experience, and length of treatment time in the program.Conclusion: The ACTiv program is used by patients of various ages, family life situations, and locations. Patient satisfaction with the program is high, which enables patients to benefit from long-term use of tocilizumab

[QR-Code based patient tracking: a cost-effective option to improve patient safety].

Science.gov (United States)

Fischer, M; Rybitskiy, D; Strauß, G; Dietz, A; Dressler, C R

2013-03-01

Hospitals are implementing a risk management system to avoid patient or surgery mix-ups. The trend is to use preoperative checklists. This work deals specifically with a type of patient identification, which is realized by storing patient data on a patient-fixed medium. In 127 ENT surgeries data relevant for patient identification were encrypted in a 2D-QR-Code. The code, as a separate document coming with the patient chart or as a patient wristband, has been decrypted in the OR and the patient data were presented visible for all persons. The decoding time, the compliance of the patient data, as well as the duration of the patient identification was compared with the traditional patient identification by inspection of the patient chart. A total of 125 QR codes were read. The time for the decrypting of QR-Code was 5.6 s, the time for the screen view for patient identification was 7.9 s, and for a comparison group of 75 operations traditional patient identification was 27.3 s. Overall, there were 6 relevant information errors in the two parts of the experiment. This represents a ratio of 0.6% for 8 relevant classes per each encrypted QR code. This work allows a cost effective way to technically support patient identification based on electronic patient data. It was shown that the use in the clinical routine is possible. The disadvantage is a potential misinformation from incorrect or missing information in the HIS, or due to changes of the data after the code was created. The QR-code-based patient tracking is seen as a useful complement to the already widely used identification wristband. © Georg Thieme Verlag KG Stuttgart · New York.

The experiences of chronically ill patients and registered nurses when they negotiate patient care in hospital settings: a feminist poststructural approach: A qualitative study that explores negotiation of patient care between patients and chronically ill patients in hospital settings.

Science.gov (United States)

Griscti, Odette; Aston, Megan; Martin-Misener, Ruth; Mcleod, Deborah; Warner, Grace

2016-07-01

The aim of this study was to understand the experiences of chronically ill patients and registered nurse in negotiating patient care in hospital. Specifically, we explored how social and institutional discourses shaped power relations and negotiation of patient care. Current literature indicates that although nurses embrace this notion, such partnerships are not easily implemented. Most existing studies focus on the role of the nurse as the leader of the partnership with little attention paid to how social and institutional values, beliefs and practices shape nurse/patient power relations; or how these relationships are negotiated between nurses and patients. The theoretical and methodological approaches used in this study are based on the precepts of Foucault and feminist poststructural theorists. In depth interviews were conducted with eight chronically ill patients and 10 registered nurses. Both nurses and patients commented about the relationships that develop between nurses and chronically ill patients and how these relationships facilitate negotiation of patient care. Both parties described challenging moments and how institutional discourses may hinder positive negotiations of care. In this paper we highlight three themes that emerged: getting to know each other, they are not the sickest patients and finding time to listen. This study offers an innovative way of unpacking negotiation of care between chronically ill patients and registered nurses. It exposes how social and institutional discourses play a pivotal role in shaping negotiations between nurses and chronically ill patients. Negotiating care with chronically ill patients is not as asymmetric as portrayed in some of the literature and tends to be based on mutual agreements between nurses and patients. Nurses make it a point to listen to patients' needs and resist institutional discourses that preclude them from spending time with patients. © 2016 John Wiley & Sons Ltd.

Effect of the patient-to-patient communication model on dysphagia caused by total laryngectomy.

Science.gov (United States)

Tian, L; An, R; Zhang, J; Sun, Y; Zhao, R; Liu, M

2017-03-01

The study aimed to evaluate the effect of a patient-to-patient communication model on dysphagia in laryngeal cancer patients after total laryngectomy. Sixty-five patients who had undergone total laryngectomy were randomly divided into three groups: a routine communication group, a patient communication group (that received the patient-to-patient communication model) and a physician communication group. Questionnaires were used to compare quality of life and swallowing problems among all patient groups. The main factors causing dysphagia in total laryngectomy patients were related to fear and mental health. The patient communication group had improved visual analogue scale scores at one week after starting to eat. Quality of life in swallowing disorders questionnaire scores were significantly higher in the patient communication and physician communication groups than in the routine communication group. In addition, swallowing problems were much more severe in patients educated to high school level and above than in others. The patient-to-patient communication model can be used to resolve swallowing problems caused by psychological factors in total laryngectomy patients.

Patient education about cough: effect on the consulting behaviour of general practice patients.

Science.gov (United States)

Rutten, G; Van Eijk, J; Beek, M; Van der Velden, H

1991-07-01

The aim of this general practice study was to examine how the consulting behaviour of patients with a cough was affected when the tasks and responsibilities of patients, practice nurses and general practitioners were reorganized. In four 'average' single-handed general practices the effects on the consulting behaviour of patients of a rational practice policy on cough and the provision of systematic patient education on cough were compared with patient behaviour in four matched control practices. Changes of behaviour were measured in 548 patients who consulted for cough at least twice, in two successive autumn-winter periods. Significantly more patients in the experimental practice changed their behaviour to follow the practice guidelines than did patients in the control practices (56% versus 30%, P less than 0.001). The proportion of patients who continued to consult in the approved manner was greater among patients receiving intervention (66% versus 29%, P less than 0.001). This was equally true for patients who had suffered less than four episodes of cough or more than four episodes. The more often the patients received the education, the more effective it was. All patients who consulted the general practitioner for cough during the first autumn-winter period filled in a cough diary during the second period. From this it appeared that the intervention did not result in patients delaying consultation when they had a cough lasting longer than three weeks or one with 'serious' symptoms. It would appear that a rational practice policy and the provision of patient education can stimulate patients to modify their consulting behaviour. This could result in a reduction in the costs of health care.

Nuclear medicine in traumatology; Nuklearmedizin in der Traumatologie

Energy Technology Data Exchange (ETDEWEB)

Spitz, J. [Praxis fuer Nuklearmedizin am Staedtischen Klinikum Wiesbaden (Germany)

2002-12-01

Bone scintigraphy is a splendid tool to detect fractures by its high affinity to the newly built amorphous calcium phosphate of the callus. MRI on the other hand demonstrates anatomical details without radiation burden to the patient and has become the favourite tool of orthopediques and traumatologists. Nevertheless bone scintigraphy has kept its special indications - sometimes in addition to routine MRI. Main indications are the wholebody-investigation, the estimation of relative fracture age, unclear situations of pain, extraarticular ossifications, algodystrophy and the estimation of bone damage after polytrauma. If MRI is not available bone-scintigraphy covers the following indications: detection and exclusion of ischaemia and necrosis of bones, stress and insufficiency fractures, differentiation of soft tissue leasions from fractures and so called ''bone bruises''. i.e. damage to the bone layer immediately below the chondral surface of the joints. The same catalogue is valid, if there are technical problems in MRI (pacemaker-patient, risk of anesthesia in patient with claustrophobia or with adipositas per magna and metall artefacts in MRI reconstruction). Optimized technical procedures are essentials for efficient application of bone scintigraphy in traumatology (SPECT for the trunk and multiplanar views in extremities) as well as good anatomical knowledge and integrated interpretation of functional bone scans together with the morphological information's of ultrasound, X-Ray and even MRI. (orig.) [German] Die Skelettszintigraphie eignet sich aufgrund der intensiven Anreicherung der markierten Phosphatkomplexe im neu gebildeten amorphen Calciumphosphat des Frakturkallus hervorragend zum Nachweis von knoechernen Verletzungen. Andererseits ist das ''strahlenlose'' MRT mit seiner anatomischen Wiedergabe von Knochen und Weichteilen der absolute Favorit in der Orthopaedie und Traumatologie geworden. Dennoch hat sich die

A DICOM based PACS for nuclear medicine; Ein DICOM-basiertes PACS fuer die Nuklearmedizin

Energy Technology Data Exchange (ETDEWEB)

Lassmann, M.; Reiners, C. [Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

2002-02-01

The installation of a radiology information system (RIS) connected to a hospital information system (HIS) and a picture archiving and communications system (PACS) seems mandatory for a nuclear medicine department in order to guarantee a high patient throughput. With these systems a fast transmission of reports, images to the in- and out-patients' wards and private practitioners is realized. Therefore, since April 2000, at the department of nuclear medicine of the university of Wuerzburg a completely DICOM based PACS has been implemented in addition to the RIS. With this system a DICOM based workflow is realized throughout the department of nuclear medicine for reporting and archiving. The PACS is connected to six gamma-cameras, a PET scanner, a bone densitometry system and an ultrasound device. The volume of image data archived per month is 4 GByte. Patient demographics are provided to the modalities via DICOM-Worklist. With these PACS components a department specific archive purely based on DICOM can be realized. During the installation process problems occurred mainly because of the complex DICOM standard for nuclear medicine. Related to that is the problem that most of the software implementations still contain bugs or are not adapted to the needs of a nuclear medicine department (particularly for PET). A communication software for the distribution of nuclear medicine reports and images based on techniques used for the worldwide web is currently tested. (orig.) [German] Fuer eine nuklearmedizinische Klinik ist ein Klinikinformationssystem (KIS) gekoppelt mit einem Radiologieinformationssystem (RIS) sowie einem Bildarchivierungs- und Verteilungssystem (PACS) unabdingbar, um einen schnellen Patientendurchsatz sowie die zeitnahe Uebermittlung von Befunden inklusive nuklearmedizinischen Bildern an zuweisende Stationen, Ambulanzen und externe Zuweiser zu gewaehrleisten. Daher wurde im April 2000 an der Klinik und Poliklinik fuer Nuklearmedizin der Universitaet

Patient empowerment

DEFF Research Database (Denmark)

Eskildsen, Nanna Bjerg; Joergensen, Clara Ruebner; Thomsen, Thora Grothe

2017-01-01

Background There is an increased attention to and demand for patient empowerment in cancer treatment and follow-up programmes. Patient empowerment has been defined as feeling in control of or having mastery in relation to cancer and cancer care. This calls for properly developed questionnaires...... assessing empowerment from the user perspective. The aim of this review was to identify questionnaires and sub-scales measuring empowerment and manifestations of empowerment among cancer patients. Materials and methods We conducted a systematic search of the PubMed, PsycINFO and CINAHL databases....... Empowerment and multiple search terms associated with empowerment were included. We included peer-reviewed articles published in English, which described questionnaires measuring empowerment or manifestations of empowerment in a cancer setting. In addition, the questionnaire had to be a patient...

Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

Science.gov (United States)

Trevizoli, Jose Eduardo; de Paula Menezes, Raissa; Ribeiro Velasco, Lara Franciele; Amorim, Regina; de Carvalho, Mauro Birche; Mendes, Liliana Sampaio; Neto, Columbano Junqueira; de Deus Macedo, José Roberto; de Assis, Francisco; Neves, Rocha

2008-01-01

Background and objectives: The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function. Design, setting, participants, & measurements: A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection. Results: HCV patients on hemodialysis had lower levels of alanina aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P = 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio = 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001). Conclusions: The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV. PMID:18650408

76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Child Health Patient Safety...

Science.gov (United States)

2011-11-17

... Organizations: Voluntary Relinquishment From Child Health Patient Safety Organization, Inc. AGENCY: Agency for... notification of voluntary relinquishment from Child Health Patient Safety Organization, Inc. of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety...

76 FR 79192 - Patient Safety Organizations: Voluntary Relinquishment From HSMS Patient Safety Organization

Science.gov (United States)

2011-12-21

... Organizations: Voluntary Relinquishment From HSMS Patient Safety Organization AGENCY: Agency for Healthcare... voluntary relinquishment from the HSMS Patient Safety Organization of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), Public Law 109...

Infrared-Guided Patient Setup for Lung Cancer Patients

International Nuclear Information System (INIS)

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

2008-01-01

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

Examining chronic care patient preferences for involvement in health-care decision making: the case of Parkinson's disease patients in a patient-centred clinic.

Science.gov (United States)

Zizzo, Natalie; Bell, Emily; Lafontaine, Anne-Louise; Racine, Eric

2017-08-01

Patient-centred care is a recommended model of care for Parkinson's disease (PD). It aims to provide care that is respectful and responsive to patient preferences, values and perspectives. Provision of patient-centred care should entail considering how patients want to be involved in their care. To understand the participation preferences of patients with PD from a patient-centred care clinic in health-care decision-making processes. Mixed-methods study with early-stage Parkinson's disease patients from a patient-centred care clinic. Study involved a modified Autonomy Preference Index survey (N=65) and qualitative, semi-structured in-depth interviews, analysed using thematic qualitative content analysis (N=20, purposefully selected from survey participants). Interviews examined (i) the patient preferences for involvement in health-care decision making; (ii) patient perspectives on the patient-physician relationship; and (iii) patient preferences for communication of information relevant to decision making. Preferences for participation in decision making varied between individuals and also within individuals depending on decision type, relational and contextual factors. Patients had high preferences for communication of information, but with acknowledged limits. The importance of communication in the patient-physician relationship was emphasized. Patient preferences for involvement in decision making are dynamic and support shared decision making. Relational autonomy corresponds to how patients envision their participation in decision making. Clinicians may need to assess patient preferences on an on-going basis. Our results highlight the complexities of decision-making processes. Improved understanding of individual preferences could enhance respect for persons and make for patient-centred care that is truly respectful of individual patients' wants, needs and values. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

CT-docking patient stretcher

International Nuclear Information System (INIS)

Mirvis, S.E.; Owens, E.; Maslyn, J.; Rizutto, M.

1990-01-01

This paper assesses the use of a patient stretcher that directly docks to a CT scanner for acutely injured and/or critically ill patients. The stretcher permits performance of radiography and acts as a platform for critical care monitoring and patient support devices. During a 1-year period, the prototype CT-docking stretcher was used for 35 patients sustaining acute trauma and 25 patients from critical care units. Observations were elicited from physicians, nurses and technologists concerning the advantages or disadvantages of the docking stretcher. Advantages of the CT-docking stretcher included time saved in moving patients to the CT table from the admitting/emergency ward, transfer of critically ill patients onto the stretcher in the controlled environment of the intensive care unit rather than the CT suite, increasing CT throughput by direct docking of the patient stretcher to the CT scanner rather than manual transfer of complex support and monitoring devices with the patient, decreased risk associated with physical movement of patients with potentially unstable spinal injuries or unstable physiologic status, and decrease in potential for injury to medical personnel performing patient transfer

PATIENT WEB PORTALS AND PATIENT-PROVIDER RELATIONSHIPS: A SUMMARY PERSPECTIVE.

Science.gov (United States)

Caldwell, Hannah D; Minkoff, Neil B; Murthy, Kalyani

2017-01-01

Patient Web portals (PWPs) have been gaining traction as a means to collect patient-reported outcomes and maintain quality patient care between office visits. PWPs have the potential to impact patient-provider relationships by rendering additional channels for communication outside of clinic visits and could help in the management of common chronic medical conditions. Studies documenting their effect in primary care settings are limited. This perspective aims to summarize the benefits and drawbacks of using PWPs in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma, focusing on communication, disease management, compliance, potential barriers, and the impact on patient-provider dynamic. After a review of these topics, we present potential future directions. We conducted an exploratory PubMed search of the literature published from inception through December 2015, and focused our subsequent searches specifically to assess benefits and drawbacks of using PWPs in the management of diabetes mellitus, hypertension, and asthma. Our search revealed several potential benefits of PWP implementation in the management of chronic conditions with regards to patient-provider relationships, such as improved communication, disease management, and compliance. We also noted drawbacks such as potentially unreliable reporting, barriers to use, and increased workload. PWPs offer opportunities for patients to report symptoms and outcomes in a timely manner and allow for secure online communication with providers. Despite the drawbacks noted, the overall benefits from successful PWP implementation could improve patient-provider relationships and help in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma.

Patients' perceptions of patient care providers with tattoos and/or body piercings.

Science.gov (United States)

Westerfield, Heather V; Stafford, Amy B; Speroni, Karen Gabel; Daniel, Marlon G

2012-03-01

This study evaluated patients' perceptions of patient care providers with visible tattoos and/or body piercings. As tattooing and body piercing are increasingly popular, research that informs nursing administrators regarding policies on patient care providers having visible tattoos and body piercings is warranted. A total of 150 hospitalized adult patients compared pictures of male and female patient care providers in uniform with and without tattoos and/or nonearlobe body piercings. Patient care providers with visible tattoos and/or body piercings were not perceived by patients in this study as more caring, confident, reliable, attentive, cooperative, professional, efficient, or approachable than nontattooed or nonpierced providers. Tattooed female providers were perceived as less professional than male providers with similar tattoos. Female providers with piercings were perceived as less confident, professional, efficient, and approachable than nonpierced female providers. Nursing administrators should develop and/or evaluate policies regarding patient care providers with visible tattoos and/or body piercings.

What is patient-centered care really? Voices of Hispanic prenatal patients.

Science.gov (United States)

Bergman, Alicia A; Connaughton, Stacey L

2013-01-01

Variations in patient-centered care (PCC) models and approaches contribute to ambiguity in how PCC is understood and defined, especially with regard to meeting the needs of diverse patient populations. One of the biggest challenges of putting PCC into practice is knowing what elements are the most important to patients. This qualitative study privileges patients' voices and adds a cultural dimension to existing health communication research on PCC through an empirical investigation of 48 Hispanic prenatal care patients' understandings and expectations of PCC. Semistructured interviews with 48 patients revealed five key themes in order of frequency: (a) una relación amable (a friendly relationship), (b) la atencion médica efectiva (effective medical care), (c) Español hablado (the Spanish language spoken), (d) comprensión de la información (understanding of information), and (e) eliminación del racismo (elimination of racism). The themes reflected several different assumptions and expectations with regard to PCC as compared to those espoused in many of the existing models and frameworks, such as the extent to which friendly interpersonal behaviors (e.g., smiling, making eye contact, displaying patience, and engaging in formal greetings, introductions, and farewells) were critical to patient satisfaction with the health care experience. Not only did patients feel better understood, but accompanied by friendly behaviors, information was viewed as more believable and accurate, and thus more patient-centered. The findings suggest that implementing culturally sensitive PCC approaches to caring for Hispanic prenatal care patients can include training health care staff on the importance of displaying friendly communicative behaviors such as smiling.

[Microalbuminuria in diabetic and hypertensive patients: a study of 979 patients].

Science.gov (United States)

Roberto Robles, Nicolás; Velasco, Joaquín; Mena, Cándido; Angulo, Enrique; Garrote, Timotea

2006-11-25

Microalbuminuria is a known complication of diabetes mellitus but it is also a cardiovascular risk factor commonly present among hypertensive (non diabetic) population. The prevalence of microalbuminuria is variable and it has been never estimated in our region. The aim of this study has been to determine the prevalence of microalbuminuria in hypertensive (non diabetic) and diabetic population in Extremadura (Spain). The study included diabetic patients and non-diabetic hypertensive ones randomly selected. Microalbuminuria was measured in every patient using albumin/creatinin reactive stick in fasting first morning urine. Whenever possible microalbuminuria was confirmed in laboratory by microalbuminuria/creatinina coefficient in first morning urine samples. A total of 979 patients (mean age [SD], 67.9 [10.8] years; 409 men and 570 women, 505 diabetics) were studied. The presence of microalbuminuria was found in 12.4% of hypertensive patients and in 21.4% of diabetic patients (p < 0.001). Hypertensives and normotensive diabetics showed a similar prevalence of microalbuminuria (13.3%, not significant), but it tripled in hypertensive diabetics (33.8; p < 0.01). Glicemic control was not different for microalbuminuric diabetic patients and non microalbuminuric ones. The patients receiving rennin-angiotensin axis blocking drugs do not showed less prevalence of microalbuminuria (hypertensives 10.5%, diabetics 23.5%). Microalbuminuria was confirmed in 65.4% of patients. The prevalence of microalbuminuria in Extremadura seems to be high either in diabetics or non diabetic hypertensive patients. The finding of microalbuminuria in diabetics patients correlates with hypertension but do not with glicemic control. The prevalence of microalbuminuria is high in spite of using rennin-angiotensin axis blocking drugs.

Development of a patient-reported outcome instrument for patients with lumbar radicular pain

OpenAIRE

Ibsen, Charlotte; Schiøttz-Christensen, Berit; Handberg, Charlotte; Nielsen, Claus Vinther; Hørder, Mogens; Maribo, Thomas

2017-01-01

Background Low back pain (LBP) is the leading cause to years lived with disability. 10–20% of patients with LBP experience radicular pain (lumbar radiculopathy). Patient-reported outcomes (PROs) play an important role in advancing patient-centered health care. Although patient involvement is essential to develop valid patient-centred PRO instruments patients are not always involved. The International Classification of Functioning, Disability and Health (ICF) are proposed to facilitate consist...

Patient safety in out-of-hours primary care: a review of patient records

Directory of Open Access Journals (Sweden)

Wensing Michel

2010-12-01

Full Text Available Abstract Background Most patients receive healthcare in primary care settings, but relatively little is known about patient safety. Out-of-hours contacts are of particular importance to patient safety. Our aim was to examine the incidence, types, causes, and consequences of patient safety incidents at general practice cooperatives for out-of-hours primary care and to examine which factors were associated with the occurrence of patient safety incidents. Methods A retrospective study of 1,145 medical records concerning patient contacts with four general practice cooperatives. Reviewers identified records with evidence of a potential patient safety incident; a physician panel determined whether a patient safety incident had indeed occurred. In addition, the panel determined the type, causes, and consequences of the incidents. Factors associated with incidents were examined in a random coefficient logistic regression analysis. Results In 1,145 patient records, 27 patient safety incidents were identified, an incident rate of 2.4% (95% CI: 1.5% to 3.2%. The most frequent incident type was treatment (56%. All incidents had at least partly been caused by failures in clinical reasoning. The majority of incidents did not result in patient harm (70%. Eight incidents had consequences for the patient, such as additional interventions or hospitalisation. The panel assessed that most incidents were unlikely to result in patient harm in the long term (89%. Logistic regression analysis showed that age was significantly related to incident occurrence: the likelihood of an incident increased with 1.03 for each year increase in age (95% CI: 1.01 to 1.04. Conclusion Patient safety incidents occur in out-of-hours primary care, but most do not result in harm to patients. As clinical reasoning played an important part in these incidents, a better understanding of clinical reasoning and guideline adherence at GP cooperatives could contribute to patient safety.

Patient choice modelling: how do patients choose their hospitals?

Science.gov (United States)

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

2018-06-01

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

Putting patients first: a novel patient-centered model for medical enterprise success.

Science.gov (United States)

Dhawan, Naveen

2014-01-01

This article introduces a new way of viewing patient-customers. It encourages a greater emphasis on patients' needs and the importance of considering dimensions of the patient experience to better serve them. It also draws from examples in the general business world as they can be applied to medical enterprises. The author introduces a model that directs all business activities toward the end consumer with an underlying guidance by patient needs. A business is advised to understand its customer, design a patient-directed vision, and focus on creating a unique customer experience. The article delineates key action items for physicians and administrators that will allow them to better meet their patient-customers' needs and develop loyalty. By practicing a patient-centered approach and following these guidelines, one may ensure greater success of the medical enterprise.

Patient representatives' views on patient information in clinical cancer trials

DEFF Research Database (Denmark)

Dellson, Pia; Nilbert, Mef; Carlsson, Christina

2016-01-01

of future simplified and more attractive informed consent forms. CONCLUSIONS: The emotional and cognitive responses to written patient information reported by patient representatives provides a basis for revised formats in future trials and add to the body of information that support use of plain language......BACKGROUND: Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informed...... consent is possible to provide. We explored patient representatives' views and perceptions on the written trial information used in clinical cancer trials. METHODS: Written patient information leaflets used in four clinical trials for colorectal cancer were used for the study. The trials included phase I...

Patient representatives' views on patient information in clinical cancer trials.

Science.gov (United States)

Dellson, Pia; Nilbert, Mef; Carlsson, Christina

2016-02-01

Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informed consent is possible to provide. We explored patient representatives' views and perceptions on the written trial information used in clinical cancer trials. Written patient information leaflets used in four clinical trials for colorectal cancer were used for the study. The trials included phase I-III trials, randomized and non-randomized trials that evaluated chemotherapy/targeted therapy in the neoadjuvant, adjuvant and palliative settings. Data were collected through focus groups and were analysed using inductive content analysis. Two major themes emerged: emotional responses and cognitive responses. Subthemes related to the former included individual preferences and perceptions of effect, while subthemes related to the latter were comprehensibility and layout. Based on these observations the patient representatives provided suggestions for improvement, which largely included development of future simplified and more attractive informed consent forms. The emotional and cognitive responses to written patient information reported by patient representatives provides a basis for revised formats in future trials and add to the body of information that support use of plain language, structured text and illustrations to improve the informed consent process and thereby patient enrolment into clinical trials.

Effects of Program and Patient Characteristics on Retention of Drug Treatment Patients.

Science.gov (United States)

Hser, Yih-Ing; Joshi, Vandana; Maglione, Margaret; Chou, Chih Ping; Anglin, M. Douglas

2001-01-01

Studied the effects of program and patient characteristics on patient retention in residential, out-patient, and methadone maintenance drug treatment programs. Data for 26,047 patients in 87 programs show that threshold retention rates were generally low for all 3 program types, although program practice and service provision played important…

Patients' evaluations of patient safety in English general practices: a cross-sectional study.

Science.gov (United States)

Ricci-Cabello, Ignacio; Marsden, Kate S; Avery, Anthony J; Bell, Brian G; Kadam, Umesh T; Reeves, David; Slight, Sarah P; Perryman, Katherine; Barnett, Jane; Litchfield, Ian; Thomas, Sally; Campbell, Stephen M; Doos, Lucy; Esmail, Aneez; Valderas, Jose M

2017-07-01

Description of safety problems and harm in general practices has previously relied on information from health professionals, with scarce attention paid to experiences of patients. To examine patient-reported experiences and outcomes of patient safety in primary care. Cross-sectional study in 45 general practices across five regions in the north, centre, and south of England. A version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was sent to a random sample of 6736 patients. Main outcome measures included 'practice activation' (what a practice does to create a safe environment); 'patient activation' (how proactive are patients in ensuring safe healthcare delivery); 'experiences of safety events' (safety errors); 'outcomes of safety' (harm); and 'overall perception of safety' (how safe patients rate their practice). Questionnaires were returned by 1244 patients (18.4%). Scores were high for 'practice activation' (mean [standard error] = 80.4 out of 100 [2.0]) and low for 'patient activation' (26.3 out of 100 [2.6]). Of the patients, 45% reported experiencing at least one safety problem in the previous 12 months, mostly related to appointments (33%), diagnosis (17%), patient provider communication (15%), and coordination between providers (14%). Twenty-three per cent of the responders reported some degree of harm in the previous 12 months. The overall assessment of level of safety of practices was generally high (86.0 out of 100 [16.8]). Priority areas for patient safety improvement in general practices in England include appointments, diagnosis, communication, coordination, and patient activation. © British Journal of General Practice 2017.

disease patient

Directory of Open Access Journals (Sweden)

Setareh Mamishi

2016-09-01

Full Text Available Background and Purpose: Chronic granulomatous disease (CGD is an inherited disorder of the nicotinamide adenine dinucleotide phosphate (NADPH oxidase complex. This disorder results in recurrent life-threatening bacterial and fungal infections. Aspergillus species are the most common fungal infections in these patients. Case Report: Herein, we present a case of fungal infection in a girl with CGD. We confirmed aspergillosis through the positive microscopic and macroscopic examinations, as well as radiology results. Invasive aspergillosis in this patient with pneumonia, lung abscess, and osteomyelitis of the ribs was not initially treated with amphotericin B (Am B and recombinant interferon-gamma. Conclusion: Among infectious diseases, fungal infections, in particular aspergillosis, remain a serious problem in CGD patients. Considering poor clinical response and deficient immune system, rapid diagnosis of fungal infection and optimizing the treatment of these patients are recommended.

Ergonomics and patient handling.

Science.gov (United States)

McCoskey, Kelsey L

2007-11-01

This study aimed to describe patient-handling demands in inpatient units during a 24-hour period at a military health care facility. A 1-day total population survey described the diverse nature and impact of patient-handling tasks relative to a variety of nursing care units, patient characteristics, and transfer equipment. Productivity baselines were established based on patient dependency, physical exertion, type of transfer, and time spent performing the transfer. Descriptions of the physiological effect of transfers on staff based on patient, transfer, and staff characteristics were developed. Nursing staff response to surveys demonstrated how patient-handling demands are impacted by the staff's physical exertion and level of patient dependency. The findings of this study describe the types of transfers occurring in these inpatient units and the physical exertion and time requirements for these transfers. This description may guide selection of the most appropriate and cost-effective patient-handling equipment required for specific units and patients.

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.

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

Science.gov (United States)

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

2013-08-01

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

Emerging Good Practices for Transforming Value Assessment: Patients' Voices, Patients' Values.

Science.gov (United States)

Perfetto, Eleanor M; Harris, Jason; Mullins, C Daniel; dosReis, Susan

2018-04-01

Patient engagement is a transformative strategy for improving value assessment. US value framework developers have increased engagement activities, but more needs to be learned about how to best achieve meaningful patient engagement in value assessment. The objective was to glean good practices in patient engagement emerging from patient community experiences, to be used in value assessment. The National Health Council Value Workgroup conducted a survey and held a focus group with its member advocacy organizations to gather experiences with value framework developers and views on emerging good practices. Ten of 13 organizations completed the survey; reporting 13 interactions with four framework developers. Most rated experiences as "good" to "very good." Emerging good practices included (1) engage early; (2) engage a range of patients; (3) leverage patient-provided information, data resources, and outreach mechanisms; (4) be transparent; and (5) appreciate and accommodate resource constraints. Twelve of 13 organizations participated in the focus group, and this produced 30 emerging good practices in four areas: (1) timing; (2) methodology and data; (3) partnering; and (4) characterizing engagement. Patient engagement was limited in early development of value frameworks but has increased in the past few years. Patient groups report positive experiences that can serve as emerging good practices. These groups also reported experienced challenges in their interactions and recommended good practices to mitigate those challenges. The growing pool of patient engagement experiences can be translated into good practices to advance a patient-centered, value-driven health care ecosystem. Lessons learned from these early experiences can help establish recommend emerging good practices that can eventually result in best practices and standards in the field. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc

Results of immunoscintigraphy of osteomyelitis (LeukoScan) {sup trademark}; Ergebnisse zur Immunszintigraphie der Osteomyelitis (LeukoScan) {sup trademark}

Energy Technology Data Exchange (ETDEWEB)

Gratz, S.; Becker, W. [Goettingen Univ. (Germany). Abt. fuer Nuklearmedizin

2000-05-01

99mTc-labeled antigranulocyte monoclonal antibody Fab' fragments have shown a high sensitivity and specificity for detecting osteomyelitis in prospective studies. We retrospectively evaluated the use of LeukoScan {sup trademark} (Immunomedics, Morris Plains, N.J.) in clinical routine for the detection of bone and soft tissue infections and we want to present the results of our findings as well as some of the more interesting cases in this occasion. Imaging infection can be performed fast and easy with {sup 99m}Tc-Fab' fragments due to a fast targeting of infection and good background clearance, which increases in imaging quality. The application of {sup 99m}Tc-Fab' fragments gives good results in patients with bone and soft tissue infections of peripheral bones, as well as in patients with infected prostheses and infected arthritis. The use of {sup 99m}Tc-Fab' fragments should not be limited to these patients only, since good results can also be achieved in patients with infections of vascular grafts, of appendicitis and of endocarditis as well. A higher number of false-negative results has to be expected in case of subacute/chronic infections instead. Independent of the grade of infection acute/subacute infections of the spine always show 'cold lesions'. If cold lesions are used as guide for diagnosing a pathologic finding, an increase in sensitivity together with a decrease in specificity can be achieved. (orig.) [German] {sup 99m}Tc-markierte Antigranulozytenantikoerper-Fab'-Fragmente konnten in prospektiven Studien eine hohe Sensitivitaet und Spezifitaet bei der Detektion von Osteomyelitiden unter Beweis stellen. Retrospektiv haben wir die Anwendung von {sup 99m}Tc-markierten Fab'-Fragmenten ({sup 99m}Tc-Fab') (LeukoScan {sup trademark}, Immunomedics, Morris Plains, N.J.) in der klinischen Routine zum Nachweis von Knochen- und Weichteilentzuendungen ausgewertet und moechten einen Teil unserer Ergebnisse sowie einige

Clinical value of the esophageal scintigraphy in multi-swallow technique comparing to esophageal manometry; Bedeutung der parametrisierten Oesophagusszintigraphie in Mehrfachschlucktechnik im Vergleich zur Oesophagusmanometrie

Energy Technology Data Exchange (ETDEWEB)

Eising, E.G. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Essen (Germany); Holtmann, G. [Abt. fuer Gastroenterologie, Medizinische Klinik, Univ. Essen (Germany); Reiners, C. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Essen (Germany)

1996-06-01

erhoffen. Zur Ueberpruefung dieser relativ neuen Methode wurden die Befunde der invasiven, jedoch gut standardisierten Oesophagusmanometrie mit dieser Form der Oesophagusszintigraphie verglichen. Untersucht wurden 12 Patienten 16mal mittels Manometrie und Szintigraphie (davon 4 Patienten mit Achalasie und sekundaerer Hypomotilitaet im turbulaeren Oesophagus, 7 Patienten mit unspezifischen, monometrisch nachgewiesenen Motilitaetsstoerungen und 1 Patient mit Dysphagie und unauffaelliger Manometrie). 14 der 15 manometrisch pathologischen Untersuchungen konnten szintigraphisch bestaetigt werden. Falsch negativ fielen die Manometrie und die Szintigraphie in jeweils einem Fall aus. Die ermittelten prozentualen Werte fuer die szintigraphischen Entleerungssraten nach 10 bzw. 12 s (jeweils Mittelw. {+-}Standardabw.) betrugen fuer feste Kost 56{+-}34 bzw. 60{+-}34 Prozent und fuer fluessige Kost 54{+-}25 bzw. 57{+-}22 Prozent. 48 der 60 szintigraphisch gemessenen Entleerungsraten erschienen mit unter 80% pathologisch. Erwartungsgemaess ergab sich kein signifikanter Unterschied zwischen den szintigraphischen 10 s- und 12 s-Entleerungsraten (t-Test fuer gepaarte Stichproben, 5%-Signifkanzniveau, zweiseitige Testung). Zusammenfassend erscheint das vorgestellt szintigraphische Verfahren nicht invasiv und sensitiv zur Erfassung und posttherapeutischen Verlaufskontrolle oesophagealer Motilitaetsstoerungen und kann im Einzelfall sogar ueber die manometrischen Ergebnisse hinausgehende Informationen liefern. (orig.)

Learning from patients

DEFF Research Database (Denmark)

Henriksen, Ann-Helen; Ringsted, Charlotte

2011-01-01

Prior research on the use of patients as teachers has focused on testing the effectiveness of this practice and exploring its benefits for students. However, very little is known about the added value of patient teaching and how it relates to patient-centred learning. The aim of this study...

Detection of patient psychological distress and longitudinal patient-doctor relationships: a cross-sectional study.

Science.gov (United States)

Ridd, Matthew; Lewis, Glyn; Peters, Tim J; Salisbury, Chris

2012-03-01

Psychological distress in patients who attend their GP is thought to be under-recognised. However, it is likely that both disclosure and detection are influenced by how well the patient and doctor know each another. To examine whether patient-doctor depth of relationship is associated with identification of psychological distress. Cross-sectional study in general practices in and around Bristol, England. Patients (aged ≥16 years) were asked to complete a questionnaire and consent to their electronic medical records being reviewed. Study GPs independently assessed patient psychological distress. Multivariable logistic regression was used to look for associations between patient-doctor depth of relationship and GP detection of patient psychological distress (defined according to the 12-item General Health Questionnaire, GHQ-12). There were 643 eligible appointments with 31 GPs. In total, 541 (84.1%) patients returned questionnaires and 490 (76.2%) consented to their records being reviewed. Patient-doctor depth of relationship was not associated with GP detection of mild to severe patient psychological distress (adjusted odds ratio [OR] 0.94, 95% CI = 0.87 to 1.02) but, in secondary analyses, it was associated with the identification of moderate to severe distress (adjusted OR 1.13, 95% CI = 1.02 to 1.26). GPs reported more patient psychological distress in patients who reported a greater depth of relationship but this did not relate to patients' GHQ-12 scores. Evidence to support an association between patient-doctor depth of relationship and improved GP detection of patients with psychological distress was weak, except in those patients who GPs thought were more distressed. GPs may overestimate emotional distress in patients who report deeper patient-doctor relationships.

Depression in Cancer Patients

Directory of Open Access Journals (Sweden)

Beyhan Bag

2014-06-01

Full Text Available It is not enough to consider treatment and care depression in the oncology that is the most common psychiatric illness in cancer patient affects of cancer treatment and the patient`s quality of life negatively, which is determined through researches in the field. With development of psycho-oncology it has been demonstrated to establish an important link between the cancer patient`s treatment as well as psycho-social support for the patient and psychiatric treatment and care for the if it is needed. With this connection between them it has been proposed to use of bio-psycho-social-model in cancer patient to improve their care. To achieve this goal, it is expected from medical personnel to realize patients psychosocial need und if he/she has a psychiatric disorders or syndromes. For the medical personnel that work in oncology services, it is inevitable to organize in order to raise the awareness of depression in the cancer patients. In the present study, it is focused on raising the awareness of depression in cancer patient for the medical personnel. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 186-198

Recruiting newly referred lung cancer patients to a patient navigator intervention (PACO)

DEFF Research Database (Denmark)

Kjær, Trille Kristina; Mellemgaard, Anders; Stensøe Oksen, Marianne

2017-01-01

OBJECTIVES: The incidence of and survival from lung cancer are associated with socioeconomic position, and disparities have been observed in both curative and palliative treatment for lung cancer. 'Patient navigation' is valuable in addressing health disparity, with timely treatment and transitio...... of internal and external obstacles to patients' recruitment. The study provides insight into the barriers to recruitment of socially disadvantaged cancer patients to clinical trials and will inform future trial designs....... to care. We conducted a pilot study to test the feasibility of a patient navigator program (PAtient COach) for newly diagnosed lung cancer. We present the trial, the findings from the pilot study and discuss factors that might have affected recruitment rates. MATERIAL AND METHODS: We invited 24 lung...... of 1 or 2 or be over 65 years of age. The patient navigators targeted four phases of treatment: planning, initiation, compliance and end of treatment. RESULTS: Six months after the start of the study, we had recruited only six patients, due mainly to inherent patient resistance and because only 50...

Patients' communication with doctors: a randomized control study of a brief patient communication intervention.

Science.gov (United States)

Talen, Mary R; Muller-Held, Christine F; Eshleman, Kate Grampp; Stephens, Lorraine

2011-09-01

In research on doctor-patient communication, the patient role in the communication process has received little attention. The dynamic interactions of shared decision making and partnership styles which involve active patient communication are becoming a growing area of focus in doctor-patient communication. However, patients rarely know what makes "good communication" with medical providers and even fewer have received coaching in this type of communication. In this study, 180 patients were randomly assigned to either an intervention group using a written communication tool to facilitate doctor-patient communication or to standard care. The goal of this intervention was to assist patients in becoming more effective communicators with their physicians. The physicians and patients both rated the quality of the communication after the office visit based on the patients' knowledge of their health concerns, organizational skills and questions, and attitudes of ownership and partnership. The results supported that patients in the intervention group had significantly better communication with their doctors than patients in the standard care condition. Physicians also rated patients who were in the intervention group as having better overall communication and organizational skills, and a more positive attitude during the office visit. This study supports that helping patients structure their communication using a written format can facilitate doctor-patient communication. Patients can become more adept at describing their health concerns, organizing their needs and questions, and being proactive, which can have a positive effect on the quality of the doctor-patient communication during outpatient office visits. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Cancer Patients and the Internet: a Survey Among German Cancer Patients.

Science.gov (United States)

Ebel, Marie-Desiree; Stellamanns, Jan; Keinki, Christian; Rudolph, Ivonne; Huebner, Jutta

2017-09-01

An increasing number of patients and relatives use the Internet to get additional or initial information about their disease. The aim of the study was to reevaluate the Internet usage among German cancer patients. Using a standardized questionnaire, we did an anonymous survey on patients attending a series of lectures on complementary medicine in 2014. We received 255 questionnaires. Nearly 80 % of the participants stated that they used the Internet to read up information about health or medicine issues. There was no significant difference regarding gender, age, or status (patient, current treatment/former treatment; relatives). Most users use the Internet in order to get additional information after a consultation with a physician (82.2 %). Important qualities from the view of the patient are a trustable source (65.3 %), information from experts (59.6 %), and actual information (52.8 %). There is an increasing number of patients in Germany looking for information in the Internet mostly in the intention of getting additional information. Yet, as the quality of information is heterogeneous, false information may lead to distrust in the doctor or wrong decision-making. Accordingly, organizations working on improving quality of cancer care should engage in conveying comprehensive and actual information adapted to the needs of patients. Physicians should know trustful websites for referral of patients.

Hospital pharmacists' and patients' views about what constitutes effective communication between pharmacists and patients.

Science.gov (United States)

Chevalier, Bernadette A M; Watson, Bernadette M; Barras, Michael A; Cottrell, William N

2017-12-06

The study's objective was to explore hospital pharmacists' and patients' views about what constitutes effective communication exchanges between pharmacists and patients. This was a novel theory-based qualitative study using semi-structured interviews to elicit patients' and pharmacists' perspectives. Pharmacists providing clinical pharmacy services in either inpatient or outpatient settings were recruited first. Eligible patients had been admitted to a study pharmacist's practice area and were prescribed three or more medications to manage a chronic disease(s). Following each pharmacist-patient medication counselling session, semi-structured interviews were held separately with patients and pharmacists. Participants were asked questions intended to explore their views about what constitutes an effective pharmacist-patient conversation. Audio recordings were transcribed verbatim, analysed using a process of inductive thematic analysis and then mapped to Communication Accommodation Theory strategies. Observational notes and reflexive note taking were conducted throughout. Twelve pharmacists each engaged four individual patients for a total of 48 pharmacist-patient conversations (resulting in 48 separate interviews with pharmacists and patients). An overall shared goal was the assurance of patients' confidence in managing their medications at home. Themes included shared colloquialisms/slang, well-explained information, engagement, established rapport and empowerment. Participants provided rich exemplars for each of the themes. Pharmacists and patients provided valuable insights about what makes pharmacist-patient interactions effective. Patient-identified preferences for pharmacist-patient exchanges may help guide pharmacy students and practitioners to engage patients in effective conversations. © 2017 Royal Pharmaceutical Society.

Patient-perceived surgical indication influences patient expectations of surgery for degenerative spinal disease.

Science.gov (United States)

Wilson, Thomas J; Franz, Eric; Vollmer, Carolyn F; Chang, Kate W-C; Upadhyaya, Cheerag; Park, Paul; Yang, Lynda J-S

2017-06-01

Patients frequently have misconceptions regarding diagnosis, surgical indication, and expected outcome following spinal surgery for degenerative spinal disease. In this study, we sought to understand the relationship between patient-perceived surgical indications and patient expectations. We hypothesized that patients reporting appendicular symptoms as a primary surgical indication would report a higher rate of having expectations met by surgery compared to those patients reporting axial symptoms as a primary indication. Questionnaires were administered to patients who had undergone surgery for degenerative spinal disease at 2 tertiary care institutions. Questions assessed perception of the primary indication for undergoing surgery (radicular versus axial), whether the primary symptom improved after surgery, and whether patient expectations were met with surgery. Outcomes of interest included patient-reported symptomatic improvement following surgery and expectations met by surgery. Various factors were assessed for their relationship to these outcomes of interest. There were 151 unique survey respondents. Respondents were nearly split between having a patient-perceived indication for surgery as appendicular symptoms (55.6%) and axial symptoms (44.4%). Patient-perceived surgical indication being appendicular symptoms was the only factor predictive of patient-reported symptomatic improvement in our logistic regression model (OR 2.614; 95% CI 1.218-5.611). Patient-perceived surgical indication being appendicular symptoms (OR 3.300; 95% CI 1.575-6.944) and patient-reported symptomatic improvement (OR 33.297; 95% CI 12.186-90.979) were predictive of patients reporting their expectations met with surgery in both univariate and multivariate logistic regression modeling. We found that patient-reported appendicular symptoms as the primary indication for surgery were associated with a higher rate of both subjective improvement following surgery and having expectations met

[Nutritional support response in critically ill patients; differences between medical and surgical patients].

Science.gov (United States)

Zamora Elson, M; Serón Arbeloa, C; Labarta Monzón, L; Garrido Ramírez de Arellano, I; Lander Azcona, A; Marquina Lacueva, M I; López Claver, J C; Escós Orta, J

2012-01-01

To assess the nutritional response of a group of critically ill patients, as well as the differences in the response to nutritional support between medical and surgical patients. One-year long retrospective study including critically ill patients on artificial nutrition for 7 days. Throughout the first week, three nutritional biochemical controls were done that included albumin, prealbumin, transferrin, cholesterol, and electrolytes. Other data gathered were: nutritional risk index, age, gender, weight, height, APACHE, delay of onset of nutritional support, access route, predicted and real caloric intake, medical or surgical patient, hospital stay, duration of the central venous catheter, urinary tube, and/or mechanical ventilation, incidence and density of incidence of nosocomial infections. Sixty-three patients were studied, 30 (47%) medical and 33 (53%) surgical/trauma patients, with a usage of EN higher among medical patients (16/30, 53% vs. 5/33, 15%), PN higher among surgical patients (25/33, 76%), and mixed nutrition similar in both groups (5 medical and 3 surgical patients) (p = 0.001). There were no differences between medical and surgical patients regarding: both predicted and real caloric and nitrogenous intake, APACHE, delay of onset of nutrition, phosphorus, magnesium or glucose levels, mortality and incidence of nosocomial infections. There were no differences either in hospital stay or use of mechanical ventilation, although these tended to be lower in surgical patients. The baseline biochemical parameters did not show differences between both groups, although they were worse among surgical patients. These patients presented during the study period steady albumin levels with improvement in the remaining parameters, whereas medical patients showed a decrease in albumin and transferrin levels, steady prealbumin levels, and slightly improvement in cholesterol levels. We have observed higher usage of PN among surgical patients, which showed worse

Patient life

DEFF Research Database (Denmark)

Ludvigsen, Mette Spliid

2004-01-01

Background: The hypothesis for the study is that the informal relationships amongst patients during hospitalisation have more influence on wellbeing, understanding of own illnesses and recovery than we until now have recognised in nursing. Aim: The purpose is to describe patients' experiences of ...

Patient Satisfaction With Health Services At The Out-patient ...

African Journals Online (AJOL)

Journal Home > Vol 5, No 1 (2013) > ... Introduction: The patient's view as a recipient of health care service is rarely ... This study was aimed at assessing patient satisfaction with healthcare services received at a tertiary hospital in Nigeria.

Comparison of digital selenium radiography with an analog screen-film system in the diagnostic process of pneumoconiosis according to ILO classification; Vergleich der digitalen Selenradiographie mit einem analogen Film-Folien-System in der Diagnostik von Staublungenerkrankungen anhand der ILO-Klassifikation

Energy Technology Data Exchange (ETDEWEB)

Zaehringer, M.; Winnekendonk, G.; Gossmann, A.; Krueger, K.; Krug, B. [Koeln Univ. (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Piekarski, C.; Saupe, M. [Koeln Univ. (Germany). Inst. und Poliklinik fuer Arbeitsmedizin, Sozialmedizin und Sozialhygiene; Braun, W. [Koeln Univ. (DE). Inst. fuer Medizinische Statistik, Informatik und Epidemiologie (IMSIE)

2001-10-01

Purpose: The aim of the study was to determine the diagnostic value of digital selenium radiography in patients with pneumoconiosis. For this purpose chest X-rays by digital selenium radiography and analog screen-film system were compared according to the ILO classification of pneumoconiosis. Method: After approval of the study by the local ethic commission and the Federal German Office for Radiation Protection 50 patients were subjected to X-rays by digital selenium radiography (Thoravision; Philips Medical Systems, Hamburg, Germany) and analog screen-film system of the same day within the scope of an industrial medicine preventive checkup. Four investigators rated the chest X-rays according to the ILO classification of pneumoconiosis. Results: The findings demonstrated by chest X-rays according to ILO classification were rated similar by digital selenium radiography and analog screen film systems. Image quality of the digital pictures was rated significantly better. Conclusion: The use of digital selenium radiography in evaluating chest X-rays according to the ILO classification does not result in over- or underestimation of pulmonary pathologies. Hence, in the diagnosis of pneumoconiosis, digital selenium radiography can replace the tested analog screen-film system. (orig.) [German] Ziel: Zur Ermittlung des Stellenwertes der digitalen Selenradiographie in der Diagnostik von Staublungenerkrankungen werden mittels Selenradiographie und einer analogen Film-Folienkombination angefertigte Thoraxuebersichtsaufnahmen im sagittalen Strahlengang anhand der ILO-Klassifikation fuer Staublungenerkrankungen verglichen. Methoden: Nach Genehmigung der Studie durch die oertliche Ethikkommission und das Bundesamt fuer Strahlenschutz wurden bei 50 Patienten im Rahmen einer arbeitsmedizinischen Vorsorgeuntersuchung am selben Tag Thoraxuebersichtsaufnahmen im sagittalen Strahlengang in analoger und digitaler Technik (Thoravision; Philips Medizin Systeme, Hamburg, Deutschland

Pulmonary manifestations in collagen vascular diseases; Pulmonale Manifestationen bei Kollagenosen

Energy Technology Data Exchange (ETDEWEB)

Vogel, M.N.A. [Thoraxklinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Kreuter, M. [Thoraxklinik, Universitaetsklinikum Heidelberg, Zentrum fuer interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Kauczor, H.U. [Radiologische Klinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany); Heussel, C.P. [Thoraxklinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Heidelberg (Germany); Radiologische Klinik, Universitaetsklinikum Heidelberg, Abteilung fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Translational Lung Research Center (TLRC), Heidelberg (Germany)

2016-10-15

Pulmonary complications are frequent in patients with collagen vascular diseases (CVD). Frequent causes are a direct manifestation of the underlying disease, side effects of specific medications and lung infections. The standard radiological procedure for the work-up of pulmonary pathologies in patients with CVD is multidetector computed tomography (MDCT) with thin-slice high-resolution reconstruction. The accuracy of thin-slice CT for the identification of particular disease patterns is very high. The pattern of usual interstitial pneumonia (UIP) representing the direct pulmonary manifestation of rheumatoid arthritis (RA) can be identified with a sensitivity of 45 % and a specificity of 96 %. Both direct pulmonary manifestations, drug-induced toxicity and certain infections can have a similar appearance in thin-slice MDCT in various forms of CVD. Knowledge of the patterns and causes contributes to the diagnostic certainty. At first diagnosis of a CVD and associated pulmonary symptoms thin-slice MDCT is recommended. Clinical, lung function and imaging follow-up examinations should be performed every 6-12 months depending on the results of the MDCT. In every case the individual CT morphological patterns of pulmonary involvement must be identified. The combination of information on the anamnesis, clinical and imaging results is a prerequisite for an appropriate disease management. (orig.) [German] Pulmonale Komplikationen sind bei Patienten mit Kollagenosen keine Seltenheit. Haeufig sind eine direkte Manifestation der Grunderkrankung, eine Nebenwirkung der medikamentoesen Therapie oder eine Lungeninfektion die Ursachen. Das radiologische Standardverfahren zur Klaerung pulmonaler Pathologien bei Patienten mit Kollagenosen ist die Multidetektorcomputertomographie mit duennschichtigen Rekonstruktionen (Duennschicht-MDCT). Die Treffsicherheit der Duennschicht-MDCT ist fuer die Identifikation eines Erkrankungsmusters sehr hoch. So kann beispielsweise das Muster einer

Workflow improvement and efficiency gain with near digitalization of a Radiology Department; Workflowverbesserung und Effizienzsteigerungsaspekte durch nahezu vollstaendige Digitalisierung einer Roentgenabteilung

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Langen, H.L.; Bielmeier, J.; Selbach, R. [Missionsaerztlichen Klinik Wuerzburg (Germany). Radiologische Abteilung; Wittenberg, G. [Univ. Wuerzburg (Germany). Inst. fuer Roentgendiagnostik; Feustel, H. [Missionsaerztlichen Klinik Wuerzburg (Germany). Chirurgische Abteilung

2003-10-01

Purpose: To determine the temporal changes of the workflow caused by digitalization of the radiology department after installation of digital luminescence-radiography (DLR), a radiology information system (RIS) and picture archiving and communication system (PACS) at the Missionsaerztliche Klinik in April 2000. Materials and methods: In a comparative study, a workflow analysis by manual registration of different work steps was performed before (1999) and after (2001) digitalization of a radiology department. Results: The digitalization shortened the examination time for patients from a mean of 8 min to 5 min. The time the patient is absent from the emergency room did not change. Reporting radiographic examinations including comparison with previous studies begins earlier from a mean of 2 h 37 min to 17 min. Using PACS, 85.9% of all cases could be interpreted on the day of the examination (without PACS 41.2%) and 87.2% of the reports were completed the day after the examination (without PACS 64.5%). No time differences were found between reading conventional studies on the monitor or as soft-copy. Conclusion: Compared to conventional film-screen systems, complete digitalization of a radiology department is time saving at nearly all steps of the workflow, with expected positive effects on the workflow quality of the entire hospital. (orig.) [German] Fragestellung/Zielsetzung: An der Missionsaerztlichen Klinik folgte im April 2000 mit der Einfuehrung der digitalen Lumineszenzradiographie (DLR), eines radiologischen Informationssystems (RIS) und eines Bildarchivierungs- und Kommunkationssystems (PACS) die vollstaendige Digitalisierung der Roentgenabteilung. Die durch diese Umstellung bedingten zeitlichen Veraenderungen der Prozessablaeufe in der Roentgenabteilung wurden untersucht. Material und Methode: In Form einer Vorher-Nachher-Studie wurde 1999 im konventionellen und 2001 im digitalen Routinebetrieb anhand von Analysen der Prozessablaeufe eine manuelle

Grief symptoms and difficult patient loss for oncologists in response to patient death.

Science.gov (United States)

Granek, Leeat; Ben-David, Merav; Shapira, Shahar; Bar-Sela, Gil; Ariad, Samuel

2017-07-01

The study aimed to explore oncologist's grief symptoms over patient death and to identify why and which losses are particularly challenging when patients die. The grounded theory method was used to collect and analyze the data. Twenty-two oncologists were interviewed between March 2013 and June 2014 from three adult oncology centers in the north, center, and south of Israel. Oncologists were at different stages of their careers and varied in their sub-specialties, gender, and personal and professional backgrounds. Grief begun when the patient died, in anticipation of the patient's death, many days after the death, or when the patient received a poor prognosis. The phenomenological experience of grief for oncologists included behavioral, cognitive, physical, and emotional symptoms in response to patient death. Behavioral symptoms included crying and difficulties sleeping. Cognitive symptoms included self-doubt and rumination about the patient and the care the patient had received before death. Physical symptoms included chest pain, fatigue, and general physical discomfort. Emotional symptoms included sadness, anxiety, helplessness, guilt, relief, irritability, and loss. Difficult patient loss was caused by patient-related factors, family-related factors, and disease-related factors. Patient deaths result in behavioral, cognitive, physical, and emotional symptoms of grief in oncologists. These symptoms become particularly intense in the context of patient, family, and disease-related factors. Educational and supportive interventions for managing grief related to patient death are needed in order to support oncologists in their emotionally and mentally taxing work. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Pacemakers in patients with familial dysautonomia--a review of experience with 20 patients.

Science.gov (United States)

Gold-von Simson, Gabrielle; Rutkowski, Monika; Berlin, Dena; Axelrod, Felicia B

2005-02-01

Familial dysautonomia (FD) is a genetic disease associated with a high incidence of sudden death. If fatal bradyarrhythmia is an etiological factor then the incidence of sudden death should decrease after pacemaker placement. Retrospective review of 596 registered FD patients revealed that 22 FD patients (3.7%) had pacemakers placed between December 1984 and June 2003. Clinical and electrocardiographic indications for placement and demographic data were assessed for 20 of the 22 patients (10 males, 10 females, ages 4 to 48 years). Two patients were excluded because of insufficient data. Prior to pacemaker placement, presenting symptoms were syncope and cardiac arrest, 16/20 (80%) and 6/20 (30 %), respectively. Asystole was the most frequent electrocardiographic finding and was documented in 17/20 patients (85 %). Other electrocardiographic abnormalities included bradycardia, AV block, prolonged QTc and prolonged JTc. The average duration of pacemaker utilization was 5.7 years (range 5 months to 14.5 years). Complications included infection (1 patient) and wire migration (2 patients). In the one patient with infection, the pacemaker was permanently removed. This patient then experienced multiple syncopal episodes and death. There were 7 other deaths. Three deaths occurred suddenly without preceding events, and 4 patients had non-cardiac causes of death. None of these 7 deceased patients had recurrence of syncope after pacemaker placement. In the 12 surviving patients, 6 had recurrence of syncope but none had cardiac arrest. Pacemaker placement may protect FD patients from fatal bradyarrhythmia and may decrease the incidence of syncope. However, data are limited and prospective analysis is needed.

MR findings of cerebral palsy: comparison between preterm patients and fullterm patients

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Hwang, Yoon Joon; Kim, Dong Ik; Yoon, Pyeong Ho; Jeon, Pyoung; Ryu, Young Hoon; Hwang, Geum Ju; Kim, Eun Kyung [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of); Lee, Byung Hee [Pundang Cha General Hospital, Sungnam (Korea, Republic of)

1997-09-01

To observe the MR findings of cerebral palsy by evaluating cerebral damage resulting from hypoxic ischemic injury and other variable causes and to compare the findings between preterm and full-term patients. We reviewed the MR findings of 102 cerebral palsy patients (71 full-term and 31 preterm). These were analysed with regard to deep and peripheral white matter, gray matter, basal ganglia, the thalamus, brainstem, cerebellum, corpus callosum and ventricles, according to the pattern of injury such as hypoxic ischemic injury, migration anomaly and early intrauterine injury, the findings of full-term and preterm patients were then compared. MR findings of preterm patients(n=3D31) were as follows;hypoxic ischemic injury(n=3D26),normal(n=3D2), and migration anomaly(n=3D3), while those of full-term patients(n=3D71) were hypoxic ischemic injury(n=3D41), normal(n=3D24), migration anomaly(n=3D4), early uterine injury(n=3D2), and perirolandic ischemic injury(n=3D6);in 5 patients, this latter condition was combined with status marmoratus. Periventricular leukomalacia was the most common finding in both preterm patients and full-term patients;selective neuronal necrosis, parasagittal injury and perirolandic injury were observed only in full-term patients. On MRI, variable findings of cerebral palsy were clearly observed;periventricular leukomalacia was the most common finding in both preterm and full-term patients.=20.

MR findings of cerebral palsy: comparison between preterm patients and fullterm patients

International Nuclear Information System (INIS)

Hwang, Yoon Joon; Kim, Dong Ik; Yoon, Pyeong Ho; Jeon, Pyoung; Ryu, Young Hoon; Hwang, Geum Ju; Kim, Eun Kyung; Lee, Byung Hee

1997-01-01

To observe the MR findings of cerebral palsy by evaluating cerebral damage resulting from hypoxic ischemic injury and other variable causes and to compare the findings between preterm and full-term patients. We reviewed the MR findings of 102 cerebral palsy patients (71 full-term and 31 preterm). These were analysed with regard to deep and peripheral white matter, gray matter, basal ganglia, the thalamus, brainstem, cerebellum, corpus callosum and ventricles, according to the pattern of injury such as hypoxic ischemic injury, migration anomaly and early intrauterine injury, the findings of full-term and preterm patients were then compared. MR findings of preterm patients(n=3D31) were as follows;hypoxic ischemic injury(n=3D26),normal(n=3D2), and migration anomaly(n=3D3), while those of full-term patients(n=3D71) were hypoxic ischemic injury(n=3D41), normal(n=3D24), migration anomaly(n=3D4), early uterine injury(n=3D2), and perirolandic ischemic injury(n=3D6);in 5 patients, this latter condition was combined with status marmoratus. Periventricular leukomalacia was the most common finding in both preterm patients and full-term patients;selective neuronal necrosis, parasagittal injury and perirolandic injury were observed only in full-term patients. On MRI, variable findings of cerebral palsy were clearly observed;periventricular leukomalacia was the most common finding in both preterm and full-term patients.=20

A Web-based patient information system--identification of patients' information needs.

Science.gov (United States)

Hassling, Linda; Babic, Ankica; Lönn, Urban; Casimir-Ahn, Henrik

2003-06-01

Research described here was carried out to explore possibilities of creating a web-based patient information system within the areas of thoracic surgery. Data were collected to distinguish and assess the actual information needs of patients (1) prior to surgical treatment, (2) before discharge, and (3) 8 months after the hospitalization using a follow-up questionnaire. Interviews were performed with patients undergoing heart surgery. The study included material of 19 consecutive patients undergoing coronary artery bypass surgery (12) and valve replacement (7), age 35-74, 13 males and 6 females with nonacademic background. Patient satisfaction with given information was high. Analysis of the interviews held at the hospital resulted in seven different categories describing and giving a picture of the patients' information needs and apprehension of received care. The results found in this study can be used as guidance for developers in their design and development process of a health information system.

Patient participation in the medical specialist encounter: does physicians' patient-centred communication matter?

NARCIS (Netherlands)

Zandbelt, Linda C.; Smets, Ellen M. A.; Oort, Frans J.; Godfried, Mieke H.; de Haes, Hanneke C. J. M.

2007-01-01

OBJECTIVE: Physicians' patient-centred communication is assumed to stimulate patients' active participation, thus leading to more effective and humane exchange in the medical consultation. We investigated the relationship between physicians' patient-centred communication and patient participation in

Use of Patient-Authored Prehistory to Improve Patient Experiences and Accommodate Federal Law.

Science.gov (United States)

Warner, Michael J; Simunich, Thomas J; Warner, Margaret K; Dado, Joseph

2017-02-01

Although federal law grants patients the right to view and amend their medical records, few studies have proposed a process for patients to coauthor their subjective history in their medical record. Allowing patients to fully disclose and document their medical history is an important step to improve the diagnostic process. To evaluate patients' office experience before and after they authored their subjective medical history for the electronic health record. Patients were mailed a prehistory form and presurvey to be completed before their family medicine office visit. On arrival to the office, the prehistory form was scanned into the electronic health record while the content was transcribed by hospital staff into the appropriate fields in the history component of the encounter note. Postsurveys were given to patients to be completed after their visit. Pre- and postsurveys measured the patients' perception of office visit quality as well as completeness and accuracy of their electronic health record documentation before and after their appointment. Medical staff surveys were collected weekly to measure the staff's viewpoint of the federal law that allows patients to view and amend their medical records. Of 405 patients who were asked to participate, 263 patients aged 14 to 94 years completed a presurvey and a prehistory form. Of those 263 patients, 134 completed a postsurvey. The pre- and postsurveys showed improved patient satisfaction with the office visit and high scores for documentation accuracy and completeness. Before filling out the prehistory form, 116 of 249 patients (46.6%) agreed or strongly agreed that they felt more empowered in their health care by completing the prehistory form compared with 110 of 131 (84.0%) who agreed or strongly agreed after the visit (Pprehistory form beforehand to improve the patient experience while accommodating federal law.

Patient acceptability and practical implications of pharmacokinetic studies in patients with advanced cancer.

Science.gov (United States)

Dobbs, N A; Twelves, C J; Ramirez, A J; Towlson, K E; Gregory, W M; Richards, M A

1993-01-01

We have studied the practical implications and acceptability to patients of pharmacokinetic studies in 34 women receiving anthracyclines for advanced breast cancer. The following parameters were recorded: age, ECOG performance status, psychological state (Rotterdam Symptom Checklist), cytotoxic drug and dose, number of venepunctures for treatment and sampling, and time when the sampling cannula was removed. Immediately after finishing pharmacokinetic sampling, patients completed a questionnaire which revealed that (i) all patients understood sampling was for research, (ii) 35% of patients experienced problems with sampling, (iii) benefits from participation were perceived by 56% of patients. Of 20 patients later questioned after completion of their treatment course, 40% recalled difficulties with blood sampling. Factors identifying in advance those patients who tolerate pharmacokinetic studies poorly were not identified but the number of venepunctures should be minimised. Patients may also perceive benefits from 'non-therapeutic' research.

The Angry Dying Patient.

Science.gov (United States)

Houston, Robert E.

1999-02-01

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

Patient satisfaction with cataract surgery

Directory of Open Access Journals (Sweden)

Wasfi Ehab I

2008-10-01

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

Patient loyalty model.

Science.gov (United States)

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

2015-07-06

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

Using patients as educators for communication skills: Exploring dental students' and patients' views.

Science.gov (United States)

Coelho, C; Pooler, J; Lloyd, H

2018-05-01

A qualitative study to explore the issues for patients and students when giving feedback on the communication of dental students. The Department of Health and National Institute for Health Research are committed to involving patients in improving clinical education, research and service delivery. Yet, there is a limited body of evidence on the perceptions of patients when asked to be involved in this way, and specifically when asked to provide feedback on the communication skills of dental students. This study seeks to address this gap and heighten the understanding of the issues faced by patients when asked to be involved in clinical education. Data were collected using focus groups with dental students (n=10) and patients (n=8) being treated by these students. Both groups were asked about their thoughts, feelings and beliefs about patients being asked to provide feedback on the communication skills of dental students. Data analysis involved inductive thematic analysis of transcribed audio recordings. Four themes emerged from the data: "legitimacy," "co-educators," "maintaining the equilibrium of the patient-student relationship" and the "timing of patient feedback." Support for involving patients in giving feedback on students' communication skills was established, with patients considering they were best placed to comment on the communication skills of dental students. Patients and students do not want to provide feedback alone and want support to assist them, especially if feedback was negative. Issues of anonymity, confidentiality and ownership of the feedback process were worrisome, and the positioning of patient feedback in the programme was seen as critical. Patients and students are willing to engage in patient feedback on students' communication skills, and with support and training, the concerns around this are not insurmountable and the benefits could potentially profit both groups. These findings have resonance with other healthcare educators when

User interface and patient involvement.

Science.gov (United States)

Andreassen, Hege Kristin; Lundvoll Nilsen, Line

2013-01-01

Increased patient involvement is a goal in contemporary health care, and of importance to the development of patient oriented ICT. In this paper we discuss how the design of patient-user interfaces can affect patient involvement. Our discussion is based on 12 semi-structured interviews with patient users of a web-based solution for patient--doctor communication piloted in Norway. We argue ICT solutions offering a choice of user interfaces on the patient side are preferable to ensure individual accommodation and a high degree of patient involvement. When introducing web-based tools for patient--health professional communication a free-text option should be provided to the patient users.

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.

The effect of congruence in patient and therapist alliance on patient's symptomatic levels.

Science.gov (United States)

Zilcha-Mano, Sigal; Snyder, John; Silberschatz, George

2017-05-01

The ability of alliance to predict outcome has been widely demonstrated, but less is known about the effect of the level of congruence between patient and therapist alliance ratings on outcome. In the current study we examined whether the degree of congruence between patient and therapist alliance ratings can predict symptomatic levels 1 month later in treatment. The sample consisted of 127 patient-therapist dyads. Patients and therapists reported on their alliance levels, and patients reported their symptomatic levels 1 month later. Polynomial regression and response surface analysis were used to examine congruence. Findings suggest that when the congruence level of patient and therapist alliance ratings was not taken into account, only the therapist's alliance served as a significant predictor of symptomatic levels. But when the degree of congruence between patient and therapist alliance ratings was considered, the degree of congruence was a significant predictor of symptomatic levels 1 month later in treatment. Findings support the importance of the level of congruence between patient and therapist alliance ratings in predicting patient's symptomatic levels.

Involving patients in patient safety programmes: A scoping review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care

NARCIS (Netherlands)

Trier, H.; Valderas, J.M.; Wensing, M.; Martin, H.M.; Egebart, J.

2015-01-01

BACKGROUND: Patient involvement has only recently received attention as a potentially useful approach to patient safety in primary care. OBJECTIVE: To summarize work conducted on a scoping review of interventions focussing on patient involvement for patient safety; to develop consensus-based

Internet based patient pathway as an educational tool for breast cancer patients.

Science.gov (United States)

Ryhänen, Anne M; Rankinen, Sirkku; Tulus, Kirsi; Korvenranta, Heikki; Leino-Kilpi, Helena

2012-04-01

The aim of this paper was to describe the process of developing an Internet-based empowering patient education program for breast cancer patients and to evaluate the quality of the program from the perspective of patients. In this program, the patient pathway was used as an educational tool. The Breast Cancer Patient Pathway (BCPP) was developed and tested at one Finnish university hospital in 2005-2007. Thirty-eight newly diagnosed breast cancer patients used the program during their treatment process until the end of all treatments (average 9 months) in 2008-2010. After the treatments the patients evaluated the content, language and structure, instructiveness, external appearance and technical characteristics of the web site as subcategories with the Evaluating Internet Pages of Patient Education instrument, which is a 37-item Likert scale (1-4) questionnaire. Comparison between the subcategories was done with Friedman's test. Dependencies between demographic variables and evaluation values were tested with Pearson correlation coefficients. The mean value of all evaluation criteria was 3.40. However, patients' evaluations between different subcategories varied, being the highest in language and structure (mean 3.48) and lowest in content (mean 3.13). Language and structure, external appearance and technical characteristics were significantly better than content, and language and structure better than instructiveness. Significant correlations were not found between demographic variables and evaluation values. Patients evaluated the quality of the BCPP to be best in language and structure and weakest in content. In terms of future development of the BCPP, the most improvement is needed in content and instructiveness. There is also a need for further development and study of Internet-based patient education. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Patients' views of patient-centred care: a phenomenological case study in one surgical unit.

Science.gov (United States)

Marshall, Amy; Kitson, Alison; Zeitz, Kathryn

2012-12-01

To report a study of patients' views of patient-centred care. The study aimed to explore patients' understanding and conceptualization of patient-centred care and link it to existing literature on the topic. Patient-centred care currently lacks a widely accepted definition, with much of the literature based on definitions formulated by health professionals and researchers. Qualitative research study grounded in phenomenology. Interpersonal interviews were conducted with ten participants who were patients in a surgical ward in a large metropolitan hospital in South Australia in 2010. Participants were unfamiliar with the concept of patient-centred care, but despite this, were able to describe what the term meant to them and what they wanted from their care. Patients equated the type and quality of care they received with the staff that provided it and themes of connectedness, involvement and attentiveness were prevalent in their descriptions of what they wanted from their care. Ensuring that patients have a voice in the definition and conceptualization of patient-centred care is essential and further and regular consultation with patients about their needs and priorities will ensure an integrated approach to patient-centred care. © 2012 Blackwell Publishing Ltd.

Patient representatives? views on patient information in clinical cancer trials

OpenAIRE

Dellson, Pia; Nilbert, Mef; Carlsson, Christina

2016-01-01

Background Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informed consent is possible to provide. We explored patient representatives? views and perceptions on the written trial information used in clinical cancer trials. Methods Written patient information leaflet...

HRET patient safety leadership fellowship: the role of "community" in patient safety.

Science.gov (United States)

Leonhardt, Kathryn Kraft

2010-01-01

Community engagement is widely endorsed but poorly defined as a strategy to improve patient safety. With strong evidence that engaging patients can positively influence health outcomes, it is presumed that community engagement could improve patient safety. Leaning on the models from other disciplines such as public health, the adequate knowledge and application of the principles of community engagement are critical for this approach to be effective. This article provides a description of the theories supporting patient partnership and community engagement, reviews critical elements of successful community-based programs, and identifies the potential for empowering communities to improve patient safety.

MR-arthrography of the acetabular labrum - radiologic-pathologic correlation in 20 cadaveric hip joints; MR-Arthrographie des Labrum acetabulare - Radiologisch-anatomische Korrelation an 20 Leichenhueften

Energy Technology Data Exchange (ETDEWEB)

Brossmann, J.; Steffens, J.C.; Heller, M. [Kiel Univ. (Germany). Klinik fuer Diagnostische Radiologie; Ploetz, G.M.J.; Hassenpflug, J. [Kiel Univ. (Germany). Klinik fuer Orthopadie

1999-08-01

Veraenderungen. Material und Methoden: Zwanzig Leichenhueftgelenke wurden mit der MRa untersucht. Unter Durchleuchtung erfolgte die intraartikulaere Injektion von 15 ml einer Mischung aus Solutrast 300 und Gd-DTPA (Mischungsverhaeltnis 100:1). Anschliessend wurden die Hueftgelenke mit einem 1,5 T MRT (Vision, Siemens) untersucht (FOV 16 cm, Matrix 256x256, fettunterdrueckte 3D-FLASH Sequenz). Bildrekonstruktionen erfolgten senkrecht zum Pfanneneingang in schraeg-koronaren, schraeg-transversalen und radialen Schichten. Die Hueftpraeparate wurden makroskopisch aufgearbeitet. Ergebnisse: Bei 12-20 Hueftgelenken (60%) fand sich ein pathologischer Befund des Labrum acetabulare. Bei 7 Praeparaten war das Labrum in der Belastungszone teilweise oder voellig abgeloest. Das Labrum acetabulare war in einem Fall lappenfoermig veraendert; 4 Hueftgelenke wiesen ein degeneriertes Labrum auf (eine zystische Degeneration). Pathologische Labrumbefunde wurden in 8/12 Faellen (Sensitivitaet 67%) richtig erkannt. Degenerationen des Labrum wurden in allen Faellen richtig diagnostiziert. Drei kleine Labrumabloesungen und die lappenfoermige Veraenderung wurden nicht richtig erkannt. Es wurde kein falsch positiver Befund erhoben (Spezifitaet 100%; Genauigkeit 80%). Labrumlaesionen fanden sich bei 6/8 Hueftgelenken mit Arthrose und bei 6/12 der Praeparate ohne Arthrose. Schlussfolgerungen: Die MRa stellt das Labrum acetabulare in den meisten Faellen ausreichend dar. Kleine Labrumabloesungen und anatomische Varianten sind nur schwierig und mit viel Erfahrung zu erkennen. Labrumlaesionen zeigen sich haeufig im Rahmen einer Coxarthrose, jedoch auch bei einem aelteren Kollektiv ohne signifikante Arthrose. (orig.)

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

Science.gov (United States)

2011-02-11

... Organizations: Voluntary Delisting From Community Medical Foundation for Patient Safety AGENCY: Agency for... Medical Foundation for Patient Safety, of its status as a Patient Safety Organization (PSO). The Patient... notification from Community Medical Foundation for Patient Safety, PSO number P0029, to voluntarily relinquish...

76 FR 60495 - Patient Safety Organizations: Voluntary Relinquishment From the Patient Safety Group

Science.gov (United States)

2011-09-29

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From the Patient Safety Group AGENCY: Agency for Healthcare Research and... voluntary relinquishment from The Patient Safety Group of its status as a Patient Safety Organization (PSO...

Mediating Effects of Patients' Stigma and Self-Efficacy on Relationships Between Doctors' Empathy Abilities and Patients' Cellular Immunity in Male Breast Cancer Patients.

Science.gov (United States)

Yang, Ningxi; Cao, Yingnan; Li, Xiaoyan; Li, Shiyue; Yan, Hong; Geng, Qingshan

2018-06-12

BACKGROUND Doctors' empathy is closely related to patients' health. This study aimed to examine whether patients' stigma and self-efficacy play a mediating role in the relationship between doctors' empathy abilities and patients' cellular immunity in male patients with breast cancer. MATERIAL AND METHODS Doctors' empathy scores and patients' demographic data, disease condition, stigma, and self-efficacy were measured. Patient T cell subset was tested at admission and 3 months after the operation and was compared by paired t test. The multivariate linear regression model was applied to analyze the factors influencing the immune index. Pearson correlation analysis and structural equation modeling were applied to explore the relationships among patients' stigma, self-efficacy, and cellular immunity and doctors' empathy abilities. RESULTS At the 2 time points, only the change in NK subset was statistically significant, while the changes in percentage of CD3+, CD4+, CD8+, and B cells were not statistically significant. The doctors' empathy abilities were negatively correlated with patients' stigma and were positively related to patients' self-efficacy. Patients' stigma was negatively related to NK subset, while self-efficacy was positively associated with NK subset. Patients' stigma and self-efficacy played a mediating role in the relationship between doctors' empathy abilities and patients' NK subset, and stigma had a stronger effect than self-efficacy. CONCLUSIONS Doctors' empathy abilities affected breast cancer patients' NK subset through their stigma and self-efficacy. The mental health of male breast cancer patients need more attention and empathy education needs to be improved.

Importance of patient centred care for various patient groups.

NARCIS (Netherlands)

Rademakers, J.J.D.J.M.; Delnoij, D.M.J.; Boer, D. de

2010-01-01

Background: Though patient centred care is a somewhat ‘fuzzy’ concept, in general it is considered as something to strive for. However, preliminary evidence suggests that the importance of elements of patient-centred care (PCC), such as communication, information and shared decision making, may vary

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.

Refusal of Treatment by Mentally Competent Patient: The Choice of Doctor-Patient Relationship Models

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Andrei M. Beliaev

2010-01-01

Full Text Available Introduction: In modern medicine professional relationship between the clinician and the patient is patient-centered. Patients become actively involved in the treatment decision making process and are encouraged to express their health-related preferences. Some patients may, however, refuse a favorable risk/benefit ratio treatment. This manuscript presents three cases of refusal of treatment by mentally competent surgical patients and discusses differences in their management. Conclusion: To achieve the best medical outcome for patients who possess the Actual Understanding test of mental competence clinicians use the deliberate model of medical professional relationship. For patients demonstrating the Understanding test of mental competence and wishing to utilize their health-related preferences physicians are obliged to deploy the interpretive model of doctor-patient relationship. In mentally competent patients with an illness-induced acute psychological regression the interpretive model of doctor-patient relationship as an initial strategy and cognitive behavior therapy can be useful in modifying treatment rejecting behavior and improving medical outcome.

 Nutritional care of Danish medical in-patients - patients' perspectives

DEFF Research Database (Denmark)

Lassen, Karin Østergaard; Kruse, Filip; Bjerrum, Merete

2005-01-01

with the nutritional care.The patients includeed a total of 91 medical inpatients at two internal medical wards, aarhus University Hospital, Denmark. Their average age was 72 (+/-) 11 yerars. They were individually interviewed about the fodd service ad the nutritinal care upon discharge.Patients satifaction...... with the meals was overall high (90%). About 80% found the meals to be very important, but they lacked information about the food service, and the patient-staff communication about the food service was poor. The reults indicate that the nursing staff was exercising a 'knowledge monopoly' in relation to the food...... service. In conclusion, a majority of the patients dis not perceive the nutritional care as part of the therapy and nursing care during their hospitalization....

Problem in tracheostomy patient care: recognizing the patient with a displaced tracheostomy tube.

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Seay, S J; Gay, S L

1997-01-01

There are times when a tracheostomy tube slips out of the trachea. A displaced tracheostomy tube can occur in any patient but is frequently seen in the patient with a full neck. In the overweight patient or patient with a full neck, the tracheostomy tube must pass through a greater amount of soft tissue. Because of this, a smaller portion of the tube is actually within the lumen of the trachea. When the patient coughs excessively or moves the head, the tube can easily slip out of the trachea and into the interstitial tissues of the neck. If the patient has complete obstruction of the upper airway, a displaced tracheostomy tube will result in immediate respiratory distress and can lead to respiratory arrest. If the patient has an intact or at least a partially open upper airway, the displaced tube may not cause an immediate problem. Therefore, displacement of the tracheostomy tube may not be obvious in the patient with a partial airway.

Denying a patient's final will: public safety vs. medical confidentiality and patient autonomy.

Science.gov (United States)

Gaertner, Jan; Vent, Julia; Greinwald, Ralf; Rothschild, Markus A; Ostgathe, Christoph; Kessel, Rene; Voltz, Raymond

2011-12-01

Especially when caring for patients approaching the end of life, physicians and nursing staff feel committed to fulfilling as many patient desires as possible. However, sometimes a patient's "final will" may threaten public safety. This can lead to severe conflicts, outweighing the physician's obligation and dedication to care for the patient and to respect his autonomy. Yet, public safety can be threatened if confidentiality is not broken. This article provides a concise summary of the medicolegal and ethical fundamentals concerning this difficult situation. If the patient's and others' health and safety are at risk, physicians may (and in some countries must) break medical confidentiality and disclose confidential patient information to the police and other authorities. Physicians should be able to professionally deal with such a conflict in all patients, not only in patients with advanced illness. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

The patient-doctor relationship: a synthesis of the qualitative literature on patients' perspectives.

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Ridd, Matthew; Shaw, Alison; Lewis, Glyn; Salisbury, Chris

2009-04-01

The patient-doctor relationship is an important but poorly defined topic. In order to comprehensively assess its significance for patient care, a clearer understanding of the concept is required. To derive a conceptual framework of the factors that define patient-doctor relationships from the perspective of patients. Systematic review and thematic synthesis of qualitative studies. Medline, EMBASE, PsychINFO and Web of Science databases were searched. Studies were screened for relevance and appraised for quality. The findings were synthesised using a thematic approach. From 1985 abstracts, 11 studies from four countries were included in the final synthesis. They examined the patient-doctor relationship generally (n = 3), or in terms of loyalty (n = 3), personal care (n = 2), trust (n = 2), and continuity (n = 1). Longitudinal care (seeing the same doctor) and consultation experiences (patients' encounters with the doctor) were found to be the main processes by which patient-doctor relationships are promoted. The resulting depth of patient-doctor relationship comprises four main elements: knowledge, trust, loyalty, and regard. These elements have doctor and patient aspects to them, which may be reciprocally related. A framework is proposed that distinguishes between dynamic factors that develop or maintain the relationship, and characteristics that constitute an ongoing depth of relationship. Having identified the different elements involved, future research should examine for associations between longitudinal care, consultation experiences, and depth of patient-doctor relationship, and, in turn, their significance for patient care.

Radiological protection of patients

International Nuclear Information System (INIS)

Niroomand-Rad, A.

2003-01-01

The benefits of ionizing radiation in the diagnosis and treatment of cancer, as well as other conditions such as cardiac ablation, are well established. However determination, monitoring, and evaluation of patient doses is not as easy task. Furthermore, radiation doses for individual patients may vary greatly from one radiological procedure to another. Attention is needed to reduce unnecessary radiation exposure to patients from All types of radiation producing machines and equipment. The patient risk from radiation injury-stochastic and/or deterministic must be weighted against the benefits of a proper medical examination or treatment as well as the risk of depriving the patient from the necessary medical care. Arbitrary reduction of radiological patient doses without regard to final outcome is determined to proper medical care provided to the patient. Sacrificing image quality in order to reduce patient dose is potentially harmful to the patient as well. Furthermore, the role of radiation exposure incurred from screening procedures such as mammography, needs to be properly considered and differentiated from medically indicated procedures. A known radiation induced risk needs to be balanced against diagnostic efficacy of a screening procedure. In these cases, regulations on standards and guidelines for determination, monitoring, and evaluation of patient doses may be appropriate. In this paper, the technical data collected in the United States have been compared with the corresponding data in Canada. However, even here, it has been recognized that we can not assume that one dose limit fits all. It is advisable to consider individual patient specifics if it means the difference between detection and miss

Shared Decision Making and Effective Physician-Patient Communication: The Quintessence of Patient-Centered Care

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Huy Ming Lim

2015-03-01

Full Text Available The Institute of Medicine’s (IOM 2001 landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, identified patient-centeredness as one of the fundamental attributes of quality health care, alongside safety, effectiveness, timeliness, efficiency, and equity. The IOM defined patient-centeredness as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” This concept of patient-centered care represents a paradigm shift from the traditional disease-oriented and physician-centered care, grounding health care in the subjective experience of illness and the needs and preferences of individual patients rather than the evaluation and treatment of diseases which emphasizes on leveraging clinical expertise and evidence derived from population-based studies. Regrettably, despite the ubiquitous talk about patient-centered care in modern health care, shared decision-making and effective physician-patient communication—the two cruxes of patient-centered care—are yet to become the norms. Strategies to promote and enhance shared decision-making and effective communication between clinicians and patients should be rigorously implemented to establish a health care system that truly values patients as individuals and turn the rhetoric of patient-centered care into reality.

Patient-Centered Prescription Model to improve therapeutic adherence in patients with multimorbidity

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Javier González-Bueno

2018-05-01

Full Text Available To date, interventions to improve medication adherence in patients with multimorbidity have shown modest and inconsistent efficacy among available studies. Thereby, we should define new approaches aimed at improving medication adherence tailored to effective prescribing, with a multidisciplinary approach and patient-centered. In this regard, the Patient-Centered Prescription Model has shown its usefulness on improving appropriateness of drug treatments in patients with clinical complexity. For that, this strategy addresses the following four steps: 1 Patient-Centered assessment; 2 Diagnosis-Centered assessment; 3 Medication-Centered assessment; and 4 Therapeutic Plan. We propose through a clinical case an adaptation of the Patient-Centered Prescription Model to enhance both appropriateness and medication adherence in patients with multimorbidity. To this end, we have included on its first step the Spanish version of a cross-culturally adapted scale for the multidimensional assessment of medication adherence. Furthermore, we suggest a set of interventions to be applied in the three remaining steps of the model. These interventions were firstly identified by an overview of systematic reviews and then selected by a panel of experts based on Delphi methodology. All of these elements have been considered appropriate in patients with multimorbidity according to three criteria: strength of their supporting evidence, usefulness in the target population and feasibility of implementation in clinical practice. The proposed approach intends to lay the foundations for an innovative way in tackling medication adherence in patients with multimorbidity.

Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care.

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Yedidia, Michael J

2007-01-01

Palliative care was studied for its potential to yield lessons for transforming doctor-patient relationships to promote patient-centered care. Examination of patient and provider experiences of the transition from curative to palliative care promises valuable insights about establishing and maintaining trust as the goals of care shift and about addressing a broad spectrum of patient needs. The study was guided by a conceptual framework grounded in existing models to address five dimensions of doctor-patient relationships: range of needs addressed, source of authority, maintenance of trust, emotional involvement, and expression of authenticity. Data collection included observation of the care of 40 patients in the inpatient hospice unit and at home, interviews with patients and family members, and in-depth interviews with 22 physicians and two nurses providing end-of-life care. Standard qualitative procedures were used to analyze the data, incorporating techniques for maximizing the validity of the results and broadening their relevance to other contexts. Findings provide evidence for challenging prominent assumptions about possibilities for doctor-patient relationships: questioning the merits of the prohibition on emotional involvement, dependence on protocols for handling difficult communication issues, unqualified reliance on consumer empowerment to assure that care is responsive to patients' needs, and adoption of narrowly defined boundaries between medical and social service systems in caring for patients. Medical education can play a role in preparing doctors to assume new roles by openly addressing management of emotions in routine clinical work, incorporating personal awareness training, facilitating reflection on interactions with patients through use of standardized patients and videotapes, and expanding capacity to effectively address a broad range of needs through teamwork training.

Reconstruction of alveolar defects in patients with cleft lip and palate - 111 consecutive patients

DEFF Research Database (Denmark)

Andersen, Kristian

2012-01-01

Reconstruction of alveolar defects in patients with cleft lip and palate - 111 consecutive patients......Reconstruction of alveolar defects in patients with cleft lip and palate - 111 consecutive patients...

Characteristic risk factors in cirrhotic patients for posthepatectomy complications: comparison with noncirrhotic patients.

Science.gov (United States)

Itoh, Shinji; Uchiyama, Hideaki; Kawanaka, Hirofumi; Higashi, Takahiro; Egashira, Akinori; Eguchi, Daihiko; Okuyama, Toshiro; Tateishi, Masahiro; Korenaga, Daisuke; Takenaka, Kenji

2014-02-01

There seemed to be characteristic risk factors in cirrhotic patients for posthepatectomy complications because these patients have less hepatic reserve as compared with noncirrhotic patients. The aim of the current study was to identify these characteristic risk factors in cirrhotic patients. We performed 419 primary hepatectomies for hepatocellular carcinoma. The patients were divided into the cirrhotic group (n = 198) and the noncirrhotic group (n = 221), and the risk factors for posthepatectomy complications were compared between the groups. Thirty-six cirrhotic patients (18.2%) experienced Clavien's Grade III or more complications. Tumor size, intraoperative blood loss, duration of operation, major hepatectomy (two or more segments), and necessity of blood transfusion were found to be significant risk factors in univariate analyses. Multivariate analysis revealed that major hepatectomy and intraoperative blood loss were independent risk factors for posthepatectomy complications in patients with cirrhosis. On the other hand, the duration of operation was only an independent risk factor for posthepatectomy complication in noncirrhotic patients. Cirrhotic patients should avoid a major hepatectomy and undergo a limited resection preserving as much liver tissue as possible and meticulous surgical procedures to lessen intraoperative blood loss are mandatory to prevent major posthepatectomy complications.

Quality of life and mediating role of patient scar assessment in burn patients.

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Oh, Hyunjin; Boo, Sunjoo

2017-09-01

In this study, we examined the plausibility of the mediating effect of the levels of patient scar assessment on the relationship between burn severity measured with total body surface area and burn-specific health-related quality of life (HRQL) among patients with burns in South Korea. In this cross sectional descriptive study, we collected data from 100 burn patients in three burn centers specializing in burn care in South Korea. Patient scar assessment, burn specific HRQL, and burn-related characteristics were self-reported with anonymous, paper-based surveys. The findings showed a positive correlation between burn severity, patient scar assessment, and HRQL in burn patients. The evidence of this paper is that quality of life after burns more determined by scar characteristics than burn severity. In the light of the poor HRQL in burn patients, the results of this study support that improving scar status could improve patients' HRQL. Health care providers should keep in mind that patients' perspectives of their scars would be a great indicator of their HRQL, so the providers' focus should be on intensive scar management intervention in their care. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Why measure patient satisfaction?

Science.gov (United States)

Riskind, Patty; Fossey, Leslie; Brill, Kari

2011-01-01

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

e effect of nurse-patient language barrier on patients' satisfaction

International Nuclear Information System (INIS)

Ali M. Al-Khathami; Sulieman W. Kojan; Mohammed A. Aljumah; Hussein Alqahtani; Hind Alrwaili

2010-01-01

To study Saudi patients' perception of nursing care delivered by non-Arabic speaking nurses (NASNs). A cross-sectional survey of randomly selected patients admitted to King Abdul-Aziz Medical City, Riyadh, Saudi Arabia during the summer of 2009. We conducted structured face-to-face interviews, and the Institutional Review Board approved the study. 47% were men. Half was illiterate or had a low level of education. Eighty percent was served by NASNs. Most believed that the Arabic language is important to provide high quality of care. Two thirds reported difficulties in understanding nursing instructions, and felt that NASNs could not understand their concerns on many occasions. Half believed that NASNs are more susceptible to error. Seventy percent felt uncomfortable dealing with a nurse who cannot communicate in the same language, and 30% question the reliability of information delivered by NASNs. Patients noticed that NASN avoid (50%) or end conversation (70%) due to language barriers. Sixty-one percent reported that NASNs never or rarely called the interpreter. Overall satisfaction of nursing care was high (90%), with no significant difference between patients who were served by Arabic versus NASNs. Our patients were concerned about the language barrier during nursing care delivery. It may lead to miscommunication and compromise the patient-nurse relationship. Further exploration of this issue (Author).

Postoperative pain and patient-controlled epidural analgesia-related adverse effects in young and elderly patients: a retrospective analysis of 2,435 patients

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Koh JC

2017-04-01

Full Text Available Jae Chul Koh, Young Song, So Yeon Kim, Sooyeun Park, Seo Hee Ko, Dong Woo Han Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea Abstract: In this retrospective study, data of 2,435 patients who received fentanyl and ropivacaine-based patient-controlled epidural analgesia (PCEA for pain relief after elective surgery under general or spinal anesthesia were reviewed. Differences in postoperative pain, incidence of patient-controlled analgesia (PCA-related adverse effects, and risk factors for the need for rescue analgesics for 48 hours postsurgery in young (age 20–39 years and elderly (age ≥70 years patients were evaluated. Although there were no significant differences in postoperative pain intensity between the two groups until 6 hours postsurgery, younger patients experienced greater postoperative pain intensity compared with older patients 6–48 hours postsurgery. While younger patients exhibited greater incidence of numbness, motor weakness, and discontinuation of PCA postsurgery, elderly patients exhibited greater incidence of hypotension, nausea/vomiting, rescue analgesia, and antiemetic administration. Upon multivariate analysis, low fentanyl dosage and history of smoking were found to be associated with an increased need for rescue analgesia among younger patients, while physical status classification III/IV and thoracic surgery were associated with a decreased need for rescue analgesia among the elderly. Discontinuation of PCA was more frequent among younger patients than the elderly (18.5% vs 13.5%, P=0.001. Reasons for discontinuation of PCA among young and elderly patients, respectively, were nausea and vomiting (6.8% vs 26.6%, numbness or motor weakness (67.8% vs 11.5%, urinary retention (7.4% vs 8.7%, dizziness (2.2% vs 5.2%, and hypotension (3.1% vs 20.3%. In conclusion, PCEA was more frequently associated with numbness, motor

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.

Designing User-Centric Patient Portals: Clinician and Patients' Uses and Gratifications.

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Alpert, Jordan M; Krist, Alex H; Aycock, Rebecca A; Kreps, Gary L

2017-03-01

Legislation mandates that clinicians make patients' medical information available digitally. This has resulted in hurriedly installing patient portals that do not fully meet the needs of patients or clinicians. This study examined a specific portal, MyPreventiveCare (MPC), a patient-centered portal designed to promote preventive care to consumers, to elicit recommendations from patients and clinicians about how it could be more beneficial by uncovering their uses and gratifications (U&G). In-depth interviews with 31 patients and two clinician focus groups were conducted. Multiple methods were utilized, such as grounded theory coding to develop themes and content analysis to classify responses according to the U&G framework. Four main categories emerged that users desire to be included in health portals: integration with technology (27%), coordination of care (27%), incorporation of lifestyle (26%), and increased control (20%). Additional analysis revealed that health portals are mainly utilized to fulfill cognitive and affective needs, with over 80% of recommendations related to the U&G categories of cognitive and affective needs. Cognitive (60%), affective (21%), social integrative (10%), personal integrative (9%), and tension release (0%). Portals will continue to evolve and become important health communication tools if they address the user's perspective and are inclusive of new technological advances. Specifically, portals must become more user centric and incorporate aspects of the patients' lifestyle and integrate health information technology.

Heart failure patients monitored with telemedicine: patient satisfaction, a review of the literature.

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Kraai, I H; Luttik, M L A; de Jong, R M; Jaarsma, T; Hillege, H L

2011-08-01

Remote monitoring of the clinical status of heart failure patients has developed rapidly and is the subject of several trials. Patient satisfaction is an important outcome, as recommended by the U.S. Food and Drug Administration to use in clinical research, and should be included in studies concerning remote monitoring. The objective of this review is to describe the current state of the literature on patient satisfaction with noninvasive telemedicine, regarding definition, measurement, and overall level of patient satisfaction with telemedicine. The Pubmed, Embase, Cochrane, and Cinahl databases were searched using heart failure-, satisfaction-, and telemedicine-related search terms. The literature search identified 193 publications, which were reviewed by 2 independent reviewers. Fourteen articles were included. None of the articles described a clear definition or concept of patient satisfaction with telemedicine. Patient satisfaction with telemedicine was measured with self-developed questionnaires or face-to-face or telephonic interviews. None of the articles used the same questionnaire or telephonic survey to measure patient satisfaction. Only one questionnaire was assessed for validity and reliability. In general, patients seemed to be satisfied or very satisfied with the use of telemedicine. Measurement of patient satisfaction is still underexposed in telemedicine research and the measurement of patient satisfaction with telemedicine underappreciated with poorly constructed questionnaires. Copyright © 2011 Elsevier Inc. All rights reserved.

Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work?

Science.gov (United States)

Mahmoudian, Ahmad; Zamani, Ahmadreza; Tavakoli, Neda; Farajzadegan, Ziba; Fathollahi-Dehkordi, Fariba

2017-01-01

It is assumed that doctor-patient relationship plays an effective role in patients' satisfaction, medication adherence, and health outcomes since exploring different aspects of this relationship, such as addressing medication adherence, has rarely been investigated. Therefore, the main aim of the present study was to assess the impact of patients' satisfaction derived from communicating with doctors on medication adherence in hypertensive patients. This cross-sectional survey was conducted on three hundred patients with hypertension, using multistage sampling technique in health care centers in Isfahan, Iran. Data were collected by two questionnaires comprised (1) patients' satisfaction derived from the relationship with doctors and (2) medication adherence named "Morisky Medication Adherence Scale" with 8 items. Multivariate logistic regression model was applied to test the odds ratio (OR) of patients' satisfaction resulting from the relationship with physicians in numerous aspects in two groups: appropriate and inappropriate medication adherence. A lower level of satisfaction derived from building the relationship (confidence interval [CI] =0.95, 0.06-0.71 and OR = 0.20) and empathy subscales (CI = 0.95, 13-0.80 and OR = 0.33) was associated with nonadherence to treatment after controlling the physicians' gender and patients' age, gender, education, and duration of disease. Patients' satisfaction resulting from building the relationship and empathy with physicians appeared to be associated with medication adherence among hypertensive patients.

Physician-patient communication in HIV disease: the importance of patient, physician, and visit characteristics.

Science.gov (United States)

Wilson, I B; Kaplan, S

2000-12-15

Although previous work that considered a variety of chronic conditions has shown that higher quality physician-patient communication care is related to better health outcomes, the quality of physician-patient communication itself for patients with HIV disease has not been well studied. To determine the relationship of patient, visit, physician, and physician practice characteristics to two measures of physician-patient communication for patients with HIV disease. Cross-sectional survey of physicians and patients. Cohort study enrolling patients from throughout eastern Massachusetts. 264 patients with HIV disease and their their primary HIV physicians (n = 69). Two measures of physician-patient communication were used, a five-item general communication measure (Cronbach's alpha = 0.93), and a four-item HIV-specific communication measure that included items about alcohol, drug use, and sexual behaviors (Cronbach's alpha = 0.92). The mean age of patients was 39. 5 years, 24% patients were women, 31.1% were nonwhite, and 52% indicated same-sex contact as their principal HIV risk factor. The mean age of physicians was 39.1 years, 33.3% were female, 39.7% were specialists, and 25.0% self-identified as gay, lesbian, or bisexual. In multivariable models relating patient and visit characteristics to general communication, longer reported visit length (pbetter communication. The interaction of patient gender and visit length was also significant (p =.02); longer visit length was more strongly associated with better general communication for male than female patients. In similar models relating patient and visit characteristics to HIV-specific communication, longer visit length (p better communication. In multivariable models relating physician and practice characteristics to general communication no variables were significant. However, both female physician gender (p =.002) and gay/lesbian/bisexual sexual preference (p =.003) were significantly associated with better HIV

Agreement between touch-screen and paper-based patient-reported outcomes for patients with fibromyalgia

DEFF Research Database (Denmark)

Wæhrens, Eva Elisabet Ejlersen; Amris, Kirstine; Bartels, Else Marie

2015-01-01

OBJECTIVES: To compare data based on computerized and paper versions of health status questionnaires (HSQs) for sampling patient-reported outcomes (PROs) in patients with fibromyalgia (FM). In addition, to examine associations between patient characteristics (age, education, computer experience......) and differences between versions. Finally, to evaluate the acceptability of computer-based questionnaires among patients with FM. METHOD: The study population comprised female patients diagnosed with FM. All patients completed six HSQs: the Fibromyalgia Impact Questionnaire (FIQ), the Major Depression Inventory...

MRT of scaphoid pseudo-arthrosis using Gd-DTPA. Staging and clinical correlation; MRT der Skaphoidpseudarthrose mit Gd-DTPA. Stadieneinteilung und klinische Korrelation

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Vogl, T.J. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Beutel, F. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Wilhelm, K. [LMU Muenchen (Germany). Abt. fuer Handchirurgie; Tempka, A. [Freie Univ. Berlin (Germany). Klinik fuer Unfall- und Wiederherstellungschirurgie; Schedel, H. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Haas, R. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Felix, R. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik

1994-11-01

During a period of two years, 134 patients with pseudo-arthrosis of the scaphoid were examined by conventional radiography and by MRI in the course of a prospective study. The aim of the study was to define radiological staging using contrast enhanced MRI in order to improve the prognostic criteria. All MRI examinations were carried out with a 1.5 Tesla scanner (SP63) using a surface coil and T{sub 1} weighted spin echo sequences in sagittal and frontal projection and frontal FLASH T{sub 2}-sequences and axial spin echo T{sub 2} sequences. The T{sub 1} weighted SE sequences in frontal projection were carried out before and after iv contrast (0.1 mmol Gd-DTPA/kg KG). All sequences were compared with conventional radiographs and the operative findings. Eight patients in stage 0 showed high signal intensity of both fragments in T{sub 1} weighted SE sequences and at surgery there was good vascularisation. In 22 cases there was reduced signal intensity in at least one fragment (stage I). 45 patients with scaphoid pseudo-arthrosis showed complete signal loss but marked contrast uptake with still vital nuclei at surgery (stage II). In 22 patients, there was no increase in signal intensity after contrast and complete loss of vitality of the fragments at surgery. Staging was not possible in 37 patients because of previous operative intervention. The use of contrast enhanced MRI provides additional information compared with conventional radiography or plain MRI. (orig.) [Deutsch] Im Rahmen einer prospektiven Studie wurden in einem Zeitraum von 2 Jahren 134 Patienten mit einer Skaphoidpseudarthrose (SPA) vergleichend konventionell roentgenologisch und magnetresonanztomographisch untersucht. Ziel der Studie war die Erstellung einer klinisch radiologischen Stadieneinteilung mit Hilfe der kontrastverstaerkten MRT zur Verbesserung von Prognosekriterien. Alle MRT-Untersuchungen wurden an einem 1,5 Tesla-Geraet (SP63) mittels einer Oberflaechenspule unter Verwendung von T{sub 1

Economic Evaluation of a Patient-Directed Music Intervention for ICU Patients Receiving Mechanical Ventilatory Support.

Science.gov (United States)

Chlan, Linda L; Heiderscheit, Annette; Skaar, Debra J; Neidecker, Marjorie V

2018-05-04

Music intervention has been shown to reduce anxiety and sedative exposure among mechanically ventilated patients. Whether music intervention reduces ICU costs is not known. The aim of this study was to examine ICU costs for patients receiving a patient-directed music intervention compared with patients who received usual ICU care. A cost-effectiveness analysis from the hospital perspective was conducted to determine if patient-directed music intervention was cost-effective in improving patient-reported anxiety. Cost savings were also evaluated. One-way and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness. Midwestern ICUs. Adult ICU patients from a parent clinical trial receiving mechanical ventilatory support. Patients receiving the experimental patient-directed music intervention received a MP3 player, noise-canceling headphones, and music tailored to individual preferences by a music therapist. The base case cost-effectiveness analysis estimated patient-directed music intervention reduced anxiety by 19 points on the Visual Analogue Scale-Anxiety with a reduction in cost of $2,322/patient compared with usual ICU care, resulting in patient-directed music dominance. The probabilistic cost-effectiveness analysis found that average patient-directed music intervention costs were $2,155 less than usual ICU care and projected that cost saving is achieved in 70% of 1,000 iterations. Based on break-even analyses, cost saving is achieved if the per-patient cost of patient-directed music intervention remains below $2,651, a value eight times the base case of $329. Patient-directed music intervention is cost-effective for reducing anxiety in mechanically ventilated ICU patients.

Developing lifetime relationships with patients: strategies to improve patient care and build your practice.

Science.gov (United States)

Levin, Roger P

2008-01-01

The purpose of this article is to describe three strategies to build a thriving, patient-centered practice and promote oral health throughout a patient's lifetime. Compared to previous decades, more dental patients are "shopping around" for dental care and changing dental practices. This trend is due to factors such as acceptance of dental insurance, more comprehensive service offerings by other dentists, and effective marketing campaigns by other dental offices. Delivering customer service exceeding patient expectations ("WOW" service), advocating patient education, and developing customized home care regimens will help lead to long-term patient retention and promote optimal patient care. A dental team making relationship-building a priority conveys respect for their patients' time and well-being. Once trust has been established patients are more likely to be receptive to oral health education and become more compliant with home care regimens. Since a patient's oral health status will likely change over time, it's important to make education and customized treatment planning an integral part of each visit. By demonstrating a strong commitment to customer service, education, and home care, patients recognize the care providers in a dental practice are interested in their well-being rather than simply treating problems. If patients recognize a dental practice is focused on prevention and at-home oral health care, they are more likely to partner with that practice for a lifetime of excellent oral health care.

Toward a patient-centered ambulatory after-visit summary: Identifying primary care patients' information needs.

Science.gov (United States)

Clarke, Martina A; Moore, Joi L; Steege, Linsey M; Koopman, Richelle J; Belden, Jeffery L; Canfield, Shannon M; Kim, Min S

2018-09-01

The purpose of this study was to determine the information needs of primary care patients as they review clinic visit notes to inform information that should be contained in an after-visit summary (AVS). We collected data from 15 patients with an acute illness and 14 patients with a chronic disease using semi-structured interviews. The acute patients reviewed seven major sections, and chronic patients reviewed eight major sections of a simulated, but realistic visit note to identify relevant information needs for their AVS. Patients in the acute illness group identified the Plan, Assessment and History of Present Illness the most as important note sections, while patients in the chronic care group identified Significant Lab Data, Plan, and Assessment the most as important note sections. This study was able to identify primary care patients' information needs after clinic visit. Primary care patients have information needs pertaining to diagnosis and treatment, which may be the reason why both patient groups identified Plan and Assessment as important note sections. Future research should also develop and assess an AVS based on the information gathered in this study and evaluate its usefulness among primary care patients. The results of this study can be used to inform the development of an after-visit summary that assists patients to fully understand their treatment plan, which may improve treatment adherence.

Hospital based patient coordination for ethnic minority patients - a health technology assessment

DEFF Research Database (Denmark)

Sodemann, Morten

A cross diciplinary, cross specialty, cross sectoral hospital based approach to cultural management of ethnic minority patients is effective in creating more approprite patient flows, better quality of care and increases functional level of patients. Surprisingly the aggregated effect saves...... especially on public medicine expenses and social services. Ethnic minority patients can achieve increased empowerment & Equity in type and quality of hospital care through cross dicplinary cross specialty cultural case management & support between hospital departments and primary sectors...

Clinical characteristics of patients with serrated polyposis syndrome in Korea: comparison with Western patients

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Eun Ran Kim

2017-07-01

Full Text Available Background/Aims: Serrated polyposis syndrome (SPS has been shown to increase the risk of colorectal cancer (CRC. However, little is known about the characteristics of Asian patients with SPS. This study aimed to identify the clinicopathological features and risk of CRC in Korean patients with SPS as well as the differences between Korean and Western patients based on a literature review.Methods: This retrospective study included 30 patients with SPS as defined by World Health Organization classification treated at Samsung Medical Center, Korea, between March 1999 and May 2011.Results: Twenty patients (67% were male. The median patient age at diagnosis was 56 years (range, 39–76 years. A total of 702 polyps were identified during a median follow-up of 43 months (range, 0–149 months. Serrated polyps were noted more frequently in the distal colon (298/702, 55%. However, large serrated polyps and serrated adenomas were mainly distributed throughout the proximal colon (75% vs. 25% and 81% vs. 19%, respectively; 73.3% had synchronous adenomatous polyps. The incidence of CRC was 10% (3/30 patients, but no interval CRC was detected. A total of 87% of the patients underwent esophagogastroduodenoscopy and 19.2% had significant lesions.Conclusions: The phenotype of SPS in Korean patients is different from that of Western patients. In Korean patients, SPS is more common in men, there were fewer total numbers of serrated adenoma/polyps, and the incidence of CRC was lower than that in Western patients. Korean patients tend to more frequently have abnormal gastric lesions. However, the prevalence of synchronous adenomatous polyps is high in both Western and Korean patients.

Communication barriers in counselling foreign-language patients in public pharmacies: threats to patient safety?

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Schwappach, David L B; Meyer Massetti, Carla; Gehring, Katrin

2012-10-01

Foreign-language (FL) patients are at increased risk for adverse drug events. Evidence regarding communication barriers and the safety of pharmaceutical care of FL patients in European countries is scarce despite large migrant populations. To investigate Swiss public pharmacists' experiences and current practices in counselling FL patients with a focus on patient safety. In a cross-sectional study heads of public pharmacies in Switzerland were surveyed using an electronic questionnaire. The survey assessed the frequency of communication barriers encountered in medication counselling of FL patients, perceptions of risks for adverse drug events, satisfaction with the quality of counselling provided to FL patients, current strategies to reduce risks, and preferences towards tools to improve safety for FL patients. 498 pharmacists completed the survey (43 % response rate). More than every second pharmacist reported at least weekly encounters at which they cannot provide good medication counselling to FL patients in the regional Swiss language. Ad-hoc interpreting by minors is also common at a considerable number of pharmacies (26.5 % reported at least one weekly occurrence). Approximately 10 % of pharmacies reported that they fail at least weekly to explain the essentials of drug therapy (e.g. dosing of children's medications) to FL patients. 79.8 % perceived the risk of FL patients for adverse drug events to be somewhat or much higher compared to other patients. 22.5 % of pharmacists reported being concerned at least monthly about medication safety when FL patients leave their pharmacy. However, the majority of pharmacists were satisfied with the quality of care provided to FL patients in their pharmacy [78.6 % (very) satisfied]. The main strategy used to improve counselling for FL patients was the employment of multilingual staff. Participants would use software for printing foreign-language labels (41.2 %) and multilingual package inserts (42.0 %) if these were

Medical narratives and patient analogs: the ethical implications of electronic patient records.

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Kluge, E H

1999-12-01

An electronic patient record consists of electronically stored data about a specific patient. It therefore constitutes a data-space. The data may be combined into a patient profile which is relative to a particular specialty as well as phenomenologically unique to the specific professional who constructs the profile. Further, a diagnosis may be interpreted as a path taken by a health care professional with a certain specialty through the data-space relative to the patient profile constructed by that professional. This way of looking at electronic patient records entails certain ethical implications about privacy and accessibility. However, it also permits the construction of artificial intelligence and competence algorithms for health care professionals relative to their specialties.

Stereotactic interstitial brachytherapy for the treatment of oligodendroglial brain tumors

Energy Technology Data Exchange (ETDEWEB)

El Majdoub, Faycal; Neudorfer, Clemens; Maarouf, Mohammad [University Hospital of Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne (Germany); University of Witten/Herdecke, Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), Cologne (Germany); Blau, Tobias; Deckert, Martina [University Hospital of Cologne, Department of Neuropathology, Cologne (Germany); Hellmich, Martin [University Hospital of Cologne, Institute of Statistics, Informatics and Epidemiology, Cologne (Germany); Buehrle, Christian [University Hospital of Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne (Germany); Sturm, Volker [University Hospital of Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne (Germany); University Hospital of Wurzburg, Department of Neurosurgery, Wuerzburg (Germany)

2015-12-15

We evaluated the treatment of oligodendroglial brain tumors with interstitial brachytherapy (IBT) using {sup 125}iodine seeds ({sup 125}I) and analyzed prognostic factors. Between January 1991 and December 2010, 63 patients (median age 43.3 years, range 20.8-63.4 years) suffering from oligodendroglial brain tumors were treated with {sup 125}I IBT either as primary, adjuvantly after incomplete resection, or as salvage therapy after tumor recurrence. Possible prognostic factors influencing disease progression and survival were retrospectively investigated. The actuarial 2-, 5-, and 10-year overall and progression-free survival rates after IBT for WHO II tumors were 96.9, 96.9, 89.8 % and 96.9, 93.8, 47.3 %; for WHO III tumors 90.3, 77, 54.9 % and 80.6, 58.4, 45.9 %, respectively. Magnetic resonance imaging demonstrated complete remission in 2 patients, partial remission in 13 patients, stable disease in 17 patients and tumor progression in 31 patients. Median time to progression for WHO II tumors was 87.6 months and for WHO III tumors 27.8 months. Neurological status improved in 10 patients and remained stable in 20 patients, while 9 patients deteriorated. There was no treatment-related mortality. Treatment-related morbidity was transient in 11 patients. WHO II, KPS ≥ 90 %, frontal location, and tumor surface dose > 50 Gy were associated with increased overall survival (p ≤ 0.05). Oligodendroglioma and frontal location were associated with a prolonged progression-free survival (p ≤ 0.05). Our study indicates that IBT achieves local control rates comparable to surgery and radio-/chemotherapy treatment, is minimally invasive, and safe. Due to the low rate of side effects, IBT may represent an attractive option as part of a multimodal treatment schedule, being supplementary to microsurgery or as a salvage therapy after chemotherapy and conventional irradiation. (orig.) [German] Die Behandlung oligodendroglialer Hirntumoren durch die interstitielle Brachytherapie

Measuring the quality of patient-centered care: why patient-reported measures are critical to reliable assessment

Directory of Open Access Journals (Sweden)

Tzelepis F

2015-06-01

Full Text Available Flora Tzelepis, Robert W Sanson-Fisher, Alison C Zucca, Elizabeth A FradgleyPriority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, AustraliaPurpose: The Institute of Medicine (IOM identified patient-centeredness as crucial to quality health care. The IOM endorsed six patient-centeredness dimensions that stipulated that care must be: respectful to patients’ values, preferences, and expressed needs; coordinated and integrated; provide information, communication, and education; ensure physical comfort; provide emotional support; and involve family and friends. Patient-reported measures examine the patient’s perspective and are essential to the accurate assessment of patient-centered care. This article’s objectives are to: 1 use the six IOM-endorsed patient-centeredness dimensions as a framework to outline why patient-reported measures are crucial to the reliable measurement of patient-centered care; and 2 to identify existing patient-reported measures that assess each patient-centered care dimension.Methods: For each IOM-endorsed patient-centeredness dimension, the published literature was searched to highlight the essential role of patients in assessing patient-centered care and informing quality improvement efforts. Existing literature was also searched to identify examples of patient-reported measures that assess each patient-centeredness dimension.Conclusion: Patient-reported measures are arguably the best way to measure patient-centeredness. For instance, patients are best positioned to determine whether care aligns with patient values, preferences, and needs and the Measure of Patient Preferences is an example of a patient-reported measure that does so. Furthermore, only the patient knows whether they received the level of information desired, and if information was understood and can be recalled. Patient-reported measures that examine information provision include

The willingness of patients to pay for intravenous patient-controlled analgesia in Korea.

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Lim, Hyungsun; Lee, Duck-Hyoung; Lee, Jeongwoo; Han, Young Jin; Choe, Huhn; Son, Ji-Seon

2012-06-01

The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients' thoughts about IV-PCA's cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients' characteristics and WTP in Korea. We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients' characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients' WTP after surgery, but the WTP may be independent of patient characteristics in Korea.

Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work?

Directory of Open Access Journals (Sweden)

Ahmad Mahmoudian

2017-01-01

Full Text Available Background: It is assumed that doctor-patient relationship plays an effective role in patients' satisfaction, medication adherence, and health outcomes since exploring different aspects of this relationship, such as addressing medication adherence, has rarely been investigated. Therefore, the main aim of the present study was to assess the impact of patients' satisfaction derived from communicating with doctors on medication adherence in hypertensive patients. Materials and Methods: This cross-sectional survey was conducted on three hundred patients with hypertension, using multistage sampling technique in health care centers in Isfahan, Iran. Data were collected by two questionnaires comprised (1 patients' satisfaction derived from the relationship with doctors and (2 medication adherence named “Morisky Medication Adherence Scale” with 8 items. Multivariate logistic regression model was applied to test the odds ratio (OR of patients' satisfaction resulting from the relationship with physicians in numerous aspects in two groups: appropriate and inappropriate medication adherence. Results: A lower level of satisfaction derived from building the relationship (confidence interval [CI] =0.95, 0.06–0.71 and OR = 0.20 and empathy subscales (CI = 0.95, 13–0.80 and OR = 0.33 was associated with nonadherence to treatment after controlling the physicians' gender and patients' age, gender, education, and duration of disease. Conclusion: Patients' satisfaction resulting from building the relationship and empathy with physicians appeared to be associated with medication adherence among hypertensive patients.

Patient risk perceptions for carotid endarterectomy: which patients are strongly averse to surgery?

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Bosworth, Hayden B; Stechuchak, Karen M; Grambow, Steven C; Oddone, Eugene Z

2004-07-01

Patient risk perception for surgery may be central to their willingness to undergo surgery. This study examined potential factors associated with patient aversion of surgery. This is a secondary data analysis of a prospective cohort study that examined patients referred for evaluation of carotid artery stenosis at five Veterans Affairs Medical Centers. The study collected demographic, clinical, and psychosocial information related to surgery. This analysis focused on patient response to a question assessing their aversion to surgery. Among the 1065 individuals, at the time of evaluation for carotid endarterectomy (CEA), 66% of patients had no symptoms, 16% had a transient ischemic attack, and 18% had stroke. Twelve percent of patients referred for CEA evaluation were averse to surgery. In adjusted analyses, increased age, black race, no previous surgery, lower level of chance locus of control, less trust of physicians, and less social support were significantly related to greater likelihood of surgery aversion among individuals referred for CEA evaluation. Patient degree of medical comorbidity and a validated measure of preoperative risk score were not associated with increased aversion to surgery. In previous work, aversion to CEA was associated with lack of receipt of CEA even after accounting for patient clinical appropriateness for surgery. We identified important patient characteristics associated with aversion to CEA. Interventions designed to assist patient decision making should focus on these more complex factors related to CEA aversion rather than the simple explanation of clinical usefulness.

Decision-making of older patients in context of the doctor-patient relationship: a typology ranging from "self-determined" to "doctor-trusting" patients.

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Wrede-Sach, Jennifer; Voigt, Isabel; Diederichs-Egidi, Heike; Hummers-Pradier, Eva; Dierks, Marie-Luise; Junius-Walker, Ulrike

2013-01-01

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.

Wooing patients with technology.

Science.gov (United States)

Myers, Michael

2013-04-01

Technologies that can give healthcare organizations a marketing advantage with patients include: Registration kiosks that request payment automatically, in a more comfortable environment for both patients and registration staff. Emails that enable patients to schedule initial visits and follow-up care. Secure online messaging platforms that enable patients to obtain timely answers to questions they have for their providers both before and after receiving services.

Patient-Centered Research

Science.gov (United States)

Wicki, J; Perneger, TV; Junod, AF; Bounameaux, H; Perrier, A

2000-01-01

PURPOSE We aimed to develop a simple standardized clinical score to stratify emergency ward patients with clinically suspected PE into groups with a high, intermediate, or low probability of PE, in order to improve and simplify the diagnostic approach. METHODS Analysis of a database of 1090 consecutive patients admitted to the emergency ward for suspected PE, in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. RESULTS 296 out of 1090 patients (27%) were found to have PE. The optimal estimate of clinical probability was based on eight variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis or elevation of a hemidiaphragm on chest X-ray. A probability score was calculated by adding points assigned to these variables. A cut-off score of 4 best identified patients with low probability of PE. 486 patients (49%) had a low clinical probability of PE (score 9). CONCLUSION This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to emergency ward patients suspected of PE could allow a more efficient diagnostic process.

Understanding polycystic ovary syndrome from the patient perspective: a concept elicitation patient interview study.

Science.gov (United States)

Martin, Mona L; Halling, Katarina; Eek, Daniel; Krohe, Meaghan; Paty, Jean

2017-08-18

The aim of this study was to explore the need for a new disease-specific patient reported outcome (PRO) measure for use in clinical trials of drugs designed to target the underlying causes of polycystic ovary syndrome (PCOS), and in the process contribute to our understanding of the symptoms and impacts that define the patient experience with PCOS. Semi-structured interviews were conducted in 20 women diagnosed with PCOS according to the Rotterdam criteria who had not menstruated in the previous month. The relative importance of PCOS symptoms and impact concepts to patients was determined by analyzing the frequency of their expression in the interview transcripts. These insights were compared to clinicians' perceptions of PCOS. Pain- and discomfort-related symptoms accounted for the highest proportion (27.6%) of the 735 patient expressions, although clinicians did not consider pain to be important to patients with PCOS. The most frequently expressed individual symptoms were cramping (70% of patients; 14.7% of concepts), irregular menstruation (95% of patients; 12.2% of concepts), facial hair growth (75% of patients; 10.6% of concepts), heavy bleeding (70% of patients; 8.8% of concepts), infertility (70% of patients; 5.4% of concepts), and bloating (60% of patients; 5.2% of concepts). Cramping, heavy bleeding, and bloating were not identified by clinicians as being important to patients with PCOS. The impacts most frequently reported by patients with PCOS related to emotional well-being (e.g. anxiety/stress) and coping behaviors (e.g. acne medication, hair removal). The only validated PCOS-specific PRO, the PCOSQ, does not capture some key PCOS symptoms and impacts expressed by patients with PCOS, most notably those related to pain and discomfort, bleeding intensity and coping behaviours. Furthermore, some key PCOS symptoms may be under-recognized in the clinic.

Designing User-Centric Patient Portals: Clinician and Patients' Uses and Gratifications

Science.gov (United States)

Krist, Alex H.; Aycock, Rebecca A.; Kreps, Gary L.

2017-01-01

Abstract Background: Legislation mandates that clinicians make patients' medical information available digitally. This has resulted in hurriedly installing patient portals that do not fully meet the needs of patients or clinicians. This study examined a specific portal, MyPreventiveCare (MPC), a patient-centered portal designed to promote preventive care to consumers, to elicit recommendations from patients and clinicians about how it could be more beneficial by uncovering their uses and gratifications (U&G). Materials and Methods: In-depth interviews with 31 patients and two clinician focus groups were conducted. Multiple methods were utilized, such as grounded theory coding to develop themes and content analysis to classify responses according to the U&G framework. Results: Four main categories emerged that users desire to be included in health portals: integration with technology (27%), coordination of care (27%), incorporation of lifestyle (26%), and increased control (20%). Additional analysis revealed that health portals are mainly utilized to fulfill cognitive and affective needs, with over 80% of recommendations related to the U&G categories of cognitive and affective needs. Cognitive (60%), affective (21%), social integrative (10%), personal integrative (9%), and tension release (0%). Conclusions: Portals will continue to evolve and become important health communication tools if they address the user's perspective and are inclusive of new technological advances. Specifically, portals must become more user centric and incorporate aspects of the patients' lifestyle and integrate health information technology. PMID:27333468

Comparing thrombin generation in patients with hemophilia A and patients on vitamin K antagonists

NARCIS (Netherlands)

de Koning, M L Y; Fischer, K; de Laat, B; Huisman, A; Ninivaggi, M; Schutgens, R E G

Essentials: It is unknown if hemophilia patients with atrial fibrillation need anticoagulation. Endogenous thrombin potentials (ETP) in hemophilia patients and patients on coumarins were compared. Severe hemophilia patients had comparable ETP to therapeutic international normalized ratio (INR). In

Learning the Patient's Story.