WorldWideScience

Sample records for patients reported discussing

  1. Interpreting patient-reported outcomes from clinical trials in COPD: a discussion

    Directory of Open Access Journals (Sweden)

    Jones PW

    2016-12-01

    Full Text Available Paul W Jones,1,2 Stephen Rennard,3,4 Maggie Tabberer,5 John H Riley,2 Mitra Vahdati-Bolouri,2 Neil C Barnes2,6 1Institute for Infection and Immunity, University of London, London, 2Global Respiratory Franchise, GlaxoSmithKline, Uxbridge, UK; 3Division of Pulmonary, Critical Care, Sleep and Allergy, Nebraska Medical Center, Omaha, NE, USA; 4Clinical Discovery Unit, AstraZeneca, Cambridge, 5Global R&D, GlaxoSmithKline, Uxbridge, 6William Harvey Institute, Bart’s and the London School of Medicine and Dentistry, London, UK Abstract: One of the challenges faced by the practising physician is the interpretation of patient-reported outcomes (PROs in clinical trials and the relevance of such data to their patients. This is especially true when caring for patients with progressive diseases such as COPD. In an attempt to incorporate the patient perspective, many clinical trials now include assessments of PROs. These are formalized methods of capturing patient-centered information. Given the importance of PROs in evaluating the potential utility of an intervention for a patient with COPD, it is important that physicians are able to critically interpret (and critique the results derived from them. Therefore, in this paper, a series of questions is posed for the practising physician to consider when reviewing the treatment effectiveness as assessed by PROs. The focus is on the St George’s Respiratory Questionnaire for worked examples, but the principles apply equally to other symptom-based questionnaires. A number of different ways of presenting PRO data are discussed, including the concept of the minimum clinically important difference, whether there is a ceiling effect to PRO results, and the strengths and weaknesses of responder analyses. Using a worked example, the value of including a placebo arm in a study is illustrated, and the influence of the study on PRO results is considered, in terms of the design, patient withdrawal, and the selection of

  2. Near-Patient Sampling to Assist Infection Control—A Case Report and Discussion

    Science.gov (United States)

    Tang, Julian W.; Hoyle, Elizabeth; Moran, Sammy; Pareek, Manish

    2018-01-01

    Air sampling as an aid to infection control is still in an experimental stage, as there is no consensus about which air samplers and pathogen detection methods should be used, and what thresholds of specific pathogens in specific exposed populations (staff, patients, or visitors) constitutes a true clinical risk. This case report used a button sampler, worn or held by staff or left free-standing in a fixed location, for environmental sampling around a child who was chronically infected by a respiratory adenovirus, to determine whether there was any risk of secondary adenovirus infection to the staff managing the patient. Despite multiple air samples taken on difference days, coinciding with high levels of adenovirus detectable in the child’s nasopharyngeal aspirates (NPAs), none of the air samples contained any detectable adenovirus DNA using a clinically validated diagnostic polymerase chain reaction (PCR) assay. Although highly sensitive, in-house PCR assays have been developed to detect airborne pathogen RNA/DNA, it is still unclear what level of specific pathogen RNA/DNA constitutes a true clinical risk. In this case, the absence of detectable airborne adenovirus DNA using a conventional diagnostic assay removed the requirement for staff to wear surgical masks and face visors when they entered the child’s room. No subsequent staff infections or outbreaks of adenovirus have so far been identified. PMID:29385031

  3. Near-Patient Sampling to Assist Infection Control—A Case Report and Discussion

    Directory of Open Access Journals (Sweden)

    Julian W. Tang

    2018-01-01

    Full Text Available Air sampling as an aid to infection control is still in an experimental stage, as there is no consensus about which air samplers and pathogen detection methods should be used, and what thresholds of specific pathogens in specific exposed populations (staff, patients, or visitors constitutes a true clinical risk. This case report used a button sampler, worn or held by staff or left free-standing in a fixed location, for environmental sampling around a child who was chronically infected by a respiratory adenovirus, to determine whether there was any risk of secondary adenovirus infection to the staff managing the patient. Despite multiple air samples taken on difference days, coinciding with high levels of adenovirus detectable in the child’s nasopharyngeal aspirates (NPAs, none of the air samples contained any detectable adenovirus DNA using a clinically validated diagnostic polymerase chain reaction (PCR assay. Although highly sensitive, in-house PCR assays have been developed to detect airborne pathogen RNA/DNA, it is still unclear what level of specific pathogen RNA/DNA constitutes a true clinical risk. In this case, the absence of detectable airborne adenovirus DNA using a conventional diagnostic assay removed the requirement for staff to wear surgical masks and face visors when they entered the child’s room. No subsequent staff infections or outbreaks of adenovirus have so far been identified.

  4. Involvement of peripheral III nerve in multiple sclerosis patient: Report of a new case and discussion of the underlying mechanism.

    Science.gov (United States)

    Shor, Natalia; Amador, Maria Del Mar; Dormont, Didier; Lubetzki, Catherine; Bertrand, Anne

    2017-04-01

    Multiple sclerosis (MS) is a chronic disorder that affects the central nervous system myelin. However, a few radiological cases have documented an involvement of peripheral cranial nerves, within the subarachnoid space, in MS patients. We report the case of a 36-year-old female with a history of relapsing-remitting (RR) MS who consulted for a subacute complete paralysis of the right III nerve. Magnetic resonance imaging (MRI) examination showed enhancement and thickening of the cisternal right III nerve, in continuity with a linear, mesencephalic, acute demyelinating lesion. Radiological involvement of the cisternal part of III nerve has been reported only once in MS patients. Radiological involvement of the cisternal part of V nerve occurs more frequently, in almost 3% of MS patients. In both situations, the presence of a central demyelinating lesion, in continuity with the enhancement of the peripheral nerve, suggests that peripheral nerve damage is a secondary process, rather than a primary target of demyelination.

  5. D 3.6 Africa: Discussion report

    DEFF Research Database (Denmark)

    Mandrup, Thomas

    2017-01-01

    in general, sub-matter experts, experts on peace and conflict studies, and practitioners in crisis management. A total of eighteen speakers explored the effectiveness of international assistance to the four African examples from different perspectives, drawing a rather pessimistic picture of the current......One round-table event was organised within the framework of Work Package III, part of the IECEU project. The events focused on the WP3’s four case studies: Libya, CAR, South Sudan and DRC. This report provides information on the round-table event and presents the main points of discussion...... that emerged during it. The round-table discussion and the subsequent seminar on the Effectiveness of International Assistance and Local Ownership in the four case studies was organised by the Royal Danish Defence College on 31 October-1. November 2016. The round-table participants included experts on Africa...

  6. 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.

  7. General Assembly discusses progress report from IAEA

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1959-01-15

    According to its Statute and the Relationship Agreement with the United Nations, the International Atomic Energy Agency reports annually to the General Assembly of the United Nations on its activities during the past year. The Report is prepared for the approval of the General Conference by the Board of Governors. The second of these reports was presented by the Director General, Mr. Sterling Cole, on behalf of the Agency on October 30th 1958; delegates from thirteen countries took part in the ensuing debate. The Report covers the period 1 November 1957 to the end of June 1958 with some more recent developments mentioned briefly in the Preface. (author)

  8. 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.

  9. Physician-patient discussions of controversial cancer screening tests.

    Science.gov (United States)

    Dunn, A S; Shridharani, K V; Lou, W; Bernstein, J; Horowitz, C R

    2001-02-01

    Screening mammography for younger women and prostate-specific antigen (PSA) measurement have controversial benefits and known potential adverse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how often these discussions take place or about barriers to these discussions. We administered a survey to medical house staff and attending physicians practicing primary care. The survey examined physicians' likelihood of discussing screening mammography and PSA testing, and factors influencing the frequency and quality of these discussions. For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians' belief that PSA screening is advantageous; house staff and attending physicians' intention to order a PSA test, and attending physicians' intention to order a mammogram; and a controversial indication for screening. The most commonly identified barriers to discussions were lack of time, the complexity of the topic, and a language barrier. Physicians report they often do not discuss cancer screening tests with their patients. Our finding that physicians' beliefs and intention to order the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some patients may be inappropriately denied the opportunity to choose whether to screen for breast and prostate cancer.

  10. Physician–Patient Discussions of Controversial Cancer Screening Tests

    Science.gov (United States)

    Dunn, Andrew S.; Shridharani, Kanan V.; Lou, Wendy; Bernstein, Jeffrey; Horowitz, Carol R.

    2016-01-01

    Background Screening mammography for younger women and prostate-specific antigen (PSA) measurement have controversial benefits and known potential adverse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how often these discussions take place or about barriers to these discussions. Methods We administered a survey to medical house staff and attending physicians practicing primary care. The survey examined physicians’ likelihood of discussing screening mammography and PSA testing, and factors influencing the frequency and quality of these discussions. Results For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians’ belief that PSA screening is advantageous; house staff and attending physicians’ intention to order a PSA test, and attending physicians’ intention to order a mammogram; and a controversial indication for screening. The most commonly identified barriers to discussions were lack of time, the complexity of the topic, and a language barrier. Conclusions Physicians report they often do not discuss cancer screening tests with their patients. Our finding that physicians’ beliefs and intention to order the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some patients may be inappropriately denied the opportunity to choose whether to screen for breast and prostate cancer. PMID:11165455

  11. Discussion

    International Nuclear Information System (INIS)

    Sutcliffe, W.G.

    1991-01-01

    This is an edited transcript of the recorded discussions that followed the presentation of each paper and on the general comments at the conclusion of the session. No attempt was made to identity those who offered comments or asked questions

  12. Preferences of Patients for Discussing Sudden Unexpected Death in Epilepsy

    Directory of Open Access Journals (Sweden)

    Sūna Normunds

    2017-08-01

    Full Text Available People with epilepsy have increased mortality rates, which is partially attributed to sudden unexpected death in epilepsy syndrome (SUDEP. Poor seizure control appears to be the strongest SUDEP risk factor. Management of epilepsy and adherence to therapy is critical to seizure control. The belief by caregivers of negative influence caused by being informed about the syndrome is the main reason SUDEP is not disclosed. There are no clear recommendations when to disclose the risk of SUDEP and how much information should be provided. We addressed the preferences of Latvian epilepsy patients for discussing SUDEP as well as awareness of the syndrome. Our study involved 55 epilepsy patients. We found that, as in other studies, our patients were relatively well informed about SUDEP. We found that a considerable proportion of patients preferred to receive information about SUDEP from a general practitioner. We note the belief of patients that the disclosure of SUDEP would either improve or have no effect on the quality of life. We were able to identify groups of patients with a self-reported belief of more frequent expected anxiety and poor adherence to medical treatment. Our data improves the understanding of preferences of patient for discussing the negative aspects of epilepsy.

  13. Challenges to code status discussions for pediatric patients.

    Directory of Open Access Journals (Sweden)

    Katherine E Kruse

    Full Text Available In the context of serious or life-limiting illness, pediatric patients and their families are faced with difficult decisions surrounding appropriate resuscitation efforts in the event of a cardiopulmonary arrest. Code status orders are one way to inform end-of-life medical decision making. The objectives of this study are to evaluate the extent to which pediatric providers have knowledge of code status options and explore the association of provider role with (1 knowledge of code status options, (2 perception of timing of code status discussions, (3 perception of family receptivity to code status discussions, and (4 comfort carrying out code status discussions.Nurses, trainees (residents and fellows, and attending physicians from pediatric units where code status discussions typically occur completed a short survey questionnaire regarding their knowledge of code status options and perceptions surrounding code status discussions.Single center, quaternary care children's hospital.203 nurses, 31 trainees, and 29 attending physicians in 4 high-acuity pediatric units responded to the survey (N = 263, 90% response rate. Based on an objective knowledge measure, providers demonstrate poor understanding of available code status options, with only 22% of providers able to enumerate more than two of four available code status options. In contrast, provider groups self-report high levels of familiarity with available code status options, with attending physicians reporting significantly higher levels than nurses and trainees (p = 0.0125. Nurses and attending physicians show significantly different perception of code status discussion timing, with majority of nurses (63.4% perceiving discussions as occurring "too late" or "much too late" and majority of attending physicians (55.6% perceiving the timing as "about right" (p<0.0001. Attending physicians report significantly higher comfort having code status discussions with families than do nurses or trainees

  14. The Patient-Reported Information Multidimensional Exploration (PRIME) Framework for Investigating Emotions and Other Factors of Prostate Cancer Patients with Low Intermediate Risk Based on Online Cancer Support Group Discussions.

    Science.gov (United States)

    Bandaragoda, Tharindu; Ranasinghe, Weranja; Adikari, Achini; de Silva, Daswin; Lawrentschuk, Nathan; Alahakoon, Damminda; Persad, Raj; Bolton, Damien

    2018-06-01

    This study aimed to use the Patient Reported Information Multidimensional Exploration (PRIME) framework, a novel ensemble of machine-learning and deep-learning algorithms, to extract, analyze, and correlate self-reported information from Online Cancer Support Groups (OCSG) by patients (and partners of patients) with low intermediate-risk prostate cancer (PCa) undergoing radical prostatectomy (RP), external beam radiotherapy (EBRT), and active surveillance (AS), and to investigate its efficacy in quality-of-life (QoL) and emotion measures. From patient-reported information on 10 OCSG, the PRIME framework automatically filtered and extracted conversations on low intermediate-risk PCa with active user participation. Side effects as well as emotional and QoL outcomes for 6084 patients were analyzed. Side-effect profiles differed between the methods analyzed, with men after RP having more urinary and sexual side effects and men after EBRT having more bowel symptoms. Key findings from the analysis of emotional expressions showed that PCa patients younger than 40 years expressed significantly high positive and negative emotions compared with other age groups, that partners of patients expressed more negative emotions than the patients, and that selected cohorts ( 70 years, partners of patients) have frequently used the same terms to express their emotions, which is indicative of QoL issues specific to those cohorts. Despite recent advances in patient-centerd care, patient emotions are largely overlooked, especially in younger men with a diagnosis of PCa and their partners. The authors present a novel approach, the PRIME framework, to extract, analyze, and correlate key patient factors. This framework improves understanding of QoL and identifies low intermediate-risk PCa patients who require additional support.

  15. Preoperative Surgical Discussion and Information Retention by Patients.

    Science.gov (United States)

    Feiner, David E; Rayan, Ghazi M

    2016-10-01

    To assess how much information communicated to patients is understood and retained after preoperative discussion of upper extremity procedures. A prospective study was designed by recruiting patients prior to undergoing upper extremity surgical procedures after a detailed discussion of their operative technique, postoperative care and treatment outcomes. Patients were given the same 20-item questionnaire to fill out twice, at two pre operative visits. An independent evaluator filled out a third questionnaire as a control. Various discussion points of the survey were compared among the 3 questionnaires and retained information and perceived comprehension were evaluated. The average patients' age was 50.3 (27-75) years The average time between the two surveys preoperative 1 and preoperative 2 was 40.7 (7-75) days,. The average patient had approximately 2 years of college or an associate's degree. Patients initially retained 73% (52-90%) of discussion points presented during preoperative 1 and 61% (36-85%) of the information at preoperative 2 p = .002. 50% of patients felt they understood 100% of the discussion, this dropped to only 10% at their preoperative 2 visit. 15% of our patients did not know what type of anesthesia they were having at preoperative 2. A communication barrier between patients and physicians exists when patients are informed about their preoperative surgical discussion. The retention of information presented is worsened with elapsing time from the initial preoperative discussion to the second preoperative visit immediately prior to surgery. Methods to enhance patients' retention of information prior to surgery must be sought and implemented which will improve patients' treatment outcome.

  16. Discussing spirituality with patients: a rational and ethical approach.

    Science.gov (United States)

    McCord, Gary; Gilchrist, Valerie J; Grossman, Steven D; King, Bridget D; McCormick, Kenelm E; Oprandi, Allison M; Schrop, Susan Labuda; Selius, Brian A; Smucker, D O William D; Weldy, David L; Amorn, Melissa; Carter, Melissa A; Deak, Andrew J; Hefzy, Hebah; Srivastava, Mohit

    2004-01-01

    This study was undertaken to determine when patients feel that physician inquiry about spirituality or religious beliefs is appropriate, reasons why they want their physicians to know about their spiritual beliefs, and what they want physicians to do with this information. Trained research assistants administered a questionnaire to a convenience sample of consenting patients and accompanying adults in the waiting rooms of 4 family practice residency training sites and 1 private group practice in northeastern Ohio. Demographic information, the SF-12 Health Survey, and participant ratings of appropriate situations, reasons, and expectations for physician discussions of spirituality or religious beliefs were obtained. Of 1,413 adults who were asked to respond, 921 completed questionnaires, and 492 refused (response rate = 65%). Eighty-three percent of respondents wanted physicians to ask about spiritual beliefs in at least some circumstances. The most acceptable scenarios for spiritual discussion were life-threatening illnesses (77%), serious medical conditions (74%) and loss of loved ones (70%). Among those who wanted to discuss spirituality, the most important reason for discussion was desire for physician-patient understanding (87%). Patients believed that information concerning their spiritual beliefs would affect physicians' ability to encourage realistic hope (67%), give medical advice (66%), and change medical treatment (62%). This study helps clarify the nature of patient preferences for spiritual discussion with physicians.

  17. LITHIUM TOXICITY IN ELDERLY-A CASE REPORT AND DISCUSSION

    Directory of Open Access Journals (Sweden)

    Mariana D. Arnaoudova

    2014-07-01

    Full Text Available Background: The therapeutic effect of Lithium as a mono therapy or as an augmenting agent in a variety of medical and psychiatric disorders is under doubt. However, lithium is associated with a number of adverse effects. Method and objective: A review of the literature on lithium use in older adults and a case report presentation. Summary of results: The literature, concerning current uses of Lithium in older patients, especially for patients with neurologic or cognitive impairments is limited due to the lack of well-designed, large clinical trials. Elderly patients are at higher risk to develop neurotoxicity in the course of lithium therapy. We present a case of 66 years old female patient, suffering bipolar disorder, who developed lithium toxicity and was admitted at the gerontopsychiatric department due to a confusional state, tremor and gait abnormality. Lithium toxicity was suspected when sufficient information about previous medical history of lithium therapy has been obtained. Lithium level found to be 1.69mmol/L. The patient has developed intoxication during maintenance therapy with a lithium dosage which had been unchanged for months. Conclusion: Elderly patients require lower doses of Lithium to achieve similar serum concentrations as those in younger adults. Neurotoxicity could be suspected at serum lithium levels which are considered therapeutic in younger adults. When prescribing lithium agents in elderly we should consider age-related changes in pharmacokinetics. The best way to prevent lithium toxicity is to control the serum concentration regularly during therapy.

  18. Empowerment of patients in online discussions about medicine use.

    Science.gov (United States)

    van Berkel, Jasper J; Lambooij, Mattijs S; Hegger, Ingrid

    2015-04-08

    Patient empowerment is crucial in the successful self-management of people with chronic diseases. In this study, we investigated whether discussions about medicine use taking place on online message boards contribute to patient empowerment and could subsequently result in the more effective use of medicines. We discuss the extent to which patient empowerment processes occur in discussions on online message boards, focusing on patients with three disorders with different characteristics: diabetes, Amyotrophic Lateral Sclerosis (ALS) and Attention Deficit / Hyperactivity Disorder (ADHD). Because information is an important factor in both patient empowerment and self-management, we also evaluate the quality of the information being exchanged. We used a deductive thematic analysis method based on pre-existing categories. We gathered and analysed 5532 posts related to the conditions ADHD, ALS and diabetes from seven message boards (three for ADHD, three for diabetes, and one for ALS). We coded the posts for empowerment processes and the quality of the information exchanged. We identified patient empowerment processes in posts related to all three disorders. There is some variation in the frequency of these processes, but they show a similar order in the results: patients used the online message boards to exchange information, share personal experiences and for empathy or support. The type of information shared in these processes could contribute to the patient's self-efficacy when it comes to medicine use. The exchanged information was either correct or largely harmless. We also observed a tendency whereby participants correct previously posted incorrect information, and refer people to a healthcare professional following a request for medical advice, e.g. concerning the choice of medicines or dosage. Our findings show that patient empowerment processes occur in posts related to all three disorders. The type of information shared in these processes can contribute to the

  19. National objectives and flexible mechanisms: A discussions report

    International Nuclear Information System (INIS)

    Johansson, Bengt

    2003-01-01

    The Swedish climate policy has the target that the national emissions of greenhouse gases should be reduced 4%, compared to the 1990 level. But according to the EU common policy in line with the Kyoto agreement, Sweden has the right to increase the emissions by 4%. The Kyoto obligations could also be fulfilled by acting through the flexible mechanisms. In the present report the following issues are discussed: Why did Sweden set so ambitious targets; How can you handle the interconnection between national targets and flexible mechanisms; Methods to determine the amounts of the emissions rights that should be allocated to the trading sectors; Are there alternative means for achieving the targets that the national objectives have set

  20. Myocardial fibrosis as the first sign of cardiac involvement in a male patient with Fabry disease: report of a clinical case and discussion on the utility of the magnetic resonance in Fabry pathology.

    Science.gov (United States)

    Sechi, Annalisa; Nucifora, Gaetano; Piccoli, Gianluca; Dardis, Andrea; Bembi, Bruno

    2014-07-16

    Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging is increasingly used to assess myocardial involvement in patients with Fabry disease, an X linked lipid storage disorder. However, it is often proposed as an optional tool. A different cardiomyopathic disease progression between male and female patients was hypothesised in previous studies, as in female myocardial fibrosis was found without left ventricular (LV) hypertrophy, while myocardial fibrosis was always detected in association to LV hypertrophy in men. A male Caucasian patient, 19 years old, diagnosed through a family-based molecular screening, presented with LGE of the LV inferolateral wall evidenced at the CMR, without LV hypertrophy, or other clinical signs of the disease. This is the first report of cardiac fibrosis as the first sign of organ involvement in a male patient with Fabry disease. This finding stresses the importance of performing CMR with LGE imaging for the initial staging and monitoring of Fabry patients of both genders.

  1. Factors Affecting Patients' Preferences for and Actual Discussions About End-of-Life Care.

    Science.gov (United States)

    Fakhri, Shoaib; Engelberg, Ruth A; Downey, Lois; Nielsen, Elizabeth L; Paul, Sudiptho; Lahdya, Alexandria Z; Treece, Patsy D; Curtis, J Randall

    2016-09-01

    Discussions about end-of-life care are often difficult for patients and clinicians, and inadequate communication poses a barrier to patients receiving the care they desire. To understand factors that facilitate end-of-life care discussions that guide interventions to improve care. We examined baseline data from an ongoing randomized trial to evaluate associations between patients' self-reported desire for, and occurrence of, discussions about end-of-life care and factors influencing these discussions. Factors included emotional symptoms and barriers and facilitators to discussions. The sample included patients with serious illness (n = 473) and their primary or specialty care clinicians (n = 128). Regression analyses were adjusted for confounders and clustered patients under clinicians. Patients who endorsed each of three barriers to discussions were less likely to have had a discussion with their clinician (P-values ranging from communication about end-of-life care is associated with patient factors including communication barriers and facilitators and symptoms of depression and anxiety. Understanding these factors may facilitate design of effective communication interventions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  2. Pulmonary Nodules with Cutaneous Manifestations: A Case Report and Discussion

    Directory of Open Access Journals (Sweden)

    Ardiles T

    2012-04-01

    Full Text Available The differential diagnosis of multiple pulmonary nodules is large and includes congenital and inherited disorders, malignancy, infectious etiologies, noninfectious granulomatous and inflammatory conditions,among many others. Diagnostic evaluation is aided by attention to extrapulmonary symptoms and features. We herein describe an unusual case of multiple pulmonary nodules attributed to cysticercosis and present a discussion of pathophysiologic changes related to medications and highlight the diagnostic value of extrapulmonary cutaneous features.

  3. Abdominal neoplasia with sarcomatoid features as the presenting illness of a patient with a newly diagnosed HIV infection and no AIDS-related disorders. Case report, clinical and diagnostic features, and literature discussion

    Directory of Open Access Journals (Sweden)

    Roberto Manfredi

    2014-12-01

    Full Text Available We aim to describe a patient with an already advanced HIV infection disclosed for the first time during a complex diagnostic workup, which detected a gross abdominal mass attributable to a poorly differentiated mesenchymal cancer with sarcomatoid features which rapidly led our patient to death, in absence of other potential HIV-associated opportunistic diseases. Although extremely rare and rapidly lethal, our case report underscores the need of all caregivers who follow HIV-infected patients also in the cART era to maintain an elevated attention toward infrequent, unexpected, and clinically atypical solid tumors, in order to ensure a timely diagnosis and management when possible.http://dx.doi.org/10.7175/cmi.v8i4.961

  4. Patient Discussion About Sexual Health With Health Care Providers After Cancer-A National Survey.

    Science.gov (United States)

    Ben Charif, Ali; Bouhnik, Anne-Déborah; Courbiere, Blandine; Rey, Dominique; Préau, Marie; Bendiane, Marc-Karim; Peretti-Watel, Patrick; Mancini, Julien

    2016-11-01

    A discussion about sexuality should become a routine part of the personalized care pathway for patients with cancer. To assess rates of patient discussion about sexuality with health care providers after cancer. We used data from the representative French nationwide 2012 VICAN survey, which included 4,349 adults 18 to 82 years old who were still alive 2 years after diagnosis at 12 cancer sites. Self-reported rates of discussion about sexuality with health care providers were assessed, and associated factors were tested after systematic adjustment for a sexual health indicator (created from six items of the Relationship and Sexuality Scale). Of 4,181 respondents to the question on a discussion about sexuality, 54.7% reported that nobody had proposed a discussion to them, 21.9% did not want any discussion, and 23.4% had had a discussion. Women had less discussion about sexuality with health care providers (11.1% vs 36.7% of men, P < .001) and were more likely to request a discussion at their own initiative (62.9% vs 48.0% of men, P < .001). Discussion about sexuality was more frequent with patients with prostate (56.3%) and cervical (39.6%) cancer, but increasing age was associated with a greater reluctance to discuss this issue (odds ratio = 1.17, 95% CI = 1.04-1.2). The likelihood of discussion increased with severe sexual problems, radiotherapy, general sequelae, having an information-seeker profile, previous professional psychological help, and initial treatment in private centers. Patients initially wishing for psychological help were more likely to desire a discussion about sexuality. Sexuality receives little attention in French patients with cancer. Inequalities in the discussion about sexuality were observed in relation to the type of care center where the patient was initially managed. Information on supportive interventions, including more systematic referral for professional psychological help, should be developed to facilitate discussion and should be

  5. Thematic report on the conference and panel discussion

    International Nuclear Information System (INIS)

    Amold, N.; Brodowski, R.; Gepp, C.; Giersch, M.; Gufler, K.; Lahodynsky, R.; Hellermschmidt-Alber, J.

    2010-01-01

    The Viennese Environmental Prosecutor's Office as nuclear protection commissioner of the city of Vienna is engaged with all aspects of nuclear energy and its hazards. Nuclear energy is in a minority of states used for energy production and in even less cases, it contributes to a short-term share of the energy supply. These conditions - in addition to the acute consideration of operational safety - are the Request of Questioning the use of nuclear energy in principle. In the light of the general raw materials debate - a conference on uranium was organized. Just over two percent of the global energy demand is covered by nuclear energy and nevertheless, a fuel debate similar to that of fossil fuels - which cover more than 80 percent of the energy demand - arose. Therefore some questions arise: It can be seen that in a hypothetical - still very low - nuclear energy's share of five percent, the range of nuclear fuel would sink on about the half. Due to the small amount that nuclear energy contributes to Energy supply and due to CO2 emissions throughout the process of at least about 30 g / kWh (also set by nuclear energy supporters), the Climate protection argument for nuclear energy is in a very questionable light. The event and the present report show that the issue of uranium availability is also a important issue for the nuclear industry. Not least for this reason, despite little progress since the 1960s, alternatives to existing reactor concepts and fuels are being researched. The purpose of this report is to provide insight into commodity forecasting and availability. It also takes a quick look at the enormous problems posed by uranium mining to the environment and the people involved. In addition, it will be shown where the border between the wishful thinking of the various actors and valid data runs. (roessner)

  6. Do health care providers discuss HIV with older female patients?

    African Journals Online (AJOL)

    2010-03-08

    Mar 8, 2010 ... as vaginal dryness and thinning, increase the risk of HIV infection through tears and abrasions during unprotected sex. .... size was required to obtain a two-sided 95% confidence .... patients about safer sex and disclosure?

  7. Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey.

    Science.gov (United States)

    Linder, Suzanne K; Hawley, Sarah T; Cooper, Crystale P; Scholl, Lawrence E; Jibaja-Weiss, Maria; Volk, Robert J

    2009-03-18

    Professional medical organizations recommend individualized patient decision making about prostate cancer screening. Little is known about primary care physicians' use of pre-screening discussions to promote informed decision making for prostate cancer screening. The aim of this study is to explore physicians' use of pre-screening discussions and reasons why physicians would or would not try to persuade patients to be screened if they initially refuse testing. Primary care physicians completed a self-administered survey about prostate cancer screening practices for informed decision making. Sixty-six physicians (75.9%) completed the survey, and 63 were used in the analysis. Thirteen physicians (20.6%) reported not using prescreening discussions, 45 (71.4%) reported the use of prescreening discussions, and 3 (4.8%) reported neither ordering the PSA test nor discussing it with patients. Sixty-nine percent of physicians who reported not having discussions indicated they were more likely to screen African American patients for prostate cancer, compared to 50% of physicians who reported the use of discussions (Chi-square(1) = 1.62, p = .20). Similarly, 91% of physicians who reported not having discussions indicated they are more likely to screen patients with a family history of prostate cancer, compared to 46% of those who reported the use of discussion (Chi-square(1) = 13.27, p practice styles. Future research needs to consider the nature of discussions and the degree to which informed decision making is being achieved in clinical practice.

  8. Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Cooper Crystale P

    2009-03-01

    Full Text Available Abstract Background Professional medical organizations recommend individualized patient decision making about prostate cancer screening. Little is known about primary care physicians' use of pre-screening discussions to promote informed decision making for prostate cancer screening. The aim of this study is to explore physicians' use of pre-screening discussions and reasons why physicians would or would not try to persuade patients to be screened if they initially refuse testing. Methods Primary care physicians completed a self-administered survey about prostate cancer screening practices for informed decision making. Results Sixty-six physicians (75.9% completed the survey, and 63 were used in the analysis. Thirteen physicians (20.6% reported not using prescreening discussions, 45 (71.4% reported the use of prescreening discussions, and 3 (4.8% reported neither ordering the PSA test nor discussing it with patients. Sixty-nine percent of physicians who reported not having discussions indicated they were more likely to screen African American patients for prostate cancer, compared to 50% of physicians who reported the use of discussions (Chi-square(1 = 1.62, p = .20. Similarly, 91% of physicians who reported not having discussions indicated they are more likely to screen patients with a family history of prostate cancer, compared to 46% of those who reported the use of discussion (Chi-square(1 = 13.27, p Conclusion Although guidelines recommend discussing the risks and benefits of prostate cancer screening, physicians report varying practice styles. Future research needs to consider the nature of discussions and the degree to which informed decision making is being achieved in clinical practice.

  9. Retrotracheal Extraskeletal Ewing's Sarcoma: Case Report and Discussion on Airway Management.

    Science.gov (United States)

    Van Der Meer, Graeme; Linkhorn, Hannah; Gruber, Maayan; Mahadevan, Murali; Barber, Colin

    2017-03-01

    Extraskeletal Ewing's sarcoma is a rare tumor, and the management of airway compromise in case of cervical Ewing's sarcoma has not been established. This report describes the case of a patient with retrotracheal Ewing's sarcoma and discusses a successful approach to airway management. A 12-year-old male presented with a 2-week history of sore throat and sleep-disordered breathing and 48 hours of stridor. Imaging confirmed a retrotracheal soft tissue mass with airway compromise. A planned and controlled approach to his airway management resulted in a secure airway prior to definitive treatment.

  10. Myocardial fibrosis as the first sign of cardiac involvement in a male patient with Fabry disease: report of a clinical case and discussion on the utility of the magnetic resonance in Fabry pathology

    OpenAIRE

    Sechi, Annalisa; Nucifora, Gaetano; Piccoli, Gianluca; Dardis, Andrea; Bembi, Bruno

    2014-01-01

    Background Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging is increasingly used to assess myocardial involvement in patients with Fabry disease, an X linked lipid storage disorder. However, it is often proposed as an optional tool. A different cardiomyopathic disease progression between male and female patients was hypothesised in previous studies, as in female myocardial fibrosis was found without left ventricular (LV) hypertrophy, while myocardial fibr...

  11. Accuracy and congruence of patient and physician weight-related discussions: from Project CHAT (Communicating Health: Analyzing Talk)

    Science.gov (United States)

    Bodner, Michael E.; Dolor, Rowena J.; Óstbye, Truls; Lyna, Pauline; Alexander, Stewart C.; Tulsky, James A.; Pollak, Kathryn I.

    2014-01-01

    Objective Primary care providers should counsel overweight patients to lose weight. Rates of self-reported weight-related counseling vary, perhaps due to self-report bias. We assessed accuracy and congruence of weight-related discussions among patients, physicians, and audio-recorded encounters. Methods We audio recorded encounters between physicians (n=40) and their overweight/obese patients (n=461) at five community-based practices. We coded weight-related content and surveyed patients and physicians immediately after the visit. Generalized linear mixed models assessed factors associated with accuracy. Results Overall, accuracy was moderate: patient (67%), physician (70%), and congruence (62%). When encounters contained weight-related content were analyzed, patients (98%) and physicians (97%) were highly accurate and congruent (95%) but when weight was not discussed patients and physicians were more inaccurate and incongruent (patient 36%; physician 44%; 28% congruence). Physicians less comfortable discussing weight were more likely to misreport that weight was discussed [OR = 4.5 (95% CI=1.88–10.75, p<0.001)]. White physicians with African-American patients were more likely to report accurately no discussion about weight than White physicians with White patients OR=0.30 (95% CI=0.13–0.69, p<0.01). Conclusion Physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed, but not when recordings indicated no weight discussions. Physician overestimation of weight discussions when weight is not discussed constitutes missed opportunities for health interventions. PMID:24390888

  12. PSYCHOPATHOLOGICAL DYNAMICS OF A DISASTER VICTIM, REJECTING MENTAL HEALTH CARE – A CASE REPORT AND DISCUSSION

    Directory of Open Access Journals (Sweden)

    Ivan Aleksandrov

    2017-05-01

    Full Text Available Background: Seeking and receiving psychological help after a stressful life event is associated with certain prejudice attitudes, especially present in minority ethnic groups. Case description: This case report describes the specific reactions and psychopathological dynamics of a female patient, the age of 43, who survived the terrible accident on December the 10th 2016, in Hitrino village. Discussion: Due to stigmatising beliefs, patient reluctantly had only a few meeting with a clinical psychologist, refused proper psychiatric treatment, and developed an acute stress reaction in the first few days after the accident, followed by post-traumatic stress disorder the next few weeks, as described chronologically in the ICD-10. Conclusion: Stigmatising beliefs are further amplified by ethnic minorities’ prejudice of seeking mental health and having a mental illness, which affects professionals’ ability to provide comprehensive medical care.

  13. Discussion of some issues in environmental impact reports of nuclear and radiation facilities

    International Nuclear Information System (INIS)

    Pan Ziqiang

    1995-01-01

    The author discusses some issues in compilation and evaluation of environmental impact reports of nuclear and radiation facilities which should be noticeable. Some recommendations are made to improve the quality of the reports as well

  14. A Systematic Approach to Discussing Active Surveillance with Patients with Low-risk Prostate Cancer.

    Science.gov (United States)

    Ehdaie, Behfar; Assel, Melissa; Benfante, Nicole; Malhotra, Deepak; Vickers, Andrew

    2017-06-01

    Physicians report difficulty convincing patients with prostate cancer about the merits of active surveillance (AS); as a result, a majority of patients unnecessarily choose to undergo radical treatment. To develop and evaluate a systematic approach for physicians to counsel patients with low-risk prostate cancer to increase acceptance of AS. A systematic counseling approach was developed and piloted in one clinic. Then five surgeons participated in a 1-h training session in which they learned about the approach. A total of 1003 patients with Gleason 3+3 prostate cancer were included in the study. We compared AS rates for 761 patients who were counseled over a 24-mo period before the training intervention with AS rates for 242 patients who were counseled over a 12-mo period afterwards, controlling for temporal trends and case mix. A systematic approach for communicating the merits of AS using appropriate framing techniques derived from principles studied by negotiation scholars. The rate of AS acceptance by patients for management of low-risk prostate cancer. In the pilot phase, 81 of 86 patients (94%) accepted AS after counseling by the physician who developed the counseling approach. In the subsequent study, the cohort for the training intervention comprised 1003 consecutive patients, 80% of whom met the Epstein criteria for very low-risk disease. The proportion of patients who selected AS increased from 69% before the training intervention to 81% afterwards. After adjusting for time trends and case mix, the rate of AS after the intervention was 9.1% higher (95% confidence interval -0.4% to 19.4%) than expected, a relative reduction of approximately 30% in the risk of unnecessary curative treatment. A systematic approach to counseling can be taught to physicians in a 1-h lecture. We found evidence that even this minimal intervention can decrease overtreatment. Our novel approach offers a framework to help address cancer screening-related overtreatment that occurs

  15. Discussing compliance. Summary report from discussions with Robert Bernero and Chris Whipple regarding compliance with the Swedish HLW Regulations from meetings in Stockholm May 3 and 4, 1999

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, Mikael

    1999-06-01

    Summary report from discussions with Robert Bernero and Chris Whipple regarding compliance with the Swedish HLW Regulations from meetings in Stockholm. The report also contains bibliographical information and preliminary observations made by Robert Bernero and Chris Whipple.

  16. Discussing compliance. Summary report from discussions with Robert Bernero and Chris Whipple regarding compliance with the Swedish HLW Regulations from meetings in Stockholm May 3 and 4, 1999

    International Nuclear Information System (INIS)

    Jensen, Mikael

    1999-06-01

    Summary report from discussions with Robert Bernero and Chris Whipple regarding compliance with the Swedish HLW Regulations from meetings in Stockholm. The report also contains bibliographical information and preliminary observations made by Robert Bernero and Chris Whipple

  17. Parents' experiences discussing pediatric vaccination with healthcare providers: a survey of Canadian naturopathic patients.

    Science.gov (United States)

    Busse, Jason W; Walji, Rishma; Wilson, Kumanan

    2011-01-01

    Parents who choose to selectively vaccinate or avoid vaccination for their children may do so at risk of compromising relations with their family physician or pediatrician. Groups that are associated with reduced rates of pedicatic vaccination, such as parents who access naturopathic care, may be particularly vulnerable to this issue. In March through September 2010, we administered a 26-item cross-sectional survey to 129 adult patients, all of whom were parents with children ≤ 16 years of age, presenting for naturopathic care in Ontario, Canada. Ninety-five parents completed the survey (response rate 74%), and only 50.5% (48 of 95) reported that their children had received all recommended vaccines. Most parents (50.5%; 48 of 95) reported feeling pressure to vaccinate from their allopathic physician and, of those who discussed vaccination with their physician, 25.9% (21 of 81) were less comfortable continuing care as a result. Five percent (4 of 81) of respondents were advised by their physician that their children would be refused care if they decided against vaccination. In our adjusted generalized linear model, feeling pressure to vaccinate (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 1.14 to 8.26) or endorsing a naturopathic physician as their most trusted source of information regarding vaccination (OR = 3.57; 95% CI = 1.22 to 10.44) were associated with greater odds of having a partially vaccinated or unvaccinated child. The majority (69.6%; 32 of 46) of parent's with partially vaccinated or unvaccinated children reported a willingness to re-consider this decision. Use of naturopathic care should be explored among parents in order to identify this high-risk group and engage them in discussion regarding pediatric vaccination to encourage evidence-based, shared decision making. Physicians should ensure that discussions regarding vaccination are respectful, even if parents are determined not to vaccinate their children.

  18. Parents' experiences discussing pediatric vaccination with healthcare providers: a survey of Canadian naturopathic patients.

    Directory of Open Access Journals (Sweden)

    Jason W Busse

    Full Text Available Parents who choose to selectively vaccinate or avoid vaccination for their children may do so at risk of compromising relations with their family physician or pediatrician. Groups that are associated with reduced rates of pedicatic vaccination, such as parents who access naturopathic care, may be particularly vulnerable to this issue.In March through September 2010, we administered a 26-item cross-sectional survey to 129 adult patients, all of whom were parents with children ≤ 16 years of age, presenting for naturopathic care in Ontario, Canada. Ninety-five parents completed the survey (response rate 74%, and only 50.5% (48 of 95 reported that their children had received all recommended vaccines. Most parents (50.5%; 48 of 95 reported feeling pressure to vaccinate from their allopathic physician and, of those who discussed vaccination with their physician, 25.9% (21 of 81 were less comfortable continuing care as a result. Five percent (4 of 81 of respondents were advised by their physician that their children would be refused care if they decided against vaccination. In our adjusted generalized linear model, feeling pressure to vaccinate (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 1.14 to 8.26 or endorsing a naturopathic physician as their most trusted source of information regarding vaccination (OR = 3.57; 95% CI = 1.22 to 10.44 were associated with greater odds of having a partially vaccinated or unvaccinated child. The majority (69.6%; 32 of 46 of parent's with partially vaccinated or unvaccinated children reported a willingness to re-consider this decision.Use of naturopathic care should be explored among parents in order to identify this high-risk group and engage them in discussion regarding pediatric vaccination to encourage evidence-based, shared decision making. Physicians should ensure that discussions regarding vaccination are respectful, even if parents are determined not to vaccinate their children.

  19. Physicians' self-reported practice behaviour regarding fertility-related discussions in paediatric oncology in Sweden.

    Science.gov (United States)

    Armuand, G M; Nilsson, J; Rodriguez-Wallberg, K A; Malmros, J; Arvidson, J; Lampic, C; Wettergren, L

    2017-10-01

    The aim of this study was to investigate practice behaviours of Swedish physicians with regard to discussing the impact of cancer treatment on fertility with paediatric oncology patients and their parents, and to identify factors associated with such discussions. A cross-sectional survey study was conducted targeting all physicians in Sweden working in paediatric oncology care settings. Participants responded to a questionnaire measuring practice behaviour, attitudes, barriers, and confidence in knowledge. Multivariable logistic regression was used to determine factors associated with seldom discussing fertility. More than half of the physicians routinely talked with their patients/parents about the treatment's potential impact on fertility (male patients: 62%; female patients: 57%; P = 0.570). Factors associated with less frequently discussing fertility with patients/parents were working at a non-university hospital (male patients: OR 11.49, CI 1.98-66.67; female patients: OR 33.18, CI 4.06-271.07), concerns that the topic would cause worry (male patients: OR 8.23, CI 1.48-45.89; female patients: OR 12.38, CI 1.90-80.70), and perceiving the parents as anxious (male patients: OR 7.18, CI 1.20-42.85; female patients: OR 11.65, CI 1.32-103.17). Based on our findings, we recommend structured training in how to communicate about fertility issues in stressful situations, which in turn might increase fertility-related discussions in paediatric oncology. © 2017 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

  20. Democratic discussion in newspaper reporting of the Australia-United States Free Trade Agreement.

    Science.gov (United States)

    Sykes, Robbie

    2008-10-01

    This article presents a Habermasian analysis of newspaper reporting of the debate surrounding the effect of the Australia-United States Free Trade Agreement (the FTA) on access to medicines through Australian patent law. Habermas's concept of the public sphere is utilised in determining whether discussion within the print media adequately conveyed complex legal issues to the public and facilitated democratic discussion. It was found that newspaper reporting generally failed to meet this standard.

  1. Adolescents and Young Adults With Cancer: Oncology Nurses Report Attitudes and Barriers to Discussing Fertility Preservation.

    Science.gov (United States)

    Nobel Murray, Alexandra; Chrisler, Joan C; Robbins, Mark L

    2016-08-01

    Fertility issues have been found to be an important topic for adolescents and young adults (AYAs) with cancer. Medical technology has made fertility preservation (FP) increasingly effective for postpubertal patients whose treatment course may inhibit their future ability to achieve biologic parenthood. Oncology providers' recommendations have been shown to vary, potentially affecting patients' decision-making processes regarding FP. This study was designed to assess oncology nurses' recommendations for patients to consider FP options and to explore what patient-related factors may influence discussion of FP with AYAs with cancer. 116 oncology nurses participated in this study and were randomized to read one of four vignettes about a patient whose proposed treatment course could affect his or her fertility. Participants' recommendations to partake in FP were analyzed to test for differences by patient age and gender. Open-ended responses to questions about their experiences as oncology nurses were analyzed descriptively. Nurses strongly recommended that all patients explore FP options before the start of treatment. Oncology nurses endorsed stronger opinions that young adult female patients should be given independent decision-making power to delay treatment for FP, compared to male and female adolescent patients and young adult male patients. Participants mentioned barriers to discussions that included concerns about exacerbating negative emotions and the decision-making capacity of young patients.

  2. Special Collections in ARL Libraries: A Discussion Report from the ARL Working Group on Special Collections

    Science.gov (United States)

    Association of Research Libraries, 2009

    2009-01-01

    This discussion report identifies key issues in the management of special collections material in the 21st century. The report uses a broad definition of "special collections," which encompasses distinctive material in all media and attendant library services. The group's main focus was on 19th- and 20th-century materials, including…

  3. Report for fiscal 2000 on electronic patient record network discussion committee. Survey on promotion of medical information use utilizing electronic patient record network; 2000 nendo denshi karute network kento iinkai hokokusho. Denshi karute network wo katsuyoshita iryo johoka no sokushin ni kansuru chosa

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Based on the movements in the most advanced IT technologies and in social system reformation in the medical and health preservation fields, discussions were given on the assignments and measures to be solved to realize the medical information network, and the secondary utilization method of the medical information and the assignments and measures in the utilization thereof. A patient record is originally a document stating the secrets of a patient for his or her medical information, and has a nature that doctors may be sued from the patient if they disclose or exchange the document. There is a large number of company owners, politicians or salaried people who would not want their diseases which they had in the past, the name of the existing disease and medical treatment to be made public. The electronic patient record network has a conflicting proposition to elevate its values by means of data re-utilization, secondary utilization and information exchange. Preparation of the database requires multilateral analyses and classifications, as well as sufficient discussions and realistic execution including the consistency with the personal information protection law, as to whether it is information that the patient wants the exchange or disclosure, or whether it is information to be exchanged or disclosed even if the patient refuses it, not speak of attention to 5W1H. (NEDO)

  4. Experiences of Scandinavian nurses in discussing sexuality with patients, clients and residents

    DEFF Research Database (Denmark)

    Laursen, Birgitte Schantz; Rasmussen, Philippa; Conroy, Tiffany

    2017-01-01

    REVIEW QUESTION/OBJECTIVE:: The objective of this review is to critically appraise, synthesize, and present the best available evidence to address the question: How do Scandinavian nurses experience discussing sexual issues with patients, residents and clients?......REVIEW QUESTION/OBJECTIVE:: The objective of this review is to critically appraise, synthesize, and present the best available evidence to address the question: How do Scandinavian nurses experience discussing sexual issues with patients, residents and clients?...

  5. LVAD patients' and surrogates' perspectives on SPIRIT-HF: An advance care planning discussion.

    Science.gov (United States)

    Metzger, Maureen; Song, Mi-Kyung; Devane-Johnson, Stephanie

    2016-01-01

    To describe LVAD patients' and surrogates' experiences with, and perspectives on SPIRIT-HF, an advance care planning (ACP) intervention. ACP is important for patients with LVAD, yet little is known about their experiences or those of their surrogates who have participated in ACP discussions. We used qualitative content analysis techniques to conduct a secondary analysis of 28 interviews with patients with LVAD (n = 14) and their surrogates (n = 14) who had participated in an RCT pilot study of SPIRIT-HF. Main themes from the data include: 1) sharing their HF stories was very beneficial; 2) participating in SPIRIT-HF led to greater peace of mind for patients and surrogates; 3) "one size does not fit all" when it comes to timing of ACP discussions. An understanding patient and surrogate perspectives may inform clinicians' approach to ACP discussions. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Psychosocial correlates of patient-provider family planning discussions among HIV-infected pregnant women in South Africa.

    Science.gov (United States)

    Rodriguez, Violeta J; Cook, Ryan R; Weiss, Stephen M; Peltzer, Karl; Jones, Deborah L

    2017-01-01

    Patient-provider family planning discussions and preconception counseling can reduce maternal and neonatal risks by increasing adherence to provider recommendations and antiretroviral medication. However, HIV-infected women may not discuss reproductive intentions with providers due to anticipation of negative reactions and stigma. This study aimed to identify correlates of patient-provider family planning discussions among HIV-infected women in rural South Africa, an area with high rates of antenatal HIV and suboptimal rates of prevention of mother-to-child transmission (PMTCT) of HIV. Participants were N=673 pregnant HIV-infected women who completed measures of family planning discussions and knowledge, depression, stigma, intimate partner violence, and male involvement. Participants were, on average, 28 ± 6 years old, and half of them had completed at least 10-11 years of education. Most women were unemployed and had a monthly income of less than ~US$76. Fewer than half of the women reported having family planning discussions with providers. Correlates of patient-provider family planning discussions included younger age, discussions about PMTCT of HIV, male involvement, and decreased stigma ( p family planning discussions through male involvement ( b = -0.010, bias-corrected 95% confidence interval [bCI] [-0.019, -0.005]). That is, depression decreased male involvement, and in turn, male involvement increased patient-provider family planning discussions. Therefore, by decreasing male involvement, depression indirectly decreased family planning discussions. Study findings point to the importance of family planning strategies that address depression and facilitate male involvement to enhance communication between patients and providers and optimize maternal and neonatal health outcomes. This study underscores the need for longitudinal assessment of men's impact on family planning discussions both pre- and postpartum. Increasing support for provision of mental

  7. Association of code status discussion with invasive procedures among advanced-stage cancer and noncancer patients

    Directory of Open Access Journals (Sweden)

    Sasaki A

    2017-07-01

    Full Text Available Akinori Sasaki,1 Eiji Hiraoka,1 Yosuke Homma,2 Osamu Takahashi,3 Yasuhiro Norisue,4 Koji Kawai,5 Shigeki Fujitani4 1Department of Internal Medicine, 2Department of Emergency Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu City, Chiba, 3Department of Internal Medicine, St. Luke’s International Hospital, Chuo-ku, Tokyo, 4Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu City, Chiba, 5Department of Gastroenterology, Ito Municipal Hospital, Ito City, Shizuoka, Japan Background: Code status discussion is associated with a decrease in invasive procedures among terminally ill cancer patients. We investigated the association between code status discussion on admission and incidence of invasive procedures, cardiopulmonary resuscitation (CPR, and opioid use among inpatients with advanced stages of cancer and noncancer diseases. Methods: We performed a retrospective cohort study in a single center, Ito Municipal Hospital, Japan. Participants were patients who were admitted to the Department of Internal Medicine between October 1, 2013 and August 30, 2015, with advanced-stage cancer and noncancer. We collected demographic data and inquired the presence or absence of code status discussion within 24 hours of admission and whether invasive procedures, including central venous catheter placement, intubation with mechanical ventilation, and CPR for cardiac arrest, and opioid treatment were performed. We investigated the factors associated with CPR events by using multivariate logistic regression analysis. Results: Among the total 232 patients, code status was discussed with 115 patients on admission, of which 114 (99.1% patients had do-not-resuscitate (DNR orders. The code status was not discussed with the remaining 117 patients on admission, of which 69 (59% patients had subsequent code status discussion with resultant DNR orders. Code status discussion on admission decreased the incidence of central venous

  8. Discussing Sexual Dysfunction with Chronic Kidney Disease Patients: Practice Patterns in the Office of the Nephrologist.

    Science.gov (United States)

    van Ek, Gaby F; Krouwel, Esmée M; Nicolai, Melianthe P; Bouwsma, Hanneke; Ringers, Jan; Putter, Hein; Pelger, Rob C M; Elzevier, Henk W

    2015-12-01

    Sexual dysfunction (SD) is a common problem in patients suffering from chronic kidney disease (CKD). Sexual health remains a difficult subject to detect and discuss. Although many studies have been performed on the incidence of SD, little is known about practice patterns when it concerns quality of life (QoL)-related questions such as SD in the nephrologists' practice. The aim of this study was to determine to which extent nephrologists, important renal care providers, discuss SD with their patients and their possible barriers toward discussing this subject. A 50-item questionnaire was sent to all Dutch nephrologists (n = 312). The survey results. The response rate of the survey was 34.5%. Almost all responders (96.4%) stated to address SD in less than half of their new patients. The most important barrier not to discuss SD was patients not expressing their concern regarding SD spontaneously (70.8%). Other important barriers were: "the lack of a suitable moment to discuss" (61.9%) and "insufficient time" (46.9%). Eighty-five percent of the nephrologists stated that insufficient attention was paid to SD and treatment options during their training. Sixty-five percent of the respondents stated to be in need of extending their knowledge on the discussing of SD. Dutch nephrologists do not discuss problems with sexual function routinely. The lack of knowledge, suitable education, and insufficient time are factors causing undervaluation of SD in CKD patients. Implementation of competent sexual education and raising awareness among nephrologists on the importance of paying attention to SD could improve care and QoL for patients with CKD. More research should be performed among patients and other renal care providers to develop an adequate method to enhance our current system. © 2015 International Society for Sexual Medicine.

  9. Communication about palliative care: A phenomenological study exploring patient views and responses to its discussion.

    Science.gov (United States)

    Collins, Anna; McLachlan, Sue-Anne; Philip, Jennifer

    2018-01-01

    Communication about palliative care is a complex task frequently delayed until otherwise unavoidable. There is a need for discussion of palliative care to be viewed as a distinct communication task that is guided by empirical data. However, little is known of patient views and responses to these encounters. To explore patient views surrounding communication about palliative care and their responses to its discussion. Cross-sectional, prospective, exploratory qualitative design, involving narrative-style interviews and underpinned by an interpretative phenomenological framework. Purposively sampled, English-speaking, adult patients with advanced cancer ( n = 30) recruited from cancer services at a tertiary metropolitan hospital in Melbourne, Australia. Three major themes evolved. (1) Death as unspeakable: death was expressed using only implicit, ambiguous or technical terms and perceived to be outside the parameters of medical interactions. (2) Palliative care as a euphemism for death: the term 'palliative care' was perceived to be used by health professionals as a tool to talk about dying and understood by patients as a euphemism for death. (3) Palliative care as unspeakable: 'palliative care' was personified by patients to mean not just death, but my death, in turn, also becoming unspeakable. This study provides important new patient insights and responses to the discussion of palliative care. Results demonstrate that the task of discussing palliative care remains complex, difficult and limited by our language. Greater consistency, sensitivity and sophistication are required when talking about palliative care to patients who may benefit from this care.

  10. Increasing uptake of comparative effectiveness and patient-centered outcomes research among stakeholders: insights from conference discussion.

    Science.gov (United States)

    Law, Ernest; Harrington, Rachel; Alexander, G Caleb; Saha, Soumi; Oehrlein, Elisabeth; Perfetto, Eleanor M

    2018-02-01

    The goal of comparative effectiveness research (CER) and patient-centered outcomes research (PCOR) is to improve health outcomes by providing stakeholders with evidence directly relevant to decision making. In January 2017, the Pharmaceutical Research and Manufacturers Association Foundation, alongside the Academy for Managed Care Pharmacy, organized a conference aimed at engaging experts and opinion leaders representing clinicians, patients and payers to identify and discuss barriers and strategies to enhancing uptake and use of CER/PCOR. This report summarizes the conference discussion in the following sections: preconference survey; summary of barriers and strategies to the uptake of CER/PCOR identified by conference attendees; and future perspectives on the field.

  11. 'Breaking Good News': Neurologists' experiences of discussing SUDEP with patients in Scotland.

    Science.gov (United States)

    Nisbet, Tom; Turbull, Sue; Mulhern, Sharon; Razvi, Saif

    2017-05-01

    Since the findings of a Fatal Accident Inquiry (FAI) in 2010, clinicians working in Scotland have been advised to discuss the risk of Sudden Unexpected Death in Epilepsy (SUDEP) with patients immediately or soon after a diagnosis of epilepsy is made. A thematic analysis was used to describe the experiences discussing SUDEP of 10 clinicians (six Consultant Neurologists and four Neurology Registrars) working in Scotland. Contrary to previous research, clinicians appear to be routinely discussing SUDEP in a standardized fashion with newly diagnosed patients and the FAI appears to have instigated this change in practice. Clinicians are ambivalent about the practice and whether this is a Breaking Bad News (BBN) experience. Clinicians appear to anticipate that patients will be anxious or distressed discussing SUDEP, despite their experiences that patients do not react this way. There are further concerns that the pressure to discuss SUDEP, as a result of the FAI, hinders effective communication of the SUDEP message. Implications for guideline development are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Patient informed governance of distributed research networks: results and discussion from six patient focus groups.

    Science.gov (United States)

    Mamo, Laura A; Browe, Dennis K; Logan, Holly C; Kim, Katherine K

    2013-01-01

    Understanding how to govern emerging distributed research networks is essential to their success. Distributed research networks aggregate patient medical data from many institutions leaving data within the local provider security system. While much is known about patients' views on secondary medical research, little is known about their views on governance of research networks. We conducted six focus groups with patients from three medical centers across the U.S. to understand their perspectives on privacy, consent, and ethical concerns of sharing their data as part of research networks. Participants positively endorsed sharing their health data with these networks believing that doing so could advance healthcare knowledge. However, patients expressed several concerns regarding security and broader ethical issues such as commercialism, public benefit, and social responsibility. We suggest that network governance guidelines move beyond strict technical requirements and address wider socio-ethical concerns by fully including patients in governance processes.

  13. Male-female patient differences in association between end-of-life discussions and receipt of intensive care near death

    Science.gov (United States)

    Sharma, Rashmi K.; Prigerson, Holly G.; Penedo, Frank J.; Maciejewski, Paul K.

    2015-01-01

    Background Patient gender plays a significant role in patient-physician communication, patient illness understanding and aggressiveness of end of life (EoL) care. However, little is known about the extent to which gender differences in the effects of EoL discussions on EoL care contribute to gender differences in EoL care. The present study aims to determine if gender differences exist in receipt of intensive care unit (ICU) care near death and in the association between EoL discussions and receipt of ICU EoL care. Methods Multi-site, prospective, cohort study of patients (N=353) with metastatic cancers, identified as terminally ill at study enrollment and interviewed a median of 4.1 months before their deaths. Postmortem chart reviews and caregiver interviews documented ICU stays in the last week of life. Results Patients who received ICU care at the EoL were more likely to be male than those who did not (73% male vs. 52% male, p=0.02). Adjusting for potential confounds, male patients reporting an EoL discussion were less likely to have an ICU stay in the last week of life than male patients with no EoL discussion (AOR=0.26, 95% CI 0.07–0.91; p=0.04). There was no association between EoL discussions and ICU stays near death among female patients. Conclusions Men with advanced cancers are more likely than women to receive aggressive, non-beneficial, ICU care near death. Gender differences in effects of EoL discussions on EoL care likely contribute to, and may even explain, gender differences in receipt of ICU care in the last week of life. PMID:25975179

  14. Patient-Provider Discussions About Strategies to Limit Air Pollution Exposures.

    Science.gov (United States)

    Mirabelli, Maria C; Damon, Scott A; Beavers, Suzanne F; Sircar, Kanta D

    2018-06-11

    Exposure to air pollution negatively affects respiratory and cardiovascular health. The objective of this study was to describe the extent to which health professionals report talking about how to limit exposure to air pollution during periods of poor air quality with their at-risk patients. In 2015, a total of 1,751 health professionals completed an online survey and reported whether they talk with their patients about limiting their exposure to air pollution. In 2017, these data were analyzed to assess the frequency that health professionals in primary care, pediatrics, obstetrics/gynecology, and nursing reported talking about limiting air pollution exposure with patients who have respiratory or cardiovascular diseases, were aged ≤18 years, were aged ≥65 years, or were pregnant women. Frequencies of positive responses were assessed across categories of provider- and practice-level characteristics. Overall, 714 (41%) respondents reported ever talking with their patients about limiting their exposure to air pollution. Thirty-four percent and 16% of providers specifically reported talking with their patients with respiratory or cardiovascular disease diagnoses, respectively. Percentages of health professionals who reported talking with their patients about limiting air pollution exposure were highest among respondents in pediatrics (56%) and lowest among respondents in obstetrics/gynecology (0%). Despite the well-described health effects of exposure to air pollution, the majority of respondents did not report talking with their patients about limiting their exposure to air pollution. These findings reveal clear opportunities to improve awareness about strategies to limit air pollution exposure among sensitive groups of patients and their health care providers. Published by Elsevier Inc.

  15. Heart team discussion in managing patients with coronary artery disease: outcome and reproducibility.

    Science.gov (United States)

    Long, Jenny; Luckraz, Heyman; Thekkudan, Joyce; Maher, Abdul; Norell, Michael

    2012-05-01

    Recent ESC/EACTS revascularization guidelines advocate a 'Heart Team' (HT) approach in the decision-making process when managing patients with coronary disease. We prospectively assessed HT decision-making in 150 patients analysing personnel attendance, data presented, the 'actioning' of the HT decision and, if not completed, then the reasons why. Additionally, 50 patients were specifically re-discussed after 1 year in order to assess consistency in decision-making. We have two HT meetings each week. At least one surgeon, interventional cardiologist and non-interventional cardiologist were present at all meetings. Data presented included patient demographics, symptoms, co-morbidities, coronary angiography, left ventricular function and other relevant investigations, e.g. echocardiograms. HT decisions included continued medical treatment (22%), percutaneous coronary intervention (PCI; 22%), coronary-artery bypass grafting (CABG; 34%) or further investigations such as pressure wire studies, dobutamine stress echo or cardiac magnetic resonance imaging (22%). These decisions were fully undertaken in 86% of patients. Reasons for aberration in the remaining 21 patients included patient refusal (CABG 29%, PCI 10%) and further co-morbidities (28%). On re-discussion of the same patient data (n = 50) a year later, 24% of decisions differed from the original HT recommendations reflecting the fact that, for certain coronary artery disease pattern, either CABG or PCI could be appropriate.

  16. Discussing study limitations in reports of biomedical studies- the need for more transparency.

    Science.gov (United States)

    Puhan, Milo A; Akl, Elie A; Bryant, Dianne; Xie, Feng; Apolone, Giovanni; ter Riet, Gerben

    2012-02-23

    Unbiased and frank discussion of study limitations by authors represents a crucial part of the scientific discourse and progress. In today's culture of publishing many authors or scientific teams probably balance 'utter honesty' when discussing limitations of their research with the risk of being unable to publish their work. Currently, too few papers in the medical literature frankly discuss how limitations could have affected the study findings and interpretations. The goals of this commentary are to review how limitations are currently acknowledged in the medical literature, to discuss the implications of limitations in biomedical studies, and to make suggestions as to how to openly discuss limitations for scientists submitting their papers to journals. This commentary was developed through discussion and logical arguments by the authors who are doing research in the area of hedging (use of language to express uncertainty) and who have extensive experience as authors and editors of biomedical papers. We strongly encourage authors to report on all potentially important limitations that may have affected the quality and interpretation of the evidence being presented. This will not only benefit science but also offers incentives for authors: If not all important limitations are acknowledged readers and reviewers of scientific articles may perceive that the authors were unaware of them. Authors should take advantage of their content knowledge and familiarity with the study to prevent misinterpretations of the limitations by reviewers and readers. Articles discussing limitations help shape the future research agenda and are likely to be cited because they have informed the design and conduct of future studies. Instead of perceiving acknowledgment of limitations negatively, authors, reviewers and editors should recognize the potential of a frank and unbiased discussion of study limitations that should not jeopardize acceptance of manuscripts.

  17. Discussing study limitations in reports of biomedical studies- the need for more transparency

    Directory of Open Access Journals (Sweden)

    Puhan Milo A

    2012-02-01

    Full Text Available Abstract Unbiased and frank discussion of study limitations by authors represents a crucial part of the scientific discourse and progress. In today's culture of publishing many authors or scientific teams probably balance 'utter honesty' when discussing limitations of their research with the risk of being unable to publish their work. Currently, too few papers in the medical literature frankly discuss how limitations could have affected the study findings and interpretations. The goals of this commentary are to review how limitations are currently acknowledged in the medical literature, to discuss the implications of limitations in biomedical studies, and to make suggestions as to how to openly discuss limitations for scientists submitting their papers to journals. This commentary was developed through discussion and logical arguments by the authors who are doing research in the area of hedging (use of language to express uncertainty and who have extensive experience as authors and editors of biomedical papers. We strongly encourage authors to report on all potentially important limitations that may have affected the quality and interpretation of the evidence being presented. This will not only benefit science but also offers incentives for authors: If not all important limitations are acknowledged readers and reviewers of scientific articles may perceive that the authors were unaware of them. Authors should take advantage of their content knowledge and familiarity with the study to prevent misinterpretations of the limitations by reviewers and readers. Articles discussing limitations help shape the future research agenda and are likely to be cited because they have informed the design and conduct of future studies. Instead of perceiving acknowledgment of limitations negatively, authors, reviewers and editors should recognize the potential of a frank and unbiased discussion of study limitations that should not jeopardize acceptance of

  18. Egypt--United States cooperative energy assessment: report on preliminary discussions

    Energy Technology Data Exchange (ETDEWEB)

    1978-04-01

    Egyptian and U.S. Government representatives met in Cairo during the period of February 14-22, 1978 to discuss a cooperative Egypt-U.S. assessment of the energy demand and supply options available to Egypt. This report summarizes those preliminary discussions. The discussions accomplished the following: the background and objectives of the U.S. initiative for a cooperative energy assessment with Egypt were explained; Egyptian electric energy activities and their priorities were presented; methods under consideration for the systematic identification and assessment of energy options available to Egypt were explained; the cooperation of Egyptian energy resource and planning organizations was assured; and arrangements to carry out the cooperative assessment were planned.

  19. Congenital duodenal obstruction with situs inversus totalis: Report of a rare association and discussion

    Directory of Open Access Journals (Sweden)

    Sharma Satendra

    2008-01-01

    Full Text Available This report is to present and discuss an extremely rare association of situs inversus with duodenal atresia in an 11-day-old male neonate born full term and weighing 1.9 kg. The baby presented with recurrent bilious vomiting. Babygram revealed situs inversus and duodenal obstruction. Echocardiography showed dextrocardia with a small ASD. Exploration confirmed a duodenal diaphragm with a central perforation between the third and fourth part of the duodenum and situs inversus. The literature search revealed 20 cases reported so far.

  20. An approach to discussing personal and social identity terminology with patients.

    Science.gov (United States)

    Sloboda, Alexander; Mustafa, Aesha; Schober, Justine

    2018-03-01

    As the United States of America becomes more socially diverse, it is more important now than ever for health care providers to become more aware of their patients' social identities. It is imperative that providers engage with their patients and see how each of them identifies personally in relation to social construction terminology. As with the terminology of human anatomy, there is a vast and diverse vocabulary concerning the anatomy of society, which is also clinically relevant to health care providers. If health care providers take the initiative to discuss how their patients identify, they can understand better how those patients experience the world, and this can significantly affect many facets of their health and health care experience. Giving respect fosters the creation of a strong relationship within which patients can share very personal and intimate information, which in turn allows health care providers the possibility of providing the best healthcare. This discussion will build upon and integrate current academic research and opinion for tangible clinical use while discussing various social and personal identities, including but not limited to race, gender, gender expression, sex, sexual orientation, religion, ethnicity, socioeconomic class, and physical and mental abilities. Clin. Anat. 31:136-139, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  1. Discussing patient's lifestyle choices in the consulting room: analysis of GP-patient consultations between 1975 and 2008

    Directory of Open Access Journals (Sweden)

    van Dulmen Sandra

    2010-11-01

    Full Text Available Abstract Background The increasing prevalence of chronic diseases and the growing understanding that lifestyle behaviour plays an essential role in improving overall health suggest a need for increased attention to lifestyle choices in the consulting room. This study aims to examine whether or not healthy and unhealthy lifestyle choices of patients are currently being discussed more often in primary care consultations than in former decades. Furthermore, we are interested in GPs' approach to lifestyle behaviour during consultations. Lastly, we examine whether lifestyle behaviour is discussed more with certain patients during consultations, depending on gender, age and educational background. Method We analysed video-recordings of medical consultations, collected between 1975 and 2008 in Dutch GP practices. Data were analysed using logistic regression. Results This study shows that discussion of smoking behaviour and physical activity has increased somewhat over time. A change in discussion of nutrition and alcohol is, however, less clear. Overall, alcohol use is the least discussed and physical activity the most discussed during consultations. GPs mainly refer to lifestyle when it is relevant to the patient's complaints (symptom approach. GPs' approach to lifestyle behaviour did not change over time. In general, lifestyle behaviour is discussed more with older, male patients (except for nutrition. GPs talk about lifestyle behaviour with patients from different educational backgrounds equally (except for physical activity. Conclusion In recent years there is greater awareness of a healthy lifestyle, which is reflected to a limited extent in this study. Still, lifestyle behaviour is discussed in only a minority of consultations. GPs do not refer to lifestyle behaviour as a routine procedure, i.e. do not include it in primary prevention. This highlights the importance of the introduction of prevention consultations, where GPs can discuss lifestyle

  2. Ethical considerations in protecting the environment from the effects of ionizing radiation. A report for discussion

    International Nuclear Information System (INIS)

    2002-02-01

    In recent years awareness of the vulnerability of the environment has increased and the need to protect it against the effects of industrial pollutants has been recognized. This trend is reflected in new and developing international policies for environmental protection. In the context of protection of the environment against ionizing radiation, the existing international approach is based on providing for the protection of humans. The current recommendations of the International Commission on Radiological Protection (ICRP) include the statement that t he standard of environmental control needed to protect man to the degree currently thought desirable will ensure that other species are not put at risk... . In the light of the new focus of concern for the environment, this statement is being critically reviewed in several international fora. The IAEA has, over many years, sponsored studies of the effects of ionizing radiation on species other than humans. Most recently it published a discussion report as IAEA-TECDOC-1091 (1999) in which the need for developing a system for protecting the environment against the effects of ionizing radiation was elaborated and in which various related technical and philosophical issues for resolution were discussed. The current report explores the ethical principles that could underlie a system of environmental protection. It is intended as one step in the development of a framework for the protection of the environment from the effects of ionizing radiation, and is being published in order to promote awareness of the current developments in this field as well as to encourage discussion amongst those involved

  3. SaskEnergy small volume customers - direct gas purchase stakeholder discussion and public input report

    International Nuclear Information System (INIS)

    Davidson, M. A.

    1998-01-01

    With the approval of the Provincial Government of Saskatchewan, SaskEnergy, the provincial utility decided to extend the premise of natural gas deregulation to all sizes of customers by opening the core market for natural gas commodity sales to private sector natural gas agents, brokers and marketers (ABMs). SaskEnergy will continue to provide natural gas transportation and storage related services. Before doing so, the Utility sought to discuss with various stakeholders the terms and conditions that would need to be met by industry to enter into the Saskatchewan market. To assure a balanced interest during the discussions that would include a perspective on consumer protection requirements, the Utility contracted KPMG Regina to chair the stakeholders discussion table and facilitate a public input process for interested individuals to channel comments and seek responses to questions. This report contains the edited summary of the four meetings held by stakeholders. The stakeholders were successful in providing SaskEnergy with insight and suggestions to ensure that a direct purchase market will be developed in Saskatchewan, and that consumers will have objective information to make informed choices about their natural gas purchase options. The meetings also produced an ABMs Code of Conduct, a Direct Purchase 'Enrollment Agreement' and a 'Disclosure Agreement' and delivery terms and conditions for the core market that are similar to industry requirements in the rest of Canada. Copies of the draft forms are included in appendices to this summary report

  4. Provider-patient in-office discussions of response to hepatitis C antiviral therapy and impact on patient comprehension.

    Science.gov (United States)

    Hamilton, Heidi E; Nelson, Meaghan; Martin, Paul; Cotler, Scott J

    2006-04-01

    Providers need to communicate projected response rates effectively to enable patients with hepatitis C virus to make informed decisions about therapy. This study used interactional sociolinguistics (1) to evaluate how gastroenterologists and allied health professionals communicate information regarding response rates to antiviral therapy, (2) to determine how these discussions relate to where the patient is in the continuum of evaluation and treatment, (3) to assess whether patients were aligned with providers in their perceptions of response rates after office visits, and (4) to identify factors that improve provider-patient alignment. Gastroenterologists, allied health professionals, and patients with hepatitis C virus were videotaped and audiotaped during regularly scheduled visits. Postvisit interviews were conducted separately with patients and providers. Visits and postvisits were transcribed and analyzed using validated sociolinguistic techniques. The phase of hepatitis C virus treatment shaped the benchmarks of response talk, although across the treatment continuum providers overwhelmingly made strategic use of positive statistics, providing motivation. In postvisit interviews, 55% of providers and patients were aligned on response rates. Patients with a favorable outcome and patients who asked response-related questions in the visit were more likely to be aligned with providers. Areas identified for improvement included the tendency to discuss response rates before an individualized assessment could be made, balancing motivation and accuracy, and assessing the patient's perspective before delivering any bad news, if necessary. Sociolinguistic analysis provides a powerful tool to evaluate provider-patient interactions and to identify ways to improve in-office communication regarding antiviral therapy.

  5. Development of the Chronic Pain Coding System (CPCS) for Characterizing Patient-Clinician Discussions About Chronic Pain and Opioids.

    Science.gov (United States)

    Henry, Stephen G; Chen, Meng; Matthias, Marianne S; Bell, Robert A; Kravitz, Richard L

    2016-10-01

    To describe the development and initial application of the Chronic Pain Coding System. Secondary analysis of data from a randomized clinical trial. Six primary care clinics in northern California. Forty-five primary care visits involving 33 clinicians and 45 patients on opioids for chronic noncancer pain. The authors developed a structured coding system to accurately and objectively characterize discussions about pain and opioids. Two coders applied the final system to visit transcripts. Intercoder agreement for major coding categories was moderate to substantial (kappa = 0.5-0.7). Mixed effects regression was used to test six hypotheses to assess preliminary construct validity. Greater baseline pain interference was associated with longer pain discussions (P = 0.007) and more patient requests for clinician action (P = 0.02) but not more frequent negative patient evaluations of pain (P = 0.15). Greater clinician-reported visit difficulty was associated with more frequent disagreements with clinician recommendations (P = 0.003) and longer discussions of opioid risks (P = 0.049) but not more frequent requests for clinician action (P = 0.11). Rates of agreement versus disagreement with patient requests and clinician recommendations were similar for opioid-related and non-opioid-related utterances. This coding system appears to be a reliable and valid tool for characterizing patient-clinician communication about opioids and chronic pain during clinic visits. Objective data on how patients and clinicians discuss chronic pain and opioids are necessary to identify communication patterns and strategies for improving the quality and productivity of discussions about chronic pain that may lead to more effective pain management and reduce inappropriate opioid prescribing. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Ethical considerations in protecting the environment from the effects of ionizing radiation. A report for discussion

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-02-01

    In recent years awareness of the vulnerability of the environment has increased and the need to protect it against the effects of industrial pollutants has been recognized. This trend is reflected in new and developing international policies for environmental protection. In the context of protection of the environment against ionizing radiation, the existing international approach is based on providing for the protection of humans. The current recommendations of the International Commission on Radiological Protection (ICRP) include the statement that {sup t}he standard of environmental control needed to protect man to the degree currently thought desirable will ensure that other species are not put at risk... {sup .} In the light of the new focus of concern for the environment, this statement is being critically reviewed in several international fora. The IAEA has, over many years, sponsored studies of the effects of ionizing radiation on species other than humans. Most recently it published a discussion report as IAEA-TECDOC-1091 (1999) in which the need for developing a system for protecting the environment against the effects of ionizing radiation was elaborated and in which various related technical and philosophical issues for resolution were discussed. The current report explores the ethical principles that could underlie a system of environmental protection. It is intended as one step in the development of a framework for the protection of the environment from the effects of ionizing radiation, and is being published in order to promote awareness of the current developments in this field as well as to encourage discussion amongst those involved.

  7. Factors Associated with the Intention of Registered Dietitians to Discuss Nutrigenetics with their Patients/Clients.

    Science.gov (United States)

    Bouchard-Mercier, Annie; Desroches, Sophie; Robitaille, Julie; Vohl, Marie-Claude

    2016-12-01

    The objective of this study was to investigate factors affecting the intention of Registered Dietitians (RDs) to discuss nutrigenetics with their patients/clients. A survey based on the theory of planned behaviour (TPB; attitude, subjective norm, and perceived behavioural control) was developed and sent by email to RD members of the Ordre professionnel des diététistes du Québec. Multiple regression analyses were performed to examine the determinants of intention and behaviour. A total of 141 RDs completed the questionnaire (5.8% response rate). On a scale from -2 to 2 (from strongly disagree to strongly agree), the intention of discussing nutrigenetics with patients/clients was neutral (mean of -0.07 ± 0.92). The TPB construct of attitude was the most strongly associated with intention (β = 0.66, P nutrigenetics with their patients/clients in the last 3 months. Only perceived behavioural control contributed to explain the behaviour (β = 0.17, P nutrigenetics with their patients/clients were determined. This knowledge will help inform the design of future educational content about nutrigenetics.

  8. Home healthcare nurse retention and patient outcome model: discussion and model development.

    Science.gov (United States)

    Ellenbecker, Carol Hall; Cushman, Margaret

    2012-08-01

    This paper discusses additions to an empirically tested model of home healthcare nurse retention. An argument is made that the variables of shared decision-making and organizational commitment be added to the model based on the authors' previous research and additional evidence from the literature. Previous research testing the home healthcare nurse retention model established empirical relationships between nurse, agency, and area characteristics to nurse job satisfaction, intent to stay, and retention. Unexplained model variance prompted a new literature search to augment understanding of nurse retention and patient and agency outcomes. Data come from the authors' previous research, and a literature search from 1990 to 2011 on the topics organizational commitment, shared decision-making, nurse retention, patient outcomes and agency performance. The literature provides a rationale for the additional variables of shared decision-making and affective and continuous organizational commitment, linking these variables to nurse job satisfaction, nurse intent to stay, nurse retention and patient outcomes and agency performance. Implications for nursing.  The new variables in the model suggest that all agencies, even those not struggling to retain nurses, should develop interventions to enhance nurse job satisfaction to assure quality patient outcomes. The new nurse retention and patient outcome model increases our understanding of nurse retention. An understanding of the relationship among these variables will guide future research and the development of interventions to create and maintain nursing work environments that contribute to nurse affective agency commitment, nurse retention and quality of patient outcomes. © 2011 Blackwell Publishing Ltd.

  9. Survey and online discussion groups to develop a patient-rated outcome measure on acceptability of treatment response in vitiligo

    Science.gov (United States)

    2014-01-01

    Background Vitiligo is a chronic depigmenting skin disorder which affects around 0.5-1% of the world’s population. The outcome measures used most commonly in trials to judge treatment success focus on repigmentation. Patient-reported outcome measures of treatment success are rarely used, although recommendations have been made for their inclusion in vitiligo trials. This study aimed to evaluate the face validity of a new patient-reported outcome measure of treatment response, for use in future trials and clinical practice. Method An online survey to gather initial views on what constitutes treatment success for people with vitiligo or their parents/carers, followed by online discussion groups with patients to reach consensus on what constitutes treatment success for individuals with vitiligo, and how this can be assessed in the context of trials. Participants were recruited from an existing database of vitiligo patients and through posts on the social network sites Facebook and Twitter. Results A total of 202 survey responses were received, of which 37 were excluded and 165 analysed. Three main themes emerged as important in assessing treatment response: a) the match between vitiligo and normal skin (how well it blends in); b) how noticeable the vitiligo is and c) a reduction in the size of the white patches. The majority of respondents said they would consider 80% or more repigmentation to be a worthwhile treatment response after 9 months of treatment. Three online discussion groups involving 12 participants led to consensus that treatment success is best measured by asking patients how noticeable their vitiligo is after treatment. This was judged to be best answered using a 5-point Likert scale, on which a score of 4 or 5 represents treatment success. Conclusions This study represents the first step in developing a patient reported measure of treatment success in vitiligo trials. Further work is now needed to assess its construct validity and responsiveness to

  10. National objectives and flexible mechanisms: A discussions report; Nationella maal och flexibla mekanismer: En diskussionsrapport

    Energy Technology Data Exchange (ETDEWEB)

    Johansson, Bengt

    2003-11-01

    The Swedish climate policy has the target that the national emissions of greenhouse gases should be reduced 4%, compared to the 1990 level. But according to the EU common policy in line with the Kyoto agreement, Sweden has the right to increase the emissions by 4%. The Kyoto obligations could also be fulfilled by acting through the flexible mechanisms. In the present report the following issues are discussed: Why did Sweden set so ambitious targets; How can you handle the interconnection between national targets and flexible mechanisms; Methods to determine the amounts of the emissions rights that should be allocated to the trading sectors; Are there alternative means for achieveing the targets that the national objectives have set.

  11. Report on a visit to Canada to discuss tritium instrumentation and radiological protection

    International Nuclear Information System (INIS)

    Gibson, J.A.B.

    1984-10-01

    A report is presented of a visit to Canada on behalf of the CEC DG II/Fusion between the 8th to 13th April 1984. Discussions were arranged by the Canadian Fusion-Fuels Technology Project near Toronto and covered all aspects of tritium technology but especially radiological protection. Visits included the CFFTP Centre, Pickering Nuclear Generating Section, Ontario Hydro's Head Office, Safety Services Department and Research Division, Scintrex Ltd (tritium instrument manufacturers) and the Atomic Energy of Canada (AECL) Chalk River Nuclear laboratories (CRNL). There are clearly many areas for the use of Canadian Technology in Europe, particularly with CRNL and Scintrex on the development of 3 H 2 / 3 H 2 O discriminating monitors. There is some doubt whether these development will be in time for applications at the JET laboratory and the JRC at ISPRA but this collaboration will be pursued. (author)

  12. Familial Multiple Myeloma: Report on Two Families and Discussion of Screening Options

    Directory of Open Access Journals (Sweden)

    Gerkes Erica H

    2007-06-01

    Full Text Available Abstract Multiple myeloma (MM is a relatively rare haematological malignancy seen in older persons. It has an unknown aetiology and usually occurs incidentally within a family. However, several families have been reported with multiple cases of MM, so that the existence of hereditary MM has been postulated although no causative germline mutations have been detected so far. First-degree relatives of MM patients have been reported to have a relative risk between two and four times higher than normal of developing MM and we presume the risks are higher for relatives in the case of familial MM. Here we report on two families with MM who requested presymptomatic screening of healthy relatives. Although risk estimates for asymptomatic relatives in these types of families are not available, a clinically significant risk of developing MM cannot be excluded. We suggest that, in a research setting, screening for MM could be offered to individuals with more than one first-degree affected relative, or to those with one first-degree and at least one second-degree relative with MM. We propose a screening programme of annual protein electrophoresis of blood and urine, starting at age 40 (or earlier if a family member presented with MM at a younger age.

  13. Patient-physician discussions about costs: definitions and impact on cost conversation incidence estimates.

    Science.gov (United States)

    Hunter, Wynn G; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A

    2016-03-31

    Nearly one in three Americans are financially burdened by their medical expenses. To mitigate financial distress, experts recommend routine physician-patient cost conversations. However, the content and incidence of these conversations are unclear, and rigorous definitions are lacking. We sought to develop a novel set of cost conversation definitions, and determine the impact of definitional variation on cost conversation incidence in three clinical settings. Retrospective, mixed-methods analysis of transcribed dialogue from 1,755 outpatient encounters for routine clinical management of breast cancer, rheumatoid arthritis, and depression, occurring between 2010-2014. We developed cost conversation definitions using summative content analysis. Transcripts were evaluated independently by at least two members of our multi-disciplinary team to determine cost conversation incidence using each definition. Incidence estimates were compared using Pearson's Chi-Square Tests. Three cost conversation definitions emerged from our analysis: (a) Out-of-Pocket (OoP) Cost--discussion of the patient's OoP costs for a healthcare service; (b) Cost/Coverage--discussion of the patient's OoP costs or insurance coverage; (c) Cost of Illness- discussion of financial costs or insurance coverage related to health or healthcare. These definitions were hierarchical; OoP Cost was a subset of Cost/Coverage, which was a subset of Cost of Illness. In each clinical setting, we observed significant variation in the incidence of cost conversations when using different definitions; breast oncology: 16, 22, 24% of clinic visits contained cost conversation (OOP Cost, Cost/Coverage, Cost of Illness, respectively; P cost conversation varied significantly depending on the definition used. Our findings and proposed definitions may assist in retrospective interpretation and prospective design of investigations on this topic.

  14. Translating data to dialogue: how to discuss mode of delivery with your patient with twins.

    Science.gov (United States)

    Meyer, Marjorie C

    2006-10-01

    Patients are given options with regard to the mode of delivery with increasing frequency. The manner in which obstetricians frame the risk/benefit information can have dramatic impact on the ultimate decision made by the patient. Recently published epidemiologic data reported increased morbidity and mortality to the second twin on the basis of mode of delivery. In this analysis, the findings of the epidemiologic studies were translated from odds ratio into the number of cesarean deliveries that would be required to prevent an adverse outcome for the second twin. For gestations of > or = 36 weeks, 97 cesarean deliveries would need to be performed to prevent a single serious morbidity or mortality in a second twin. This number is within the range needed to prevent uterine rupture associated with trial of labor following cesarean delivery (556) or morbidity related to vaginal breech delivery (167). Number needed to treat may be more useful than odds risk assessment in patient counseling.

  15. Furthering patient adherence: a position paper of the international expert forum on patient adherence based on an internet forum discussion.

    Science.gov (United States)

    van Dulmen, Sandra; Sluijs, Emmy; van Dijk, Liset; de Ridder, Denise; Heerdink, Rob; Bensing, Jozien

    2008-02-27

    As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future research, practice and theory development in patient adherence. The objective of the present project was to find out to what extent adherence experts consider this agenda relevant and feasible. The thirty-five corresponding authors of the review studies included in the meta-review were invited to join the International Expert Forum on Patient Adherence and to participate in a four-week web-based focus group discussion. The discussion was triggered by the points on the preliminary agenda presented as propositions to which forum members could react. Two researchers analysed the transcripts and selected relevant phrases. Twenty adherence experts participated. Various ideas and viewpoints were raised. After the closure of the web-site, the expert forum was asked to authorize the synthesis of the discussion, to list the propositions in order of priority and to answer a few questions on the use of the web-based focus group as a tool to obtain expert opinions. Their ranking showed that the development of simple interventions is the most promising step to take in fostering patient adherence, preferably within a multidisciplinary setting of medical, pharmaceutical, social and technical science and, not in the least, by incorporating patients' perspectives. For enhancing adherence, the development of simple interventions originating from a multidisciplinary perspective including patients' input, appears most promising. Disclosing patients' perspectives requires open communication about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent.

  16. Furthering patient adherence: A position paper of the international expert forum on patient adherence based on an internet forum discussion

    Directory of Open Access Journals (Sweden)

    Heerdink Rob

    2008-02-01

    Full Text Available Abstract Background As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future research, practice and theory development in patient adherence. The objective of the present project was to find out to what extent adherence experts consider this agenda relevant and feasible. Methods The thirty-five corresponding authors of the review studies included in the meta-review were invited to join the International Expert Forum on Patient Adherence and to participate in a four-week web-based focus group discussion. The discussion was triggered by the points on the preliminary agenda presented as propositions to which forum members could react. Two researchers analysed the transcripts and selected relevant phrases. Results Twenty adherence experts participated. Various ideas and viewpoints were raised. After the closure of the web-site, the expert forum was asked to authorize the synthesis of the discussion, to list the propositions in order of priority and to answer a few questions on the use of the web-based focus group as a tool to obtain expert opinions. Their ranking showed that the development of simple interventions is the most promising step to take in fostering patient adherence, preferably within a multidisciplinary setting of medical, pharmaceutical, social and technical science and, not in the least, by incorporating patients' perspectives. Conclusion For enhancing adherence, the development of simple interventions originating from a multidisciplinary perspective including patients' input, appears most promising. Disclosing patients' perspectives requires open communication about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent.

  17. Technicians or patient advocates?--still a valid question (results of focus group discussions with pharmacists)

    DEFF Research Database (Denmark)

    Almarsdóttir, Anna Birna; Morgall, Janine Marie

    1999-01-01

    discussions with community pharmacists in the capital area Reykjavík and rural areas were employed to answer the research question: How has the pharmacists' societal role evolved after the legislation and what are the implications for pharmacy practice? The results showed firstly that the public image...... and the self-image of the pharmacist has changed in the short time since the legislative change. The pharmacists generally said that their patient contact is deteriorating due to the discount wars, the rural pharmacists being more optimistic, and believing in a future competition based on quality. Secondly......, the results showed that the pharmacists have difficulties reconciling their technical paradigm with a legislative and professional will specifying customer and patient focus. This study describes the challenges of a new legislation with a market focus for community pharmacists whose education emphasized...

  18. A discussion of approaches to transforming care: contemporary strategies to improve patient safety.

    Science.gov (United States)

    Burston, Sarah; Chaboyer, Wendy; Wallis, Marianne; Stanfield, Jane

    2011-11-01

    This article presents a discussion of three contemporary approaches to transforming care: Transforming Care at the Bedside, Releasing Time to Care: the Productive Ward and the work of the Studer Group(®). International studies of adverse events in hospitals have highlighted the need to focus on patient safety. The case for transformational change was identified and recently several approaches have been developed to effect this change. Despite limited evaluation, these approaches have spread and have been adopted outside their country of origin and contextual settings. Medline and CINAHL databases were searched for the years 1999-2009. Search terms included derivatives of 'transformation' combined with 'care', 'nursing', 'patient safety', 'Transforming Care at the Bedside', 'the Productive Ward' and 'Studer Group'. A comparison of the three approaches revealed similarities including: the foci of the approaches; interventions employed; and the outcomes measured. Key differences identified are the implementation models used, spread strategies and sustainability of the approaches. The approaches appear to be complementary and a hybrid of the approaches such as a blend of a top-down and bottom-up leadership strategy may offer more sustainable behavioural change. These approaches transform the way nurses do their work, how they work with others and how they view the care they provide to promote patient safety. All the approaches involve the implementation of multiple interventions occurring simultaneously to affect improvements in patient safety. The approaches are complementary and a hybrid approach may offer more sustainable outcomes. © 2011 Blackwell Publishing Ltd.

  19. General practitioner views about discussing sexual issues with patients with coronary heart disease: a national survey in Ireland

    LENUS (Irish Health Repository)

    Byrne, Molly

    2010-05-25

    Abstract Background Sexual problems are common among people with coronary heart disease and can adversely affect patients\\' quality of life. GPs are ideally placed to deal with these problems. Research suggests that GPs are reluctant to address sexual problems but little is known about what currently takes place in practice. The aim of this study was to examine GPs\\' self-reported behaviour and attitudes to discussing sexual problems with people with coronary heart disease. Method Design: A cross-sectional survey which administered 230 postal questionnaires to a nationally representative, stratified random sample of GPs in the Republic of Ireland. GPs were asked about current practice, knowledge, awareness and confidence in dealing with sexual problems, barriers to addressing sexual problems, and about improving services in this area. Results Responses were available for 61 GPs (27% response rate). Seventy percent of GPs reported that they rarely or never discussed sexual problems with coronary patients. While all GPs believed addressing sexual problems was important, many GPs reported lacking awareness, knowledge and confidence in addressing sexual problems. The main barriers were lack of time, feeling the patient wasn\\'t ready and lack of training in the area. GPs wanted more training and guidelines for practice. Conclusions There is currently no standardised protocol for GPs for dealing with sexual problems among coronary patients. Awareness of these issues appears to be low among GPs. Services could be improved by developing practice guidelines for brief, effective actions or assessments, providing training in the area and improving information resources and support services for referral.

  20. Aneurysmal subarachnoid hemorrhage in patients taking direct oral anticoagulants: A case series and discussion of management

    Directory of Open Access Journals (Sweden)

    Joseph H. McMordie, MD

    2018-03-01

    Full Text Available Direct oral anticoagulants are becoming more commonplace for the treatment of nonvalvular atrial fibrillation and deep vein thrombosis. Unfortunately, effective reversal agents are not widely available limiting options for neurosurgical intervention during active anticoagulation. We report a case series of 3 patients treated for aneurysmal subarachnoid hemorrhage while taking direct oral anticoagulants. All three underwent open surgical clipping after adequate time was allowed for drug metabolism. Decision-making must take into account timing of intervention, drug half-life, and currently available reversal agents.

  1. Pleomorphic Hyalinizing Angiectatic Tumour: A Rare Case Report and Discussion of Differential Diagnosis.

    Science.gov (United States)

    Chalmeti, Ambica; Arakeri, Surekha U; Javalgi, Anita P; Goyal, Shefali

    2017-08-01

    Pleomorphic Hyalinizing Angiectatic Tumour (PHAT) is one of the rare soft tissue tumour which is non-metastasizing. The origin of this tumour is yet uncertain. It occurs in adults as a slow growing subcutaneous mass mimicking clinically and histologically to various benign and malignant soft tissue tumours such as schwannoma, haemangioma and malignant fibrous histiocytoma. The microscopic features of this tumour include clusters of ectatic, fibrin containing, hyalinized blood vessels with pleomorphic and spindle shaped tumour cells showing intranuclear inclusions, stromal haemosiderin pigment and a variable inflammatory infiltrate. Despite marked pleomorphism, the lesion behaves as a low grade neoplasm, with frequent recurrences, but no metastases. The incidence of this tumour is very rare with less than 100 cases being published. Hence, awareness of this entity is must for proper management of the patient and to avoid misdiagnosis of the lesion. We report a case of pleomorphic hyalinizing angiectatic tumour in a 50-year-old man who presented with a slow growing mass in the left calf region since two years.

  2. [Depersonalization syndrome after acquired brain damage. Overview based on 3 case reports and the literature and discussion of etiological models].

    Science.gov (United States)

    Paulig, M; Böttger, S; Sommer, M; Prosiegel, M

    1998-12-01

    Depersonalization after brain damage is still only rarely reported and poorly understood. We describe three patients between the ages of 21 and 25 who experienced depersonalization and derealization for periods of 6 weeks to 4 months, two after traumatic brain injury, the third after surgical and radiation treatment of a pineocytoma. Each one believed to be living in a nightmare and thought about committing suicide in order to wake up. One patient developed symptoms as described in Cotard delusion. Aspects of neuroanatomy, psychodynamics, and anthropology are discussed with reference to the literature. Frontal and temporal lesions seem only to play a facilitating role but not to be a necessary condition. There is evidence for additional influence of psychological and premorbid personality factors. Summarizing the current state of information we consider depersonalization with the experience of being in a dream or being dead as a heuristic reaction to brain damage. Similar models have already been discussed in neuropsychological disorders as for instance reduplicative paramnesias, neglect, and anosognosia.

  3. Testing an empirically derived mental health training model featuring small groups, distributed practice and patient discussion.

    Science.gov (United States)

    Murrihy, Rachael C; Byrne, Mitchell K; Gonsalvez, Craig J

    2009-02-01

    Internationally, family doctors seeking to enhance their skills in evidence-based mental health treatment are attending brief training workshops, despite clear evidence in the literature that short-term, massed formats are not likely to improve skills in this complex area. Reviews of the educational literature suggest that an optimal model of training would incorporate distributed practice techniques; repeated practice over a lengthy time period, small-group interactive learning, mentoring relationships, skills-based training and an ongoing discussion of actual patients. This study investigates the potential role of group-based training incorporating multiple aspects of good pedagogy for training doctors in basic competencies in brief cognitive behaviour therapy (BCBT). Six groups of family doctors (n = 32) completed eight 2-hour sessions of BCBT group training over a 6-month period. A baseline control design was utilised with pre- and post-training measures of doctors' BCBT skills, knowledge and engagement in BCBT treatment. Family doctors' knowledge, skills in and actual use of BCBT with patients improved significantly over the course of training compared with the control period. This research demonstrates preliminary support for the efficacy of an empirically derived group training model for family doctors. Brief CBT group-based training could prove to be an effective and viable model for future doctor training.

  4. Protection of the environment from the effects of ionizing radiation. A report for discussion

    International Nuclear Information System (INIS)

    1999-07-01

    The acceptability of practices which involve the release of radionuclides into the environment, and of situations where residual radionuclides from accidents or improperly controlled practices exist in the environment, are generally assessed on the basis of implied radiation doses to humans. This approach is consistent with the recommendations of the International Commission on Radiological Protection (ICRP), which include the statement that 'the standard of environmental control needed to protect man to the degree currently thought desirable will ensure that other species are not put at risk'. The general applicability of this statement has been explored in previous IAEA and other publications. These concluded that the statement is generally valid but that reliance upon human based radiological protection criteria may not be adequate for all possible space or time scales. In recent years awareness of the vulnerability of the environment has increased and the need to protect it against the effects of industrial pollutants has been recognized. This trend is reflected in new and developing international policies for environmental protection. In the context of protection of the environment against ionizing radiation, the existing international approach is being challenged in some IAEA Member States and proposals are being made for strategies which provide for explicit protection of the environment. The present publication represents a first step towards establishing an internationally accepted philosophy and associated methodology for protecting the environment against ionizing radiations. The report reviews the various related issues and examines possible approaches to establishing criteria. It is intended for use in stimulating discussion on the subject in Member States. For its part, the IAEA intends to continue a programme of work in this area with the long term objective of providing specific recommendations on primary protection criteria and methods for

  5. Discussion on the Implementation of the Patient Centred Medical Home model - Experiences from Australia

    Directory of Open Access Journals (Sweden)

    Safa Majidi Rahbar

    2017-07-01

    adaptation of PCMH model to Australian context Trial and evaluation of tools for transitioning practices to HCHs using an action based research approach, leading to improvements in the handbook. Workshop objective: To share insights and facilitate a structured discussion about practical experience in implementing the elements of the Patient Centred Medical Home, tools that have been effective, challenges that have emerged and approaches used to overcome these challenges. Discussion generated through the workshop will be used to inform further work on the Australian Handbook for Transitioning to the Health Care Home. Workshop outcome: As a result of the workshop it is anticipated that participants will have an increased understanding of the medical home model, hear rich implementation experiences from different contexts and become aware of further tools for model implementation and refinement. Workshop structure: - Brief overview of model implementation taking place in Australia - Smaller group discussion about medical home implementation challenges and successes - Structured workshop group discussion drawing together key insights, common challenges and practical steps, resources or further research needed for address these challenges. Target audience: Policy makers, Primary Health Networks/Organisations, clinicians, practice staff and anyone interested in how to support practices to transition into Medical Homes

  6. Discussing study limitations in reports of biomedical studies-the need for more transparency

    NARCIS (Netherlands)

    Puhan, Milo A.; Akl, Elie A.; Bryant, Dianne; Xie, Feng; Apolone, Giovanni; ter Riet, Gerben

    2012-01-01

    Unbiased and frank discussion of study limitations by authors represents a crucial part of the scientific discourse and progress. In today's culture of publishing many authors or scientific teams probably balance 'utter honesty' when discussing limitations of their research with the risk of being

  7. Panel Discussion : Report of the APS Ad-Hoc Committee on LGBT Issues

    Science.gov (United States)

    Atherton, Tim; Barthelemy, Ramon; Garmon, Savannah; Reeves, Kyle; APS Ad-Hoc Committee on LGBT Issues Team

    Following the presentation of the findings and recommendations of the APS Ad-Hoc Committee on LGBT Issues (C-LGBT) by Committee Chair Michael Falk, a panel discussion will be held featuring several members of the committee. The discussion will focus on how APS can best ensure the recommendations of the committee are carried out in a timely fashion and other ideas on future APS efforts toward LGBT inclusion in physics. Discussion topics will also include the research and other input that shaped the committee's findings and recommendations.

  8. Remarks presented (questions/answers discussed) at public regional meetings to discuss regulations (10 CFR Part 21) for reporting of defects and noncompliance, July 12--26, 1977

    International Nuclear Information System (INIS)

    1977-09-01

    In enacting the Energy Reorganization Act of 1974, Congress included Section 206 which requires the reporting of defects and noncompliances directly to the Nuclear Regulatory Commission (NRC). This congressional action required that the NRC promulgate rules and regulations, as necessary, to assure appropriate implementation of Section 206. In response to this mandate, the NRC drafted a new regulation. Following a period of public comment and revision, the regulation identified as 10 CFR Part 21, Reporting Defects and Noncompliance, was published in a Federal Register Notice on June 6, 1977. To assist NRC licensees and other firms and organizations covered by the new Part 21 regulation, public regional meetings were conducted by staff representatives to explain the rule. At these meetings the staff presented prepared remarks and answered questions on the meaning and application of the rule. Staff remarks contained in the original publication of this document were also provided to those in attendance. At each meeting the staff received a request for the questions and answers discussed by the staff to be made available for use as guidance by the nuclear industry covered by the rule. It was announced that a consolidation of the staff position question/answer guidance would be made available to each organization or firm attending these meetings and for others where a request is made in accordance with the directions printed insidethe front cover of the document. The staff will be guided in its implementation and enforcement of Part 21 by the positions set forth in the document. The revision of NUREG-0302 includes the following three parts relating to 10 CFR Part 21: (1) remarks presented by staff representatives; (2) Federal Register Notice material; and (3) a consolidation of questions and answers from the public regional meetings

  9. Transmutation research and fuel cycle (report on discussion at Research Reactor Institute, Kyoto University)

    International Nuclear Information System (INIS)

    Yamana, Hajimu

    1999-01-01

    A symposium was held on a topic of 'Transmutation Research' on Dec. 21 and 22, 1999 at Research Reactor Institute, Kyoto University. This meeting was held as a joint-meeting of KUR's specialist meeting and Tokyo University's activity supported by the Grant-in-Aid for Scientific Research of Ministry of Education, Sport and Culture of Japan. This paper describes the overview of the discussions of this joint-meeting, and interprets their significance. Major themes discussed are, needed discussions on the transmutation research, policy and concepts of the organizations doing transmutation researches, a view from university side, transmutation researches in the oversea countries, opinions from various standpoints of the nuclear fuel cycle, conclusive discussions. 'the meanings of the transmutation research should be discussed together with the geological disposal and fast reactor system', 'transmutation may be a cooperative option for the disposal, thus, they should not be in a independent relation', and Balance evaluation will be needed' are the examples of the conclusive remarks of this meeting. (author)

  10. Northeast Artificial Intelligence Consortium Annual Report 1987. Volume 2, Part B. Discussing, Using, and Recognizing Plans

    Science.gov (United States)

    1989-03-01

    1978. Williams. B.C. Qualitative Analysis of MOS Circuits. Artificial Inteligence . 1984. 24.. Wilson. K. From Association to Structure. Amsterdam:North...D-A208 378 RADC-TR-88-324, Vol II (of nine), Part B Interim Report March 1969 4. NORTHEAST ARTIFICIAL INTELLIGENCE CONSORTIUM ANNUAL REPORT 1987...II (of nine), Part B 6a. NAME OF PERFORMING ORGANIZATION 6b. OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION Northeast Artificial (ff ’aolicbl

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

    Directory of Open Access Journals (Sweden)

    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

  12. 76 FR 21099 - Determinations Concerning Illnesses Discussed In National Academy of Sciences Reports on Gulf War...

    Science.gov (United States)

    2011-04-14

    ... of Sciences Reports on Gulf War and Health, Volumes 4 and 8 AGENCY: Department of Veterans Affairs... that the Secretary of Veterans Affairs, under the authority granted by the Persian Gulf War Veterans...), respectively titled Gulf War and Health, Volume 4: Health Effects of Serving in the Gulf War (Volume 4) and...

  13. Education, Inequality and Life Chances: A Report on the Netherlands [and] Discussion Paper.

    Science.gov (United States)

    Tinbergen, Jan

    Six chapters compose this report on the Netherlands: (1) some general characteristics of the Netherlands; (2) some notes on the history of income distribution and social security; (3) income distribution and social security around 1973; (4) opinions on income distribution, opportunities, and equality in Holland; (5) some forecasts on future income…

  14. INFORMATION SCIENCE--OUTLINE, ASSESSMENT, INTERDISCIPLINARY DISCUSSION. REPORT FOR JUNE, 1965-JUNE, 1966.

    Science.gov (United States)

    IBERALL, A.S.

    THIS REPORT PROVIDES AN ASSESSMENT AND INTRODUCTION TO THE INTERDISCIPLINARY LITERATURE OF THREE APSECTS OF INFORMATION SCIENCE, IN ANNOTATED BIBLIOGRAPHY FORM. THESE ARE--COMMUNICATION NETWORKS, HUMAN INFORMATION PROCESSES (PRINCIPALLY LANGUAGE AND INFORMATION RETRIEVAL), AND THE LARGE CYBERNETIC SYSTEMS SUCH AS THE HUMAN BRAIN AND CENTRAL…

  15. Patient reported outcome measures (PROMs)

    DEFF Research Database (Denmark)

    Bech, Per; Austin, Stephen Fitzgerald; Lau, Marianne Engelbrecht

    2018-01-01

    INTRODUCTION: Patient-reported outcome measures (PROMs) for anxiety and depressive disorders are an important aspect of measurement-based care. AIM: The aim of the study was to perform a clinimetric analysis of two PROMs scales in patents with depression and anxiety. METHODS: Patients completed...... recruited from two Danish mental health centers with anxiety or depression. The standardization of the SCL-10 and WHO-5 by T-scores indicated that a T-score of 65 corresponding to being moderately in need of treatment and a T-score of 75 to be severely in need of treatment. The coefficient of alpha...... with anxiety or depression undergoing psychotherapy treatment....

  16. Improving the Management of Psoriatic Arthritis and Axial Spondyloarthritis: Roundtable Discussions with Healthcare Professionals and Patients.

    Science.gov (United States)

    Garrido-Cumbrera, Marco; Hillmann, Ottfrid; Mahapatra, Raj; Trigos, David; Zajc, Petra; Weiss, Luisa; Bostynets, Galya; Gossec, Laure; Coates, Laura C

    2017-12-01

    Psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA) are both chronic, inflammatory conditions that result in a substantial burden of disease and reduced quality of life for patients. Patient involvement in developing optimal disease management strategies, including defining appropriate goals, therapies, and treatment options, as well as in setting policy priorities and agendas, is key. A working group of patient organization representatives and rheumatologists explored what patients consider to be unmet needs, important treatment gaps, and future priorities in PsA and AxSpA management. Reducing pain and fatigue, and improving physical and social functioning and work productivity were identified as important treatment goals for patients. Although the major treatment target for both PsA and AxSpA is remission, with low/minimal disease activity an alternative target for patients with established or long-standing disease, the meaning of remission from the patient's perspective needs to be explored further as it may differ considerably from the physician's perspective. Key recommendations from the working group to tackle unmet needs included reducing time to diagnosis, increasing patient and physician disease awareness, focusing on patients' priorities for treatment goals, and improving patient-physician communication. By addressing these key action points moving forward, the hope is that outcomes will continue to improve for patients with PsA and AxSpA.

  17. Chronic Pain, Patient-Physician Engagement, and Family Communication Associated With Drug-Using HIV Patients' Discussing Advanced Care Planning With Their Physicians.

    Science.gov (United States)

    Hansen, Eric D; Mitchell, Mary M; Smith, Tom; Hutton, Nancy; Keruly, Jeanne; Knowlton, Amy R

    2017-10-01

    In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV into a serious chronic illness, warranting patient-provider discussion about advanced care planning (ACP). Evidence is needed to inform physicians on how to approach ACP for these patients. Chronic pain is common in PLWHA, particularly in those who have substance use disorders; although it is known that this population is at risk for poorer patient-physician engagement, the effects on ACP are unknown. To further characterize factors associated with successful ACP in PLWHA, we examined associations between patient-physician relationship, chronic pain, family communication and problem-solving skills, and rates of patients discussing ACP with their physicians. Data were from the Affirm Care study (N = 325), which examined social and environmental factors associated with health outcomes among PLWHA and their informal caregivers. In multivariate analysis, higher odds of patient reports of discussing ACP with their physicians were associated with their higher rating of their relationship with their physician (adjusted odds ratio [AOR] 1.73; P family arguments about end-of-life medical decisions (AOR 2.43; P family members about problems (AOR 1.33; P family communication and family problem-solving skills. The findings also suggest that PLWHA with chronic pain and prior family discord over end-of-life medical decisions may be primed for ACP. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  18. 77 FR 47924 - Determinations Concerning Illnesses Discussed in National Academy of Sciences Report: Veterans...

    Science.gov (United States)

    2012-08-10

    ... Orange Act of 1991, Public Law 102-4 (codified in part at 38 U.S.C. 1116), directed the Secretary to seek.... Section 2 of Public Law 102-4, codified in pertinent part at 38 U.S.C. 1116(b) and (c), provides that... endometriosis and Parkinson's disease. As in its prior reports, NAS placed each health outcome it reviewed in...

  19. Northeast Artificial Intelligence Consortium Annual Report. Volume 2. 1988 Discussing, Using, and Recognizing Plans (NLP)

    Science.gov (United States)

    1989-10-01

    Encontro Portugues de Inteligencia Artificial (EPIA), Oporto, Portugal, September 1985. [15] N. J. Nilsson. Principles Of Artificial Intelligence. Tioga...FI1 F COPY () RADC-TR-89-259, Vol II (of twelve) Interim Report October 1969 AD-A218 154 NORTHEAST ARTIFICIAL INTELLIGENCE CONSORTIUM ANNUAL...7a. NAME OF MONITORING ORGANIZATION Northeast Artificial Of p0ilcabe) Intelligence Consortium (NAIC) Rome_____ Air___ Development____Center

  20. E-Cigarette Liquid Nicotine Ingestion in a Child: Case Report and Discussion.

    Science.gov (United States)

    Gill, Natasha; Sangha, Gurinder; Poonai, Naveen; Lim, Rodrick

    2015-11-01

    Nicotine poisoning is well described in the pediatric population, and even small oral doses may result in toxic effects. The source of nicotine is usually tobacco products and nicotine replacement products such as gum and patches. With the more frequent use of novel products such as e-cigarettes, concern has arisen regarding liquid nicotine. As there are no regulations regarding childproof bottling and packaging, there may be increased potential for unintentional ingestion of these colorfully and appealingly packaged products by children. We present and discuss a case of this nature, as we feel emergency physicians should be aware of this new mode of poisoning, and public health efforts should be made to minimize such exposures.

  1. Aerosol measurements and nuclear accidents: a reconsideration, report of the round table discussion

    International Nuclear Information System (INIS)

    Raes, F.

    1988-01-01

    Radioactivity Environmental Monitoring (REM) is commonly divided into routine and emergency monitoring. Routine REM must demonstrate the adequacy of controls on releases as well as the compliance with radiological standards. It should also be able to give an early warning in case of abnormal concentrations, so that emergency REM may be initiated promptly. It should be clear, however, that stack monitoring and other in-plant measurements are the primary information sources for abnormal conditions. Emergency REM should rapidly assess the extent of an accident and provide the information needed for taking countermeasures. The collection of in-depth information on environmental processes for model validation is usually considered as an additional benefit of both routine and emergency REM. In discussing techniques for measuring radioactive aerosols, in particular the need for new and more sophisticated techniques, one must consider the objectives of REM, define how much weight should be given to each of them, and investigate whether new techniques might help in meeting the objectives. The opinions of the experts are organized into three chapters: the first compiles experiences and opinions about radioactive aerosol monitoring and defines the experimental needs for such monitoring with respect to early warning and early assessment in case of nuclear accidents; the second chapter discusses radioactive aerosol monitoring from the point of view of the scientist who wants to increase or validate his knowledge about the behaviour of radionuclides in the atmosphere; the third chapter reviews recent developments in field of aerosol and nuclear metrology and their interest for nuclear safety. Each chapter ends with a number of conclusions and recommendations

  2. Practice nurses mental health provide space to patients to discuss unpleasant emotions

    NARCIS (Netherlands)

    Griep, E.C.; Noordman, J.; Dulmen, S. van

    2016-01-01

    WHAT IS KNOWN ON THE SUBJECT?: A core skill of practice nurses' mental health is to recognize and explore patients' unpleasant emotions. Patients rarely express their unpleasant emotions directly and spontaneously, but instead give indirect signs that something is worrying them. WHAT THIS PAPER ADDS

  3. Practice nurses mental health provide space to patients to discuss unpleasant emotions.

    NARCIS (Netherlands)

    Griep, E.C.M.; Noordman, J.; Dulmen, A.M. van

    2016-01-01

    WHAT IS KNOWN ON THE SUBJECT? A core skill of practice nurses' mental health is to recognize and explore patients' unpleasant emotions. Patients rarely express their unpleasant emotions directly and spontaneously, but instead give indirect signs that something is worrying them.

  4. Encapsulated Follicular Variant of Thyroid Papillary Carcinoma - Case Report and Differential Diagnosis Discussion

    Directory of Open Access Journals (Sweden)

    Manuela Enciu

    2018-02-01

    Full Text Available Papillary carcinoma is the most common type of epithelial thyroid cancer in women, especially in the reproductive period, accounting for about 75-80% of well-differentiated cancers at this level. One of its variants, follicular encapsulated thyroid carcinoma, is a well-differentiated malignant tumor with good prognosis which, despite the presence of vascular and capsular invasion, rarely causes metastasis, if fully resected. We present the case of a young patient who presented with dysphagia and a painless cystic nodular lesion of the thyroid, and underwent thyroidectomy. The histopathological diagnosis of the lesion was a challenge, being based on the correlation of clear criteria, given the existence of numerous lesions with follicular pattern in the thyroid.

  5. Practice nurses mental health provide space to patients to discuss unpleasant emotions.

    Science.gov (United States)

    Griep, E C M; Noordman, J; van Dulmen, S

    2016-03-01

    WHAT IS KNOWN ON THE SUBJECT?: A core skill of practice nurses' mental health is to recognize and explore patients' unpleasant emotions. Patients rarely express their unpleasant emotions directly and spontaneously, but instead give indirect signs that something is worrying them. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Patients with mild psychosocial and psychological problems provide signs of worrying or express a clear unpleasant emotion in 94% of consultations with a practice nurse mental health. Nurses' responses to patients' signs of worrying or clear unpleasant emotions were mostly characterized by providing space for patients to talk about these emotions, by using minimal responses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Practice nurses' mental health have passive listening skills, and to a lesser extent, use active listening techniques. Accurate emotion detection and the ability to pick out emotional signs during consultations must also be considered as an important skill for health providers to improve patient-centred communication. Patients with physical problems are known to express their emotional concerns in an implicit way only. Whether the same counts for patients presenting mental health problems in primary care is unknown. This study aims to examine how patients with mild psychosocial and psychological complaints express their concerns during consultations with the practice nurse mental health and how practice nurses respond to these expressions. Fifteen practice nurses mental health working in Dutch general practices participated in the study. Their consultations with 116 patients with mild psychosocial or psychological complaints were video recorded. patients' explicitly expressed emotional concerns and more implicit expressions of underlying emotional problems (cues) as well as nurses' responses to these expressions were rated using the Verona Coding Definition of Emotional Sequences. Almost all consultations contained at least one cue or

  6. Setting Authorized Limits for Radioactive Discharges: Practical Issues to Consider. Report for Discussion

    International Nuclear Information System (INIS)

    2010-03-01

    Application of the principles of radioactive waste management requires the implementation of measures that afford protection of human health and of the environment, now and in the future. The IAEA has issued safety standards and other publications that provide a framework for the control of releases of radionuclides to the environment. This framework is relevant for regulatory bodies that issue authorizations and for organizations that (i) use radionuclides for medical or research purposes, (ii) operate nuclear reactors or (iii) reprocess nuclear material. An IAEA Safety Guide on Regulatory Control of Radioactive Discharges to the Environment was issued in 2000 that outlines the roles and responsibilities of regulatory bodies, licensees and registrants and provides guidance on the authorization procedure. However, there have been significant developments in radiological protection policy since the publication of this Safety Guide, most notably the issue of ICRP Publications No. 101 on Assessing Dose of the Representative Person for the Purpose of Radiation Protection of the Public and the Optimisation of Radiological Protection and No. 103 on The 2007 Recommendations of the ICRP. The objective of this IAEA-TECDOC is to stimulate discussion on the practical implementation of the control of radioactive releases in order to inform the review and revision of IAEA guidance on this subject. This IAEA-TECDOC is based on the practical experience of Member States and on information provided at Technical Committee Meetings held in 2003 and 2008 and gained by means of a questionnaire. It summarizes international experience on the optimization of discharges and the setting by the regulatory body of authorized limits on discharges for nuclear installations and non-nuclear facilities. Its issue at this stage is intended for consultation as a preparatory step pending the current process of revision of the IAEA's International Basic Safety Standards for Protection against Ionizing

  7. Breakout Session A: Safety Issues. Report from breakout session and discussion on safety issues

    International Nuclear Information System (INIS)

    Petit, Marc

    2013-01-01

    The first issue discussed during the breakout session on safety aspects of accident-tolerant fuels was the objective that must be assigned to the development of such concepts. The first goal should be to avoid, or at least limit, the release of radioactive materials into the environment in case of an accident. This implies that severe accidents (core melt) situations must be avoided. To reach this goal, the core geometry must remain coolable, even for accident scenarios worse than what current fuel designs are able to sustain. There was a consensus that the station blackout (SBO) is a good reference transient to evaluate the potential benefits from new, more robust, fuel designs. With respect to the present situation, the merits of new designs can be analysed with respect to three figures: - the 'grace period', i.e. the additional amount of time before the onset of core melt, during which more recovery actions can be made; - the amount of combustible gases produced; - the amount of radioactive materials released. It is important to note that those three values are not independent from one another. They may be understood as three different ways to measure the improvements arising from accident tolerant fuels. The notion of 'grace period' was discussed and it was suggested that it should be compared to the amount of time needed to switch from normal operation to accident management type of procedures. The participants agreed that the 'grace period' should be counted in hours (or even days but the realism of this last goal was questioned). In other words, there was a consensus that a 'grace period' of some minutes is pointless and definitely not worth the effort of developing and characterising the behaviour of new concepts. Although the purpose of accident-tolerant fuel development is to improve the core robustness in design basis accidents (DBA) and situations somewhat beyond like SBO, it was recognised that new concepts must

  8. Biofeedback as complementary treatment in patients with epilepsy – an underestimated therapeutic option? Review, results, discussion

    Directory of Open Access Journals (Sweden)

    Uhlmann Carmen

    2016-12-01

    Full Text Available Background. Biofeedback methods represent side effect free complementary options in the treatment of epilepsy. In this paper we review the current status of these methods in terms of clinical study results and their evaluation by systematic review papers. Possible mechanisms of action in biofeedback methods are discussed.

  9. Discussing options between patients and health care professionals in genetic diagnosis: ethical and legal criteria

    Directory of Open Access Journals (Sweden)

    Nicolás Pilar

    2007-09-01

    Full Text Available Abstract The specific characteristics of genetic data lead to ethical-legal conflicts in the framework of genetic diagnosis. Several international organisations, including UNESCO and the Council of Europe, have enacted rules referring to the use of genetic information. This paper discusses possible legal and ethical criteria that could be used in genetic testing.

  10. Bringing patients' social context into the examination room: an investigation of the discussion of social influence during contraceptive counseling.

    Science.gov (United States)

    Levy, Kira; Minnis, Alexandra M; Lahiff, Maureen; Schmittdiel, Julie; Dehlendorf, Christine

    2015-01-01

    Although social networks are an increasingly recognized influence on contraceptive use, little is known about if and how social influences are discussed during women's contraceptive counseling visits. We performed a mixed-methods analysis of audio recordings of contraceptive counseling visits. We examined predictors of discussion of social influence arising in a contraceptive counseling visit and analyzed the content and process of social influence discussions. Social influences were mentioned in 42% of the 342 visits included in the sample, with these discussions most commonly initiated by patients. Younger patients were more likely to have social influence mentioned than older patients. The content of social influence focused on side effects and adverse events, with the sources of influence being predominantly patients' friends and the media, with little input from partners. Providers were more likely to engage around the content of the social influence than the social influence itself. The frequency with which social influence was mentioned in these visits supports the importance of women's social context on their contraceptive decision making. However, the fact that patients initiated the discussion in the majority of cases suggests that providers may not recognize the relevance of these influences or may not be comfortable engaging with them. Increasing providers' ability to elicit and engage patients about their social context with regard to contraception could enhance providers' ability to understand women's contraceptive preferences and provide appropriate counseling to address their specific concerns or questions. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  11. Patient-provider discussion of online health information: results from the 2007 Health Information National Trends Survey (HINTS).

    Science.gov (United States)

    Chung, Jae Eun

    2013-01-01

    Increasing numbers of people have turned to the Internet for health information. Little has been done beyond speculation to empirically investigate patients' discussion of online health information with health care professionals (HCPs) and patients' perception of HCPs' reactions to such discussion. The author analyzed data from the 2007 Health Information National Trends Survey (HINTS) to identify the characteristics of patients (a) who search for health information on the Internet, (b) who discuss the information found on the Internet with HCPs, and (c) who positively assess HCPs' reaction to the online information. Findings show that men were more likely than were women to have a conversation on online information with HCPs. It is unfortunate that patients who had trouble understanding or trusting online health information were no more likely to ask questions to or seek guidance from HCPs. Reactions of HCPs to online information were perceived as particularly negative by certain groups of patients, such as those who experienced poor health and those who had more concerns about the quality of their searched information. Results are discussed for their implications for patient empowerment and patient-HCP relationships.

  12. What constitutes evidence-based patient information? Overview of discussed criteria.

    Science.gov (United States)

    Bunge, Martina; Mühlhauser, Ingrid; Steckelberg, Anke

    2010-03-01

    To survey quality criteria for evidence-based patient information (EBPI) and to compile the evidence for the identified criteria. Databases PubMed, Cochrane Library, PsycINFO, PSYNDEX and Education Research Information Center (ERIC) were searched to update the pool of criteria for EBPI. A subsequent search aimed to identify evidence for each criterion. Only studies on health issues with cognitive outcome measures were included. Evidence for each criterion is presented using descriptive methods. 3 systematic reviews, 24 randomized-controlled studies and 1 non-systematic review were included. Presentation of numerical data, verbal presentation of risks and diagrams, graphics and charts are based on good evidence. Content of information and meta-information, loss- and gain-framing and patient-oriented outcome measures are based on ethical guidelines. There is a lack of studies on quality of evidence, pictures and drawings, patient narratives, cultural aspects, layout, language and development process. The results of this review allow specification of EBPI and may help to advance the discourse among related disciplines. Research gaps are highlighted. Findings outline the type and extent of content of EBPI, guide the presentation of information and describe the development process. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  13. Medical language proficiency: A discussion of interprofessional language competencies and potential for patient risk.

    Science.gov (United States)

    Hull, Melodie

    2016-02-01

    In increasingly multilingual healthcare environments worldwide, ensuring accurate, effective communication is requisite. Language proficiency is essential, particularly medical language proficiency. Medical language is a universal construct in healthcare, the shared language of health and allied health professions. It is highly evolved, career-specific, technical and cultural-bound-a language for specific purposes. Its function differs significantly from that of a standard language. Proficiency requires at minimum, a common understanding of discipline-specific jargon, abstracts, euphemisms, abbreviations; acronyms. An optimal medical language situation demands a level of competency beyond the superficial wherein one can convey or interpret deeper meanings, distinguish themes, voice opinion, and follow directions precisely. It necessitates the use of clarity, and the ability to understand both lay and formal language-characteristics not essential to standard language. Proficiency influences professional discourse and can have the potential to positively or negatively affect patient outcomes. While risks have been identified when there is language discordance between care provider and patient, almost nothing has been said about this within care teams themselves. This article will do so in anticipation that care providers, regulators, employers, and researchers will acknowledge potential language-based communication barriers and work towards resolutions. This is predicated on the fact that the growing interest in language and communication in healthcare today appears to be rested in globalization and increasingly linguistically diverse patient populations. Consideration of the linguistically diverse healthcare workforce is absent. An argument will be posited that if potential risks to patient safety exist and there are potentials for disengagement from care by patients when health providers do not speak their languages then logically these language-based issues can

  14. Should This Patient Receive Aspirin?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

    Science.gov (United States)

    Burns, Risa B; Graham, Kelly; Sawhney, Mandeep S; Reynolds, Eileen E

    2017-12-05

    Aspirin exerts antiplatelet effects through irreversible inhibition of cyclooxygenase-1, whereas its anticancer effects may be due to inhibition of cyclooxygenase-2 and other pathways. In 2009, the U.S. Preventive Services Task Force endorsed aspirin for primary prevention of cardiovascular disease. However, aspirin's role in cancer prevention is still emerging, and no groups currently recommend its use for this purpose. To help physicians balance the benefits and harms of aspirin in primary disease prevention, the Task Force issued a guideline titled, "Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer" in 2016. In the evidence review conducted for the guideline, cardiovascular disease mortality and colorectal cancer mortality were significantly reduced among persons taking aspirin. However, there was no difference in nonfatal stroke, cardiovascular disease mortality, or all-cause mortality, nor in total cancer mortality, among those taking aspirin. Aspirin users were found to be at increased risk for major gastrointestinal bleeding. In this Beyond the Guidelines, the guideline is reviewed and 2 experts discuss how they would apply it to a 57-year-old man considering starting aspirin for primary prevention. Our experts review the data on which the guideline is based, discuss how they would balance the benefits and harms of aspirin therapy, and explain how they would incorporate shared decision making into clinical practice.

  15. Temporomandibular disorders in patients with schizophrenia using antipsychotic agents: a discussion paper

    Directory of Open Access Journals (Sweden)

    de Araújo AN

    2014-03-01

    Full Text Available Arão Nogueira de Araújo,1 Marion Alves do Nascimento,1 Eduardo Pondé de Sena,1,2 Abrahão Fontes Baptista3,4 1Postgraduate Program in Interactive Processes of Organs and Systems, 2Department of Pharmacology, Institute of Health Sciences, 3Department of Biomorphology, Institute of Health Sciences, 4Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil Abstract: Patients with psychiatric problems show a tendency to develop temporomandibular disorders (TMD. Particularly, patients with schizophrenia are quite likely to have signs and symptoms of TMD due to the impairment of their oral health, the use of antipsychotic drugs, and other general health problems. In nonschizophrenic populations, TMD have been considered as the main cause of nondental pain in the orofacial region, involving mechanisms associated with changes in masticatory activity at the cortical and neuromuscular levels. Individuals with schizophrenia do not usually complain of pain, and TMD is misdiagnosed in this population. In this paper, we aimed to review the clinical aspects of TMD in people with schizophrenia on antipsychotic drug therapy. Keywords: schizophrenia, temporomandibular joint, pain, antipsychotic agents

  16. Editorial research and the publication process in biomedicine and health: Report from the Esteve Foundation Discussion Group, December 2012

    Science.gov (United States)

    Marušić, Ana; Malički, Mario; von Elm, Erik

    2014-01-01

    Despite the fact that there are more than twenty thousand biomedical journals in the world, research into the work of editors and publication process in biomedical and health care journals is rare. In December 2012, the Esteve Foundation, a non-profit scientific institution that fosters progress in pharmacotherapy by means of scientific communication and discussion organized a discussion group of 7 editors and/or experts in peer review biomedical publishing. They presented findings of past editorial research, discussed the lack of competitive funding schemes and specialized journals for dissemination of editorial research, and reported on the great diversity of misconduct and conflict of interest policies, as well as adherence to reporting guidelines. Furthermore, they reported on the reluctance of editors to investigate allegations of misconduct or increase the level of data sharing in health research. In the end, they concluded that if editors are to remain gatekeepers of scientific knowledge they should reaffirm their focus on the integrity of the scientific record and completeness of the data they publish. Additionally, more research should be undertaken to understand why many journals are not adhering to editorial standards, and what obstacles editors face when engaging in editorial research. PMID:24969914

  17. Is it feasible to discuss an advance directive with a Chinese patient with advanced malignancy? A prospective cohort study.

    Science.gov (United States)

    Wong, S Y; Lo, S H; Chan, C H; Chui, H S; Sze, W K; Tung, Y

    2012-06-01

    Advance directives have been implemented for years in western countries, but the concept is new to Asian cultures. According to traditional Chinese culture, family members usually play a decisive role in a patient's treatment plan. Thus it may be hard to implement an advance directive despite its importance to the treatment of patients. The objectives of this study were to assess the feasibility of advance directive engagement and to explore significant contributing factors to achieving such a goal. Prospective cohort study. Palliative Care Unit of Clinical Oncology, Tuen Mun Hospital, Hong Kong. The subjects of the investigation were adult patients diagnosed to have advanced malignancy and newly referred to the hospice service from 24 April 2009 to 30 July 2009. Data were collected from nursing assessment forms, locally designed advance directive forms, a checklist completed by oncologists, and details available in the electronic hospital record. Of the 191 eligible patients, 120 (63%) had the advance directive, whereas 71 (37%) did not. In the Cox regression model, the patient having insight of a poor prognosis was the most significant factor facilitating advance directive engagement (P=0.001). Any family objection in the discussion of advance directives was also an important factor, though it did not reach statistical significance (P=0.082). Other factors like age, gender, education, religion, financial status, living environment, understanding the diagnosis, bereavement experience, type of cancer, nature of illness, courses of chemotherapy or radiotherapy received, main caregiver, in-house supporter, nurse-led clinic attendance, clinical psychologist consultation, and in-patient hospice nurse coordinator interview were all statistically insignificant. Our study demonstrated that it was feasible to discuss an advance directive with Chinese patients with advanced malignancy. When patients have insight about their poor prognosis and family members have no

  18. Effectiveness of educational and social worker interventions to activate patients' discussion and pursuit of preemptive living donor kidney transplantation: a randomized controlled trial.

    Science.gov (United States)

    Boulware, L Ebony; Hill-Briggs, Felicia; Kraus, Edward S; Melancon, J Keith; Falcone, Brenda; Ephraim, Patti L; Jaar, Bernard G; Gimenez, Luis; Choi, Michael; Senga, Mikiko; Kolotos, Maria; Lewis-Boyer, LaPricia; Cook, Courtney; Light, Laney; DePasquale, Nicole; Noletto, Todd; Powe, Neil R

    2013-03-01

    Many patients with chronic kidney disease (CKD) have difficulty becoming actively engaged in the pursuit of preemptive living donor kidney transplantation. The Talking About Live Kidney Donation (TALK) Study was a randomized controlled trial of the effectiveness of educational and social worker interventions designed to encourage early discussions and active pursuit of preemptive living donor kidney transplantation in patients with progressive CKD. We recruited participants with progressive CKD from academically affiliated nephrology practices in Baltimore, MD. Participants randomly received: (1) usual care (routine care with their nephrologists), the (2) TALK education intervention (video and booklet), or the (3) TALK social worker intervention (video and booklet plus patient and family social worker visits). We followed participants for 6 months to assess their self-reported achievement of behaviors reflecting their discussions about and/or pursuit of living donor kidney transplantation (discussions with family, discussions with physicians, initiating recipient evaluation, completing recipient evaluation, and identifying a potential living donor). We assessed outcomes through a questionnaire at 1-, 3-, and 6-months follow-up. Participants receiving usual care with their nephrologists (n = 44), TALK education (n = 43), and the TALK social worker (n = 43) were similar at baseline. TALK Study interventions improved participants' living donor kidney transplantation discussion and pursuit behaviors, with the social worker leading to greater patient activation (participants' predicted probability of achieving living donor kidney transplantation discussions, evaluations, or donor identification over 6 months): probabilities were 30% (95% CI, 20%-46%), 42% (95% CI, 33%-54%), and 58% (95% CI, 41%-83%), respectively, in the usual care, TALK education, and TALK social worker groups (P = 0.03). Our population was well educated and mostly insured, potentially limiting

  19. Furthering patient adherence: A position paper of the international expert forum on patient adherence based on an internet forum discussion

    OpenAIRE

    van Dulmen, Sandra; Sluijs, Emmy; van Dijk, Liset; de Ridder, Denise; Heerdink, Rob; Bensing, Jozien

    2008-01-01

    Abstract Background As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future research, practice and theory development in patient adherence. The objective of the present project was to find out to what extent adherence experts consider this agenda relevant and feasible. Metho...

  20. Furthering patient adherence: A position paper of the international expert forum on patient adherence based on an internet forum discussion

    NARCIS (Netherlands)

    Dulmen, S. van; Sluijs, E.; Dijk, Liset van; Ridder, D.T.D. de; Heerdink, R.; Bensing, J.

    2008-01-01

    Background: As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future

  1. Furthering patient adherence: a position paper of the international expert forum on patient adherence based on an internet forum discussion.

    NARCIS (Netherlands)

    Dulmen, S. van; Sluijs, E.; Dijk, L. van; Ridder, D. de; Heerdink, R.; Bensing, J.

    2008-01-01

    BACKGROUND: As the problem of patient non-adherence to treatment becomes ever greater and a solution appears hard to find, new ways have to be sought to tackle the issue. Given the weak theoretical underpinning of how to research the adherence problem, a fruitful step might be to find the most

  2. Preadolescents' Emotional and Prosocial Responses to Negative TV News: Investigating the Beneficial Effects of Constructive Reporting and Peer Discussion.

    Science.gov (United States)

    Kleemans, Mariska; Schlindwein, Luise F; Dohmen, Roos

    2017-09-01

    Watching news is important for preadolescents, but it may also harm their well-being. This study examined whether applying insights from positive psychology to news production can reduce this potential harm, by reducing negative emotional responses and enhancing positive emotional responses to negative news, and by encouraging prosocial intentions. Moreover, we explored whether peer discussion strengthened these effects. Preadolescents (n = 336; 9-13 years old; 48.5% female) were exposed to either constructive (solution-based news including positive emotions) or nonconstructive news. Subsequently, half of the children assigned to the constructive and the nonconstructive condition participated in a peer discussion. The findings showed that exposure to constructive news resulted in more positive emotional responses and less negative emotional responses as compared to nonconstructive news. Moreover, discussing the news with peers led to more positive and less negative emotional responses among preadolescents who watched the nonconstructive newscast, and to more prosocial intentions among preadolescents who watched constructive news. In all, constructive news reporting and peer discussion could function as tools to make negative news less harmful for preadolescents.

  3. Promoting End-of-Life Discussions in Advanced Cancer: Effects of Patient Coaching and Question Prompt Lists.

    Science.gov (United States)

    Rodenbach, Rachel A; Brandes, Kim; Fiscella, Kevin; Kravitz, Richard L; Butow, Phyllis N; Walczak, Adam; Duberstein, Paul R; Sullivan, Peter; Hoh, Beth; Xing, Guibo; Plumb, Sandy; Epstein, Ronald M

    2017-03-10

    Purpose To build on results of a cluster randomized controlled trial (RCT) of a combined patient-oncologist intervention to improve communication in advanced cancer, we conducted a post hoc analysis of the patient intervention component, a previsit patient coaching session that used a question prompt list (QPL). We hypothesized that intervention-group participants would bring up more QPL-related topics, particularly prognosis-related topics, during the subsequent oncologist visit. Patients and Methods This cluster RCT with 170 patients who had advanced nonhematologic cancer (and their caregivers) recruited from practices of 24 participating oncologists in western New York. Intervention-group oncologists (n = 12) received individualized communication training; up to 10 of their patients (n = 84) received a previsit individualized communication coaching session that incorporated a QPL. Control-group oncologists (n = 12) and patients (n = 86) received no interventions. Topics of interest identified by patients during the coaching session were summarized from coaching notes; one office visit after the coaching session was audio recorded, transcribed, and analyzed by using linear regression modeling for group differences. Results Compared with controls, more than twice as many intervention-group participants brought up QPL-related topics during their office visits (70.2% v 32.6%; P coaching, 158 (60.3%) were QPL related; 20 (12.7%) addressed prognosis. Overall, patients in the intervention group brought up 82.4% of topics of interest during the office visit. Conclusion A combined coaching and QPL intervention was effective to help patients with advanced cancer and their caregivers identify and bring up topics of concern, including prognosis, during their subsequent oncologist visits. Considering that most patients are misinformed about prognosis, more intensive steps are needed to better promote such discussions.

  4. A duplication of the mouth associated with a dysontogenic cyst: a case report and discussion of theories of origin.

    Science.gov (United States)

    Mews, Lorissa; Isaac, Andre; Leonard, Norma; Lacson, Atilano G; AlQudehy, Zeinab Ali; El-Hakim, Hamdy

    2014-05-01

    IMPORTANCE Diprosopus is a medical condition that refers to full or partial craniofacial duplication. A particular subset of this condition, duplication of the mouth, is an exceedingly rare condition, with 7 reported cases in the medical literature. The embryogenesis and mechanism of disease are not well understood. The objective of this report was to describe a case of partial facial duplication with a discussion of the previous literature, leading to a proposed theory of embryogenesis for this rare anomaly. OBSERVATIONS We present a rare case of duplication of the mouth associated with an intraoral dysontogenic cyst, which presented with upper airway obstruction. The diagnostic and management strategies are discussed, as well as the histopathological features and theories of embryogenesis. CONCLUSIONS AND RELEVANCE On the basis of our findings, we propose the mechanism of origin for duplication of the mouth to be duplication of the first branchial arch. This case offers a deeper understanding of the mechanism of this disease than previously reported. Additional basic science and clinical research is needed to corroborate this theory.

  5. Clinician-patient risk discussion for atherosclerotic cardiovascular disease prevention: importance to implementation of the 2013 ACC/AHA Guidelines.

    Science.gov (United States)

    Martin, Seth S; Sperling, Laurence S; Blaha, Michael J; Wilson, Peter W F; Gluckman, Ty J; Blumenthal, Roger S; Stone, Neil J

    2015-04-07

    Successful implementation of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines hinges on a clear understanding of the clinician-patient risk discussion (CPRD). This is a dialogue between the clinician and patient about potential for atherosclerotic cardiovascular disease risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences. Designed especially for primary prevention patients, this process of shared decision making establishes the appropriateness of a statin for a specific patient. CPRD respects the autonomy of an individual striving to make an informed choice aligned with personal values and preferences. Dedicating sufficient time to high-quality CPRD offers an opportunity to strengthen clinician-patient relationships, patient engagement, and medication adherence. We review the guideline-recommended CPRD, the general concept of shared decision making and decision aids, the American College of Cardiology/American Heart Association Risk Estimator application as an implementation tool, and address potential barriers to implementation. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Patient-reported outcomes, patient-reported information: from randomized controlled trials to the social web and beyond.

    Science.gov (United States)

    Baldwin, Mike; Spong, Andrew; Doward, Lynda; Gnanasakthy, Ari

    2011-01-01

    Internet communication is developing. Social networking sites enable patients to publish and receive communications very easily. Many stakeholders, including patients, are using these media to find new ways to make sense of diseases, to find and discuss treatments, and to give support to patients and their caregivers. We argue for a new definition of patient-reported information (PRI), which differs from the usual patient-reported outcomes (PRO). These new emergent data from the social web have important implications for decision making, at both an individual and a population level. We discuss new emergent technologies that will help aggregate this information and discuss how this will be assessed alongside the use of PROs in randomized controlled trials and how these new emergent data will be one facet of changing the relationship between the various stakeholders in achieving better co-created health.

  7. Accurate Prognostic Awareness Facilitates, Whereas Better Quality of Life and More Anxiety Symptoms Hinder End-of-Life Care Discussions: A Longitudinal Survey Study in Terminally Ill Cancer Patients' Last Six Months of Life.

    Science.gov (United States)

    Tang, Siew Tzuh; Chen, Chen Hsiu; Wen, Fur-Hsing; Chen, Jen-Shi; Chang, Wen-Cheng; Hsieh, Chia-Hsun; Chou, Wen-Chi; Hou, Ming-Mo

    2018-04-01

    Terminally ill cancer patients do not engage in end-of-life (EOL) care discussions or do so only when death is imminent, despite guidelines for EOL care discussions early in their disease trajectory. Most studies on patient-reported EOL care discussions are cross sectional without exploring the evolution of EOL care discussions as death approaches. Cross-sectional studies cannot determine the direction of association between EOL care discussions and patients' prognostic awareness, psychological well-being, and quality of life (QOL). We examined the evolution and associations of accurate prognostic awareness, functional dependence, physical and psychological symptom distress, and QOL with patient-physician EOL care discussions among 256 terminally ill cancer patients in their last six months by hierarchical generalized linear modeling with logistic regression and by arranging time-varying modifiable variables and EOL care discussions in a distinct time sequence. The prevalence of physician-patient EOL care discussions increased as death approached (9.2%, 11.8%, and 18.3% for 91-180, 31-90, and 1-30 days before death, respectively) but only reached significance in the last month. Accurate prognostic awareness facilitated subsequent physician-patient EOL care discussions, whereas better patient-reported QOL and more anxiety symptoms hindered such discussions. The likelihood of EOL care discussions was not associated with levels of physical symptom distress, functional dependence, or depressive symptoms. Physician-patient EOL care discussions for terminally ill Taiwanese cancer patients remain uncommon even when death approaches. Physicians should facilitate EOL care discussions by cultivating patients' accurate prognostic awareness early in their cancer trajectory when they are physically and psychologically competent, with better QOL, thus promoting informed and value-based EOL care decision making. Copyright © 2017 American Academy of Hospice and Palliative

  8. Colonic leishmaniasis in a patient with HIV: a case report

    Directory of Open Access Journals (Sweden)

    Estela Soria-López

    Full Text Available Background: To describe an unusual clinical presentation of visceral leishmaniasis affecting the colon. Case report: We report the case of an HIV-positive patient with visceral leishmaniasis. We describe the clinical case, the procedures performed, the treatment provided and the patient's evolution. A comparative table of previously reported similar cases is shown. Discussion: Visceral leishmaniasis with intestinal involvement is an uncommon process. Nevertheless, this possibility should be taken into consideration in the differential diagnosis of immunosuppressed patients with symptoms of diarrhea, as a favorable prognosis depends on early diagnosis and appropriate treatment.

  9. What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits.

    Science.gov (United States)

    Hunter, Wynn G; Zhang, Cecilia Z; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A

    2016-10-01

    More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized. We sought to determine how often patients and physicians discuss health care costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs. Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010 to 2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively. Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 s). We identified 4 strategies to lower costs without changing the care plan. They were, in order of overall frequency: 1) changing logistics of care, 2) facilitating co-pay assistance, 3) providing free samples, and 4) changing/adding insurance plans. We also identified 4 strategies to reduce costs by changing the care plan: 1) switching to lower-cost alternative therapy/diagnostic, 2) switching from brand name to generic, 3) changing dosage/frequency, and 4) stopping/withholding interventions. Strategies were relatively consistent across health conditions, except for switching to a lower-cost alternative (more common in breast oncology) and providing free samples (more common in depression). Focus on 3 conditions with potentially high out-of-pocket costs. Despite price opacity, physicians and patients discuss a variety of out-of-pocket cost reduction strategies during clinic visits. Almost half of cost discussions mention 1 or more cost-saving strategies, with more frequent mention of those not requiring care-plan changes. © The Author(s) 2016.

  10. Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients.

    Science.gov (United States)

    Johnson, Claire E; Chong, Jeffrey C; Wilkinson, Anne; Hayes, Barbara; Tait, Sonia; Waldron, Nicholas

    2017-07-01

    Advance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR. To assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients. A pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with 'Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer. When compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03). An increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care. © 2017 Royal Australasian College of Physicians.

  11. Should culture affect practice? A comparison of prognostic discussions in consultations with immigrant versus native-born cancer patients.

    Science.gov (United States)

    Butow, Phyllis N; Sze, Ming; Eisenbruch, Maurice; Bell, Melaine L; Aldridge, Lynley J; Abdo, Sarah; Tanious, Michelle; Dong, Skye; Iedema, Rick; Vardy, Janette; Hui, Rina; Boyle, Francis; Liauw, Winston; Goldstein, David

    2013-08-01

    Poor prognosis is difficult to impart, particularly across a cultural divide. This study compared prognostic communication with immigrants (with and without interpreters) versus native-born patients in audio-taped oncology consultations. Ten oncologists, 78 patients (31 Australian-born, 47 immigrants) and 115 family members participated. The first two consultations after diagnosis of incurable disease were audiotaped, transcribed and coded. 142 consultations were included in the analysis. Fifty percent of doctor and 59% of patient prognostic speech units were not interpreted or interpreted non-equivalently when an interpreter was present. Immigrant status predicted few prognostic facts, and oncologist characteristics no prognostic facts, disclosed. Oncologists were significantly less likely to convey hope to immigrants (p=0.0004), and more likely to use medical jargon (p=0.009) than with Australian-born patients. Incurable disease status and a limited life span were commonly acknowledged, generally with no timeframe provided. Physical issues were discussed more commonly than emotional aspects. While culture did not appear to influence doctor speech, interpreters filtered or blocked much prognostic communication. Initiatives to empower all patients to attain needed information, optimise communication when an interpreter is present and train cancer health professionals in culturally appropriate care, are urgently required. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Contextual barriers to discussing a schizophrenia diagnosis with patients and families: need for leadership and teamwork training in psychiatry.

    Science.gov (United States)

    Outram, Sue; Harris, Gillian; Kelly, Brian; Cohen, Martin; Bylund, Carma L; Landa, Yulia; Levin, Tomer T; Sandhu, Harsimrat; Vamos, Marina; Loughland, Carmel

    2015-04-01

    This research sought to gain insight into the processes used by clinicians to discuss a schizophrenia diagnosis with patients/families, with the aim of informing the development of a communications skills training program. A generic qualitative methodological approach was used. Sixteen mental health clinicians were recruited. Semi-structured individual interviews were used to explore their perceptions and experiences communicating a schizophrenia diagnosis. Interviews were recorded, transcribed, and thematic analysis undertaken. There were five key themes relating to the process of communication about a diagnosis of schizophrenia: (1) orientation to patient care, (2) planning of communication, (3) the impact of team leadership and inter/intra-professional functioning on communication tasks, (4) the roles of different clinicians in communicating about diagnosis and treatment, and (5) time and resource deficiencies. Despite expressing care and concern for vulnerable patients and embracing the concept of multidisciplinary teams, communicating diagnostic information to patients and families was generally unplanned for, with little consistency regarding leadership approaches, or how the team communicated diagnostic information to the patient and family. This contributed to tensions between different team members. The findings demonstrated a number of issues compromising good communication around a schizophrenia diagnosis, both in terms of clinician skill and clinical context, and support the importance of education and training for all members of the multidisciplinary team about their role in the communication process.

  13. Six habits to enhance MET performance under stress: A discussion paper reviewing team mechanisms for improved patient outcomes.

    Science.gov (United States)

    Fein, Erich C; Mackie, Benjamin; Chernyak-Hai, Lily; O'Quinn, C Richard V; Ahmed, Ezaz

    2016-05-01

    Effective team decision making has the potential to improve the quality of health care outcomes. Medical Emergency Teams (METs), a specific type of team led by either critical care nurses or physicians, must respond to and improve the outcomes of deteriorating patients. METs routinely make decisions under conditions of uncertainty and suboptimal care outcomes still occur. In response, the development and use of Shared Mental Models (SMMs), which have been shown to promote higher team performance under stress, may enhance patient outcomes. This discussion paper specifically focuses on the development and use of SMMs in the context of METs. Within this process, the psychological mechanisms promoting enhanced team performance are examined and the utility of this model is discussed through the narrative of six habits applied to MET interactions. A two stage, reciprocal model of both nonanalytic decision making within the acute care environment and analytic decision making during reflective action learning was developed. These habits are explored within the context of a MET, illustrating how applying SMMs and action learning processes may enhance team-based problem solving under stress. Based on this model, we make recommendations to enhance MET decision making under stress. It is suggested that the corresponding habits embedded within this model could be imparted to MET members and tested by health care researchers to assess the efficacy of this integrated decision making approach in respect to enhanced team performance and patient outcomes. Copyright © 2015. Published by Elsevier Ltd.

  14. If the shoe fits: development of an on-line tool to aid practitioner/patient discussions about 'healthy footwear'.

    Science.gov (United States)

    Farndon, Lisa; Robinson, Victoria; Nicholls, Emily; Vernon, Wesley

    2016-01-01

    A previous study highlighted the importance of footwear to individuals' sense of their identity, demonstrating that shoes must 'fit' someone socially, as well as functionally. However, unhealthy shoes can have a detrimental effect on both foot health and mobility. This project utilises qualitative social science methods to enable podiatrists to understand the broader contribution of footwear to patients' sense of themselves and from this an online toolkit was developed to aid footwear education. Semi-structured interviews were conducted with six podiatrists/shoe-fitters and 13 people with foot pathologies, some of whom also completed shoe diaries. These were supplemented with some follow-up interviews and photographs of participants' own shoes were taken to allow in-depth discussions. Four areas related to 'fit' were identified; practicalities, personal, purpose and pressures, all of which need to be considered when discussing changes in footwear. These were incorporated into an online toolkit which was further validated by service users and practitioners in a focus group. This toolkit can support podiatrists in partnership with patients to identify and address possible barriers to changing footwear towards a more suitable shoe. Enabling patients to make healthier shoe choices will help contribute to improvements in their foot health and mobility.

  15. 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...

  16. Advance directives as a tool to respect patients' values and preferences: discussion on the case of Alzheimer's disease.

    Science.gov (United States)

    Porteri, Corinna

    2018-02-20

    The proposal of the new criteria for the diagnosis of Alzheimer's disease (AD) based on biomarker data is making possible a diagnosis of AD at the mild cognitive impairment (MCI) or predementia/prodromal- stage. Given the present lack of effective treatments for AD, the opportunity for the individuals to personally take relevant decisions and plan for their future before and if cognitive deterioration occurs is one the main advantages of an early diagnosis. Advance directives are largely seen as an effective tool for planning medical care in the event the subject becomes incompetent. Nevertheless, their value has been questioned with regard to people with dementia by scholars who refer to the arguments of personal identity and of patient's changing interests before and after the onset of dementia. In this paper, I discuss the value of advance directives in Alzheimer's disease and other kind of dementia. Despite critics, I argue that advance directives are especially advisable in dementia and provide reasons in favor of their promotion at an early stage of the disease as a valuable tool to respect patients' values and preferences on medical treatment, including participation in research and end of life decisions. I mainly support advance directives that include both decisions regarding health care and the appointment of an attorney in fact. I conclude that patients with AD at a prodromal or early stage should be offered the opportunity to execute an advance directive, and that not to honor a demented individual's directive would be an unacceptable form of discrimination towards those patients.

  17. Summary discussions

    International Nuclear Information System (INIS)

    Ritchie, R.H.

    1982-01-01

    Remarks intended to highlight topics of importance for future research were made by three of the participants at the conclusion of the Seminar. A brief listing is given of topics discussed by each of these rapporteurs

  18. Primary care providers' discussion of fall prevention approaches with their older adult patients-DocStyles, 2014.

    Science.gov (United States)

    Burns, Elizabeth R; Haddad, Yara K; Parker, Erin M

    2018-03-01

    Falls are the leading cause of fatal and non-fatal injuries among older adults. The American and British Geriatric Societies recommend a fall risk assessment to identify risk factors and guide interventions to prevent these falls. This study describes the self-reported discussion of fall prevention approaches used by primary care providers (PCPs)-family practitioners, internists and nurse practitioners-who treat older adults. Results are described overall and by PCP type. We analyzed a sample of 1210 U.S. PCPs who participated in the 2014 DocStyles survey. PCPs reported on their recommendation of fall prevention approaches including general exercise, Tai Chi, medication adjustments, home safety modifications, vitamin D supplements, assistive devices, alarm systems, and referral to physical therapy, foot specialist, or vision specialist. Frequencies and adjusted odds ratios for fall prevention approaches were assessed by provider and practice characteristics. Self-reported discussion of any fall prevention approaches was 89.3%. Controlling for provider and practice characteristics, there were significant differences for some approaches by provider type. Family practitioners were more likely to suggest home modification [adjusted Odds Ratio: 1.8 (1.3-2.4)], exercise [aOR: 2.0 (1.5-2.5)], and Tai Chi [aOR: 1.5 (1.0-2.2)] than internists. Nurse practitioners were more likely to suggest home modification [aOR: 2.1 (1.3-3.4)] and less likely to suggest vitamin D [aOR: 0.6 (0.4-1.0)] than internists. Fall prevention suggestions vary by type of PCP. Dissemination of geriatric guidelines should include all PCPs who routinely see older adults.

  19. A contractor report to the Department of Energy on environmental management baseline programs and integration opportunities (discussion draft)

    International Nuclear Information System (INIS)

    1997-05-01

    In July 1996, the US Department of Energy (DOE) Assistant Secretary for Environmental Management (EM) chartered a government contractor led effort to develop a suite of technically defensible, integrated alternatives which meet the EM mission. The contractor team was challenged to ''think outside-the-box'' for solutions that cross traditional site boundaries and enable the programs to get the job done at an earlier date and at a lower cost. This report documents baseline programs current plans for material disposition and presents the opportunities for additional acceleration of cleanup and cost savings. A graphical depiction of the disposition of EM-owned waste and material from current state to final disposition is shown as disposition maps in Attachments 1, 3, 5, 7, 9, and 11. These disposition maps detail the material disposition at eleven major DOE sites as planned in the current discussion draft plan, Accelerating Cleanup: Focus on 2006. Maps reflecting material disposition at additional sites will be added in the future. Opportunities to further accelerate the cleanup of DOE-EM sites and reduce the overall cost of cleanup are depicted in the alternative disposition maps shown in Attachments 2, 4, 6, 8, 10, and 12. These integration opportunities bring nation-wide resources to bear on common problems facing the DOE sites

  20. Candy consumption patterns, effects on health, and behavioral strategies to promote moderation: summary report of a roundtable discussion.

    Science.gov (United States)

    Duyff, Roberta L; Birch, Leann L; Byrd-Bredbenner, Carol; Johnson, Susan L; Mattes, Richard D; Murphy, Mary M; Nicklas, Theresa A; Rollins, Brandi Y; Wansink, Brian

    2015-01-01

    Nearly all Americans (97%) report eating candy at least once per year; yet, on a given day, only approximately one-fourth of the US population aged ≥2 y consumes candy. Among all Americans, candy contributes a relatively small proportion of calories, added sugars, and saturated fat to the total diet, and recent research suggests that current levels of candy consumption are not associated with risk of weight gain and cardiovascular disease in children and adults. Providing guidance for the consumption of candy in moderation requires an understanding of various behavioral health-related factors that influence candy consumption. A roundtable of behavioral nutrition experts, researchers, and nutrition educators met to discuss recent data on intakes of candy, health outcomes associated with usual candy intake, and the impact of behavioral strategies, including restriction, education, and environmental awareness, on modifying eating behaviors to achieve moderate intakes of candy. Restricting access to palatable foods, whether self-imposed or by parental control, may have potentially negative consequences. Techniques and insight into how to adopt "moderation" in candy consumption, from effective parental practices to environmental strategies that facilitate behavior change without a high degree of effort, were identified as important next steps toward sustainable dietary guidance related to the role of candy and other treats in a healthy lifestyle. © 2015 American Society for Nutrition.

  1. Candy Consumption Patterns, Effects on Health, and Behavioral Strategies to Promote Moderation: Summary Report of a Roundtable Discussion12

    Science.gov (United States)

    Duyff, Roberta L; Birch, Leann L; Byrd-Bredbenner, Carol; Johnson, Susan L; Mattes, Richard D; Murphy, Mary M; Nicklas, Theresa A; Rollins, Brandi Y; Wansink, Brian

    2015-01-01

    Nearly all Americans (97%) report eating candy at least once per year; yet, on a given day, only approximately one-fourth of the US population aged ≥2 y consumes candy. Among all Americans, candy contributes a relatively small proportion of calories, added sugars, and saturated fat to the total diet, and recent research suggests that current levels of candy consumption are not associated with risk of weight gain and cardiovascular disease in children and adults. Providing guidance for the consumption of candy in moderation requires an understanding of various behavioral health-related factors that influence candy consumption. A roundtable of behavioral nutrition experts, researchers, and nutrition educators met to discuss recent data on intakes of candy, health outcomes associated with usual candy intake, and the impact of behavioral strategies, including restriction, education, and environmental awareness, on modifying eating behaviors to achieve moderate intakes of candy. Restricting access to palatable foods, whether self-imposed or by parental control, may have potentially negative consequences. Techniques and insight into how to adopt “moderation” in candy consumption, from effective parental practices to environmental strategies that facilitate behavior change without a high degree of effort, were identified as important next steps toward sustainable dietary guidance related to the role of candy and other treats in a healthy lifestyle. PMID:25593156

  2. Panel discussion

    International Nuclear Information System (INIS)

    Anon.

    1980-01-01

    The panel discussion at the 10th Allianz Forum on 'Technology and Insurance' dealt with the following topics: New technologies: energy conversion (coal, petroleum, natural gas, nuclear energy, solar energy); infrastructure (transport, data processing); basic products (metallic materials, chemical products, pharmaceutical products); integrated products (microprocessors, production line machines) as well as new risks: political; general economic (financing, market structure); insurance-related, dangers to persons and property; reduction of risks. (orig.) [de

  3. Measuring, Reporting and Verifying Nationally Appropriate Mitigation Actions. Reflecting experiences under the Mitigation Momentum Project. Discussion paper

    Energy Technology Data Exchange (ETDEWEB)

    De Vit, C.; Roeser, F.; Fekete, H.; Hoehne, N.; Wartmann, S.; Van Tilburg, X.; Larkin, J.; Escalante, D.; Haensel, G.; Veum, K.; Cameron, L.; Halcomb, J.

    2013-06-15

    The Mitigation Momentum project aims to support the development of Nationally Appropriate Mitigation Actions (NAMAs). It contributes to the concrete design of NAMA proposals in five countries (Peru, Chile, Indonesia, Tunisia and Kenya). A further aim is to foster cooperation and knowledge exchange within the NAMA community while advancing the international climate policy debate on mitigation and related issues, including approaches for the Measurement, Reporting and Verification (MRV) of NAMAs. MRV enables the assessment of the effectiveness of both internationally supported NAMAs (supported NAMAs) and domestically supported NAMAs (unilateral NAMAs) by tracking NAMA impacts including greenhouse gas (GHG) emission reductions and non-GHG related impacts such as sustainable development benefits. MRV also supports improved policy design and decision making through systematic progress reporting and is a key tool to ensure accountability of NAMA stakeholders. Both host countries and funders share the common interest of having strong, implementable MRV systems in place. From both perspectives, this raises a number of questions, as well as potential challenges, on how to adapt the MRV approach to the specific circumstances of each NAMA. The objective of this paper is to identify open issues for the MRV of impacts of NAMAs, understood here as implementable actions, i.e. a project, a policy, a programme or a strategy. It pays particular attention to NAMAs with a supported component and reflects relevant initial experiences with developing NAMA proposals in the five Mitigation Momentum countries (i.e. using country examples where appropriate). As MRV systems for these NAMAs are still under development or at their preliminary stage, we hope to share further lessons learned in a subsequent discussion paper. Key challenges analysed in this paper include: How to design a MRV system that satisfies both the host country's and funder's expectations while complying with

  4. Proceedings of Patient Reported Outcome Measure’s (PROMs) Conference Oxford 2017: Advances in Patient Reported Outcomes Research

    NARCIS (Netherlands)

    Velikova, Galina; Valderas, Jose M.; Potter, Caroline; Batchelder, Laurie; A’Court, Christine; Baker, Matthew; Bostock, Jennifer; Coulter, Angela; Fitzpatrick, Ray; Forder, Julien; Fox, Diane; Geneen, Louise; Gibbons, Elizabeth; Jenkinson, Crispin; Jones, Karen; Kelly, Laura; Peters, Michele; Mulhern, Brendan; Labeit, Alexander; Rowen, Donna; Meadows, Keith; Elliott, Jackie; Brazier, John E.; Knowles, Emma; Keetharuth, Anju; Brazier, John E.; Connell, Janice; Carlton, Jill; Buck, Lizzie Taylor; Ricketts, Thomas; Barkham, Michael; Goswami, Pushpendra; Salek, Sam; Ionova, Tatyana; Oliva, Esther; Fielding, Adele K.; Karakantza, Marina; Al-Ismail, Saad; Collins, Graham P.; McConnell, Stewart; Langton, Catherine; Jennings, Daniel M.; Else, Roger; Kell, Jonathan; Ward, Helen; Day, Sophie; Lumley, Elizabeth; Phillips, Patrick; Duncan, Rosie; Buckley-Woods, Helen; Aber, Ahmed; Jones, Gerogina; Michaels, Jonathan; Porter, Ian; Gangannagaripalli, Jaheeda; Davey, Antoinette; Ricci-Cabello, Ignacio; Haywood, Kirstie; Hansen, Stine Thestrup; Valderas, Jose; Roberts, Deb; Gumber, Anil; Podmore, Bélène; Hutchings, Andrew; van der Meulen, Jan; Aggarwal, Ajay; Konan, Sujith; Price, Andrew; Jackson, William; Bottomley, Nick; Philiips, Michael; Knightley-Day, Toby; Beard, David; Gibbons, Elizabeth; Fitzpatrick, Ray; Greenhalgh, Joanne; Gooding, Kate; Gibbons, Elizabeth; Valderas, Chema; Wright, Judy; Dalkin, Sonia; Meads, David; Black, Nick; Fawkes, Carol; Froud, Robert; Carnes, Dawn; Price, Andrew; Cook, Jonathan; Dakin, Helen; Smith, James; Kang, Sujin; Beard, David; Griffiths, Catrin; Guest, Ella; Harcourt, Diana; Murphy, Mairead; Hollinghurst, Sandra; Salisbury, Chris; Carlton, Jill; Elliott, Jackie; Rowen, Donna; Gao, Anqi; Price, Andrew; Beard, David; Lemanska, Agnieszka; Chen, Tao; Dearnaley, David P.; Jena, Rajesh; Sydes, Matthew; Faithfull, Sara; Ades, A. E.; Kounali, Daphne; Lu, Guobing; Rombach, Ines; Gray, Alastair; Jenkinson, Crispin; Rivero-Arias, Oliver; Holch, Patricia; Holmes, Marie; Rodgers, Zoe; Dickinson, Sarah; Clayton, Beverly; Davidson, Susan; Routledge, Jacqui; Glennon, Julia; Henry, Ann M.; Franks, Kevin; Velikova, Galina; Maguire, Roma; McCann, Lisa; Young, Teresa; Armes, Jo; Harris, Jenny; Miaskowski, Christine; Kotronoulas, Grigorios; Miller, Morven; Ream, Emma; Patiraki, Elizabeth; Geiger, Alexander; Berg, Geir V.; Flowerday, Adrian; Donnan, Peter; McCrone, Paul; Apostolidis, Kathi; Fox, Patricia; Furlong, Eileen; Kearney, Nora; Gibbons, Chris; Fischer, Felix; Gibbons, Chris; Coste, Joel; Martinez, Jose Valderas; Rose, Matthias; Leplege, Alain; Shingler, Sarah; Aldhouse, Natalie; Al-Zubeidi, Tamara; Trigg, Andrew; Kitchen, Helen; Davey, Antoinette; Porter, Ian; Green, Colin; Valderas, Jose M.; Coast, Joanna; Smith, Sarah; Hendriks, Jolijn; Black, Nick; Shah, Koonal; Rivero-Arias, Oliver; Ramos-Goni, Juan-Manuel; Kreimeier, Simone; Herdman, Mike; Devlin, Nancy; Finch, Aureliano Paolo; Brazier, John E.; Mukuria, Clara; Zamora, Bernarda; Parkin, David; Feng, Yan; Bateman, Andrew; Herdman, Mike; Devlin, Nancy; Patton, Thomas; Gutacker, Nils; Shah, Koonal

    2017-01-01

    The proceedings contain 36 papers. The topics discussed include: using patient reported outcome measures (PROMs) in cancer care; validation of the long-term conditions questionnaire (LTCQ) in a diverse sample of health and social care users in England; the national institutes of health

  5. Standardized patient simulation versus didactic teaching alone for improving residents' communication skills when discussing goals of care and resuscitation: A randomized controlled trial.

    Science.gov (United States)

    Downar, James; McNaughton, Nancy; Abdelhalim, Tarek; Wong, Natalie; Lapointe-Shaw, Lauren; Seccareccia, Dori; Miller, Kim; Dev, Shelly; Ridley, Julia; Lee, Christie; Richardson, Lisa; McDonald-Blumer, Heather; Knickle, Kerry

    2017-02-01

    Communication skills are important when discussing goals of care and resuscitation. Few studies have evaluated the effectiveness of standardized patients for teaching medical trainees to communicate about goals of care. To determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care. Single-blind, randomized, controlled trial of didactic teaching plus standardized patient simulation versus didactic teaching alone. First-year internal medicine residents. Changes in communication comfort and skill between baseline and 2 months post-training assessed using the Consultation and Relational Empathy measure. We enrolled 94 residents over a 2-year period. Both groups reported a significant improvement in comfort when discussing goals of care with patients. There was no difference in Consultation and Relational Empathy scores following the workshop ( p = 0.79). The intervention group showed a significant increase in Consultation and Relational Empathy scores post-workshop compared with pre-workshop (35.0 vs 31.7, respectively; p = 0.048), whereas there was no improvement in Consultation and Relational Empathy scores in the control group (35.6 vs 36.0; p = 0.4). However, when the results were adjusted for baseline differences in Consultation and Relational Empathy scores in a multivariable regression analysis, group assignment was not associated with an improvement in Consultation and Relational Empathy score. Improvement in comfort scores and perception of benefit were not associated with improvements in Consultation and Relational Empathy scores. Simulation training may improve communication skill and comfort more than didactic training alone, but there were important confounders in this study and further studies are needed to determine whether simulation is better than didactic training for this purpose.

  6. Discussion Graphs

    DEFF Research Database (Denmark)

    Kiciman, Emre; Counts, Scott; Gamon, Michael

    2014-01-01

    , time and other confounding factors, few of the studies that attempt to extract information from social media actually condition on such factors due to the difficulty in extracting these factors from naturalistic data and the added complexity of including them in analyses. In this paper, we present......Much research has focused on studying complex phenomena through their reflection in social media, from drawing neighborhood boundaries to inferring relationships between medicines and diseases. While it is generally recognized in the social sciences that such studies should be conditioned on gender...... a simple framework for specifying and implementing common social media analyses that makes it trivial to inspect and condition on contextual information. Our data model—discussion graphs—captures both the structural features of relationships inferred from social media as well as the context...

  7. Rationale for Using Social Media to Collect Patient-Reported Outcomes in Patients with Celiac Disease.

    Science.gov (United States)

    Park, Kt; Harris, Merissa; Khavari, Nasim; Khosla, Chaitan

    2014-02-01

    Patients with celiac disease (CD) are increasingly interconnected through social media, exchanging patient experiences and health-tracking information between individuals through various web-based platforms. Social media represents potentially unique communication interface between gastroenterologists and active social media users - especially young adults and adolescents with celiac disease-regarding adherence to the strict gluten-free diet, gastrointestinal symptoms, and meaningful discussion about disease management. Yet, various social media platforms may be underutilized for research purposes to collect patient-reported outcomes data. In this commentary, we summarize the scientific rationale and potential for future growth of social media in patient-reported outcomes research, focusing on college freshmen with celiac disease as a case study and provide overview of the methodological approach. Finally, we discuss how social media may impact patient care in the future through increasing mobile technology use.

  8. Glenoid hypoplasia: a report of 2 patients.

    Science.gov (United States)

    Lynch, Christopher J; Taylor, John A M; Buchberger, Dale J

    2008-06-01

    This article discusses the imaging findings, clinical findings, and conservative chiropractic management of 2 patients with glenoid hypoplasia. Conventional radiographs of both patients revealed a hypoplastic glenoid bilaterally. Notch-like defects along with signs of degenerative disease were evident within the lower portion of the glenoid rims bilaterally in 1 patient and in the left glenoid rim of the other patient. Magnetic resonance imaging revealed a degenerative cyst or cortical defect in one patient along the anterior humeral head. The second patient showed a small slightly lobulated cystic region just posterior to the glenoid rim, consistent with the appearance of a synovial or ganglion cyst. Computed tomography with 3-dimensional reconstruction in 1 patient confirmed the presence of large posterior and superior osteophytes arising from the significantly hypoplastic glenoid. These images also revealed a slight posterior subluxation of the humeral head, widening of the anterior glenohumeral joint space, and retroversion of the glenoid. Treatment consisted of manual joint manipulation, soft tissue therapies, and therapeutic exercise for both patients. Both patients experienced improvements in symptoms, function, and physical examination findings. Glenoid hypoplasia is a developmental anomaly of the scapular neck which is predominantly bilateral and symmetric. Cross-sectional imaging studies should be considered in patients with symptoms that fail to improve over time. Conservative chiropractic care may be effective in managing symptoms in patients with glenoid hypoplasia.

  9. Patient-reported Outcomes in Cystic Fibrosis

    OpenAIRE

    Goss, Christopher H.; Quittner, Alexandra L.

    2007-01-01

    Over the past 20 years, there has been tremendous progress in the area of patient-reported outcomes (PROs). A PRO instrument is defined as any measure of a patient's health status that is elicited directly from the patient and assesses how the patient “feels or functions with respect to his or her health condition.” The advances seen in clinical research regarding PROs has been mirrored in research in cystic fibrosis (CF). A large number of instruments have been used for both therapeutic and ...

  10. Panel Discussion

    Science.gov (United States)

    Langer, James

    1997-03-01

    Panelists: Arthur Bienenstock, Stanford University Cherry Ann Murray, Lucent Technologies Venkatesh Narayanamurti, University of California-Santa Barbara Paul Peercy, SEMI-SEMATECH Robert Richardson, Cornell University James Roberto, Oak Ridge National Laboratory The Board on Physics and Astronomy is undertaking a series of reassessments of all branches of physics as the foundation of a new physics survey. As part of this project, a Committee on Condensed Matter and Materials Physics has been established under the leadership of Venkatesh Narayanamurti of the University of California-Santa Barbara. The committee has been working since June on a study that will include an illustrative recounting of major recent achievements; identification of new opportunities and challenges facing the field; and articulation-for leaders in government, industry, universities, and the public at large-of the important roles played by the field in modern society. An especially urgent issue is how to maintain the intellectual vitality of condensed matter and materials physics, and its contributions to the well-being of the United States, in an era of limited resources. The forum will feature a panel of materials researchers who are members of the Committee on Condensed Matter and Materials Physics. They will give a brief report on the status of the study and engage in a dialogue with the audience about issues facing the condensed matter and materials physics community. Broad community input is vital to the success of the study. Please come and make your voice heard!

  11. 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

  12. Perceived Fall Risk and Functional Decline: Gender Differences in Patient's Willingness to Discuss Fall Risk, Fall History, or to Have a Home Safety Evaluation.

    Science.gov (United States)

    Greenberg, Marna Rayl; Moore, Elizabeth C; Nguyen, Michael C; Stello, Brian; Goldberg, Arnold; Barraco, Robert D; Porter, Bernadette G; Kurt, Anita; Dusza, Stephen W; Kane, Bryan G

    2016-06-01

    The CDC reports that among older adults, falls are the leading cause of injury-related death and rates of fall-related fractures among older women are twice those of men. We set out to 1) determine patient perceptions (analyzed by gender) about their perceived fall risk compared to their actual risk for functional decline and death and 2) to report their comfort level in discussing their fall history or a home safety plan with their provider. Elders who presented to the Emergency Department (ED†) were surveyed. The survey included demographics, the Falls Efficacy Scale (FES) and the Vulnerable Elders Survey (VES); both validated surveys measuring fall concern and functional decline. Females had higher FES scores (mean 12.3, SD 5.9) than males (mean 9.7, SD 5.9 p = .007) in the 146 surveys analyzed. Females were more likely to report an increased fear of falling, and almost three times more likely to have a VES score of 3 or greater than males (OR = 2.86, 95% CI: 1.17-7.00, p = .02). A strong correlation was observed between FES and VES scores (r = 0.80, p fall risk with a provider; there was no difference between genders (p = .57). In this study, irrespective of gender, there appears to be a high association between subjects' perceived fall risk and risk for functional decline and death. The majority of patients are likely willing to discuss their fall risk with their provider. These findings may suggest a meaningful opportunity for fall risk mitigation in this setting.

  13. Using Patient Reported Outcomes Measures to Promote Integrated Care

    Directory of Open Access Journals (Sweden)

    Marcel G. M. Olde Rikkert

    2018-04-01

    Full Text Available Introduction: Patient reported outcome measures (PROMs have been introduced as standardised outcomes, but have not been implemented widely for disease targeted pathways of care, nor for geriatric patients who prefer functional performance and quality of life. Discussion: We describe innovative multipurpose implementation of PROMs as evidenced by two best practices of PROMs application in geriatric and physiotherapy practice. We show that PROMs can show meaningful outcomes in older subjects’ patient journeys, which can at the same time serve individuals and groups of both patients and professionals. Key lesson: PROMs can deliver generic outcomes relevant for older patients, may improve patient-physician relationship, quality of care and prediction of future outcomes in geriatric care, if they are valid, reliable and responsive, but still short and simple. A precondition to make the hard tip from research to practice is that PROMs are carefully positioned in the clinical encounters and in electronic health records.

  14. How do we incorporate patient views into the design of healthcare services for older people: a discussion paper.

    Science.gov (United States)

    Brocklehurst, Paul R; McKenna, Gerald; Schimmel, Martin; Kossioni, Anastassia; Jerković-Ćosić, Katarina; Hayes, Martina; da Mata, Cristiane; Müller, Frauke

    2018-04-06

    Across the European Union costs for the treatment of oral disease is expected to rise to €93 Billion by 2020 and be higher than those for stroke and dementia combined. A significant proportion of these costs will relate to the provision of care for older people. Dental caries severity and experience is now a major public health issue in older people and periodontal disease disproportionately affects older adults. Poor oral health impacts on older people's quality of life, their self-esteem, general health and diet. Oral health care service provision for older people is often unavailable or poor, as is the standard of knowledge amongst formal and informal carers. The aim of this discussion paper is to explore some of the approaches that could be taken to improve the level of co-production in the design of healthcare services for older people. People's emotional and practical response to challenges in health and well-being and the responsiveness of systems to their needs is crucial to improve the quality of service provision. This is a particularly important aspect of care for older people as felt, expressed and normative needs may be fundamentally different and vary as they become increasingly dependent. Co-production shifts the design process away from the traditional 'top-down' medical model, where needs assessments are undertaken by someone external to a community and strategies are devised that encourage these communities to become passive recipients of services. Instead, an inductive paradigm of partnership working and shared leadership is actively encouraged to set priorities and ultimately helps improve the translational gap between research, health policy and health-service provision. The four methodological approaches discussed in this paper (Priority Setting Partnerships, Discrete Choice Experiments, Core Outcome Sets and Experience Based Co-Design) represent an approach that seeks to better engage with older people and ensure an inductive, co

  15. 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

  16. Horror fusionis: a report of five patients.

    Science.gov (United States)

    Rutstein, R P; Bessant, B

    1996-12-01

    Horror fusionis is an uncommon anomaly and is rarely reported in the literature. Five adults with long-standing diplopia associated with horror fusionis were examined. All patients had strabismus since early childhood and had been treated at that time either with surgery, occlusion, and/or orthoptics/vision therapy. Prisms could not eliminate the diplopia. Graded occlusion was attempted with one patient but was not tolerated. Another patient with an asymmetrical dissociated vertical deviation could ignore the second image by fixating with the eye with the smaller deviation. Two patients reported the diplopia becoming less noticeable over the years. Because of its poor prognosis, the diplopia associated with horror fusionis must be differentiated from other types of diplopia occurring in adults with childhood onset strabismus.

  17. Patient Satisfaction with Physician Discussions of Treatment Impact on Fertility, Menopause and Sexual Health among Pre-menopausal Women with Cancer

    Directory of Open Access Journals (Sweden)

    Maura Scanlon, Anne Blaes, Melissa Geller, Navneet S Majhail, Bruce Lindgren, Tufia Haddad

    2012-01-01

    Full Text Available PURPOSE: Pre-menopausal women with cancer are at risk of therapy-associated infertility, premature menopause, and sexual dysfunction. However, it is unknown whether oncologists adequately address these risks during treatment planning. We conducted a study to evaluate physician-patient discussions addressing the impact of cancer treatment and actual treatment effects on fertility, menopause status, and general sexual health.METHODS: A questionnaire was administered in four oncology clinics specializing in breast, gynecologic, general hematology-oncology, and blood and marrow transplantation (BMT cancer care at a single institution. Eligible participants were pre-menopausal at the time of diagnosis and either actively receiving or within 24 months from completion of treatment. Participants completed the questionnaire at enrollment and at 1-year follow-up.RESULTS: Of the 104 eligible women, a majority were satisfied with the quality (68% and length (66% of reproductive health discussions, with the highest satisfaction levels in the gynecologic cancer clinic (85% and the lowest levels in the BMT clinic (53%. Fertility preservation was desired by 20% of women, including some >40 years old. Women were more interested in discussing treatment impact on menopause status and sexual health than fertility. Rates of discussions on treatment impact on sexual health were low despite 77% of women reporting severe sexual dysfunction at 1-year follow-up.CONCLUSIONS: One-third of women are dissatisfied with the quality and length of discussions regarding the impact of cancer treatment on reproductive health. There is notably inadequate counseling on the effect of treatment on fertility in women > 40 and on sexual function in all women. Oncologists must offer better resources and improve communication on the effect of treatment on reproductive health to pre-menopausal women with cancer.

  18. How to report and discuss ADME data in medicinal chemistry publications: in vitro data or in vivo extrapolations?

    Science.gov (United States)

    Svennebring, Andreas M

    2015-01-01

    Early drug discovery projects often utilize data from ADME (absorption, distribution, metabolism, elimination) assays to benchmark data and guide discussion, rather than the predicted in vivo consequences of these data. Here, the two paradigms are compared, using evaluations of metabolic stability based on either microsomal clearance assay data or from the predicted in vivo hepatic clearance and half-life calculated through the combination of the venous well-stirred model and Øie-Tozer's model. The need for a shift in paradigm is presented, and its implications discussed. It is suggested that discussions about ADME data should revolve around potential clinical problems that are most likely to surface during the development phase, each benchmarked with a suitable variable derived from the assay data.

  19. Patient-reported outcomes in borderline personality disorder

    Science.gov (United States)

    Hasler, Gregor; Hopwood, Christopher J.; Jacob, Gitta A.; Brändle, Laura S.; Schulte-Vels, Thomas

    2014-01-01

    Patient-reported outcome (PRO) refers to measures that emphasize the subjective view of patients about their health-related conditions and behaviors. Typically, PROs include self-report questionnaires and clinical interviews. Defining PROs for borderline personality disorder (BPD) is particularly challenging given the disorder's high symptomatic heterogeneity, high comorbidity with other psychiatric conditions, highly fluctuating symptoms, weak correlations between symptoms and functional outcomes, and lack of valid and reliable experimental measures to complement self-report data. Here, we provide an overview of currently used BPD outcome measures and discuss them from clinical, psychometric, experimental, and patient perspectives. In addition, we review the most promising leads to improve BPD PROs, including the DSM-5 Section III, the Recovery Approach, Ecological Momentary Assessments, and novel experimental measures of social functioning that are associated with functional and social outcomes. PMID:25152662

  20. Scientist versus sceptic. Report of a weblog discussion between a climatic change researcher and a climatic change sceptic

    International Nuclear Information System (INIS)

    Strengers, B.J.; Labohm, H.H.J.

    2010-05-01

    In the run up to the international climate conference in Copenhagen in December 2009, climate sceptic Hans Labohm and climate researcher Bart Strengers of the Environmental Assessment Agency entered into a debate on the website of the Dutch Broadcasting Foundation NOS. The blog discussion offers a good view on the dilemmas surrounding knowledge about climate change. [nl

  1. Analysis and discussion on reports of additional safety assessment of nuclear installations with respect to the Fukushima accident

    International Nuclear Information System (INIS)

    Sene, Monique; Sene, Raymond

    2011-11-01

    This document proposes an analysis of the reports made by the different operators of nuclear installations within the frame of a safety audit of the French nuclear installations with respect to the Fukushima accident. Operators (mainly AREVA, the CEA and EDF) were asked to perform additional safety assessments. In a first part, the conclusions of EDF reports are analysed regarding the seismic risk, the flooding risk, the situation of some specific sites (Fessenheim, Tricastin), other phenomena (rains, winds), loss of electricity supplies and of cooling systems, severe accidents, hydrogen issue, chemical hazards, subcontractors, crisis management. Conclusions of AREVA reports are analysed for the different sites (Tricastin, La Hague, MELOX factory, Romans factory). Conclusions of CEA reports are analysed for the different concerned installations (ATPu, Masurca, Osiris, Phenix, Jules Horowitz reactor). A second part proposes a global analysis of EDF's additional safety assessment reports regarding earthquake, flooding, other extreme natural phenomena, loss of electricity supplies and cooling system, subcontracting conditions, crisis management, and radiation protection organisation. AREVA's and CEA's reports are then analysed in terms of report structure and content, and for the different concerned sites

  2. Case report patients diagnosed with rheumatoid arthritis

    OpenAIRE

    Váňová, Tereza

    2012-01-01

    Title of bachelors thesis: Case report patients diagnosed with rheumatoid arthritis Summary: The work is focused on diseases rheumatoid arthritis and its physiotherapy care. It consists of two parts. Part of the general anatomy of the joint contains a general, deals with the disease rheumatoid arthritis, its diagnosis, treatment and comprehensive rehabilitation treatment. Part has its own special case report physiotherapy sessions on this topic. Key words: rheumatoid arthritis, comprehensive ...

  3. The Future of Russia and the Russian Navy. Report of Discussions in Moscow November 2-6, 2003

    Science.gov (United States)

    2004-01-01

    grave existence of their workers. It is also reported that for oil especially, the companies are simply 4. IKEA has found that the average Russian...shopper spends as much as the average Swedish shopper— IKEA is only in Moscow now, but is planning to expand around the country. 5. Erin A. Arvedlund

  4. Principals Discuss Early Implementation of the ASSISTments Online Homework Tutor for Mathematics. ASSISTments Efficacy Study Report 2

    Science.gov (United States)

    Fairman, Janet; Porter, Michael; Fisher, Susannah

    2015-01-01

    This report presents the findings from interviews with principals about their schools' participation in the ASSISTments efficacy study on seventh-grade mathematics. The purpose of the interviews was to explore the following areas: To what extent schools had policies or expectations regarding homework practice and completion; To what extent schools…

  5. Problems and Opportunities of an International Financial Reporting Standard for Small and Medium-sized Entities. The EAA FRSC's Comment on the IASB's Discussion Paper

    DEFF Research Database (Denmark)

    Thinggaard, Frank; Evans, Lisa; Gebhardt, Günther

    2005-01-01

    and questions arising from this. This paper briefly introduces the background to the publication of the Discussion Paper. This is followed by a review of prior litterature on SME financial reporting implications, prepared by the European Accountin Association's Financial Reporting Standards Committee...

  6. A discussion for alteration of the radiation issues based on the clipping analyses of radiation articles reported in Korea

    International Nuclear Information System (INIS)

    Kim, Joo Yeon; Youn, Dol Mi; Yoo, Ji Yup; Park, Tai Jin

    2016-01-01

    Radiation accidents having occurred in recent containing the accident in Fukushima nuclear power plants of Japan were resulted to the increase in some public concern, anxiety and confusion for radiation or nuclear safety. The public anxiety for radiation is not being decreased though the announcements done in radiation research institutes in Korea. Therefore, this study aims at providing an effective system for radiation publicity to the public members by the clipping analysis for the radiation articles reported in the media. And, the relation between those radiation issues and the radiation perception to the public members is analyzed. The radiation articles reported by them in 2013 and 2014 have been collected, and they are then classified with the article characteristic, field and tendency. Classified articles have been reviewed by dividing as two year. The 210 articles have been compared for their tendencies, characteristics and fields by year reported, and their characteristic comparison by reported year are then reviewed. Though the frequency that the radiological accidents have occurred in worldwide is far low compared to the accidental frequencies occurred in the general industrial fields, the radiation perception is being still deteriorated because of its special problem, which is defined as exposure, contamination or radioactivity, about radiation. The basic principles for radiation communication were suggested for preventing some unnecessary misunderstanding due to the variation of understanding for radiation issues. It is necessary to perform a variety of strategies for the publicity in improving the radiation perception, to build a relationship with the press or the media and then to consistently interact with them. Radiation communication must be performed by radiation experts or complete charge department, and must be consistently performed and be taken predictable patterns

  7. A discussion for alteration of the radiation issues based on the clipping analyses of radiation articles reported in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Joo Yeon; Youn, Dol Mi; Yoo, Ji Yup; Park, Tai Jin [Korean Association for Radiation Application, Seoul (Korea, Republic of)

    2016-06-15

    Radiation accidents having occurred in recent containing the accident in Fukushima nuclear power plants of Japan were resulted to the increase in some public concern, anxiety and confusion for radiation or nuclear safety. The public anxiety for radiation is not being decreased though the announcements done in radiation research institutes in Korea. Therefore, this study aims at providing an effective system for radiation publicity to the public members by the clipping analysis for the radiation articles reported in the media. And, the relation between those radiation issues and the radiation perception to the public members is analyzed. The radiation articles reported by them in 2013 and 2014 have been collected, and they are then classified with the article characteristic, field and tendency. Classified articles have been reviewed by dividing as two year. The 210 articles have been compared for their tendencies, characteristics and fields by year reported, and their characteristic comparison by reported year are then reviewed. Though the frequency that the radiological accidents have occurred in worldwide is far low compared to the accidental frequencies occurred in the general industrial fields, the radiation perception is being still deteriorated because of its special problem, which is defined as exposure, contamination or radioactivity, about radiation. The basic principles for radiation communication were suggested for preventing some unnecessary misunderstanding due to the variation of understanding for radiation issues. It is necessary to perform a variety of strategies for the publicity in improving the radiation perception, to build a relationship with the press or the media and then to consistently interact with them. Radiation communication must be performed by radiation experts or complete charge department, and must be consistently performed and be taken predictable patterns.

  8. X – linked Hypohidrotic Ectodermal Dysplasia and atopic eczema – case report and discussion on mechanisms of eczema

    Directory of Open Access Journals (Sweden)

    Catarina Moreira

    2017-12-01

    Although XHED has a favorable prognosis, eczema is a major problem and the eczematous characteristics of patient’s skin resemble those of atopic dermatitis. Ceramide profile, reduction of natural moisturizing factors due to hypohidrosis and skin barrier dysfunction elicited by airborne proteins likely contribute to persistent and difficult-to-control AD-like eczema. As a consequence of the rarity of the disease, obtaining a significant number of clinical studies to clarify and validate the pathways involved in skin barrier dysfunction and the consequent eczematous lesions in HED patients will probably remain a challenge.

  9. Dental management of patient with Williams Syndrome - A case report.

    Science.gov (United States)

    Wong, Daniel; Ramachandra, Srinivas Sulugodu; Singh, Ashish Kumar

    2015-01-01

    Williams syndrome is a multisystemic rare genetic disorder caused by deletion of 26-28 genes in the long arm of chromosome 7. It is characterized by developmental and physical abnormalities including congenital cardiovascular abnormalities, mental retardation, neurological features, growth deficiency, genitourinary manifestations, gastrointestinal problems, musculoskeletal problems, unique behavioral characteristics, and dental problems. Dental abnormalities include malocclusion, hypodontia, malformed teeth, taurodontism, pulp stones, increased space between teeth, enamel hypoplasia, and high prevalence of dental caries. Authors report a 17-year-old female patient with underlying Williams syndrome. Oral features and problems seen in the patient are listed. Malocclusion and screwdriver shaped teeth were noticed. Generalized widening of the periodontal ligament space with vital teeth was seen. This finding has not been reported in cases of Williams syndrome earlier. Precautions taken during dental treatment in patients with Williams syndrome are also discussed.

  10. The use of intraoperative monitoring and treatment of symptomatic microemboli in carotid artery stenting: case report and discussion

    Energy Technology Data Exchange (ETDEWEB)

    Rangi, P.S.; Clifton, A. [St Georges Hospital, Department of Neuroradiology, Atkinson Morley Wing, Tooting, London (United Kingdom); Markus, H.S.; Punter, M.N.M. [St Georges University of London, Centre for Clinical Neuroscience, Cranmer Terrace, London (United Kingdom)

    2007-03-15

    Carotid artery stenting is a recently introduced treatment in symptomatic atherosclerotic carotid artery disease with acceptable complication rates. The major risk is perioperative embolic stroke. Transcranial Doppler ultrasonography (TCD) can be used to identify embolic signals and guide therapy. We present a case of symptomatic embolization in a 72-year-old female following carotid stent deployment complicated by haemodynamic changes. Despite concurrent dual antiplatelet medication significant symptomatic embolization occurred even after restoration of the blood pressure, and modulation of the rate of embolization was achieved using dextran-40 guided by TCD monitoring. The patient recovered from an initially profound hemiparesis and dysphasia to minor sensory changes. Microemboli are common following carotid artery stenting and there appears to be a threshold phenomenon associated with prolonged embolization and progression to cerebral infarction. TCD can be used to detect particulate microemboli and therefore may be useful in guiding antithrombotic therapy in this setting. Dextran-40 has been shown to reduce the embolic load following carotid endarterectomy and was used to good effect in this patient in terms of both embolic load and clinical outcome. This is the first case of embolization following carotid stenting successfully treated with dextran-40, and offers a further option for therapeutic intervention in microembolism detected by TCD and stresses the importance of perioperative monitoring of embolic load for postoperative stroke risk. (orig.)

  11. Development of a patient-reported outcome

    DEFF Research Database (Denmark)

    Juul, Tina; Søgaard, Karen; Roos, Ewa M.

    2015-01-01

    removed from the original 69. A multidimensional questionnaire, divided into five subscales, was developed from the remaining 34 items: mobility; symptoms; sleep disturbance; everyday activity and pain; and participation in everyday life. Exploratory factor analysis supported a 5-subscale structure......OBJECTIVE: To develop a patient-reported outcome evaluating the impact of neck pain. The results of item generation and reduction and subscale structure in support of the content and construct validity of the measure are reported. METHODS: Items were generated from the literature and through focus...

  12. Workshops for state review of site suitability criteria for high-level radioactive waste repositories. Discussion Group reports

    International Nuclear Information System (INIS)

    1977-10-01

    The NRC Waste Management Program and the Office of State Programs held three regional workshops to solicit ideas from State executives and legislators on the siting and licensing procedures for high level waste repositories and to solicit comments on the NRC preliminary site suitability criteria. The workshops were held in Denver, Colorado; New Orleans, Louisiana; and Philadelphia, Pennsylvania during the period 19-30 September 1977. The reports from these workshops are contained herein. The workshops were attended by 170 invited State executives and legislators from 46 states. In addition, there were over 80 observers from diverse backgrounds including the general public, government, industry, professional consultants and university faculty. The workshops were announced in the Federal Register on September 1, 1977

  13. Ultra-low microcurrent in the management of diabetes mellitus, hypertension and chronic wounds: Report of twelve cases and discussion of mechanism of action

    Science.gov (United States)

    Lee, Bok Y.; AL-Waili, Noori; Stubbs, Dean; Wendell, Keith; Butler, Glenn; AL-Waili, Thia; AL-Waili, Ali

    2010-01-01

    either reduced their medication or completely stopped after the course of treatment. No side effects were reported. The mechanism of action was discussed. PMID:20046232

  14. How do physicians discuss e-health with patients? the relationship of physicians' e-health beliefs to physician mediation styles.

    Science.gov (United States)

    Fujioka, Yuki; Stewart, Erin

    2013-01-01

    A survey of 104 physicians examined the role of physicians' evaluation of the quality of e-health and beliefs about the influence of patients' use of e-health in how physicians discuss e-health materials with patients. Physicians' lower (poor) evaluation of the quality of e-health content predicted more negative mediation (counter-reinforcement of e-health content). Perceived benefits of patients' e-health use predicted more positive (endorsement of e-health content). Physician's perceived concerns (negative influence) regarding patients' e-health use were not a significant predictor for their mediation styles. Results, challenging the utility of restrictive mediation, suggested reconceptualizing it as redirective mediation in a medical interaction. The study suggested that patient-generated e-health-related inquiries invite physician mediation in medical consultations. Findings and implications are discussed in light of the literature of physician-patient interaction, incorporating the theory of parental mediation of media into a medical context.

  15. Who cares? A critical discussion of the value of caring from a patient and healthcare professional perspective.

    Science.gov (United States)

    Flynn, Sandra

    2016-02-01

    This study was undertaken in order to discover and illuminate the essential caring behaviours valued by both patients and staff in an orthopaedic setting within a district general hospital in the United Kingdom. This descriptive study was undertaken in order to acquire a greater understanding of perceptions of caring from both patient and orthopaedic healthcare professional perspectives. A sample of 30 patients and 53 healthcare professionals consisting of doctors, nurses, physiotherapists and occupational therapists were asked to complete the Caring Behaviours Inventory (CBI) questionnaire (Wolf et al., 1994). Data were analysed using descriptive and inferential statistics. The findings revealed both similarities and differences relating to the importance of positive caring behaviours exhibited during caring interactions. Healthcare professionals working in the orthopaedic setting acknowledged the value of similar positive caring behaviours to those of the patient group but ranked the importance of these differently. Several important insights into perceptions of caring have been gained. These relate to an overall understanding of the caring behaviours that are considered of importance to patients and healthcare professionals; the differences that exist between the caring perceptions of both groups and the factors which influence these perceptions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Is it acceptable to approach colorectal cancer patients at diagnosis to discuss genetic testing? A pilot study

    OpenAIRE

    Porteous, M; Dunckley, M; Appleton, S; Catt, S; Dunlop, M; Campbell, H; Cull, A

    2003-01-01

    In this pilot study, the acceptability of approaching 111 newly diagnosed colorectal cancer patients with the offer of genetic testing for hereditary nonpolyposis colorectal cancer (HNPCC) was assessed. A total of 78% of participants found it highly acceptable to have the information about HNPCC brought to their attention at that time.

  17. Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome

    DEFF Research Database (Denmark)

    Storgaard, Filip Holst; Pedersen, Christina Gravgaard; Jensen, Majbritt Lykke

    Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome.......Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome....

  18. Art Therapy Outcomes in the Rehabilitation Treatment of a Stroke Patient: A Case Report

    Science.gov (United States)

    Kim, Sun-Hyun; Kim, Min-Young; Lee, Jae-Hyuk; Chun, Sae-il

    2008-01-01

    This case report discusses the potential for art therapy to aid in the recovery of early-chronic stroke patients. The patient was diagnosed with having a subarachnoid hemorrhage from a cerebral aneurysm rupture 1 year prior to hospitalization. Therapies used as part of the patient's treatment included 10 weeks of art therapy conducted twice a…

  19. Should This Patient Receive Prophylactic Medication to Prevent Delirium?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

    Science.gov (United States)

    Tess, Anjala V; Mattison, Melissa L P; Leo, Joshua R; Reynolds, Eileen E

    2018-04-03

    In 2015, the American Geriatrics Society released recommendations for prevention and management of postoperative delirium, based on a systematic literature review and evaluation of nonpharmacologic and pharmacologic approaches by an expert panel. The guidelines recommend an interdisciplinary focus on nonpharmacologic measures (reorientation, medication management, early mobility, nutrition, and gastointestinal motility) for prevention and consideration of this strategy for acute management. They also recommend optimizing nonopioid medication as a means to manage pain and avoiding benzodiazepines other than to treat substance withdrawal. The authors concluded that evidence to recommend antipsychotics for prevention of delirium is insufficient but that these drugs may be considered for short-term treatment in the setting of imminent harm to the patient or caregivers or severe distress due to agitation. Patients should be given the lowest possible dose for the shortest duration when other nonpharmacologic measures have failed. In this Beyond the Guidelines, a psychiatrist and a geriatrician debate whether Mr. W, a 79-year-old man at high risk for postoperative delirium, should receive prophylactic antipsychotics with his next surgery. They review risk factors, appropriate evaluation, and potential benefits and harms of the various medications often used in this setting.

  20. Investigation of the effects of group discussion on the empowerment of patients with hypertension who were referred to two health centers in Tehran in 1390

    Directory of Open Access Journals (Sweden)

    Nasrin Kheibar

    2014-04-01

    Results: The average age of the subjects was 54 ± 8.4 years and 34.4% of the participants had a history of hypertension for 5 years. Group discussions could lead to improve the average empowerment of individuals (P=0.04. Furthermore, among all the aspects of empowerment, group discussions had the greatest impact on the perception and sensitivity levels (P=0.001 and P=0.02 respectively. Conclusion: In patients with hypertension, group discussions can lead to increased perception and sensitivity levels and also enhance the ability of individuals to control their lifestyles.

  1. Aspects of family caregiving as addressed in planned discussions between nurses, patients with chronic diseases and family caregivers: a qualitative content analysis.

    Science.gov (United States)

    Hagedoorn, E I; Paans, W; Jaarsma, T; Keers, J C; van der Schans, C; Luttik, M Louise

    2017-01-01

    Caregiving by family members of elderly with chronic conditions is currently intensifying in the context of an aging population and health care reform in the Netherlands. It is essential that nurses have attention for supporting roles of family caregivers of older patients and address family caregiving aspects on behalf of the continuity of care. This study aims to explore what aspects of family caregiving were addressed during planned discussions between nurses, patients and family caregivers in the hospital. Qualitative descriptive research was conducted using non-participant observation and audio-recordings of planned discussions between nurses, older patients and their family caregivers as they took place in the hospital. Through purposive sampling eligible patients (≥ 65 years) with one or more chronic conditions were included. These patients were admitted to the hospital for diagnostics or due to consequences of their chronic illness. Retrospective chart review was done to obtain patient characteristics. Data were collected in November/December 2013 and April/May 2014 in four hospitals. Qualitative content analysis was performed using the inductive approach in order to gain insight into addressed aspects of family caregiving. A total of 62 patients (mean age (SD) 76 years (7.2), 52% male) were included in the study, resulting in 146 planned discussions (62 admission and discharge discussions and 22 family meetings). Three themes were identified regarding addressed aspects of family caregiving. Two themes referred to aspects addressing the patients' social network, and included 'social network structure' and 'social network support'. One theme referred to aspects addressing coordination of care issues involving family caregiving, referred to as 'coordination of care'. During discussions nurses mostly addressed practical information on the patients' social network structure. When specific family caregiving support was addressed, information was limited and

  2. Why should I talk about emotion? Communication patterns associated with physician discussion of patient expressions of negative emotion in hospital admission encounters.

    Science.gov (United States)

    Adams, Kristen; Cimino, Jenica E W; Arnold, Robert M; Anderson, Wendy G

    2012-10-01

    To describe hospital-based physicians' responses to patients' verbal expressions of negative emotion and identify patterns of further communication associated with different responses. Qualitative analysis of physician-patient admission encounters audio-recorded between August 2008 and March 2009 at two hospitals within a university system. A codebook was iteratively developed to identify patients' verbal expressions of negative emotion. We categorized physicians' responses by their immediate effect on further discussion of emotion - focused away (away), focused neither toward nor away (neutral), and focused toward (toward) - and examined further communication patterns following each response type. In 79 patients' encounters with 27 physicians, the median expression of negative emotion was 1, range 0-14. Physician responses were 25% away, 43% neutral, and 32% toward. Neutral and toward responses elicited patient perspectives, concerns, social and spiritual issues, and goals for care. Toward responses demonstrated physicians' support, contributing to physician-patient alignment and agreement about treatment. Responding to expressions of negative emotion neutrally or with statements that focus toward emotion elicits clinically relevant information and is associated with positive physician-patient relationship and care outcomes. Providers should respond to expressions of negative emotion with statements that allow for or explicitly encourage further discussion of emotion. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. Barriers and Facilitators to Patient-Provider Communication When Discussing Breast Cancer Risk to Aid in the Development of Decision Support Tools.

    Science.gov (United States)

    Yi, Haeseung; Xiao, Tong; Thomas, Parijatham S; Aguirre, Alejandra N; Smalletz, Cindy; Dimond, Jill; Finkelstein, Joseph; Infante, Katherine; Trivedi, Meghna; David, Raven; Vargas, Jennifer; Crew, Katherine D; Kukafka, Rita

    2015-01-01

    The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%-94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention.

  4. Encouraging Classroom Discussion

    Directory of Open Access Journals (Sweden)

    Robert Joseph McKee

    2014-10-01

    Full Text Available Classroom discussion has the potential to enhance the learning environment and encourages students to become active participants in the educational process. Student participation in classroom discussion has been shown to significantly improve the student learning experience. Research suggests that classroom discussion is an effective method for encouraging student classroom participation and for motivating student learning beyond the classroom. Participation in classroom discussion encourages students to become active collaborators in the learning process, while at the same time providing instructors with a practical method of assessing student learning. Classroom discussion is an effective tool for developing higher-level cognitive skills like critical thinking. Despite the potential discussion holds for student learning, many in academia lament the lack of participation in the classroom. The lack of student participation in classroom discussion is not a recent problem; it is one that has frustrated instructors for decades. Instructors report that some of the more current methods for encouraging classroom discussion can be exasperating and at times non-productive. This two-year study of 510 college and university students provides insight into the reasons why some students do not participate in classroom discussion. This study, which also elicited input from sixteen college and university professors and two high school teachers, offers some suggestions for creating and encouraging an environment conducive to student participation in the classroom.

  5. Cooling in Surgical Patients: Two Case Reports

    Directory of Open Access Journals (Sweden)

    Bibi F. Gurreebun

    2014-01-01

    Full Text Available Moderate induced hypothermia has become standard of care for children with peripartum hypoxic ischaemic encephalopathy. However, children with congenital abnormalities and conditions requiring surgical intervention have been excluded from randomised controlled trials investigating this, in view of concerns regarding the potential side effects of cooling that can affect surgery. We report two cases of children, born with congenital conditions requiring surgery, who were successfully cooled and stabilised medically before undergoing surgery. Our first patient was diagnosed after birth with duodenal atresia after prolonged resuscitation, while the second had an antenatal diagnosis of left-sided congenital diaphragmatic hernia and suffered an episode of hypoxia at birth. They both met the criteria for cooling and after weighing the pros and cons, this was initiated. Both patients were medically stabilised and successfully underwent therapeutic hypothermia. Potential complications were investigated for and treated as required before they both underwent surgery successfully. We review the potential side effects of cooling, especially regarding coagulation defects. We conclude that newborns with conditions requiring surgery need not be excluded from therapeutic hypothermia if they might benefit from it.

  6. Understandings and discussions regarding the gender pay gap in Norway. Report by the gender pay gap and gender care gap project Report 2016:02

    OpenAIRE

    Orupabo, Julia; Kitterød, Ragni Hege

    2016-01-01

    This report presents results from six interviews with people that are responsible for/or negotiate in collective bargaining, and/or participate in the managing of human resources in their company. The questions applied to the interviewees’ own workplace as well as to the Norwegian labour market more generally and captured the interviewees’ viewpoints about women and men’s situation on the labour market, possible gender differences in employees’ competence, productivity, career ambitions and w...

  7. Measuring Patient-Reported Outcomes: Key Metrics in Reconstructive Surgery.

    Science.gov (United States)

    Voineskos, Sophocles H; Nelson, Jonas A; Klassen, Anne F; Pusic, Andrea L

    2018-01-29

    Satisfaction and improved quality of life are among the most important outcomes for patients undergoing plastic and reconstructive surgery for a variety of diseases and conditions. Patient-reported outcome measures (PROMs) are essential tools for evaluating the benefits of newly developed surgical techniques. Modern PROMs are being developed with new psychometric approaches, such as Rasch Measurement Theory, and their measurement properties (validity, reliability, responsiveness) are rigorously tested. These advances have resulted in the availability of PROMs that provide clinically meaningful data and effectively measure functional as well as psychosocial outcomes. This article guides the reader through the steps of creating a PROM and highlights the potential research and clinical uses of such instruments. Limitations of PROMs and anticipated future directions in this field are discussed.

  8. Pierre Bourdieu's Theory of Practice offers nurses a framework to uncover embodied knowledge of patients living with disabilities or illnesses: A discussion paper.

    Science.gov (United States)

    Oerther, Sarah; Oerther, Daniel B

    2018-04-01

    To discuss how Bourdieu's theory of practice can be used by nurse researchers to better uncover the embodied knowledge of patients living with disability and illness. Bourdieu's theory of practice has been used in social and healthcare researches. This theory emphasizes that an individual's everyday practices are not always explicit and mediated by language, but instead an individual's everyday practices are often are tacit and embodied. Discussion paper. Ovid MEDLINE, CINAHL and SCOPUS were searched for concepts from Bourdieu's theory that was used to understand embodied knowledge of patients living with disability and illness. The literature search included articles from 2003 - 2017. Nurse researchers should use Bourdieu's theory of practice to uncover the embodied knowledge of patients living with disability and illness, and nurse researchers should translate these discoveries into policy recommendations and improved evidence-based best practice. The practice of nursing should incorporate an understanding of embodied knowledge to support disabled and ill patients as these patients modify "everyday practices" in the light of their disabilities and illnesses. Bourdieu's theory enriches nursing because the theory allows for consideration of both the objective and the subjective through the conceptualization of capital, habitus and field. Uncovering individuals embodied knowledge is critical to implement best practices that assist patients as they adapt to bodily changes during disability and illness. © 2017 John Wiley & Sons Ltd.

  9. Intermediate report. Base for the Broad Public Discussion on Energy Policy in the Netherlands. Het tussenrapport. Basis voor de Brede Maatschappelijke Discussie

    Energy Technology Data Exchange (ETDEWEB)

    1983-01-01

    The Broad Public Djiscussion on Energy Policy (BMD) in the Netherlands is subdivided in an informative and a discussion stage. This intermediate report gives a summary of the first stage. In Ch. 2 the concept of energy and the utilized unities are discussed. Ch. 3 gives information about the actual energy consumption in the world and in the Netherlands and about the varying estimations for the future energy consumption. In Ch. 4 various possibilities for economization of energy in the Netherlands are discussed. Ch. 5 to 7 give the necessary information about the various energy sources. By source respectively the storages, applications, costs, effects on men and environment and public consequences are under discussion. Ch. 8 presents a comparative summary of the advantages and the drawbacks of various energy sources, the estimations for the future use and possibilities for energy economization. Also some attention is paid to the question on which grounds a choice from the policy possibilities may be based. Ch. 9 and 10 deal with the actual energy policy: how it is realized and what it holds. In Ch. 11 the results are discussed of four scenario-studies: how does the future energy consumption look like under different economical circumstances. What could be the effects of this on the environment at different applications of coal, natural gas, nuclear energy etc.. Furthermore the alternatives, which anounce themselves on the ground of the scenario studies, for the future energy policy are discussed. Finally the discussion questions are presented which following the coordination group will be the centre of interest in the second stage of the BMD. 427 refs.; figs.; tabs.

  10. Daily nursing feedback and discussion – a method to develop skills and augment quality and rehabilitative nursing for patients with spinal cord injury

    DEFF Research Database (Denmark)

    Steensgaard, Randi; Bonne, Stine

    2017-01-01

    Abstract Content: Background: Rehabilitation pathways for patients admitted with a spinal cord injury (SCI) are becoming increasingly complex, even as admission times are becoming shorter and more intensive. At the Spinal Cord Injury Centre of Western Denmark this means there is a growing need...... for sharing knowledge and experience to develop professional nursing skills in providing rehabilitative nursing care at the highest level, and in making a positive and valuable contribution to collaboration across professions. Aim: To improve knowledge, skills, and behaviour in rehabilitative nursing services...... to SCI patients through nursing feedback and discussion. Method: Four days each week, the nursing group meets for a 20-minute session of feedback and discussion on professional nursing issues, led by a session moderator. All nurses, whether new arrivals or experienced employees, have equal opportunity...

  11. Advance Care Planning Discussions with Adolescent and Young Adult Cancer Patients Admitted to a Community Palliative Care Service: A Retrospective Case-Note Audit.

    Science.gov (United States)

    Fletcher, Sophie; Hughes, Rachel; Pickstock, Sarah; Auret, Kirsten

    2018-02-01

    Adolescents and young adults (AYA) with cancer are a cohort requiring specialized healthcare models to address unique cognitive and physical challenges. Advance care planning (ACP) discussions likely warrant age-appropriate adaptation, yet, there is little Australian research data available to inform best practice for this group. The goal of this work is to inform future models of ACP discussions for AYA. Retrospective medical record audit of AYA patients and an adult comparison group, diagnosed with a malignancy and referred to a community hospice service, in Western Australia, in the period between January 1, 2012 and December 1, 2015. Information was collected regarding end-of-life care discussions, documentation of agreed plan of care, and care received. Twenty-seven AYA and 37 adult medical records were reviewed. Eighteen (66.7%) AYA patients died at home, compared with 19 (51.4%) adults (p = 0.028). Desire to pursue all available oncological therapies, including clinical trials, was documented for 14 (51.9%) AYA patients compared with 9 (24.3%) of the adult group (p = 0.02). Eleven AYA patients (40.7%) received chemotherapy during the last month of life compared with two (5.4%) adults (p = 0.001). The results indicate that end-of-life care preferences for this unique cohort may differ from those of the adult population and need to be captured and understood. An ACP document incorporating a discussion regarding goals of care, preferred location of care, preference for place of death, and consent to future intervention, including cardiopulmonary resuscitation and prompts for review, could assist in pursuing this objective.

  12. Patient reported outcomes in pediatric oncology practice: suggestions for future usage by parents and pediatric oncologists

    NARCIS (Netherlands)

    Schepers, S. A.; Engelen, V. E.; Haverman, L.; Caron, H. N.; Hoogerbrugge, P. M.; Kaspers, G. J. L.; Egeler, R. M.; Grootenhuis, M. A.

    2014-01-01

    Several studies in adults have shown patient reported outcomes (PROs) to be effective in enhancing patient-physician communication and discussion of Health Related Quality of Life outcomes. Although less studied, positive results have been demonstrated in children. A PRO-intervention needs to be

  13. Sugammadex in patients with chronic renal failure: two case reports

    Directory of Open Access Journals (Sweden)

    Gwi Eun Yeo

    2016-04-01

    Full Text Available Rocuronium is a non-depolarizing aminosteroidal neuromuscular blocking agent that is widely used in general anesthesia. Its effects may be prolonged in patients with renal disease, especially renal failure, due to reduced clearance of the drug. Sugammadex, a modified γ-cyclodextrin, is known to be a highly effective reversal agent for rocuronium-induced muscle relaxation. However, the administration of sugammadex for reversal of rocuronium-induced neuromuscular block in patients with renal disease is controversial. Recently, we administered rocuronium for neuromuscular blockade during the surgery of two patients with chronic renal failure, instead of cisatracurium, a benzylisoquinoline compound. Therefore, we had to administer sugammadex to ensure maximum alleviation of residual neuromuscular blockade risk after surgery. Although the effect of rocuronium was prolonged during surgery, sugammadex quickly and completely restored the response of train-of-four stimulation postoperatively. There were no residual neuromuscular block signs or symptoms observed in these patients throughout the postoperative period. In this report, we share our experience with these cases, and discuss the effectiveness and safety of sugammadex in the context of chronic renal failure.   Keywords: Neuromuscular blockade; Neuromuscular monitoring; Renal failure; Residual neuromuscular blockade; Rocuronium; Sugammadex

  14. Patient Experience Assessment is a Requisite for Quality Evaluation: A Discussion of the In-Center Hemodialysis Consumer Assessment of Health Care Providers and Systems (ICH CAHPS) Survey.

    Science.gov (United States)

    Cavanaugh, Kerri L

    2016-01-01

    Patient experience surveys provide a critical and unique perspective on the quality of patient-centered healthcare delivery. These surveys provide a mechanism to systematically express patients' voice on topics valued by patients to make decisions about choices in care. They also provide an assessment to healthcare organizations about their service that cannot be obtained from any other source. Regulatory agencies have mandated the assessment of patients' experience as part of healthcare value based purchasing programs and weighted the results to account for up to 30% of the total scoring. This is a testimony to the accepted importance of this metric as a fundamental assessment of quality. After more than a decade of rigorous research, there is a significant body of growing evidence supporting specifically the validity and use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, including a version specific to in-center hemodialysis (ICH CAHPS). This review will focus on the ICH CAHPS survey including a review of its development, content, administration, and also a discussion of common criticisms. Although it is suggested that the survey assesses activities and experiences that are not modifiable by the healthcare organization (or the dialysis facility in our case) emerging evidence suggests otherwise. Dialysis providers have an exclusive opportunity to lead the advancement of understanding the implications and serviceability of the evaluation of the patient experience in health care. © 2016 Wiley Periodicals, Inc.

  15. Focusing on SSI's risk and radiation protection criteria. A report based on discussions in focus groups in Oesthammar and Oskarshamn municipalities

    International Nuclear Information System (INIS)

    Drottz-Sjoeberg, Britt-Marie

    2003-11-01

    The project was a result of the authority's continued work on the 1998 regulations on protection of human health and the environment in final disposal of spent nuclear fuel and nuclear waste. The idea behind the project, to involve persons from the municipalities participating in SKB's site selection investigation in focus group discussions, was that the questions and points of views that emerged in the discussions could serve as a basis for the authority's work of producing general guidelines associated with the regulations. The finished report would then be handed over to an expert group at the authority which answered or commented on the issues raised, and made a report on this to the participating municipalities Oskarshamn and Oesthammar. The result of discussions in two focus groups in Oskarshamn municipality and two in Oesthammar municipality in October 2002 is presented here, together with a presentation of the project's purpose and organisation. The results are presented in three main sections. The first concentrates on radiation and radioactivity since the task in the discussion groups was to attempt to clarify the issues and problems observed in this area in order to contribute to the authority's work of developing the general guidelines. The second section, on understanding of concepts, measurement, risk and safety, illustrates that the frequently asked and 'simple' knowledge related questions are only the tip of the iceberg where many of the participants have also thought about the more complex contexts and the fundamental problems in the risk and safety analysis, its validity and use. The third section of the report focuses primarily on content and information aspects. It provides a number of ideas about how information on current problems and important issues can be improved, how knowledge can be deepened in the site selection municipalities and how working methods in the process can be developed. The report mainly consists of a presentation of the

  16. Focusing on SSI's risk and radiation protection criteria. A report based on discussions in focus groups in Oesthammar and Oskarshamn municipalities

    Energy Technology Data Exchange (ETDEWEB)

    Drottz-Sjoeberg, Britt-Marie [BMD Research (Sweden)

    2003-11-01

    The project was a result of the authority's continued work on the 1998 regulations on protection of human health and the environment in final disposal of spent nuclear fuel and nuclear waste. The idea behind the project, to involve persons from the municipalities participating in SKB's site selection investigation in focus group discussions, was that the questions and points of views that emerged in the discussions could serve as a basis for the authority's work of producing general guidelines associated with the regulations. The finished report would then be handed over to an expert group at the authority which answered or commented on the issues raised, and made a report on this to the participating municipalities Oskarshamn and Oesthammar. The result of discussions in two focus groups in Oskarshamn municipality and two in Oesthammar municipality in October 2002 is presented here, together with a presentation of the project's purpose and organisation. The results are presented in three main sections. The first concentrates on radiation and radioactivity since the task in the discussion groups was to attempt to clarify the issues and problems observed in this area in order to contribute to the authority's work of developing the general guidelines. The second section, on understanding of concepts, measurement, risk and safety, illustrates that the frequently asked and 'simple' knowledge related questions are only the tip of the iceberg where many of the participants have also thought about the more complex contexts and the fundamental problems in the risk and safety analysis, its validity and use. The third section of the report focuses primarily on content and information aspects. It provides a number of ideas about how information on current problems and important issues can be improved, how knowledge can be deepened in the site selection municipalities and how working methods in the process can be developed. The report mainly

  17. A combined periodontal - prosthetic treatment approach to manage unusual gingival visibility in resting lip position and inversely inclined upper anterior teeth: a case report with discussion.

    Science.gov (United States)

    Biniraj, K R; Janardhanan, Mahija; Sunil, M M; Sagir, Mohammed; Hariprasad, A; Paul, Tony P; Emmatty, Rishi

    2015-03-01

    Excessive gingival visibility during smile is a common esthetic complaint in dentistry, but excessive gingival visibility in resting lip position is relatively uncommon condition. Several exclusive radical to conservative surgical treatment or its combination with orthodontic therapy to treat this condition are within the reach of every patient nowadays. A case report of an excessive gingival visibility because of altered passive eruption along with inversely inclined maxillary anterior teeth is presented here. A relatively simple treatment approach combining periodontal and restorative therapy is used here to achieve the desirable aesthetic results. The gingival exposure resulting from altered passive eruption was completely managed by a gingivectomy, but the inclined appearance of teeth was still an aesthetic complaint. After complete healing of gingivectomy surgery, appropriately designed crowns were given to rectify the inversely inclined appearance. A complete rehabilitation of patient's smile could be achieved, the case was followed up for 3 years and the condition was found satisfactory.

  18. Summary of group discussions

    International Nuclear Information System (INIS)

    2009-01-01

    A key aspect of the workshop was the interaction and exchange of ideas and information among the 40 participants. To facilitate this activity the workshop participants were divided into five discussions groups. These groups reviewed selected subjects and reported back to the main body with summaries of their considerations. Over the 3 days the 5 discussion groups were requested to focus on the following subjects: the characteristics and capabilities of 'good' organisations; how to ensure sufficient resources; how to ensure competence within the organisation; how to demonstrate organisational suitability; the regulatory oversight processes - including their strengths and weaknesses. A list of the related questions that were provided to the discussion groups can be found in Appendix 3. Also included in Appendix 3 are copies of the slides the groups prepared that summarised their considerations

  19. Achondroplasia and Down syndrome in the same patient. Report of a case

    International Nuclear Information System (INIS)

    Sanchez, O; Guerra, D; Nastasi, J; Escalona, J

    1999-01-01

    Achondroplasia and trisomy 21 are, within their respective categories, conditions the most frequent genetic diseases found in newborns. The simultaneous presence of both conditions in the same patient, has been however, reported only once in the world literature. In this paper we present a patient affected by both entities (Achondroplasia and Trisomy 21). The clinical findings (using, among other, achondroplasia radiography), and the reasons for the rare reported frequency of these cases are discussed

  20. Patient-Reported Safety Information: A Renaissance of Pharmacovigilance?

    Science.gov (United States)

    Härmark, Linda; Raine, June; Leufkens, Hubert; Edwards, I Ralph; Moretti, Ugo; Sarinic, Viola Macolic; Kant, Agnes

    2016-10-01

    The role of patients as key contributors in pharmacovigilance was acknowledged in the new EU pharmacovigilance legislation. This contains several efforts to increase the involvement of the general public, including making patient adverse drug reaction (ADR) reporting systems mandatory. Three years have passed since the legislation was introduced and the key question is: does pharmacovigilance yet make optimal use of patient-reported safety information? Independent research has shown beyond doubt that patients make an important contribution to pharmacovigilance signal detection. Patient reports provide first-hand information about the suspected ADR and the circumstances under which it occurred, including medication errors, quality failures, and 'near misses'. Patient-reported safety information leads to a better understanding of the patient's experiences of the ADR. Patients are better at explaining the nature, personal significance and consequences of ADRs than healthcare professionals' reports on similar associations and they give more detailed information regarding quality of life including psychological effects and effects on everyday tasks. Current methods used in pharmacovigilance need to optimise use of the information reported from patients. To make the most of information from patients, the systems we use for collecting, coding and recording patient-reported information and the methodologies applied for signal detection and assessment need to be further developed, such as a patient-specific form, development of a severity grading and evolution of the database structure and the signal detection methods applied. It is time for a renaissance of pharmacovigilance.

  1. Organising a manuscript reporting quality improvement or patient safety research.

    Science.gov (United States)

    Holzmueller, Christine G; Pronovost, Peter J

    2013-09-01

    Peer-reviewed publication plays important roles in disseminating research findings, developing generalisable knowledge and garnering recognition for authors and institutions. Nonetheless, many bemoan the whole manuscript writing process, intimidated by the arbitrary and somewhat opaque conventions. This paper offers practical advice about organising and writing a manuscript reporting quality improvement or patient safety research for submission to a peer-reviewed journal. Each section of the paper discusses a specific manuscript component-from title, abstract and each section of the manuscript body, through to reference list and tables and figures-explaining key principles, offering content organisation tips and providing an example of how this section may read. The paper also offers a checklist of common mistakes to avoid in a manuscript.

  2. Assessing HIV and AIDS treatment safety and health-related quality of life among cohort of Malaysian patients: a discussion on methodological approach.

    Science.gov (United States)

    Syed, Imran Ahmed; Syed Sulaiman, Syed Azhar; Hassali, Mohammad Azmi; Lee, Christopher K C

    2015-10-01

    Health-related quality of life (HRQoL) is increasingly recognized as an important outcome and as a complement to traditional biological end points of diseases such as mortality. Unless there is a complete cure available for HIV/AIDS, development and implementation of a reliable and valid cross cultural quality of life measure is necessary to assess not only the physical and medical needs of HIV/AIDS people, but their psychological, social, environmental, and spiritual areas of life. A qualitative exploration of HIV/AIDS patients' understanding, perceptions and expectations will be carried out with the help of semi structured interview guide by in depth interviews, while quantitative assessment of patient reported adverse drug reactions and their impact on health related quality of life will be carried out by using data collection tool comprising patient demographics, SF-12, Naranjo scale, and a clinical data sheet. The findings may serve as baseline QOL data of people living with HIV/AIDS in Malaysia and also a source data to aid construction of management plan to improve HIV/AIDS patients' QOL. It will also provide basic information about HIV/AIDS patients' perceptions, expectations and believes towards HIV/AIDS and its treatment which may help in designing strategies to enhance patients' awareness which in turn can help in addressing issues related to compliance and adherence. © 2013 John Wiley & Sons Ltd.

  3. Periocular dermatitis: a report of 401 patients.

    Science.gov (United States)

    Temesvári, E; Pónyai, G; Németh, I; Hidvégi, B; Sas, A; Kárpáti, S

    2009-02-01

    Periocular contact dermatitis may appear as contact conjunctivitis, contact allergic and/or irritative eyelid and periorbital dermatitis, or a combination of these symptoms. The clinical symptoms may be induced by several environmental and therapeutic contact allergens. The aim of the present study was to map the eliciting contact allergens in 401 patients with periocular dermatitis (PD) by patch testing with environmental and ophthalmic contact allergens. Following the methodics of international requirements, 401 patients were tested with contact allergens of the standard environmental series, 133 of 401 patients with the Brial ophthalmic basic and supplementary series as well. Contact hypersensitivity was detected in 34.4% of the patients. Highest prevalence was seen in cases of PD without other symptoms (51.18%), in patients of PD associated with ophthalmic complaints (OC; 30.4%), and PD associated with atopic dermatitis (AD; 27.9%). In the subgroup of PD associated with seborrhoea (S) and rosacea (R), contact hypersensitivity was confirmed in 17.6%. Most frequent sensitisers were nickel sulphate (in 8.9% of the tested 401 patients), fragrance mix I (4.5%), balsam of Peru (4.0%), paraphenylendiamine (PPD) (3.7%), and thiomersal (3.5%). By testing ophthalmic allergens, contact hypersensitivity was observed in nine patients (6.7% of the tested 133 patients). The most common confirmed ophthalmic allergens were cocamidopropyl betaine, idoxuridine, phenylephrine hydrochloride, Na chromoglycinate, and papaine. Patients with symptoms of PD were tested from 1996 to 2006. The occurence of contact hypersensitivity in PD patients was in present study 34.4%. A relatively high occurrence was seen in cases of PD without other symptoms, in PD + OC and in PD + AD patients. The predominance of environmental contact allergens was remarkable: most frequent sensitizers were nickel sulphate, fragrance mix I, balsam of Peru, thiomersal, and PPD. The prevalence of contact

  4. Knowledge Representation in Patient Safety Reporting: An Ontological Approach

    OpenAIRE

    Liang Chen; Yang Gong

    2016-01-01

    Purpose: The current development of patient safety reporting systems is criticized for loss of information and low data quality due to the lack of a uniformed domain knowledge base and text processing functionality. To improve patient safety reporting, the present paper suggests an ontological representation of patient safety knowledge. Design/methodology/approach: We propose a framework for constructing an ontological knowledge base of patient safety. The present paper describes our desig...

  5. 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.

  6. A case series discussing the anaesthetic management of pregnant patients with brain tumours [v1; ref status: indexed, http://f1000r.es/y7

    Directory of Open Access Journals (Sweden)

    Alaa A Abd-Elsayed

    2013-03-01

    Full Text Available Pregnancy may aggravate the natural history of an intracranial tumour, and may even unmask a previously unknown diagnosis. Here we present a series of seven patients who had brain tumours during pregnancy. The aim of this case series is to characterize the current perioperative management and to suggest evidence based guidelines for the anaesthetic management of pregnant females with brain tumours. This is a retrospective study. Information on pregnant patients diagnosed with brain tumours that underwent caesarean section (CS and/or brain tumour resection from May 2003 through June 2008 was obtained from the Department of General Anaesthesia and the Rose Ella Burkhardt Brain Tumour & Neuro-Oncology Centre (BBTC at the Cleveland Clinic, OH, USA. The mean age was 34.5 years (range 29-40 years old. Six patients had glioma, two of whom had concomitant craniotomy and CS. Six cases had the tumour in the frontal lobe. Four cases were operated on under general anaesthesia and three underwent awake craniotomy. The neonatal outcomes of the six patients with elective or emergent delivery were six viable infants with normal Apgar scores. Pregnancy was terminated in the 7th patient. In conclusion, management of brain tumours in pregnant women is mainly reliant on case reports and the doctor’s personal experience. Therefore, close communication between the neurosurgeon, neuroanaesthetist, obstetrician and the patient is crucial. General anaesthesia, propofol, dexmedetomidine and remifentanil were used in our study and were safe. Although this may not agree with previous studies, desflurane and isoflurane were used in our patients with no detectable complications.

  7. Patient-reported quality indicators for osteoarthritis: a patient and public generated self-report measure for primary care.

    Science.gov (United States)

    Blackburn, Steven; Higginbottom, Adele; Taylor, Robert; Bird, Jo; Østerås, Nina; Hagen, Kåre Birger; Edwards, John J; Jordan, Kelvin P; Jinks, Clare; Dziedzic, Krysia

    2016-01-01

    ) worked with researchers to co-produce a set of self-report, patient-generated QIs for OA. The QIs were intended for use in the MOSAICS study, which developed and evaluated a new model of supported self-management of OA to implement the NICE guidelines. We report on 1) the co-development of the OA QI (UK) questionnaire for primary care; and 2) the comparison of the content of the OA QI (UK) questionnaire with a parallel questionnaire developed in Norway for the Musculoskeletal Pain in Ullensaker (MUST) study. Methods Researchers were invited to OA RUG meetings. Firstly, RUG members were asked to consider factors important to patients consulting their general practitioner (GP) for OA and then each person rated their five most important. RUG members then discussed these in relation to a systematic review of OA QIs in order to form a list of OA QIs from a patient perspective. RUG members suggested wording and response options for a draft OA QI (UK) questionnaire to assess the QIs. Finally RUG members commented on draft and final versions of the questionnaire and how it compared with a translated Norwegian OA-QI questionnaire. Results RUG members (5 males, 5 females; aged 52-80 years) attended up to four meetings. RUG members ranked 20 factors considered most important to patients consulting their GP for joint pain. Following discussion, a list of eleven patient-reported QIs for OA consultations were formed. RUG members then suggested the wording and response options of 16 draft items - four QIs were split into two or more questionnaire items to avoid multiple dimensions of care quality within a single item. On comparison of this to the Norwegian OA-QI questionnaire, RUG members commented that both questionnaires contained seven similar QIs. The RUG members and researchers agreed to adopt the Norwegian OA-QI wording for four of these items. RUG members also recommended adopting an additional seven items from the Norwegian OA-QI with some minor word changes to improve their

  8. Evaluation of radiotherapists' reports for treatment of prosthodontic patients after irradiation

    International Nuclear Information System (INIS)

    Matalon, V.

    1977-01-01

    A simplified explanation of gaining insight into the radiotherapist's report in order to deal with a patient who has received radiation treatment has been discussed. The best method for increasing understanding of this report is to work in conjunction with the radiotherapist before and after the patient is given radium. Five factors are important in the treatment of the irradiated patient. These are: (1) initially recognizing the radiation patient, (2) understanding the radiotherapist's report, (3) following good prosthodontic principles, (4) integrating treatment with the radiotherapist's report to prevent future problems, and (5) maintaining extremely close follow-up to detect any sore spots that could lead to major complications such as bone or soft-tissue necrosis. A poor candidate for dentures is normally a difficult candidate following radiation. Not all patients are capable of tolerating a prosthesis following radiation therapy. However, for many, function and esthetics can be restored

  9. [The heart failure patient: a case report].

    Science.gov (United States)

    Alconero-Camarero, Ana Rosa; Arozamena-Pérez, Jorge; García-Garrido, Lluïsa

    2014-01-01

    Given its prevalence, high mortality rate, morbidity, chronicity and use of resources, heart failure (HF) is a priority issue from a social and health standpoint, due to the ageing population and to lack of adherence to and the complexity of treatment. For these reasons, an individualized care plan needs to be established to meet the real and potential needs of the patient diagnosed with HF. A clinical case is presented of a patient admitted to the Cardiology Critical Care (CCC) unit of a tertiary hospital. A patient care plan was prepared following the steps of the scientific method and relying on the NANDA taxonomy, and the NOC and NIC to design goals and nursing interventions, respectively. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  10. A Combined Periodontal – Prosthetic Treatment Approach to Manage Unusual Gingival Visibility in Resting Lip Position and Inversely Inclined Upper Anterior Teeth: A Case Report with Discussion

    Science.gov (United States)

    Biniraj, K R; Janardhanan, Mahija; Sunil, M M; Sagir, Mohammed; Hariprasad, A; Paul, Tony P; Emmatty, Rishi

    2015-01-01

    Excessive gingival visibility during smile is a common esthetic complaint in dentistry, but excessive gingival visibility in resting lip position is relatively uncommon condition. Several exclusive radical to conservative surgical treatment or its combination with orthodontic therapy to treat this condition are within the reach of every patient nowadays. A case report of an excessive gingival visibility because of altered passive eruption along with inversely inclined maxillary anterior teeth is presented here. A relatively simple treatment approach combining periodontal and restorative therapy is used here to achieve the desirable aesthetic results. The gingival exposure resulting from altered passive eruption was completely managed by a gingivectomy, but the inclined appearance of teeth was still an aesthetic complaint. After complete healing of gingivectomy surgery, appropriately designed crowns were given to rectify the inversely inclined appearance. A complete rehabilitation of patient’s smile could be achieved, the case was followed up for 3 years and the condition was found satisfactory. PMID:25878482

  11. Cogan's Syndrome in a Jordanian patient: A case report | Al ...

    African Journals Online (AJOL)

    We reported a Jordanian case of Cogan's Syndrome (CS). A 22-year old male patient presented with interstitial keratitis. The patient was treated successfully with topical steroids but over the following months, he developed vertigo, sensorineural hearing loss (SNHL) and generalized vasculitis. This is the first reported case ...

  12. Remifentanil in a patient with Huntington's chorea - case report ...

    African Journals Online (AJOL)

    Relatively few published case reports related to the anaesthetic management of Huntington's chorea (HC) exist. At the time of surgery no publications were found related to remifentanil's use in patients with HC. This case report describes the management of a confirmed HC patient requiring urgent decompression of a spinal ...

  13. Case report of a patient with peripheral facial nerve palsy

    OpenAIRE

    Rysová, Jana

    2013-01-01

    Title of bachelor's thesis: Case report of a patient with peripheral facial nerve palsy Summary: Teoretical part of bachelor's thesis contains theoretical foundation of peripheral facial nerve palsy. Practical part of bachelor's thesis contains physiotherapeutic case report of patient with peripheral facial nerve palsy. Key words: peripheral facial nerve palsy, casuistry, rehabilitation

  14. Eosinophilia in a patient with cyclical vomiting: a case report

    Directory of Open Access Journals (Sweden)

    Fitzgerald S Matthew

    2004-05-01

    Full Text Available Abstract Background Eosinophilic gastritis is related to eosinophilic gastroenteritis, varying only in regards to the extent of disease and small bowel involvement. Common symptoms reported are similar to our patient's including: abdominal pain, epigastric pain, anorexia, bloating, weight loss, diarrhea, ankle edema, dysphagia, melaena and postprandial nausea and vomiting. Microscopic features of eosinophilic infiltration usually occur in the lamina propria or submucosa with perivascular aggregates. The disease is likely mediated by eosinophils activated by various cytokines and chemokines. Therapy centers around the use of immunosuppressive agents and dietary therapy if food allergy is a factor. Case presentation The patient is a 31 year old Caucasian female with a past medical history significant for ulcerative colitis. She presented with recurrent bouts of vomiting, abdominal pain and chest discomfort of 11 months duration. The bouts of vomiting had been reoccurring every 7–10 days, with each episode lasting for 1–3 days. This was associated with extreme weakness and cachexia. Gastric biopsies revealed intense eosinophilic infiltration. The patient responded to glucocorticoids and azathioprine. The differential diagnosis and molecular pathogenesis of eosinophilic gastritis as well as the molecular effects of glucocorticoids in eosinophilic disorders are discussed. Conclusions The patient responded to a combination of glucocorticosteroids and azathioprine with decreased eosinophilia and symptoms. It is likely that eosinophil-active cytokines such as interleukin-3 (IL-3, granulocyte macrophage colony stimulating factor (GM-CSF and IL-5 play pivotal roles in this disease. Chemokines such as eotaxin may be involved in eosinophil recruitment. These mediators are downregulated or inhibited by the use of immunosuppressive medications.

  15. Using Patient-Reported Information to Improve Clinical Practice.

    Science.gov (United States)

    Schlesinger, Mark; Grob, Rachel; Shaller, Dale

    2015-12-01

    To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries. We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians. First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the

  16. Patient reported outcomes in hip arthroplasty registries.

    Science.gov (United States)

    Paulsen, Aksel

    2014-05-01

    PROs are used increasingly in orthopedics and in joint registries, but still many aspects of use in this area have not been examined in depth. To be able to introduce PROs in the DHR in a scientific fashion, my studies were warranted; the feasibility of four often used PROs (OHS, HOOS, EQ-5D and SF-12) was examined in a registry context. Having the PROs in the target language is an absolute necessity, so I translated, cross-culturally adapted and validated a Danish language version of an often used PRO (OHS), since this PRO had no properly developed Danish language version. To minimize data loss and to maximize the data quality I validated our data capture procedure, an up to date AFP system, by comparing scannable, paper-based PROs, with manual single-key- and double-key entered data. To help further registry-PRO studies, I calculated the number of patients needed to discriminate between subgroups of age, sex, diagnosis, and prosthesis type for each of four often used PROs (OHS, HOOS, EQ-5D and SF-12), and to simplify the clinical interpretation of PRO scores and PRO change scores in PRO studies, I estimated MCII and PASS for two often used PROs (EQ-5D and HOOS). The feasibility study included 5,747 THA patients registered in the DHR, and I found only minor differences between the disease-specific and the generic PROs regarding ceiling and floor effects as well as discarded items. The HOOS, the OHS, the SF-12, and the EQ-5D are all appropriate PROs for administration in a hip registry. I found that group sizes from 51 to 1,566 were needed for subgroup analysis, depending on descriptive factors and choice of PRO. The AFP study included 200 THA patients (398 PROs, 4,875 items and 21,887 data fields), and gave excellent results provided use of highly structured questionnaires. OMR performed equally as well as manual double-key entering, and better than single-key entering. The PRO translation and validation study included 2,278 patients (and 212 patients for the test

  17. Public reporting, consumerism, and patient empowerment.

    Science.gov (United States)

    Huckman, Robert S; Kelley, Mark A

    2013-11-14

    Public reporting of health care outcomes is largely ignored by consumers, perhaps because it doesn't include concise, comprehensible information on factors such as out-of-pocket costs, the effectiveness of a procedure or treatment, and applicability to their situation.

  18. PATIENT - 2 year report (2013 - 2014) public version

    NARCIS (Netherlands)

    Drachsler, Hendrik; Henn, Patrick; Hynes, Helen; Stieger, Lina; Schroeder, Hanna; Sopka, Sasa; Hartkopf, Kathleen; Orrego, Carola

    2014-01-01

    This report extends the first project report with a summary of the latest activities of the second year of the PATIENT project. The first report provided an overview about empirical studies of the stakeholder needs, as conducted in WP2, and the target learning outcomes of the handover study

  19. Submandibular sialolithiasis in pediatric patient. Case report

    Directory of Open Access Journals (Sweden)

    Cindy Campos-Villanueva

    2014-10-01

    Full Text Available Sialolithiasis is an obstructive pathology of the salivary gland character- ized by the formation of stones in the ductal system or parenchyma. Its incidence is greater in the submandibular gland in 85%, 10% to the parotid gland and 5% to the gland sublingual. Its etiology is attributed to the deposition of inorganic material around an organic nest with salivary mucin, desquamated epithelial cells and bacteria as well as to the anatomical distribution of the gland with respect to its excretor conduct. The sialolit is formed by calcium phosphate compound, small amounts of carbonates in the hydroxyapatite form, magnesium, potas- sium and ammonia. On patients with sialolithiasis symptoms hydration is essential, moist has is to be applied and massaged into the affected gland, while sialogogues intake and salivary production promoting stone passage through the conduit. Sometimes the obstruction of the saliva output may be signs and symptoms of an infectious process. Almost half of the submandibular sialoliths are located in the middle third or distal duct and are susceptible to elimination under conservative treatment or lithectomy. Sialolithiasis is an unusual condition in the pediatric patient. This article includes a review of the literature presenting the etiology, diagnosis aids and conservative or surgical treatments.

  20. The complexity of patient safety reporting systems in UK dentistry.

    Science.gov (United States)

    Renton, T; Master, S

    2016-10-21

    Since the 'Francis Report', UK regulation focusing on patient safety has significantly changed. Healthcare workers are increasingly involved in NHS England patient safety initiatives aimed at improving reporting and learning from patient safety incidents (PSIs). Unfortunately, dentistry remains 'isolated' from these main events and continues to have a poor record for reporting and learning from PSIs and other events, thus limiting improvement of patient safety in dentistry. The reasons for this situation are complex.This paper provides a review of the complexities of the existing systems and procedures in relation to patient safety in dentistry. It highlights the conflicting advice which is available and which further complicates an overly burdensome process. Recommendations are made to address these problems with systems and procedures supporting patient safety development in dentistry.

  1. 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...

  2. Self-reported stressors among patients with Exhaustion Disorder: an exploratory study of patient records

    Science.gov (United States)

    2014-01-01

    Background Several researchers imply that both work-related and non-work-related stress exposure are likely to contribute to stress-related mental illness. Yet empirical studies investigating both domains seem to be limited, particularly in a clinical population. The purpose of this study was to a) explore which stressors (non-work and work-related) are reported as important for the onset of illness by patients seeking medical care for stress-related exhaustion and b) explore the prevalence of each stressor and examine whether the pattern differs between men and women. Methods This is an exploratory mixed method study, comprising patients at a specialist outpatient stress clinic. Information from medical records of 20 patients was initially used in a first qualitative step to construct the instrument, using a combination of a conventional content analysis and a directed content analysis. In the second phase patient records from 50 men and 50 women were selected and coded in accordance with the coding instrument. Frequency statistics were calculated for all stressors. Results A total of 24 categories of stressors (11 related to work and 13 related to private life) were identified in the first qualitative step. A median of four stressors, usually both work and non-work-related was reported by the patients. The most common stressors were 1) quantitative demands at work, 2) private relational conflicts and 3) emotional demands at work. Conclusions Work demands are, by far, the most prevalent stressor, followed by relational problems in private life. The pattern was similar for women and men, with a slight difference in the distribution between work and non-work stressors. Men and women also show similar patterns when comparing the occurrence of each stressor. Slight differences were seen, in particular with regard to managerial responsibility that was reported by 6% of the women compared to 36% of the men. One important practical implication of this study is that

  3. Reporte de Caso Clínico y discusión de tema: Síndrome del opérculo Torácico / Report and discussion of a study case: Thoracic Outlet Syndrome / Descrição do caso clínico e discussão do tema: síndrome do desfiladeiro torácico

    Directory of Open Access Journals (Sweden)

    Celso Miguel Lemus Torres MD., Esp

    2015-11-01

    realizó un abordaje supraclavicular para resección de costilla cervical accesoria, escalenotomia, descompresión del plexo braquial y Arteria subclavia. Posterior, la paciente presentó mejoría notoria y remisión de los síntomas. [Lemus CM, Cadena JE, Valle AP, Mateus JC, Lemus JE. Reporte de Caso Clínico y discusión de tema: Síndrome del opérculo Torácico. MedUNAB 2015; 18(2:135-143] Introduction: Thoracic Outlet Syndrome - TOS - is a heterogeneous and potentially dysfunctional group of syndromes related to extrinsic compression of neurovascular structures from the neck to the upper limb for different congenital or acquired anatomical structures, being more frequent the neurological compression, causing a variety of symptoms that vary according to the degree of compression and affected structure that in some cases make it difficult to diagnose. Due to the lack of established diagnostic criteria, the physical exam is the most important element used to formulate a diagnosis. The initial treatment is conservative. The surgical treatment becomes an option with multiple personalized procedures for each type of patient according to the etiology. Objective: The purpose of the article is to discuss the clinical case based on the evidence allowing general knowledge of that pathology, and understanding the causes of pain in the upper limb, to therefore guide medical staff to perform a timely diagnosis and effective treatment that decreases the risk of irreversible complications. Results and conclusions: A study case of a young adult patient presenting neurovascular symptoms due to syncope, left anterior thoracic pain, localized pain in the upper limbs, sensation of lumps in the neck, paresthesia, decrease in muscular strength, edema, pallor and coldness of the limb was presented. A radiological diagnostic test in the accessory cervical rib was performed and later confirmed with a nuclear resonance. Thoracic Outlet Syndrome in the left side was diagnosed resulting in

  4. Patient empowerment: The need to consider it as a measurable patient-reported outcome for chronic conditions

    Science.gov (United States)

    2012-01-01

    Background Health policy in the UK and elsewhere is prioritising patient empowerment and patient evaluations of healthcare. Patient reported outcome measures now take centre-stage in implementing strategies to increase patient empowerment. This article argues for consideration of patient empowerment itself as a directly measurable patient reported outcome for chronic conditions, highlights some issues in adopting this approach, and outlines a research agenda to enable healthcare evaluation on the basis of patient empowerment. Discussion Patient empowerment is not a well-defined construct. A range of condition-specific and generic patient empowerment questionnaires have been developed; each captures a different construct e.g. personal control, self-efficacy/self-mastery, and each is informed by a different implicit or explicit theoretical framework. This makes it currently problematic to conduct comparative evaluations of healthcare services on the basis of patient empowerment. A case study (clinical genetics) is used to (1) illustrate that patient empowerment can be a valued healthcare outcome, even if patients do not obtain health status benefits, (2) provide a rationale for conducting work necessary to tighten up the patient empowerment construct (3) provide an exemplar to inform design of interventions to increase patient empowerment in chronic disease. Such initiatives could be evaluated on the basis of measurable changes in patient empowerment, if the construct were properly operationalised as a patient reported outcome measure. To facilitate this, research is needed to develop an appropriate and widely applicable generic theoretical framework of patient empowerment to inform (re)development of a generic measure. This research should include developing consensus between patients, clinicians and policymakers about the content and boundaries of the construct before operationalisation. This article also considers a number of issues for society and for healthcare

  5. Clinical Evaluation of Percutaneous Vertebroplasty in a Patient with Paraplegia and Immobilization Syndrome: A Case Report

    OpenAIRE

    Masala, Salvatore; Calabria, Eros; Nezzo, Marco; De Vivo, Dominique; Neroni, Luca; Simonetti, Giovanni

    2013-01-01

    We will discuss a potential role of percutaneous vertebroplasty (PVP) in the management of a patient with immobilization syndrome due to paraplegia and vertebral osteoporotic fractures. While PVP is commonly used for the treatment of osteoporotic thoracolumbar vertebral compression fractures, its role in vertebral stabilization in patient with immobilization syndrome has not been reported in the literature. A 73-year-old woman affected by immobilization syndrome due to paraplegia and vertebra...

  6. Caregiver reports of patient-initiated violence in psychosis.

    Science.gov (United States)

    Onwumere, Juliana; Grice, Sarah; Garety, Philippa; Bebbington, Paul; Dunn, Graham; Freeman, Daniel; Fowler, David; Kuipers, Elizabeth

    2014-07-01

    Aggressive behaviour in psychosis is not uncommon. Community provision for people with psychosis has left informal caregivers to take on a greater role in their care. However, few studies have explored links between patient-initiated violence in mental health caregiving relationships and caregiver functioning. Our study investigated caregiver reports of aggressive acts committed by their relative with psychosis and their links to caregiver appraisals of the caregiving relationship and caregiver outcomes. Caregivers of patients with a recent relapse of psychosis, recruited to a psychological therapy trial, completed the audiotaped Camberwell Family Interview at baseline. This semi-structured interview includes questions on the quality of the relationship between caregiver and patient, and patient history of violence. Seventy-two transcripts of interviews were assessed for reports of patient-initiated violence. One-half of the caregiver sample (52.9%) reported an incident of patient-initiated violence during their interview; 62.2% of these involved violence toward themselves, and 24.3% toward property. Reports of patient violence were associated with caregiver ratings of hostility expressed toward patients, lower self-esteem, and emotion-focused coping. People caring on their own were more likely to report incidents of patient violence. Younger patients, males, and inpatients were more frequently identified as having a history of this kind of violence. Our findings suggested that caregiver reports of patient-initiated violence in psychosis are not uncommon. Mental health staff need to be aware of the risks of such violence for caregivers of people with psychosis, and consider appropriate procedures for minimizing it.

  7. capital. A discussion paper

    Directory of Open Access Journals (Sweden)

    Ewa Chojnacka

    2015-04-01

    Full Text Available The purpose of this study is to confront certain propositions presented in Lesław Niemczyk’s publication Rachunkowość finansowa aktywów kompetencyjnych i kapitału intelektualnego. Nowy dział rachunkowości(Accounting for Competence Assets and Intellectual Capital. A New Area in Accounting with ideas published in other studies. The authors discuss issues concerning firm value, selected definitions of intellectual capital, as well as certain methods of intellectual capital measurement and valuation. Other problems analysed include accounting for and reporting of intellectual capital and similarities and differences between the way those issues are presented in Polish and in international studies as well as in existing legal regulations and standards.

  8. Panel discussion: Nuclear cardiology

    International Nuclear Information System (INIS)

    Schwaiger, M.

    1991-01-01

    The panel discussion opened with a question concerning whether true quantification of myocardial sympathetic presynaptic function or receptor density can be obtained with currently available radiopharmaceuticals. What are the relative advantages of the two general approaches that have been proposed for quantification: (1) The assessment of tracer distribution volume in tissue following bolus injection and (2) quantification based on tracer displacement kinetics following administration of excess unlabeled tracer. It was pointed out that tracer kinetics for the delineation of presynaptic and postsynaptic binding sites by radiopharmaceuticals or radiolabeled receptor antagonists are rather complex, reflecting several physiologic processes that are difficult to separate. Several approaches were examined. The possibility of regional definition of receptor density by PET was questioned and it was noted that regions of interest can be applied to calculate regional receptor kinetics. However, due to the limited spatial resolution of PET, only average transmural values can be determined. The discussion then turned to the discrepancy between the known sparse parasympathetic innervation of the heart and the high density of muscarinic receptors observed with PET. Experiences with MIBG imaging were reported, including uptake in the transplanted heart and interaction of drugs with MIBG uptake

  9. Discussing prognosis and end-of-life care in the final year of life: a randomised controlled trial of a nurse-led communication support programme for patients and caregivers.

    Science.gov (United States)

    Walczak, Adam; Butow, Phyllis N; Clayton, Josephine M; Tattersall, Martin H N; Davidson, Patricia M; Young, Jane; Epstein, Ronald M

    2014-06-26

    Timely communication about life expectancy and end-of-life care is crucial for ensuring good patient quality-of-life at the end of life and a good quality of death. This article describes the protocol for a multisite randomised controlled trial of a nurse-led communication support programme to facilitate patients' and caregivers' efforts to communicate about these issues with their healthcare team. This NHMRC-sponsored trial is being conducted at medical oncology clinics located at/affiliated with major teaching hospitals in Sydney, Australia. Patients with advanced, incurable cancer and life expectancy of less than 12 months will participate together with their primary informal caregiver where possible. Guided by the self-determination theory of health-behaviour change, the communication support programme pairs a purpose-designed Question Prompt List (QPL-an evidence-based list of questions patients/caregivers can ask clinicians) with nurse-led exploration of QPL content, communication challenges, patient values and concerns and the value of early discussion of end-of-life issues. Oncologists are also cued to endorse patient and caregiver question asking and use of the QPL. Behavioural and self-report data will be collected from patients/caregivers approximately quarterly for up to 2.5 years or until patient death, after which patient medical records will be examined. Analyses will examine the impact of the intervention on patients' and caregivers' participation in medical consultations, their self-efficacy in medical encounters, quality-of-life, end-of-life care receipt and quality-of-death indicators. Approvals have been granted by the human ethics review committee of Royal Prince Alfred Hospital and governance officers at each participating site. Results will be reported in peer-reviewed publications and conference presentations. Australian New Zealand Clinical Trials Registry ACTRN12610000724077. Published by the BMJ Publishing Group Limited. For

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

    International Nuclear Information System (INIS)

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

    2004-01-01

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

  11. 2009 VHA Facility Quality and Safety Report - Patient Satisfaction

    Data.gov (United States)

    Department of Veterans Affairs — The 2008 Hospital Report Card was mandated by the FY08 Appropriations Act, and focused on Congressionally-mandated metrics applicable to general patient populations....

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-02-01

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

  13. Emphysematous liver abscess in diabetic patient: two cases report

    International Nuclear Information System (INIS)

    Rhim, Hyun Chul; Koo, Ja Hong; Kim, Sung Tae; Kim, Yong Soo; Koh, Byung Hee; Cho, On Koo

    1995-01-01

    There has not been any report on massive air-containing liver abscess in diabetic patients, although emphysematous cholecystitis or pyelonephritis is a well-known complication in them. Authors report two cases of emphysematous liver abscess in diabetic patient, which showed typical findings of massive air-containing hepatic abscess on ultrasonography and computed tomography, but very poor prognosis in spite of immediate and successful percutaneous drainage procedure

  14. Knowledge Representation in Patient Safety Reporting: An Ontological Approach

    Directory of Open Access Journals (Sweden)

    Liang Chen

    2016-10-01

    Full Text Available Purpose: The current development of patient safety reporting systems is criticized for loss of information and low data quality due to the lack of a uniformed domain knowledge base and text processing functionality. To improve patient safety reporting, the present paper suggests an ontological representation of patient safety knowledge. Design/methodology/approach: We propose a framework for constructing an ontological knowledge base of patient safety. The present paper describes our design, implementation, and evaluation of the ontology at its initial stage. Findings: We describe the design and initial outcomes of the ontology implementation. The evaluation results demonstrate the clinical validity of the ontology by a self-developed survey measurement. Research limitations: The proposed ontology was developed and evaluated using a small number of information sources. Presently, US data are used, but they are not essential for the ultimate structure of the ontology. Practical implications: The goal of improving patient safety can be aided through investigating patient safety reports and providing actionable knowledge to clinical practitioners. As such, constructing a domain specific ontology for patient safety reports serves as a cornerstone in information collection and text mining methods. Originality/value: The use of ontologies provides abstracted representation of semantic information and enables a wealth of applications in a reporting system. Therefore, constructing such a knowledge base is recognized as a high priority in health care.

  15. Patient-Reported Safety Information : A Renaissance of Pharmacovigilance?

    NARCIS (Netherlands)

    Härmark, Linda; Raine, June; Leufkens, Bert|info:eu-repo/dai/nl/075255049; Edwards, I Ralph; Moretti, Ugo; Sarinic, Viola Macolic; Kant, Agnes

    2016-01-01

    The role of patients as key contributors in pharmacovigilance was acknowledged in the new EU pharmacovigilance legislation. This contains several efforts to increase the involvement of the general public, including making patient adverse drug reaction (ADR) reporting systems mandatory. Three years

  16. Patient experiences with oily skin: The qualitative development of content for two new patient reported outcome questionnaires

    OpenAIRE

    Arbuckle, Robert; Atkinson, Mark J; Clark, Marci; Abetz, Linda; Lohs, Jan; Kuhagen, Ilka; Harness, Jane; Draelos, Zoe; Thiboutot, Diane; Blume-Peytavi, Ulrike; Copley-Merriman, Kati

    2008-01-01

    Abstract Objective To develop the content for two new patient reported outcome (PRO) measures to: a) assess the severity of symptoms; and b) the impact of facial skin oiliness on emotional wellbeing using qualitative data from face to face, and internet focus groups in Germany and the US. Methods Using input from initial treatment satisfaction focus groups (n = 42), a review of relevant literature and expert clinicians (n = 3), a discussion guide was developed to guide qualitative inquiry usi...

  17. Post-partum pituitary insufficiency and livedo reticularis presenting a diagnostic challenge in a resource limited setting in Tanzania: a case report, clinical discussion and brief review of existing literature

    Directory of Open Access Journals (Sweden)

    Sheriff Faheem G

    2012-07-01

    Full Text Available Abstract Background Pituitary disorders following pregnancy are an important yet under reported clinical entity in the developing world. Conversely, post partum panhypopituitarism has a more devastating impact on women in such settings due to high fertility rates, poor obstetric care and scarcity of diagnostic and therapeutic resources available. Case presentation A 37 year old African female presented ten years post partum with features of multiple endocrine deficiencies including hypothyroidism, hypoadrenalism, lactation failure and secondary amenorrhea. In addition she had clinical features of an underlying autoimmune condition. These included a history of post-partum thyroiditis, alopecia areata, livedo reticularis and deranged coagulation indices. A remarkable clinical response followed appropriate hormone replacement therapy including steroids. This constellation has never been reported before; we therefore present an interesting clinical discussion including a brief review of existing literature. Conclusion Post partum pituitary insufficiency is an under-reported condition of immense clinical importance especially in the developing world. A high clinical index of suspicion is vital to ensure an early and correct diagnosis which will have a direct bearing on management and patient outcome.

  18. Emotional discussions reduce memory recall.

    Science.gov (United States)

    Soleti, Emanuela; Wright, Daniel B; Curci, Antonietta

    2017-05-01

    People often discuss events they have seen and these discussions can influence later recollections. We investigated the effects of factual, emotional, and free retelling discussion on memory recollections of individuals who have witnessed an event. Participants were shown a video, made an initial individual recall, participated in one of the three retelling conditions (emotional versus factual versus free) or a control condition, and then recalled the event individually again. Participants in the factual and free retelling conditions reported more items not previously recalled than participants in the control condition did, while the emotional condition did not show the same advantage. Participants in all three retelling conditions failed to report more previously recalled items as compared with the control condition. Finally, a memory conformity effect was observed for all three retelling conditions. These findings suggest that eyewitnesses' discussions may influence the accuracy of subsequent memory reports, especially when these discussions are focused on emotional details and thoughts.

  19. A report of 2 patients with transient blindness following Le Fort I osteotomy and a review of past reported cases

    Directory of Open Access Journals (Sweden)

    Philip Mathew

    2015-01-01

    Full Text Available Blindness following a LeFort I osteotomy is a rare but extremely serious complication. Ten cases have been reported to date. None of these patients recovered vision. Optic neuropathy is believed to be the cause but the exact mechanism has not been settled. We report the first, and the only two, documented cases of complete loss of vision that recovered subsequently. The first patient was a 19-year-old male with repaired bilateral cleft lip and palate. He developed loss of vision in the right eye on the second postoperative day. The second patient was a 22-year-old male with repaired unilateral cleft lip and palate. He developed complete loss of vision in the left eye on the day of surgery. Both these patients underwent ongoing studies, which did not show any abnormalities. Both were treated with methylprednisolone. Both the patients gradually showed improvement in their vision. The first patient recovered normal vision several months postoperatively. The second patient′s vision improved to 4/60 by 4 months postoperatively. We discuss the probable mechanisms of optic nerve injury and also the possible reasons why sight was restored in these patients. This is a rare but serious complication following a fairly common procedure. Through this article we wish to create an awareness of this complication and also a possible way of avoiding such a disaster.

  20. Patient reported outcomes: looking beyond the label claim

    Directory of Open Access Journals (Sweden)

    Doward Lynda C

    2010-08-01

    Full Text Available Abstract The use of patient reported outcome scales in clinical trials conducted by the pharmaceutical industry has become more widespread in recent years. The use of such outcomes is particularly common for products developed to treat chronic, disabling conditions where the intention is not to cure but to ameliorate symptoms, facilitate functioning or, ultimately, to improve quality of life. In such cases, patient reported evidence is increasingly viewed as an essential complement to traditional clinical evidence for establishing a product's competitive advantage in the marketplace. In a commercial setting, the value of patient reported outcomes is viewed largely in terms of their potential for securing a labelling claim in the USA or inclusion in the summary of product characteristics in Europe. Although, the publication of the recent US Food and Drug Administration guidance makes it difficult for companies to make claims in the USA beyond symptom improvements, the value of these outcomes goes beyond satisfying requirements for a label claim. The European regulatory authorities, payers both in the US and Europe, clinicians and patients all play a part in determining both the availability and the pricing of medicinal products and all have an interest in patient-reported data that go beyond just symptoms. The purpose of the current paper is to highlight the potential added value of patient reported outcome data currently collected and held by the industry for these groups.

  1. Collecting Patient Reported Outcomes in the Wild: Opportunities and Challenges.

    Science.gov (United States)

    Cabitza, Federico; Dui, Linda Greta

    2018-01-01

    Collecting Patient Reported Outcomes (PROs) is generally seen as an effective way to assess the efficacy and appropriateness of medical interventions, from the patients' perspective. In 2016 the Galeazzi Orthopaedic Institute established a digitized program of PROs collection from spine, hip and knee surgery patients. In this work, we re-port the findings from the data analysis of the responses collected so far about the complementarity of PROs with respect to the data reported by the clinicians, and about the main biases that can undermine their validity and reliability. Although PROs collection is recognized as being far more complex than just asking the patients "how they feel" on a regular basis and it entails costs and devoted electronic platforms, we advocate their further diffusion for the assessment of health technology and clinical procedures.

  2. Lunch to discuss IDRC's programming

    International Development Research Centre (IDRC) Digital Library (Canada)

    chantal Taylor

    Page 1. Description: Lunch to discuss IDRC's programming. Date: 2017-02-10. Attendees: 2 (IDRC 1). Location: Ottawa. Total: $79.92. Comments: 2016-2017 Hospitality Expense. Reports for Jean Lebel, President.

  3. The timeliness of patients reporting the side effects of chemotherapy.

    Science.gov (United States)

    Olver, Ian; Carey, Mariko; Boyes, Allison; Hall, Alix; Noble, Natasha; Bryant, Jamie; Walsh, Justin; Sanson-Fisher, Rob

    2018-05-03

    To explore the actions cancer patients reported they would take in response to a range of common side effects of chemotherapy and whether these were considered appropriate based on current guidelines and evidence; and to explore the sociodemographic and cancer-related variables associated with patients selecting the appropriate action (immediate medical attention or reporting) for two potentially life-threatening side effects: fever, and unusual bleeding and bruising. Four hundred thirty-six medical oncology and haematology patients receiving chemotherapy completed two surveys to provide demographic, disease and treatment characteristics, and details on how they would respond if they experienced a range of specified side effects of chemotherapy (for example, nausea and vomiting, fatigue, and skin rash or nail changes). The proportion of patients reporting the appropriate action for each side effect was calculated. Multiple logistic regressions examined the patient demographic and cancer characteristics associated with selecting the appropriate action (seeking immediate medical attention) for two potentially life-threatening side effects of chemotherapy: high fever of 38 °C or more, and unusual bleeding or bruising. Two thirds of patients indicated that they would seek immediate medical attention for high fever (67%), but only 41% would seek immediate attention for bleeding or bruising. Cancer type and time since diagnosis were significantly associated with patients indicating that they would seek immediate medical attention for high fever; while time since diagnosis was the only variable significantly associated with patients reporting that they would seek immediate medical attention for unusual bleeding or bruising. For chronic side effects, like skin rash or nail changes, and tingling or numbness, which usually do not require urgent reporting, only between 12 and 16% would report them immediately. A significant proportion of patients reported that they would

  4. [Anesthetic Care of Patient With Heroin Addiction: A Case Report].

    Science.gov (United States)

    Lee, Wen-Yi; Kuo, Shu-Yu

    2018-04-01

    The use of illegal drugs in Taiwan is on the rise. Drug addicts often have complex physical, psychological, and social problems. In addition, they often avoid disclosing their illicit drug use by deceit, concealment, or under-reporting. Building and maintaining relationships of trust with drug-addict patients has become a critical issue in achieving better care quality. In this case report, we report on an anesthesia care process for a heroin addict who was admitted for open reduction and internal fixation surgery for the femur and patella fractures after a car accident. During the six-hour perioperative care period, starting from 11pm on November 30th to 5am on December 1st, 2015, the patient was not willing to disclose his illicit drug use before the surgery. However, the nurse anesthetist noticed signs and symptoms of drug use. The nurse empathized with the patient's worries, provided him with a safe communication environment, and gained trust from the patient in a timely manner, which then enabled the patient to fully disclose his illicit drug use with the nurse anesthetist. The anesthesia-care strategy was then modified according to client's condition. The nurse anesthetist played an important role of bridging communications between the patient and medical care staffs and of modifying the care strategies in a timely manner. During the care period, the blood-borne disease contamination was successfully prevented, the client received uneventful pain management, there was a lack of withdrawal symptoms, and the staffs and patient safety was maintained. The literature on the anesthetic care of heroin patients undergoing surgery is relatively limited in Taiwan. The findings in the current case report add information on providing anesthetic care to patients with drug addiction. Publishing additional case reports, research, and clinical recommendations is essential for improving care quality for this vulnerable population.

  5. Improving a newly developed patient-reported outcome for thyroid patients, using cognitive interviewing

    DEFF Research Database (Denmark)

    Watt, Torquil; Rasmussen, Ase Krogh; Groenvold, Mogens

    2008-01-01

    Objective To improve a newly developed patient-reported outcome measure for thyroid patients using cognitive interviewing. Methods Thirty-one interviews using immediate retrospective and expansive probing were conducted among patients with non-toxic goiter (n = 4), nodular toxic goiter (n = 5) Gr...

  6. Transparency When Things Go Wrong: Physician Attitudes About Reporting Medical Errors to Patients, Peers, and Institutions.

    Science.gov (United States)

    Bell, Sigall K; White, Andrew A; Yi, Jean C; Yi-Frazier, Joyce P; Gallagher, Thomas H

    2017-12-01

    Transparent communication after medical error includes disclosing the mistake to the patient, discussing the event with colleagues, and reporting to the institution. Little is known about whether attitudes about these transparency practices are related. Understanding these relationships could inform educational and organizational strategies to promote transparency. We analyzed responses of 3038 US and Canadian physicians to a medical error communication survey. We used bivariate correlations, principal components analysis, and linear regression to determine whether and how physician attitudes about transparent communication with patients, peers, and the institution after error were related. Physician attitudes about disclosing errors to patients, peers, and institutions were correlated (all P's transparent communication with patients and peers/institution included female sex, US (vs Canadian) doctors, academic (vs private) practice, the belief that disclosure decreased likelihood of litigation, and the belief that system changes occur after error reporting. In addition, younger physicians, surgeons, and those with previous experience disclosing a serious error were more likely to agree with disclosure to patients. In comparison, doctors who believed that disclosure would decrease patient trust were less likely to agree with error disclosure to patients. Previous disclosure education was associated with attitudes supporting greater transparency with peers/institution. Physician attitudes about discussing errors with patients, colleagues, and institutions are related. Several predictors of transparency affect all 3 practices and are potentially modifiable by educational and institutional strategies.

  7. [Patient endangerment due to device diversity? : Discussion of a risk factor based on the results of two surveys of German hospitals].

    Science.gov (United States)

    Lange, K; Brinker, A; Nowak, M; Zöllner, C; Lauer, W

    2018-05-25

    The Federal Institute for Drugs and Medical Devices (BfArM) was notified of an event in which it was not possible to sufficiently ventilate a patient suffering a severe asthma attack. It turned out that the ventilation pressures used by the device for pressure-controlled ventilation were below the values set by the user, which the user was not aware of. The ventilation pressures chosen by the user exceeded the preset alarm limits of the ventilator. This pressure and alarm management significantly differed from that of other ventilators used in the hospital. This and similar incident reports suggest that safely operating medical devices for anesthesia and intensive care may be impaired when different models of a device are used within a hospital. If different models are used, more device information needs to be stored in memory. Existing knowledge on human memory suggests that the more individual memory items (e. g. different operating rules) are stored, the greater the risk of memory interference and hence of impaired retrieval, particularly if the different items are associated with overlapping retrieval cues. This is the case when different devices are used for a single functional purpose under identical or similar circumstances. Based on individual incident reports and theoretical knowledge on an association between device diversity and use problems, this study aimed to determine the organizational conditions regarding device diversity that prevail in German hospitals. Additionally, the anesthetists' perspectives and experiences in defined clinical settings were investigated. For selected groups of medical devices, the biomedical engineers of German hospitals were surveyed about the different makes used in their hospital. Additionally, questionnaires were sent to a department of anesthesiology of a large University Hospital to investigate the personal experiences of working with different makes and models of a device. Using devices by different

  8. Awareness, discussion and non-prescribed use of HIV pre-exposure prophylaxis among persons living with HIV/AIDS in Italy: a Nationwide, cross-sectional study among patients on antiretrovirals and their treating HIV physicians.

    Science.gov (United States)

    Palummieri, Antonio; De Carli, Gabriella; Rosenthal, Éric; Cacoub, Patrice; Mussini, Cristina; Puro, Vincenzo

    2017-11-28

    Before Pre-Exposure Prophylaxis (PrEP) was officially recommended and made available, a few surveys among gay and bisexual men, and persons living with HIV/AIDS (PLWHA), identified an informal use of antiretrovirals (ARVs) for PrEP among HIV-negative individuals. Before PrEP availability in Italy, we aimed to assess whether PLWHA in Italy shared their ARVs with HIV-negative individuals, whether they knew people who were on PrEP, and describe the level of awareness and discussion on this preventive measure among them and people in their close circle. Two anonymous questionnaires investigating personal characteristics and PrEP awareness, knowledge, and experience were proposed to HIV specialists and their patients on ARVs in a one-week, cross-sectional survey (December 2013-January 2014). Among PLWHA, a Multivariable Logistic Regression analysis was conducted to identify factors associated with PrEP discussion with peers (close circle and/or HIV associations), and experience (use in close circle and/or personal ARV sharing). Eighty-seven specialists in 31 representative Infectious Diseases departments administered the questionnaire to 1405 PLWHA. Among specialists, 98% reported awareness, 65% knew the dosage schedule, and 14% had previously suggested or prescribed PrEP. Among PLWHA, 45.6% were somehow aware, discussed or had direct or indirect experience of PrEP: 38% "had heard" of PrEP, 24% were aware of studies in HIV-negative individuals demonstrating a risk reduction through the use of ARVs, 22% had discussed PrEP, 12% with peers; 9% reported PrEP use in close circle and 1% personal ARV sharing. Factors predictive of either PrEP discussion with peers or experience differed between men and women, but across all genders were mainly related to having access to information, with HIV association membership being the strongest predictor. At a time and place where there were neither official information nor proposals or interventions to guide public policies on PrEP in

  9. [Use of social media by psychiatric in-patients : Case report and further perspectives].

    Science.gov (United States)

    Czech, O M; Podoll, K; Schneider, F

    2017-08-03

    Communication by means of social networks and messenger programs as well as the use of smartphones have rapidly increased during recent years and are constantly present in everyday life. We report about a 25-year-old patient with a diagnosis of borderline personality disorder who posted photographs of acute self-injuries to a group of fellow patients by means of a messenger app while on weekend leave during psychiatric hospital treatment. The implications about possible effects of the use of social media by psychiatric in-patients on treatment and group dynamics are discussed. Furthermore, social media communication by patients is focused on in general and potential consequences for psychiatric, psychotherapeutic and psychosomatic treatment are discussed.

  10. Reported Sildenafil Side Effects in Pediatric Pulmonary Hypertension Patients

    Directory of Open Access Journals (Sweden)

    Stephanie Leigh Siehr

    2015-03-01

    Full Text Available Background: Sildenafil, a phosphodiestase type 5 inhibitor, was approved in 2005 for the treatment of pulmonary arterial hypertension (PAH in adults, and is commonly used off-label for pediatric patients. Little is known, however, about sildenafil’s side effects in this population.Methods: Single institution, longitudinal survey-based study performed in an outpatient pediatric cardiology clinic. Pediatric patients on sildenafil (alone or in combination with other PH therapies completed questionnaires regarding frequency of vascular, gastrointestinal, neurologic and hematologic side effects. Results: Between January 2011 and May 2014, 66 pediatric patients with PH on sildenafil filled out 214 surveys, 32 patients (96 surveys on monotherapy, and 43 patients (118 surveys on sildenafil plus an endothelin receptor antagonist (bosentan or ambrisentan and/or a prostacyclin (epoprostenol or treprostinil. Overall, 30% of respondents identified at least one side effect. For all patients on sildenafil, incidence of side effects by system was 37% gastrointestinal, 35% vascular and 22% neurologic. For patients on sildenafil monotherapy, incidence of side effects by system was 24% gastrointestinal, 21% vascular and 18% neurologic compared to patients on combination therapy who reported an incidence of 48% gastrointestinal, 45% vascular and 25% neurologic.Conclusion: Incidence of vascular, gastrointestinal and neurologic side effect in pediatric patients on sildenafil therapy for pulmonary arterial hypertension was 30%. Side effects were more common in patients on combination therapy with an endothelin receptor antagonist and/or prostacyclin than in patients on sildenafil monotherapy.

  11. Technical report: an ePRO patient reported outcome program for the evaluation of patients with irritable bowel syndrome.

    Science.gov (United States)

    Gerson, C D; Gerson, M-J

    2014-02-01

    Patient reported outcome (PRO) is an important healthcare concept that describes patient's participation in their care by self-evaluation, usually in the form of questionnaires. This report describes an unique computerized technique, electronic PRO (ePRO), for following the progress of patients with irritable bowel syndrome (IBS). Patients first completed a series of questionnaires, including questions about their illness history, symptom severity, and, in this application, psychological and relationship issues. The symptom severity and psychological questionnaires were then completed at intervals by the patients on their own computers. The ePRO was constructed to allow scores to be automatically summed and placed on a time-line graph for review at the time of the next office visit. Of the 32 patients who completed the initial set of questionnaires, 20 maintained participation in the program for a 6-month period. Of those 20 patients, median number of submissions was 7.0; median interval between questionnaire submissions was 3.0 weeks, whereas median interval between office visits was 5.9 weeks. On average, questionnaire completion took less than 5 min and was positively experienced by the patients. The ePRO program proved to be technically feasible, clinically useful, and positively experienced by the patients. It provides a focus on a collaborative conversation between physician and patient. It has significant potential as a technique for evaluating outcome in response to various therapies. © 2013 John Wiley & Sons Ltd.

  12. Patient Satisfaction Reporting for the Treatment of Femoroacetabular Impingement.

    Science.gov (United States)

    Kahlenberg, Cynthia A; Nwachukwu, Benedict U; Schairer, William W; McCormick, Frank; Ranawat, Anil S

    2016-08-01

    The purpose of this study was to evaluate how patient satisfaction after surgical femoroacetabular impingement (FAI) treatment is measured and reported in the current evidence base. A review of the MEDLINE database was performed. Clinical outcome studies of FAI that reported a measure of patient satisfaction were included. Patient demographics, clinical outcome scores, and patient satisfaction measures were extracted. The NewCastle Ottawa Scale (NOS) was used to grade quality. Statistical analysis was primarily descriptive. Twenty-six studies met inclusion criteria; the mean NOS score among included studies was 5.7. Most studies were level 3 or 4 (n = 25, 96.1%). A 0 to 10 numeric scale, described by some studies as a visual analog scale, was the most commonly used method to assess satisfaction (n = 21; 80.8%), and mean reported scores ranged from 6.8 to 9.2 out of 10. Four studies (15.4%) used an ordinal scale, and 1 study (3.8%) used willingness to undergo surgery again as the measure of satisfaction. None of the included studies assessed preoperative satisfaction or patient expectation. Pooled cohort analysis was limited by significant overlapping study populations. Predictors of patients' satisfaction identified in included studies were presence of arthritis and postoperative outcome scores. Patient satisfaction was not uniformly assessed in the literature. Most studies used a 0- to 10-point satisfaction scale, but none distinguished between the process of care and the outcome of care. Although satisfaction scores were generally high, the quality of the methodologies in the studies that reported satisfaction was low, and the studies likely included overlapping patient populations. More work needs to be done to develop standardized ways for assessing patient satisfaction after arthroscopic hip surgery and other procedures in orthopaedic sports medicine. Level III, systematic review of Level III studies. Copyright © 2016 Arthroscopy Association of North

  13. Discussion in Postsecondary Classrooms

    Directory of Open Access Journals (Sweden)

    Curt Dudley-Marling

    2013-11-01

    Full Text Available Spoken language is, arguably, the primary means by which teachers teach and students learn. Much of the literature on language in classrooms has focused on discussion that is seen as both a method of instruction and a curricular outcome. While much of the research on discussion has focused on K-12 classrooms, there is also a body of research examining the efficacy of discussion in postsecondary settings. This article provides a review of this literature in order to consider the effect of discussion on student learning in college and university classrooms, the prevalence of discussion in postsecondary settings, and the quality of discussion in these settings. In general, the results of research on the efficacy of discussion in postsecondary settings are mixed. More seriously, researchers have not been explicit about the meaning of discussion and much of what is called discussion in this body of research is merely recitation with minimal levels of student participation. Although the research on discussion in college and university classrooms is inconclusive, some implications can be drawn from this review of the research including the need for future researchers to clearly define what they mean by “discussion.”

  14. Patients' reports of barriers to expressing concerns during cancer consultations.

    Science.gov (United States)

    Brandes, Kim; Linn, Annemiek J; Smit, Edith G; van Weert, Julia C M

    2015-03-01

    To identify cancer patients' most influential barriers to expressing concerns during cancer consultations in a new manner by examining patients' reports of perceived barriers and perceived occurrence of barriers in consultations. Two online focus groups (N=16) and an online survey (N=236) were conducted among cancer patients and cancer survivors. The online focus groups and survey were used to examine two elements of patients' barriers, i.e., patients' reports of perceived barriers and perceived occurrence of barriers in consultations. Composite scores of these two elements were calculated to determine influential barriers. Results showed that the most influential barriers were related to providers' behavior (e.g., providers do not explicitly invite patients to express concerns) and the environment where the consultation takes place (e.g., perceived lack of time). The results of this study indicate that influential barriers to expressing concerns are barriers that patients cannot overcome themselves (i.e., they are related to providers' behavior or the environment of the consultation). A collaborative approach between researchers, providers and policy makers is needed to overcome these barriers. The results of this study can be used to develop strategies to overcome barriers to patients expressing concerns. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Patient-reported outcomes and adult patients' disease experience in the idiopathic inflammatory myopathies. report from the OMERACT 11 Myositis Special Interest Group.

    Science.gov (United States)

    Alexanderson, Helene; Del Grande, Maria; Bingham, Clifton O; Orbai, Ana-Maria; Sarver, Catherine; Clegg-Smith, Katherine; Lundberg, Ingrid E; Song, Yeong Wook; Christopher-Stine, Lisa

    2014-03-01

    The newly formed Outcome Measures in Rheumatology (OMERACT) Myositis Special Interest Group (SIG) was established to examine patient-reported outcome measures (PROM) in myositis. At OMERACT 11, a literature review of PROM used in the idiopathic inflammatory myopathies (IIM) and other neuromuscular conditions was presented. The group examined in more detail 2 PROM more extensively evaluated in patients with IIM, the Myositis Activities Profile, and the McMaster-Toronto Arthritis Patient Preference Disability Questionnaire, through the OMERACT filter of truth, discrimination, and feasibility. Preliminary results from a qualitative study of patients with myositis regarding their symptoms were discussed that emphasized the range of symptoms experienced: pain, physical tightness/stiffness, fatigue, disease effect on emotional life and relationships, and treatment-related side effects. Following discussion of these results and following additional discussions since OMERACT 11, a research agenda was developed. The next step in evaluating PROM in IIM will require additional focus groups with a spectrum of patients with different myositis disease phenotypes and manifestations across a range of disease activity, and from multiple international settings. The group will initially focus on dermatomyositis and polymyositis in adults. Qualitative analysis will facilitate the identification of commonalities and divergent patient-relevant aspects of disease, insights that are critical given the heterogeneous manifestations of these diseases. Based on these qualitative studies, existing myositis PROM can be examined to more thoroughly assess content validity, and will be important to identify gaps in domain measurement that will be required to develop a preliminary core set of patient-relevant domains for IIM.

  16. Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report.

    Science.gov (United States)

    Harle, Christopher A; Listhaus, Alyson; Covarrubias, Constanza M; Schmidt, Siegfried Of; Mackey, Sean; Carek, Peter J; Fillingim, Roger B; Hurley, Robert W

    2016-01-01

    In this case report, the authors describe the implementation of a system for collecting patient-reported outcomes and integrating results in an electronic health record. The objective was to identify lessons learned in overcoming barriers to collecting and integrating patient-reported outcomes in an electronic health record. The authors analyzed qualitative data in 42 documents collected from system development meetings, written feedback from users, and clinical observations with practice staff, providers, and patients. Guided by the Unified Theory on the Adoption and Use of Information Technology, 5 emergent themes were identified. Two barriers emerged: (i) uncertain clinical benefit and (ii) time, work flow, and effort constraints. Three facilitators emerged: (iii) process automation, (iv) usable system interfaces, and (v) collecting patient-reported outcomes for the right patient at the right time. For electronic health record-integrated patient-reported outcomes to succeed as useful clinical tools, system designers must ensure the clinical relevance of the information being collected while minimizing provider, staff, and patient burden. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Sexual Functions in Obsessive Compulsive Disorder Patients: A Case Report

    Directory of Open Access Journals (Sweden)

    Nergis LAPSEKİLİ

    2012-11-01

    Full Text Available Introduction: Obsessive-compulsive disorder (OCD, even if the patient’s obsession content is not related to sexuality, may be a problem in the sexual lives of individuals. In this article, sexual function in obsessive compulsive disorder patients is discussed based on an OCD case. Case: Male 36 years old and female 32 years old couple. Man had complaints of lack of control of ejaculation and woman had complaints of lack of orgasm. Man was diagnosed with premature ejaculation and woman was diagnosed with aversion and anorgasmia according to DSM-IV (Diagnostic and Statistical Manual Of Mental Disorders criteria. During therapy, the female patient was diagnosed with OCD as well. Loss of control was not acceptable to the patient. Thus she was avoiding from exhilarating stimuli. After cognitive restructuring of her evaluations about control, sex therapy was continued. At the end of the therapy the avoidance of the patient disappeared and anorgasmia was treated and ejeculation time of the male patient was 15 minutes. Conclusion: Sexual dysfunction is a common problem in patients with OCD. Patient may have avoidance that may adversely affect her sexuality. If a patient has avoidance about sexuality, the reason of this avoidance may or may not be the usual and expected thought content like avoidance of contamination. The evaluations of OCD patients about control may also adversely affect their sexuallity. The thought leading to avoidance behavior, may vary from patient to patient. However, to identify these thoughts with cognitive interventions and work with them will improve.the patient.

  18. Implementation of the Welfare Quality broiler assessment protocol – final report : overview of outcome-based measurement of broiler welfare and a general discussion on the Welfare Quality broiler assessment protocol

    NARCIS (Netherlands)

    Jong, de I.C.; Gunnink, H.; Hindle, V.A.

    2015-01-01

    In the current report, two topics related to our study on the implementation of the Welfare Quality® broiler assessment protocol are discussed. First, animal-based measures for broiler welfare, currently included in the Welfare Quality® broiler assessment protocol, are discussed with respect to

  19. Conference Report: Drug Metabolism Discussion Group Short Meeting: microsampling--the next big thing. Alderley Park, Macclesfield, UK, 14 March 2012.

    Science.gov (United States)

    Jackson-Addie, Kirsty; Woods, Karen; Muir, Allan; Smith, Christopher; Higton, David

    2012-12-01

    On behalf of the Drug Metabolism Discussion Group, Regulatory Bioanalysis AstraZeneca (UK) recently organized and hosted an extremely successful Drug Metabolism Discussion Group Short Meeting on 'microsampling--the next big thing'. This attracted over 140 delegates and a strong line up of presenters of respected scientists within the field. This meeting focused on the impact of taking a reduced sample (5-20 µl) from an animal, or later in the clinic, particularly neonates. The agenda covered the spectrum of microsampling, from capillary plasma microsampling, as championed by Ove Jonsson and Kristian Königsson, through to dried blood spots. The day was split up in to three sections, the morning concentrating on the sampling aspects from animals. A highlight of the first section was the 'poster blitz' where four poster presenters gave a quick overview of their work. This introduced the poster session and created a good atmosphere for general debate between the delegates. The mid-session saw the bioanalytical challenges discussed from the discovery to the preclinical stage. To encourage interaction between the presenters and the audience, a panel discussion was used that led to interesting insights into study design from toxicological and bioanalytical viewpoints. The final session was left to clinical aspects of microsampling and a particularly interesting presentation from Hitesh Pandya from the Pediatric Respiratory Medicine Department (University of Leicester, Leicester, UK). An eloquent and hard-hitting presentation put into perspective the importance of advancements in this field that enables sample to be taken in a noninvasive manner. The meeting was well received with excellent feedback from all concerned.

  20. Patient- and clinician- reported outcome in eating disorders

    DEFF Research Database (Denmark)

    Winkler, Laura Vad; Frølich, Jacob Stampe; Gudex, Claire

    2017-01-01

    Patient-reported outcome is increasingly applied in health sciences. Patients with eating disorders (EDs) characteristically have a different opinion of their needs to that of the health professionals, which can lead to ambivalence towards treatment and immense compliance difficulties. This cross....... This association was not observed in bulimia nervosa (BN). We did not find a correlation between SF-36 scores and BMI in any of the diagnostic groups....

  1. Rhabdomyosarcoma in an elderly patient. A case report

    OpenAIRE

    Leopoldo Garduño-Vieyra; Sergio E. Hernandez-Da Mota; Claudia Ruth Gonzalez; Roberto Gamez-Carrillo

    2017-01-01

    Purpose: To describe a case of rhabdomyosarcoma in an elderly patient. Methods: An exenteration surgery was performed of the right orbit with desperiostization and temporal muscle-skin flap rotation to cover the defect in a 96 year old patient with a history of right eye exotropia. Results: The pathology report showed a malignant striate muscle neoplasm with pleomorphic neuclei of variable size with discromic and disperse cromatine that was consistent with pleomorphic rhabdomyosarcoma. ...

  2. Patient- and clinician- reported outcome in eating disorders.

    Science.gov (United States)

    Winkler, Laura Al-Dakhiel; Frølich, Jacob Stampe; Gudex, Claire; Hørder, Kirsten; Bilenberg, Niels; Støving, René Klinkby

    2017-01-01

    Patient-reported outcome is increasingly applied in health sciences. Patients with eating disorders (EDs) characteristically have a different opinion of their needs to that of the health professionals, which can lead to ambivalence towards treatment and immense compliance difficulties. This cross-sectional study compared data assessed by the clinician to patient-reported measures in patients with a history of EDs. We included data from a cohort of patients with EDs (n=544) referred to a specialized ED unit in Denmark. Patient-reported measures included the Eating Disorder Inventory-2 (EDI-2) and the Short Form 36 (SF-36), and clinical data included remission status and body mass index (BMI). We found a positive association between BMI and EDI-2 scores for anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS), reflecting increasing ED symptomatology with increasing BMI. This association was not observed in bulimia nervosa (BN). We did not find a correlation between SF-36 scores and BMI in any of the diagnostic groups. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Patient perspective workshop: moving towards OMERACT guidelines for choosing or developing instruments to measure patient-reported outcomes.

    Science.gov (United States)

    Kirwan, John R; Fries, James F; Hewlett, Sarah E; Osborne, Richard H; Newman, Stanton; Ciciriello, Sabina; van de Laar, Mart A; Dures, Emma; Minnock, Patricia; Heiberg, Turid; Sanderson, Tessa C; Flurey, Caroline A; Leong, Amy L; Montie, Pamela; Richards, Pam

    2011-08-01

    The workshop Choosing or Developing Instruments held at the Outcome Measures in Rheumatology (OMERACT) 10 meeting was designed to help participants think about the underlying methods of instrument development. Conference pre-reading material and 3 brief introductory presentations elaborated the issues, and participants broke into discussion groups before reconvening to share insights, engage in a more general discussion of the issues, and vote on recommendations. Tradeoffs between using current imperfect measures and the long and complex process of developing new instruments were considered, together with the need for rigor in patient-reported outcome (PRO) instrument development. The main considerations for PRO instrument development were listed and a research agenda for action produced. As part of the agenda for action, it is recommended that researchers and patient partners work together to tackle these issues, and that OMERACT bring forward proposals for acceptable instrument development protocols that would meet an enhanced "Truth" statement in the OMERACT Filter.

  4. Improving patient safety in radiotherapy through error reporting and analysis

    International Nuclear Information System (INIS)

    Findlay, Ú.; Best, H.; Ottrey, M.

    2016-01-01

    Aim: To improve patient safety in radiotherapy (RT) through the analysis and publication of radiotherapy errors and near misses (RTE). Materials and methods: RTE are submitted on a voluntary basis by NHS RT departments throughout the UK to the National Reporting and Learning System (NRLS) or directly to Public Health England (PHE). RTE are analysed by PHE staff using frequency trend analysis based on the classification and pathway coding from Towards Safer Radiotherapy (TSRT). PHE in conjunction with the Patient Safety in Radiotherapy Steering Group publish learning from these events, on a triannual and summarised on a biennial basis, so their occurrence might be mitigated. Results: Since the introduction of this initiative in 2010, over 30,000 (RTE) reports have been submitted. The number of RTE reported in each biennial cycle has grown, ranging from 680 (2010) to 12,691 (2016) RTE. The vast majority of the RTE reported are lower level events, thus not affecting the outcome of patient care. Of the level 1 and 2 incidents reported, it is known the majority of them affected only one fraction of a course of treatment. This means that corrective action could be taken over the remaining treatment fractions so the incident did not have a significant impact on the patient or the outcome of their treatment. Analysis of the RTE reports demonstrates that generation of error is not confined to one professional group or to any particular point in the pathway. It also indicates that the pattern of errors is replicated across service providers in the UK. Conclusion: Use of the terminology, classification and coding of TSRT, together with implementation of the national voluntary reporting system described within this report, allows clinical departments to compare their local analysis to the national picture. Further opportunities to improve learning from this dataset must be exploited through development of the analysis and development of proactive risk management strategies

  5. Initial-Stage Primary Intraosseous Squamous Cell Carcinoma Derived from Odontogenic Keratocyst with Unusual Keratoameloblastomatous Change of the Maxilla: A Case Report and Literature Discussion

    Directory of Open Access Journals (Sweden)

    Kentaro Kikuchi

    2018-01-01

    Full Text Available Primary intraosseous squamous cell carcinoma (PIOSCC is a rare malignant neoplasm derived from odontogenic epithelial remnants in the central jaw bone. Most PIOSCCs originate from odontogenic cysts with a nonkeratinized epithelial lining, especially from radicular/residual and dentigerous cysts. There have been few reports of PIOSCCs derived from the odontogenic keratocyst (OKC, particularly those describing pathological features at the initial stage. The diagnosis of PIOSCC is difficult and based on exclusion of other carcinomas, including metastatic tumors from other primary sites. Here, we report an extremely rare case of initial-stage PIOSCC derived from the OKC with unusual keratoameloblastomatous change of the maxilla.

  6. Systems automated reporting of patient dose in digital radiology

    International Nuclear Information System (INIS)

    Collado Chamorro, P.; Sanz Freire, C. J.; Martinez Mirallas, O.; Tejada San Juan, S.; Lopez de Gammarra, M. S.

    2013-01-01

    It has developed a procedure automated reporting of doses to patients in Radiology. This procedure allows to save the time required of the data used to calculate the dose to patients by yields. Also saves the time spent in the transcription of these data for the realization of the necessary calculations. This system has been developed using open source software. The characteristics of the systems of digital radiography for the automation of procedures, in particular the registration of dose should benefit from patient. This procedure is validated and currently in use at our institution. (Author)

  7. Proceedings of Patient Reported Outcome Measure’s (PROMs Conference Sheffield 2016: advances in patient reported outcomes research

    Directory of Open Access Journals (Sweden)

    Tim Croudace

    2016-10-01

    Full Text Available Table of contents S1 Using computerized adaptive testing Tim Croudace S2 Well-being: what is it, how does it compare to health and what are the implications of using it to inform health policy John Brazier O1 “Am I going to get better?”—Using PROMs to inform patients about the likely benefit of surgery Nils Gutacker, Andrew Street O2 Identifying Patient Reported Outcome Measures for an electronic Personal Health Record Dan Robotham, Samantha Waterman, Diana Rose, Safarina Satkunanathan, Til Wykes O3 Examining the change process over time qualitatively: transformative learning and response shift Nasrin Nasr, Pamela Enderby O4 Developing a PROM to evaluate self-management in diabetes (HASMID: giving patients a voice Jill Carlton, Donna Rowen, Jackie Elliott, John Brazier, Katherine Stevens, Hasan Basarir, Alex Labeit O5 Development of the Primary Care Outcomes Questionnaire (PCOQ Mairead Murphy, Sandra Hollinghurst, Chris Salisbury O6 Developing the PKEX score- a multimodal assessment tool for patients with shoulder problems Dominic Marley, James Wilson, Amy Barrat, Bibhas Roy O7 Applying multiple imputation to multi-item patient reported outcome measures: advantages and disadvantages of imputing at the item, sub-scale or score level Ines Rombach, Órlaith Burke, Crispin Jenkinson, Alastair Gray, Oliver Rivero-Arias O8 Integrating Patient Reported Outcome Measures (PROMs into routine primary care for patients with multimorbidity: a feasibility study Ian Porter, Jaheeda Gangannagaripalli, Charlotte Bramwell, Jose M. Valderas O9 eRAPID: electronic self-report and management of adverse-events for pelvic radiotherapy (RT patients Patricia Holch, Susan Davidson, Jacki Routledge, Ann Henry, Kevin Franks, Alex Gilbert, Kate Absolom & Galina Velikova O10 Patient reported outcomes (PROMs based recommendation in clinical guidance for the management of chronic conditions in the United Kingdom Ian Porter, Jose M.Valderas O11 Cross-sectional and

  8. Learning through Discussions

    Science.gov (United States)

    Ellis, Robert A.; Calvo, Rafael; Levy, David; Tan, Kelvin

    2004-01-01

    Students studying a third-year e-commerce subject experienced face-to-face and online discussions as an important part of their learning experience. The quality of the students' experiences of learning through those discussions is investigated in this study. This study uses qualitative approaches to investigate the variation in the students'…

  9. Assessment of patient knowledge of diabetic goals, self-reported medication adherence, and goal attainment

    Directory of Open Access Journals (Sweden)

    Whitley HP

    2006-12-01

    Full Text Available Background: Medication adherence is an integral aspect of disease state management for patients with chronic illnesses, including diabetes mellitus. It has been hypothesized that patients with diabetes who have poor medication adherence may have less knowledge of overall therapeutic goals and may be less likely to attain these goals. Objective: The purpose of this study was to assess self-reported medication adherence, knowledge of therapeutic goals (hemoglobin A1C [A1C], low density lipoprotein cholesterol [LDL-C] and blood pressure [BP], and goal attainment in adult patients with diabetes. Methods: A survey was created to assess medication adherence, knowledge of therapeutic goals, and goal attainment for adult patients with diabetes followed at an internal medicine or a family medicine clinic. Surveys were self-administered prior to office visits. Additional data were collected from the electronic medical record. Statistical analysis was performed. Results: A total of 149 patients were enrolled. Knowledge of therapeutic goals was reported by 14%, 34%, and 18% of survived patients for LDL-C, BP, and A1C, respectively. Forty-six percent, 37%, and 40% of patients achieved LDL-C, BP, and A1C goals, respectively. Low prescribing of cholesterol-lowering medications was an interesting secondary finding; 36% of patients not at LDL-C goal had not been prescribed a medication targeted to lower cholesterol. Forty-eight percent of patients were medication non-adherent; most frequently reported reasons for non-adherence were forgot (34% and too expensive (14%. Patients at A1C goal were more adherent than patients not at goal (p=0.025. Conclusion: The majority did not reach goals and were unknowledgeable of goals; however, most were provided prescriptions to treat these parameters. Goal parameters should be revisited often amongst multidisciplinary team members with frequent and open communications. Additionally, it is imperative that practitioners discuss

  10. Perspectives of patients and professionals on the use of patient reported outcome measures in primary care

    DEFF Research Database (Denmark)

    Porter, Ian; Gangannagaripalli, Jaheeda; Davey, Antoinette

    2017-01-01

    /or healthcare professional’s perspectives on the clinical utility of using PROMs in clinical practice. Results: 19 studies met the inclusion criteria (4 after 2012), 11 of which were conducted in the UK, reporting on the views of professionals (8), patients (5), and both (7). The majority of studies (12...... communication it was also noted that they undermined the human element of consultations, along with professional intuition and judgement. Burden on GP time was also noted. Conclusions: Patients and professionals highlighted a number of benefits of using PROMs in clinical practice, particularly in terms......A71 Perspectives of patients and professionals on the use of patient-reported outcome measures in primary care: a systematic review of qualitative studies Background: Although the use of patient-reported outcome measures (PROMs) in healthcare settings has increased substantially over recent years...

  11. Yoga & Cancer Interventions: A Review of the Clinical Significance of Patient Reported Outcomes for Cancer Survivors

    Directory of Open Access Journals (Sweden)

    S. Nicole Culos-Reed

    2012-01-01

    Full Text Available Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004–2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies.

  12. Cognitive rehabilitation in neuro-oncological patients: three case reports

    Directory of Open Access Journals (Sweden)

    Chiara Zucchella

    2012-06-01

    Full Text Available Cognitive impairment is one of the most common neurological disorders in neuro-oncological patients, linked with morbidity, disability, and poor quality of life. As pharmacologic interventions have not yet proven effective in the treatment of cognitive deficits, cognitive rehabilitation could represent an alternative approach. This paper presents three case studies, describing the cognitive intervention and discussing its effectiveness in the light of current evidence.

  13. Subareolar breast abscess in male patients: a report of two patients with a literature review.

    Science.gov (United States)

    Kazama, Takashi; Tabei, Isao; Sekine, Chikako; Funamizu, Naotake; Onda, Shinji; Okamoto, Tomoyoshi; Takeyama, Hiroshi; Morikawa, Toshiaki

    2017-12-19

    Subareolar breast abscess (SBA) is a rare infectious disease of the breast in male patients. Herein, we report two male patients with SBA. Patient 1 was initially diagnosed with a malignant tumor based on imaging findings; ultrasonography revealed a hypoechoic mass with blood flow. Patient 2 was diagnosed with inflammatory changes to his nipple; ultrasonography findings supported the diagnosis with an irregular hypoechoic mass with blood flow. Both patients received a cytological or histological biopsy preoperatively, which showed an abscess without malignant cells. These cases serve as an important reminder to consider complete resection of the tumor including the responsible mammary duct (tumor and duct resection (TDR)) for curative therapy of SBA.

  14. Inflammatory myofibroblastic tumor of maxilla showing sarcomatous change in an edentulous site with a history of tooth extraction following periodontitis: A case report with discussion.

    Science.gov (United States)

    Biniraj, K R; Janardhanan, Mahija

    2014-05-01

    Inflammatory myofibroblastic tumor (IMT) is a rare tumor of uncertain origin with variable biological behavior ranging from reactive lesions to highly aggressive malignancy. Oral IMTs are extremely rare and only 25 cases had been reported so far. A case of IMT with sarcomatous transformation in an extraction site with a history of tooth extraction following tooth mobility of an upper left molar tooth is presented here. The tooth was extracted following a complaint of gingival swelling and mobility of tooth. Though malignant transformation in IMTs had been documented in the extra oral sites, wide search of associated literature suggests, this is the first case of oral IMT showing malignant change associated with gingiva. The case report attempts to highlight the variant possibilities of tooth mobility other than periodontitis and the importance of assessing the primary cause of such conditions.

  15. How to improve communication for the safe use of medicines?: Discussions on social marketing and patient-tailored approaches at the annual meetings of the WHO Programme for International Drug Monitoring.

    Science.gov (United States)

    Bahri, Priya; Harrison-Woolrych, Mira

    2012-12-01

    Over the past decade, the annual meetings of national centres participating in the WHO Programme for International Drug Monitoring have increasingly included discussions on how to improve communication between national pharmacovigilance centres, patients, healthcare professionals, policy makers and the general public, with the aim of promoting the safe use of medicines. At the most recent meetings, working groups were dedicated to discuss possible applications and implementation of social marketing and patient-tailored approaches. This article provides the history and a summary of the recent discussions and recommendations to support progress in this respect at national and global level. Recommendations are made to investigate and pilot these approaches in small-scale projects at national pharmacovigilance centres. Applying elements from the social marketing and patient-tailored approaches to support behaviours of safe medicines use in patients and healthcare professionals should give the pharmacovigilance community new tools to achieve their goal to minimize risks with medicines and improve patient safety.

  16. Atypical mycobacterial infection mimicking carbuncle in an elderly patient: A case report

    Directory of Open Access Journals (Sweden)

    Terlinda Barros

    2015-08-01

    Full Text Available Background: Atypical mycobacterium infection occurs under certain skin conditions, namely the disruption of skin integrity and mucous membranes accompanied by the reduction of cellular immunity. However, atypical mycobacterial infection in elderly patients is rarely reported. Case: A 64 years old male patient, complained of red lumps on the upper-backfor a month, accompanied by mild fever and minimal pain. Three months before, the patient had accupuncture on the neck and upper back. Physical examination showed multiple miliar to lenticular sized papules and pustules on an erythematous-violaceus base with hard and immobile palpable nodes and infiltrate. After clinical and laboratory workup, the patient was diagnosed withcarbuncle with Candida spp colonization. The treatment consisted of systemicantibiotics and topical antifungals. There was no clinical improvement after 3 weeks. Histopathology and laboratory results suggested atypical mycobacterium infection. Discussion: Atypical mycobacterium infection should be considered in elderly patients with skin and soft tissue infections that show no clinical improvement tostandard therapy.

  17. Reported exposure to trauma among adult patients referred for ...

    African Journals Online (AJOL)

    Reported exposure to trauma among adult patients referred for psychological services at the Free State Psychiatric Complex, Bloemfontein. ... trauma exposure screening in routine psychiatric interviewing practices is highlighted. Keywords: Trauma exposure, Mental illness, Screening, Post-traumatic stress disorder ...

  18. Ovarian pregnancy in an HIV positive patient: Case report ...

    African Journals Online (AJOL)

    Ovarian pregnancy in an HIV positive patient: Case report. A Mohammed, AG Adesiyun, AA Mayun, CA Ameh. Abstract. No Abstract. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  19. Splenic abscess in children: A report of three patients | Rattan ...

    African Journals Online (AJOL)

    Splenic abscess is uncommon in paediatric age group. It usually occurs in conditions of disseminated infective focus. Conventional treatment of abscess is incision and drainage, although splenectomy or splenic conservation is alternative. In this report, we are presenting case summaries of three patients suffering from ...

  20. Georgia; First Review Under the Stand-By Arrangement-Staff Report; Press Release on the Executive Board Discussion; and Statement by the Executive Director for Georgia

    OpenAIRE

    International Monetary Fund

    2009-01-01

    The staff report for the First Review Under the Stand-By Arrangement with the officials of Georgia highlights economic developments and policies. Sustaining economic growth and maintaining confidence in the currency and the financial system within the constraints of available external financing are the main program priorities. IMF staff recommended a more active role for monetary policy in encouraging market interest rate adjustments. With global markets in distress, the authorities should wo...

  1. Bolivia; 2009 Article IV Consultation: Staff Report; Staff Supplement; Staff Statement; Public Information Notice on the Executive Board Discussion; and Statement by the Executive Director for Bolivia

    OpenAIRE

    International Monetary Fund

    2010-01-01

    The staff report for Bolivia’s 2009 Article IV Consultation describes economic developments and policies. The impact of the global recession on Bolivia has been milder than in other countries in the region. Lower commodity exports and remittances have resulted in a sharp narrowing of the external current account surplus. The financial system has been barely affected by the global crisis owing to its limited integration with international capital markets. As the economy gathers momentum, a tig...

  2. Discussing epigenetics in Southern California: a report from the International Symposium on Epigenetic Control and Cellular Plasticity, UCI, December 15-16, 2011.

    Science.gov (United States)

    Rattner, Barbara P

    2012-04-01

    With the goal of discussing how epigenetic control and chromatin remodeling contribute to the various processes that lead to cellular plasticity and disease, this symposium marks the collaboration between the Institut National de la Santé et de la Recherche Médicale (INSERM) in France and the University of California, Irvine (UCI). Organized by Paolo Sassone-Corsi (UCI) and held at the Beckman Center of the National Academy of Sciences at the UCI campus December 15-16, 2011, this was the first of a series of international conferences on epigenetics dedicated to the scientific community in Southern California. The meeting also served as the official kick off for the newly formed Center for Epigenetics and Metabolism at the School of Medicine, UCI (http://cem.igb.uci.edu).

  3. [The effectiveness of error reporting promoting strategy on nurse's attitude, patient safety culture, intention to report and reporting rate].

    Science.gov (United States)

    Kim, Myoungsoo

    2010-04-01

    The purpose of this study was to examine the impact of strategies to promote reporting of errors on nurses' attitude to reporting errors, organizational culture related to patient safety, intention to report and reporting rate in hospital nurses. A nonequivalent control group non-synchronized design was used for this study. The program was developed and then administered to the experimental group for 12 weeks. Data were analyzed using descriptive analysis, X(2)-test, t-test, and ANCOVA with the SPSS 12.0 program. After the intervention, the experimental group showed significantly higher scores for nurses' attitude to reporting errors (experimental: 20.73 vs control: 20.52, F=5.483, p=.021) and reporting rate (experimental: 3.40 vs control: 1.33, F=1998.083, porganizational culture and intention to report. The study findings indicate that strategies that promote reporting of errors play an important role in producing positive attitudes to reporting errors and improving behavior of reporting. Further advanced strategies for reporting errors that can lead to improved patient safety should be developed and applied in a broad range of hospitals.

  4. The monitoring, evaluation, reporting, and verification of climate change mitigation projects: Discussion of issues and methodologies and review of existing protocols and guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Vine, E.; Sathaye, J.

    1997-12-01

    Because of concerns with the growing threat of global climate change from increasing emissions of greenhouse gases, the US and other countries are implementing, by themselves or in cooperation with one or more other nations (i.e., joint implementation), climate change mitigation projects. These projects will reduce greenhouse gas (GHG) emissions or sequester carbon, and will also result in non-GHG impacts (i.e., environmental, economic, and social impacts). Monitoring, evaluating, reporting, and verifying (MERV) guidelines are needed for these projects in order to accurately determine their net GHG, and other, benefits. Implementation of MERV guidelines is also intended to: (1) increase the reliability of data for estimating GHG benefits; (2) provide real-time data so that mid-course corrections can be made; (3) introduce consistency and transparency across project types and reporters; and (4) enhance the credibility of the projects with stakeholders. In this paper, the authors review the issues and methodologies involved in MERV activities. In addition, they review protocols and guidelines that have been developed for MERV of GHG emissions in the energy and non-energy sectors by governments, nongovernmental organizations, and international agencies. They comment on their relevance and completeness, and identify several topics that future protocols and guidelines need to address, such as (1) establishing a credible baseline; (2) accounting for impacts outside project boundaries through leakage; (3) net GHG reductions and other impacts; (4) precision of measurement; (5) MERV frequency; (6) persistence (sustainability) of savings, emissions reduction, and carbon sequestration; (7) reporting by multiple project participants; (8) verification of GHG reduction credits; (9) uncertainty and risk; (10) institutional capacity in conducting MERV; and (11) the cost of MERV.

  5. 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.

  6. Geochemistry Review Panel report on the SRP geochemistry program and draft geochemistry summary program plan (May, 1986) and discussion of panel recommendations

    International Nuclear Information System (INIS)

    1986-12-01

    The Geochemistry Review Panel (GRP) was established by the Salt Repository Project Office (SRPO) to help evaluate geochemistry-related issues in the US Department of Energy's nuclear waste repository program. The May 1986 meeting of the GRP reviewed the Salt Repository Program (SRP) geochemistry program developed by the Office of Nuclear Waste Isolation (ONWI). This program is described in the Draft Geochemistry Plan of April 9, 1986. This report documents the GRP's comments and recommendations on this subject and the ONWI responses to the specific points raised by the GRP

  7. Cancer patients' reluctance to discuss psychological distress with their physicians was not associated with underrecognition of depression by physicians: a preliminary study.

    Science.gov (United States)

    Okuyama, Toru; Endo, Chiharu; Seto, Takashi; Kato, Masashi; Seki, Nobuhiko; Akechi, Tatsuo; Furukawa, Toshiaki A; Eguchi, Kenji; Hosaka, Takashi

    2009-06-01

    To investigate the association between cancer patients' reluctance for emotional disclosure to their physician and underrecognition of depression by physicians. Randomly selected ambulatory patients with lung cancer were evaluated by the Hospital Depression and Anxiety Scale (HADS), and those with scores over the validated cutoff value for adjustment disorder or major depressive disorder were included in this analysis. The data set included the responses to the 13-item questionnaire to assess four possible concerns of patients in relation to emotional disclosure to the treating physician ("no perceived need to disclose emotions," "fear of the negative impact of emotional disclosure," "negative attitude toward emotional disclosure," "hesitation to disturb the physician with emotional disclosure"). The attending physicians rated the severity of depression in each patient using 3-point Likert scales (0 [absent] to 2 [clinical]). Depression was considered to be underrecognized when the patients had a HADS score above the cutoff value, but in whom the depression rating by the attending physician was 0. The HADS score was over the cutoff value in the 60 patients. The mean age was 65.1 +/- 10.0, and 82% had advanced cancer (Stage IIIb or IV or recurrence). Depression was underrecognized in 44 (73%) patients. None of the four factors related to reluctance for emotional disclosure was associated with the underrecognition of depression by the physicians. None of the demographic or cancer-related variables were associated with depression underrecognition by physicians. The results did not support the assumption that patients' reluctance for emotional disclosure is associated with the underrecognition of depression by physicians.

  8. Session 1 - discussion

    International Nuclear Information System (INIS)

    Wells, C.; Richards, K.M.; McKerrow, J.F.

    1991-01-01

    This discussion session of the Landfill Gas-Energy and Environment 90 Conference covered the landfill gas potential, the setting up of the Non-Fossil Fuel Obligation; anticipated developments in the post 1998 period, the problem of smell for those who live near a landfill, and the length of time a landfill site is productive in terms of gas evolution. Relevant regulations in California are briefly discussed. (author)

  9. A case series discussing the anaesthetic management of pregnant patients with brain tumours [v2; ref status: indexed, http://f1000r.es/2hn

    Directory of Open Access Journals (Sweden)

    Alaa A Abd-Elsayed

    2013-12-01

    Full Text Available Pregnancy may aggravate the natural history of an intracranial tumour, and may even unmask a previously unknown diagnosis. Here we present a series of seven patients who had brain tumours during pregnancy. The aim of this case series is to characterize the current perioperative management and to suggest evidence based guidelines for the anaesthetic management of pregnant females with brain tumours. This is a retrospective study. Information on pregnant patients diagnosed with brain tumours that underwent caesarean section (CS and/or brain tumour resection from May 2003 through June 2008 was obtained from the Department of General Anaesthesia and the Rose Ella Burkhardt Brain Tumour & Neuro-Oncology Centre (BBTC at the Cleveland Clinic, OH, USA. The mean age was 34.5 years (range 29-40 years old. Six patients had glioma, two of whom had concomitant craniotomy and CS. Six cases had the tumour in the frontal lobe. Four cases were operated on under general anaesthesia and three underwent awake craniotomy. The neonatal outcomes of the six patients with elective or emergent delivery were six viable infants with normal Apgar scores. Pregnancy was terminated in the 7th patient. In conclusion, good knowledge of the variable anesthetic agents and their effects on the fetus is very important in managing those patients.

  10. Discussion on Papers 8 - 10

    International Nuclear Information System (INIS)

    Walker, R.; Wilson, E.A.; Gibson, P.

    1992-01-01

    Questions raised in the discussion are reported. These concerned: the Treasury discount rate for the construction of such a project; the CO 2 benefits of tidal schemes in developing countries; the criteria for deciding the total installed capacity of the scheme; the Government review of the cost-benefit analysis; the benefit arising from the elimination of nitrogen and sulphur oxides; security of supply; carbon tax projections. The only response reported is on the question of criteria for deciding the total installed capacity. Separate abstracts have been prepared on the three papers under discussion. (UK)

  11. Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying.

    Science.gov (United States)

    Pino, Marco; Parry, Ruth; Land, Victoria; Faull, Christina; Feathers, Luke; Seymour, Jane

    2016-01-01

    To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of "eliciting and responding to cues", which has been widely advocated in the EoL care literature, promotes EoL talk. Conversation analysis of video- and audio-recorded consultations. Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors. Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice. Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce-then later further articulate-EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients' talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as "cues" as is common in EoL communication contexts. We examine these limitations and propose "possible EoL considerations" as a descriptively more accurate term. Through communicating-via open elaboration solicitations-in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst

  12. Pain management discussion forum.

    Science.gov (United States)

    Breivik, Harald

    2013-08-01

    A 23-year-old hemophilia patient with severe pain from bleeding into his joints who developed problematic opioid use is described. The potential value of methadone in such a patient is described, as are the risks of drug interactions leading to toxicity and cardiac arrhythmias.

  13. Report: Discussion on the development of nano Ag/TiO2 coating bracket and its antibacterial property and biocompatibility in orthodontic treatment.

    Science.gov (United States)

    Zhang, Ronghe; Zhang, Weiwei; Bai, Xueyan; Song, Xiaotong; Wang, Chunyan; Gao, Xinxin; Tian, Xubiao; Liu, Fengzhen

    2015-03-01

    This paper aims to explore the antibacterial property of nano Ag/TiO2 coating bracket for the common bacteria in oral cavity, and discuss its biocompatibility. Micro morphology in the surface of nano Ag/TiO2 coating bracket was detected by scanning electron microscope (SEM), and surface roughness of ordinary mental bracket, nano TiO2 coating bracket and nano Ag/TiO2 coating bracket were measured. First, antibacterial property of nano Ag/TiO2 coating bracket on the common bacteria in oral cavity was studied by sticking membrane method. Secondly, bonding strength of nano TiO2 coating and nano Ag/TiO2 coating bracket in groups were detected by scratching test. The result showed that, the synthetic nano Ag/TiO2 coating was nanogranular films with rigorous organizational structure, presenting as smooth and clean surface, and antibacterial rate of nano Ag/TiO2 coating for the common bacteria in oral cavity for 20 min was more than 79% in the dark. All the findings suggested that, nano Ag/TiO2 coating bracket not only has antibacterial effect but also has good biocompatibility, therefore, it can satisfy the clinical request of orthodontic treatment.

  14. Coexistence of meningioma and glioblastoma multiforme in a same patient: a case report

    International Nuclear Information System (INIS)

    Pereira, C.; Dumont, P.; Romero, P.C.; Lima, J.P.; Caldas, J.G.; Settanni, F.

    1991-01-01

    Tumoral collision has been defined as a coexistence of two or more central nervous system tumors histologically distinct, in a patient not harbouring a neuro-ectodermic disease (phakomatosis). Several theories exist for explaining this phenomenon but most of them assume that there is spacial proximity between the tumors and/or ionizing radiation effects. We report the case of coexistence of meningothelial meningioma and glioblastoma multiforme in a same patient, occurring in different hemispheres on different times. The tomographic aspects of the gliomatous lesion and the difficulty in differentiating by neuroimaging among high grade gliomas and recent hemorrhagic cerebral events are discussed. (author)

  15. Emergency cesarean section in a patient with achondroplasia: A case report

    Directory of Open Access Journals (Sweden)

    M. Mokhtari

    2018-04-01

    Full Text Available Dwarfism occurs when a medical condition causes short stature due to slow growth. Achondroplasia is the commonest form of dwarfism. Some pregnancy problems like significant increase in cesarean section rate, respiratory distress towards the end of pregnancy, preterm labor and delivery and abortion are more prevalent in these patients. Management of pregnancy and delivery are challengeable for obstetricians and anesthesiologist and there are controversies. This case report discusses a 30-year-old achondroplastic primigravida Baluch woman at 37 weeks gestation. She weighed 44 kg and her height was 110 cm. The patient had an emergency cesarean section under general anesthesia.

  16. Anesthetic management of a patient with Bartter’s syndrome: A case report

    Directory of Open Access Journals (Sweden)

    Harun Aydoğan

    2012-09-01

    Full Text Available Bartter’s syndrome is a rare disorder characterized bysevere hypochloremic metabolic alkalosis, hypokalemia,hyponatremia, hyperaldosteronism, elevation in plasmarenin activity and insensitivity to angiotensin II. Electrolyteimbalances such as hypomagnesemia, hyponatremiamight make anesthetic management difficult in Barttersyndrome. A 4 years old patient underwent surgery foringuinal hernia with caudal anesthesia using bupivacaine0.25%. In this case report, it was aimed to discuss the anestheticmanagement of a patient with Bartter syndrome.Key words: Regional anesthesia, Bartter syndrome, inguinalhernia surgery, pediatric anesthesia

  17. Obesity-Related Adipokines Predict Patient-Reported Shoulder Pain

    Directory of Open Access Journals (Sweden)

    Rajiv Gandhi

    2013-12-01

    Full Text Available Background/Aims: Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. Methods: 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire and pain (Short Form McGill Pain Questionnaire measures. Synovial fluid (SF samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. Results: 54% of the cohort was female (n = 27. The mean age (SD of the sample was 62.9 (9.9 years and the mean BMI (SD was 28.1 (5.4 kg/m2. From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p Conclusions: The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets.

  18. Obesity-related adipokines predict patient-reported shoulder pain.

    Science.gov (United States)

    Gandhi, Rajiv; Perruccio, Anthony V; Rizek, Randy; Dessouki, Omar; Evans, Heather M K; Mahomed, Nizar N

    2013-01-01

    Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire) and pain (Short Form McGill Pain Questionnaire) measures. Synovial fluid (SF) samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. 54% of the cohort was female (n = 27). The mean age (SD) of the sample was 62.9 (9.9) years and the mean BMI (SD) was 28.1 (5.4) kg/m(2). From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p < 0.05). Adipokine levels were not associated with functional outcome scores. The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets. © 2013 S. Karger GmbH, Freiburg.

  19. Gabapentin pharmacotherapy for antipsychotic-induced akathisia: single-patient experiment and case report.

    Science.gov (United States)

    Sullivan, Maria A; Wilbur, Robert

    2014-04-01

    This clinical study reports upon the efficacy of gabapentin (Neurontin) for treating severe akathisia (3 on the Barnes Akathisia Rating Scale) in two patients receiving quetiapine (Seroquel), one of whom also received olanzapine (Zyprexa) for a short period. The first patient participated in an open-label experiment in which the bedtime dose of gabapentin was discontinued three times at intervals 1 week apart, resulting in severe akathisia which was quickly terminated by taking his usual 1200 mg gabapentin dose. This patient was also taking high doses of two benzodiazepines and a beta blocker, without therapeutic effect upon his akathisia; only gabapentin was efficacious. The second case is a report of a woman taking a high dose of quetiapine for anxiety who experienced severe akathisia which was relieved by taking 1200 mg of gabapentin. Possible mechanisms of action of gabapentin are discussed. Particular attention is drawn to the difference between neuroleptic-induced akathisia and the neurological condition of restless legs syndrome.

  20. Relationship between patient-reported and objective measurements of hand function in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    S.M. Günay

    2016-12-01

    Full Text Available Rheumatoid arthritis (RA often results in impairments in upper extremities, especially in the small joints of hand. Involvement of hand brings limitations in activities of daily living. However, it is commonly observed that patient-reported functional status of hand does not always corresponds to their actual physical performance in the clinical setting. The aim of this pilot study is to investigate the relationship between patient self-reported and objectively measured hand functions in patients with RA. Twenty-six patients (51±13 years with RA diagnosis participated in the study. Hand grip and pinch (lateral, bipod, tripod strengths were measured and Jebsen Hand Function Test (JHFT was performed for objective functional performance. Duruöz Hand Index and Beck Depression Inventory - Turkish version were completed by patients. Grip and all three-pinch strength results significantly correlated with Duruöz Hand Index scores (p<0.05. JHFT results except the sentence writing also correlated with the Duruöz scores (p<0.05. Our results showed that self-reported outcome scales might be used for determining functional level of hand in patients with RA in rheumatology practice. Objective quantitative functional tests are the best methods in evaluating functional level of hand, but require valid and reliable equipment with accurate calibration. Therefore, in case of unavailability of objective assessment tools, patient-reported scales may also reflect the real status of hand functions.

  1. Doctors discussing religion and spirituality: A systematic literature review.

    Science.gov (United States)

    Best, Megan; Butow, Phyllis; Olver, Ian

    2016-04-01

    Discussion of religion and/or spirituality in the medical consultation is desired by patients and known to be beneficial. However, it is infrequent. We aimed to identify why this is so. We set out to answer the following research questions: Do doctors report that they ask their patients about religion and/or spirituality and how do they do it? According to doctors, how often do patients raise the issue of religion and/or spirituality in consultation and how do doctors respond when they do? What are the known facilitators and barriers to doctors asking their patients about religion and/or spirituality? A mixed qualitative/quantitative review was conducted to identify studies exploring the physician's perspective on discussion of religion and/or spirituality in the medical consultation. We searched nine databases from inception to January 2015 for original research papers reporting doctors' views on discussion of religion and/or spirituality in medical consultations. Papers were assessed for quality using QualSyst and results were reported using a measurement tool to assess systematic review guidelines. Overall, 61 eligible papers were identified, comprising over 20,044 physician reports. Religion and spirituality are discussed infrequently by physicians although frequency increases with terminal illness. Many physicians prefer chaplain referral to discussing religion and/or spirituality with patients themselves. Such discussions are facilitated by prior training and increased physician religiosity and spirituality. Insufficient time and training were the most frequently reported barriers. This review found that physician enquiry into the religion and/or spirituality of patients is inconsistent in frequency and nature and that in order to meet patient needs, barriers to discussion need to be overcome. © The Author(s) 2015.

  2. Periodontal disease in a patient receiving Bevacizumab: a case report

    Directory of Open Access Journals (Sweden)

    Gujral Dorothy M

    2008-02-01

    Full Text Available Abstract Introduction Bevacizumab is a monoclonal antibody that inhibits the action of vascular endothelial growth factor (VEGF thereby acting as an angiogenesis inhibitor. As a result, supply of oxygen and nutrients to tissues is impaired and tumour cell growth is reduced. Reported side effects due to bevacizumab are hypertension and increased risk of bleeding. Bowel perforation has also been reported. Periodontal disease in patients on bevacizumab therapy has not been reported before. Case Presentation We report a case of a forty-three year old woman who developed periodontitis whilst receiving bevacizumab for lung cancer. The periodontal disease remained stable on discontinuation of the drug. Conclusion Further investigations are needed to determine the mechanism for bevacizumab-induced periodontal disease.

  3. Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying

    OpenAIRE

    Pino, Marco; Parry, Ruth; Land, Victoria; Faull, Christina; Feathers, Luke; Seymour, Jane

    2016-01-01

    Objective\\ud To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL)\\ud talk. To examine whether the practice of “eliciting and responding to cues”, which has been\\ud widely advocated in the EoL care literature, promotes EoL talk.\\ud Design\\ud Conversation analysis of video- and audio-recorded consultations.\\ud Participants\\ud Unselected terminally ill patients and their companions in consultation with experienced palliative\\ud medicine doctors.\\ud Setting\\ud O...

  4. Trajectories of Patient-Reported Health Status in Patients With an Implantable Cardioverter Defibrillator

    DEFF Research Database (Denmark)

    Mastenbroek, Mirjam H; Denollet, Johan; Versteeg, Henneke

    2015-01-01

    , no use of ACE inhibitors, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer mental health status. In conclusion, the population with an ICD seems to be heterogeneous in terms of patient-reported physical and mental health status......To date, no study has assessed the course of patient-reported health status in patients with an implantable cardioverter defibrillator (ICD). Studying health status trajectories and their baseline determinants would permit the identification of patients at risk for poor health outcomes after ICD...... implantation. A combined cohort of 1,222 patients with an ICD (79% men; age = 61.4 [11.2] years) completed the 12-Item Short-Form Health Survey at baseline and 2 to 3 months and 12 to 14 months after implantation. Latent class analyses were used to identify trajectories and predictors of health status over...

  5. Ectodermal Dysplasia: Report and Analysis of Eleven South Indian Patients with Review of Literature

    Directory of Open Access Journals (Sweden)

    Renuka Ammanagi

    2010-01-01

    Full Text Available Ectodermal dysplasia represents a rare syndrome affecting two or more ectodermally derived structures. The condition is thought to occur in approximately 1 in every 100,000 live births. It affects men more frequently and severely, while women being the carriers and heterozygote usually show minor defects. There are more than 150 different variants of ectodermal dysplasia (ED reported in the literature. Most commonly encountered among them is hypohidrotic ED which frequently exhibits the most severe dental anomalies like hypodontia or anodontia along with hypohidrosis and hypotrichosis. Here we make an attempt to collectively report and discuss eleven South Indian patients who reported to our department during the year 1998 to 2004. An added emphasis is laid on family history of consanguineous marriage among the parents of these patients.

  6. Focus group discussions

    CERN Document Server

    Hennink, Monique M

    2014-01-01

    The Understanding Research series focuses on the process of writing up social research. The series is broken down into three categories: Understanding Statistics, Understanding Measurement, and Understanding Qualitative Research. The books provide researchers with guides to understanding, writing, and evaluating social research. Each volume demonstrates how research should be represented, including how to write up the methodology as well as the research findings. Each volume also reviews how to appropriately evaluate published research. Focus Group Discussions addresses the challenges associated with conducting and writing focus group research. It provides detailed guidance on the practical and theoretical considerations in conducting focus group discussions including: designing the discussion guide, recruiting participants, training a field team, moderating techniques and ethical considerations. Monique Hennink describes how a methodology section is read and evaluated by others, such as journal reviewers or ...

  7. Plutonium roundtable discussion

    International Nuclear Information System (INIS)

    Penneman, R.A.

    1982-01-01

    The roundtable discussion began with remarks by the chairman who pointed out the complicated nature of plutonium chemistry. Judging from the papers presented at this symposium, he noticed a pattern which indicated to him the result of diminished funding for investigation of basic plutonium chemistry and funding focused on certain problem areas. Dr. G.L. silver pointed to plutonium chemists' erroneous use of a simplified summary equation involving the disproportionation of Pu(EV) and their each of appreciation of alpha coefficients. To his appreciation of alpha coefficients. To his charges, Dr. J.T. Bell spoke in defense of the chemists. This discussion was followed by W.W. Schulz's comments on the need for experimental work to determine solubility data for plutonium in its various oxidation states under geologic repository conditions. Discussion then turned to plutonium pyrachemical process with Dana C. Christensen as the main speaker. This paper presents edited versions of participants' written version

  8. Myocardial revascularization in patient with situs inversus totalis: case report

    Directory of Open Access Journals (Sweden)

    Soncini da Rosa George Ronald

    2002-01-01

    Full Text Available This is a report of an unusual case of a patient, with dextrocardia and a "situs inversus totalis". She presented angina pectoris during an ECG stress test. The coronary arteriography revealed severe obstruction in the main left coronary artery. The patient underwent coronary artery bypass grafting surgery. We did not find a similar case in the national medical literature. The myocardial revascularization performed utilizing the right mammary artery for anterior descending artery and saphenous vein grafts for first diagonal branch and first marginal branch.

  9. Patient-reported outcomes (PROs) in chronic urticaria

    DEFF Research Database (Denmark)

    Moestrup, Kristian; Ghazanfar, Misbah N.; Thomsen, Simon F.

    2017-01-01

    Chronic urticaria is an itching skin disease which persists for more than 6 weeks. Chronic urticaria has great impact on the daily life of the patient, and the fluctuating nature of the symptoms complicates the monitoring and treatment of the disease. Currently, there are no reliable biomarkers...... to identify and measure disease activity in chronic spontaneous urticaria. Consequently, use of patient-reported outcomes (PROs) is crucial when evaluating and monitoring different aspects of chronic urticaria such as disease activity/severity, disease control, and quality of life. We present an overview...... of seven different PROs used in chronic urticaria and highlight their strengths, limitations, and use in clinical practice and research....

  10. To Accept or Refuse Patient's Gift in Money? and How? - Case Report with Review.

    Science.gov (United States)

    Kos, Vesna

    2016-11-01

    This report describes a (rare) situation when a patient's first gift to a young doctor was in money. This happened in very specific circumstances - in a refugee camp during the War in Croatia. The data are taken from a large study on gifts, conducted on a representative sample of Croatian general practitioners (GPs), N = 265, from 2358 in total. Pro and contra factors are discussed, considering tradition and customs, but also a lack of knowledge of young doctors in handling gifts in general. The intention of this report is primarily educative, with review of (scarce) literature, and recommendations, where the generally accepted rules might have exceptions.

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

    DEFF Research Database (Denmark)

    Ibsen, Charlotte; Schiøttz-Christensen, Berit; Handberg, Charlotte

    and ICF Rehabilitation Set. Items in the ICF-PRO are developed within methods and terminology of The Patient-Reported Outcomes Measurement Information System (PROMIS®). The development process contains five phases (figure 1). Results This poster presents preliminary results from phase 1-3. 89...... the focus group identified three themes: 'Simplicity', 'Application' and 'Individuality' representing elements of most importance for the patients toward a patient centered consultation (figure 2). Conclusions We found that ‘Simplicity’, ‘Application’ and ‘Individuality’ was essential to patients to lead...

  12. Learning through synchronous electronic discussion

    NARCIS (Netherlands)

    Kanselaar, G.; Veerman, A.L.; Andriessen, J.E.B.

    2000-01-01

    This article reports a study examining university student pairs carrying out an electronic discussion task in a synchronous computer mediated communication (CMC) system (NetMeeting). The purpose of the assignment was to raise students' awareness concerning conceptions that characterise effective

  13. Discussion on nuclear issues

    International Nuclear Information System (INIS)

    Andrlova, Z.

    2012-01-01

    Treatment of the radioactive waste and utilisation of the ionisation radiation. Interesting contributions to two topics appeared in conference of Slovak Nuclear Society in Casta-Papiernicka in May 2012. The members from the female section 'Women in nuclear sector; were discussing in particular of the mind-set of Europeans to radioactive waste and novelties in nuclear medicine. (author)

  14. Summary of discussion

    International Nuclear Information System (INIS)

    2006-01-01

    This document provides summaries of the discussions occurred during the second international workshop on the indemnification of nuclear damage. It concerns the second accident scenario: a fire on board of a ship transporting enriched uranium hexafluoride along the Danube River. (A.L.B.)

  15. Discussion 2: David Dobbs

    OpenAIRE

    Dobbs, David; Murray-Rust, Peter; Hatcher, Jordan; Pollock, Rufus

    2010-01-01

    David Dobbs writes on science, medicine and culture. He has contributed to a diversity of publications, including Scientific American, Slate magazine, Wired, Audubon, Atlantic Monthly, and the New York Times magazine. He has also authored a number of books. Other participants in this discussion were Peter Murray-Rust, Jordan Hatcher, and Rufus Pollock.

  16. Summary and Discussion.

    Science.gov (United States)

    Hetherington, E. Mavis

    1992-01-01

    Summarizes and discusses results of the longitudinal study that comprises this monograph issue. Results concern: (1) marital, parent-child, and sibling relationships in families with single and remarried mothers; (2) the relationship between parenting style and adolescent adjustment; and (3) the relationship between marital transitions and…

  17. WORKSHOP: Discussion, debate, deliberation

    NARCIS (Netherlands)

    Jeliazkova, Margarita I.

    2014-01-01

    Discussing, deliberating and debating are a core part of any democratic process. To organise these processes well, a great deal of knowledge and skill is required. It is not simple to find a good balance between a number of elements: appropriate language and terminology; paying attention to solid

  18. Profile of rheumatology patients willing to report adverse drug reactions: bias from selective reporting

    Directory of Open Access Journals (Sweden)

    Protić D

    2016-02-01

    Full Text Available Dragana Protić,1 Nada Vujasinović-Stupar,2 Zoran Bukumirić,3 Slavica Pavlov-Dolijanović,4 Snežana Baltić,5 Slavica Mutavdžin,6 Ljiljana Markovic-Denić,7 Marija Zdravković,8 Zoran Todorović1 1Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department 2, Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 3Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 4Department 5, Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 5Department 5, Institute of Rheumatology, Belgrade, Serbia; 6Institute of Physiology “Rihard Burjan”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 7Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 8Department of Cardiology, Medical Center “Bežanijska kosa”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia Background: Adverse drug reactions (ADRs have a significant impact on human health and health care costs. The aims of our study were to determine the profile of rheumatology patients willing to report ADRs and to identify bias in such a reporting system. Methods: Semi-intensive ADRs reporting system was used in our study. Patients willing to participate (N=261 completed the questionnaire designed for the purpose of the study at the hospital admission. They were subsequently classified into two groups according to their ability to identify whether they had experienced ADRs during the previous month. Group 1 included 214 out of 261 patients who were able to identify ADRs, and group 2 consisted of 43 out of 261 patients who were not able to identify ADRs in their recent medical history. Results: Group 1 patients were more significantly aware of their diagnosis than the patients from group 2. Marginal significance was found

  19. Assessment of patient-reported symptoms of anxiety

    Science.gov (United States)

    Rose, Matthias; Devine, Janine

    2014-01-01

    Patient self-reported symptoms are of crucial importance to identify anxiety disorders, as well as to monitor their treatment in clinical practice and research. Thus, for evidence-based medicine, a precise, reliable, and valid (ie, “objective”) assessment of the patient's reported “subjective” symptoms is warranted. There is a plethora of instruments available, which can provide psychometrically sound assessments of anxiety, but there are several limitations of current tools that need to be carefully considered for their successful use. Nevertheless, the empirical assessment of mental health status is not as accepted in medicine as is the assessment of biomarkers. One reason for this may be that different instruments assessing the same psychological construct use different scales. In this paper we present some new developments that promise to provide one common metric for the assessment of anxiety, to facilitate the general acceptance of mental health assessments in the future. PMID:25152658

  20. How, When and Where to Discuss Do Not Resuscitate: A Prospective Study to Compare the Perceptions and Preferences of Patients, Caregivers, and Health Care Providers in a Multidisciplinary Lung Cancer Clinic.

    Science.gov (United States)

    Ahmed, Naseer; Lobchuk, Michelle; Hunter, William M; Johnston, Pam; Nugent, Zoann; Sharma, Ankur; Ahmed, Shahida; Sisler, Jeff

    2015-03-01

    Do Not Resuscitate (DNR) is a significant but challenging part of end-of-life discussions when dealing with incurable lung cancer patients. We have explored the perceptions and preferences of patients, their caregivers (CGs), and health care providers (HCPs) and the current practice and opinions on DNR discussions in a multidisciplinary lung cancer clinic. This is a prospective descriptive study with a mixed quantitative and qualitative methodology to capture perceptions of the participants. To obtain a rich description of participant responses to questionnaire items, we employed a 'think aloud' process that prompted participants to immediately verbalize their thoughts when responding to questionnaire items. We used content analysis and constant comparison techniques to identify, code and categorize primary themes in the captured data. Ten patients with advanced-stage lung cancer; nine CGs from the lung clinic and ten HCPs from the Thoracic Disease Site Group (DSG) were enrolled in the study. Most patients had only a limited understanding of DNR. Most CGs had a fair to good understanding of DNR. Most HCPs perceived their patients to have understood DNR most of the time. When patients were interviewed, a theme of "anticipated discussion" about DNR was identified. Patients and CGs expressed having faith in the system and responsible physicians as to when to discuss DNR. HCPs embraced a clinician preference-based decision-making approach to engaging in DNR discussions. They desired more resources, more knowledge, more structure and more time to discuss DNR. Most HCPs felt that it would be worth conducting a prospective clinical trial to determine the best time to discuss DNR. This pilot study provides a unique mixed quantitative and qualitative understanding of the perceptions of patients with lung cancer and their CGs and HCPs regarding DNR discussion. Our findings will help further the development of evidence-based guidelines and a broad prospective study

  1. Patient-reported outcomes in insomnia: development of a conceptual framework and endpoint model.

    Science.gov (United States)

    Kleinman, Leah; Buysse, Daniel J; Harding, Gale; Lichstein, Kenneth; Kalsekar, Anupama; Roth, Thomas

    2013-01-01

    This article describes qualitative research conducted with patients with clinical diagnoses of insomnia and focuses on the development of a conceptual framework and endpoint model that identifies a hierarchy and interrelationships of potential outcomes in insomnia research. Focus groups were convened to discuss how patients experience insomnia and to generate items for patient-reported questionnaires on insomnia and associated daytime consequences. Results for the focus group produced two conceptual frameworks: one for sleep and one for daytime impairment. Each conceptual framework consists of hypothesized domains and items in each domain based on patient language taken from the focus group. These item pools may ultimately serve as a basis to develop new questionnaires to assess insomnia.

  2. Heparin- induced thrombocytopenia (HIT: a case report of CABG patient

    Directory of Open Access Journals (Sweden)

    Alireza Jahangirifard

    2016-08-01

    Full Text Available Heparin- induced thrombocytopenia (HIT is an antibody mediated adverse effect of heparin therapy which is classified into two subtypes, HITI which is non-immune, spontaneously reversible thrombocytopenia and; HITII which is an autoimmune-mediated adverse effect of heparin therapy. In this case report, we described a 65-year old male patient with HITII after coronary artery bypass grafting.Key words: Heparin- induced thrombocytopenia, Heparin- induced thrombosis, coronary artery bypass grafting.

  3. A Discussion of Patient Safety Programs in the United States Air Force Ground Medical Expeditionary Environment and an Analysis of Potential Solutions for Increasing Their Effectiveness

    Science.gov (United States)

    2017-05-01

    deployed environment . Finally, recommendations are introduced to help realize the ultimate trusted care goal of “zero (patient) harm,” wherever care may...Defense Medical Treatment Facilities (MTFs).10 Specifically, Department of Defense health care organizations were now required to establish “a...expeditionary environment , to the maximum extent possible. Trusted Care begins with me, you, and us all – everywhere and anywhere care may be provided

  4. Testing a new form to document 'Goals-of-Care' discussions regarding plans for end-of-life care for patients in an Australian emergency department.

    Science.gov (United States)

    Mills, Amber C; Levinson, Michele; Dunlop, William A; Cheong, Edward; Cowan, Timothy; Hanning, Jennifer; O'Callaghan, Erin; Walker, Katherine J

    2018-04-16

    There is limited literature to inform the content and format of Goals-of-Care forms, for use by doctors when they are undertaking these important conversations. This was a prospective, qualitative and quantitative study evaluating the utility of a new 'Goals-of-Care' form to doctors in a private, tertiary ED, used from December 2016 to February 2017 at Cabrini, Melbourne. A Goals-of-Care form was designed, incorporating medical aims of therapy and patient values and preferences. Doctors wishing to complete a Not-for-CPR form were also supplied with the trial Goals-of-Care form. Form use, content and patient progress were followed. Doctors completing a form were invited to interview. Forms were used in 3% of attendances, 120 forms were taken for use and 108 were analysed. The median patient age was 91, 81% were Supportive and Palliative Care Indicators Tool (SPICT) positive and patients had a 48% 6-month mortality. A total of 34 doctors completed the forms, 16 were interviewed (two ED trainees, 11 senior ED doctors and three others). Theme saturation was only achieved for the senior doctors interviewed. Having a Goals-of-Care form was valued by 88% of doctors. The frequency of section use was: Aims-of-Care 91%; Quality-of-Life 75% (the term was polarising); Functional Impairments 35%; and Outcomes of Value 29%. Opinions regarding the ideal content and format varied. Some doctors liked free-text space and others tick-boxes. The median duration of the conversation and documentation was 10 min (interquartile range 6-20 min). Having a Goals-of-Care form in emergency medicine is supported; the ideal contents of the form was not determined. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  5. Clinical research in implant dentistry: evaluation of implant-supported restorations, aesthetic and patient-reported outcomes.

    Science.gov (United States)

    Lang, Niklaus P; Zitzmann, Nicola U

    2012-02-01

    The articles discussed in working group 3 dealt with specific aspects of clinical research. In this context, the literature reporting on survival and complication rates of implant-supported or implant-tooth supported restorations in longitudinal studies of at least 5 years were discussed. The second aspect dealt with the evaluation of aesthetic outcomes in clinical studies and the related index systems available. Finally, the third aspect discussed dealt with patient-reported outcome measures (PROMs). A detailed appraisal of the available methodology was presented. © 2012 John Wiley & Sons A/S.

  6. MANAGEMENT OF A PATIENT WITH ARDS: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Preethi Thomas

    2014-12-01

    Full Text Available Acute Respiratory Distress Syndrome (ARDS is a permeability pulmonary edema characterized by increased permeability of pulmonary capillary endothelial cells and alveolar epithelial cells, leading to hypoxemia that is refractory to usual oxygen therapy. ARDS is characterized by a brief precipitating event followed by rapidly developing dyspnea. These patients have markedly impaired respiratory system compliance and reduced lung volume. The hypoxemia is refractory to low fraction of oxygen concentration and low positive end expiratory pressure (PEEP. The mortality of ARDS is around 35-40%. Current therapy of ARDS resolves around treatment of underlying cause, lung protective ventilatory strategy and appropriate fluid management. We present a case of ARDS managed in our ICU along with a detailed discussion about the pathophysiology and treatment modalities for the management of a patient with ARDS.

  7. Proceedings of Patient Reported Outcome Measure?s (PROMs) Conference Sheffield 2016: advances in patient reported outcomes research

    OpenAIRE

    Croudace, Tim; Brazier, John; Gutacker, Nils; Street, Andrew; Robotham, Dan; Waterman, Samantha; Rose, Diana; Satkunanathan, Safarina; Wykes, Til; Nasr, Nasrin; Enderby, Pamela; Carlton, Jill; Rowen, Donna; Elliott, Jackie; Brazier, John

    2016-01-01

    Table of contents S1 Using computerized adaptive testing Tim Croudace S2 Well-being: what is it, how does it compare to health and what are the implications of using it to inform health policy John Brazier O1 “Am I going to get better?”—Using PROMs to inform patients about the likely benefit of surgery Nils Gutacker, Andrew Street O2 Identifying Patient Reported Outcome Measures for an electronic Personal Health Record Dan Robotham, Samantha Waterman, Diana Rose, Safarina Satkunanathan, Til W...

  8. Panel discussion : contract design

    Energy Technology Data Exchange (ETDEWEB)

    Vallas, A. [Sempra Energy Trading, Toronto, ON (Canada); Vegh, G. [MacLeod Dixon, Toronto, ON (Canada); McGee, M. [Energy Profiles Ltd., Etobicoke, ON (Canada); Zaremba, T. [Direct Energy Marketing, Calgary, AB (Canada); Seshan, A. [Larson and Toubro Information Technology, Toronto, ON (Canada); Harricks, P. [Gowlings, Toronto, ON (Canada); Bertoldi, L. [Borden Ladner Gervais, Toronto, ON (Canada); Taylor, R. [Hydro One Networks Inc., Markham, ON (Canada)

    2003-05-01

    This session presented highlights of the comments of 8 panelists who discussed the issue of contract design. The new electricity market in Ontario has introduced the energy trader, who enters into a contract with the consumer, based on the spot price set by the Independent Electricity Market Operator. Every contract has a fixed price payer as well as floating-price payers. If the floating price for a given amount of energy is higher than the fixed price, then the consumer gets the difference. Confusion, however, arises with the purchase of retail physical power in the market, particularly in deciding a fixed rate that the consumer will be paying. Different billing options were also discussed with emphasis on mid to large retail customers that have portfolios in the tens of MW and up to 100 MW or more. figs.

  9. Panel discussion : contract design

    International Nuclear Information System (INIS)

    Vallas, A.; Vegh, G.; McGee, M.; Zaremba, T.; Seshan, A.; Harricks, P.; Bertoldi, L.; Taylor, R.

    2003-01-01

    This session presented highlights of the comments of 8 panelists who discussed the issue of contract design. The new electricity market in Ontario has introduced the energy trader, who enters into a contract with the consumer, based on the spot price set by the Independent Electricity Market Operator. Every contract has a fixed price payer as well as floating-price payers. If the floating price for a given amount of energy is higher than the fixed price, then the consumer gets the difference. Confusion, however, arises with the purchase of retail physical power in the market, particularly in deciding a fixed rate that the consumer will be paying. Different billing options were also discussed with emphasis on mid to large retail customers that have portfolios in the tens of MW and up to 100 MW or more. figs

  10. Discussion with CERN Directorate

    CERN Document Server

    CERN. Geneva

    2017-01-01

    Please note that the Discussion with CERN Directorate will be transmitted also in the following rooms: Council Chamber - 503-1-001 IT Amphitheatre - 31-3-004 Prevessin 774-R-013 Simultaneous interpreting into French and English will be available in the Main Auditorium. Une interprétation simultanée en français et en anglais sera disponible dans l'amphithéâtre principal.

  11. Patients Reporting Ritual Abuse in Childhood: A Clinical Syndrome. Report of 37 Cases.

    Science.gov (United States)

    Young, Walter C.; And Others

    1991-01-01

    Thirty-seven adult dissociative disorder patients who reported ritual abuse in childhood by satanic cults are described. A clinical syndrome is presented that includes dissociative states with satanic overtones, posttraumatic stress disorder, survivor guilt, unusual fears, and substance abuse. Questions concerning reliability, credibility, and…

  12. Patient-Reported Outcomes in Patients with Chronic Kidney Disease and Kidney Transplant—Part 1

    Directory of Open Access Journals (Sweden)

    Evan Tang

    2018-01-01

    Full Text Available Chronic kidney disease (CKD is a complex medical condition that is associated with several comorbidities and requires comprehensive medical management. Given the chronic nature of the condition, its frequent association with psychosocial distress, and its very significant symptom burden, the subjective patient experience is key toward understanding the true impact of CKD on the patients’ life. Patient-reported outcome measures are important tools that can be used to support patient-centered care and patient engagement during the complex management of patients with CKD. The routine collection and use of patient-reported outcomes (PROs in clinical practice may improve quality of care and outcomes, and may provide useful data to understand the disease from both an individual and a population perspective. Many tools used to measure PROs focus on assessing health-related quality of life, which is significantly impaired among patients with CKD. Health-related quality of life, in addition to being an important outcome itself, is associated with clinical outcomes such as health care use and mortality. In Part 1 of this review, we provide an overview of PROs and implications of their use in the context of CKD. In Part 2, we will review the selection of appropriate measures and the relevant domains of interest for patients with CKD.

  13. 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.

  14. [Nursing methodology applicated in patients with pressure ulcers. Clinical report].

    Science.gov (United States)

    Galvez Romero, Carmen

    2014-05-01

    The application of functional patterns lets us to make a systematic and premeditated nursing assessment, with which we obtain a lot of relevant patient data in an organized way, making easier to analize them. In our case, we use Marjory Gordon's functional health patterns and NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification), NIC (Nursing Intervention Classification) taxonomy. The overall objective of this paper is to present the experience of implementation and development of nursing methodology in the care of patients with pressure ulcers. In this article it's reported a case of a 52-year-old female who presented necrosis of phalanxes in upper and lower limbs and suffered amputations of them after being hospitalized in an Intensive Care Unit. She was discharged with pressure ulcers on both heels. GENERAL ASSESSMENT: It was implemented the nursing theory known as "Gordon's functional health patterns" and the affected patterns were identified. The Second Pattern (Nutritional-Metabolic) was considered as reference, since this was the pattern which altered the rest. EVOLUTION OF THE PATIENT: The patient had a favourable evolution, improving all the altered patterns. The infections symptoms disappeared and the pressure ulcers of both heels healed completely. The application of nursing methodology to care patients with pressure ulcers using clinical practice guidelines, standardized procedures and rating scales of assessment improves the evaluation of results and the performance of nurses.

  15. Cervical peridural calcification in dialysed patients. Report of seven cases

    International Nuclear Information System (INIS)

    Okubo, Yasuhiro; Komura, Masayoshi; Fukuda, Minoru; Yamanaka, Mariko; Inose, Kazuto; Honda, Masanori; Shiraishi, Tateru

    2007-01-01

    Though a variety of bone joint complications are widely recognized in long-term dialysis patients, myelopathy caused by ectopic calcification surrounding the cervical spinal dura has not been reported. We encountered seven patients with the cervical peridural calcification (CPC) and performed surgery on four. The present study investigated the clinical features of this condition. All seven had a dialysis history over 20 years, and the Ca X P product was high. Plain cervical CT scan was the most useful diagnostic tool for CPC, though was quite difficult to establish the diagnosis by plain X-ray, MRI or myelography. Clinical symptoms of CPC resembled those of spinal canal stenosis caused by thickening or ossification of the ligament. The spinal cord in the area of CPC was comppressed with calcified fibrous membrane surrounding the cervical dura mater, swelling and pulsation of spinal cord was obtained after not only excising the vertebral arch but also opening and removing the calcified membrane from the dura. Clinical improvement was obtained only in two patients with a short symptomatic period. Based on these findings, CPC should be recognized as an important complication in dialysed patients. Patients demonstrating any sign of numbness and/or muscle weakness in upper and/or lower limbs should be examined by plain cervical CT scan. If calcification around the spinal dura is identified, surgery should be considered in the early stage. (author)

  16. Glaucoma Patient-Reported Concerns and Associated Factors.

    Science.gov (United States)

    Mogil, Rachel S; Tirsi, Andrew; Lee, Jung Min; Tello, Celso; Park, Sung Chul

    2017-06-01

    To assess the character and degree of concerns of glaucoma patients and identify demographic/clinical factors affecting the concerns. Prospective cross-sectional study. A questionnaire that addressed patients' concerns was administered to consecutive glaucoma patients. Severity of concern was scored with a scale of 0-5 in order of increasing severity. Age, sex, intraocular pressure, visual field (VF) mean deviation (MD), number of antiglaucoma medications, history of glaucoma surgery, and employment status were recorded. Questionnaire results of 152 patients (mean VF MD, -8.03 ± 7.86 dB [better eye] and -16.06 ± 10.22 dB [worse eye]; mean age, 69 ± 14 years) were analyzed. Severity of concern was greatest for general eyesight (2.92/5.00) and visual symptoms (2.78/5.00), followed by activities (2.20/5.00) and socioeconomic factors (2.13/5.00), and then ocular symptoms (1.69/5.00) (P factors correlated with VF MD of the better eye (r = -0.245; P = .003) and age (r = -0.260; P = .001). Glaucoma patients reported varied degrees of concern regarding items associated with quality of life. Certain items may be more concerning than others. Severity of some concerns increased with more severe VF loss, prior glaucoma surgery, or younger age. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Revision of the Word Association Test for assessing associations of patients reporting satanic ritual abuse in childhood.

    Science.gov (United States)

    Leavitt, F; Labott, S M

    1998-11-01

    A growing number of psychiatric patients report satanic ritual abuse, prompting research into this controversial area. In the current study, the Word Association Test (WAT) was modified to assess experience with satanic abuse. Pilot work resulted in norms for two domains: normative and satanic. Female psychiatric patients were compared on their associations in two studies. Based on a sexual history, they were grouped into those reporting sexual abuse, those reporting satanic ritual abuse (SRA), and those without a history of sexual abuse (controls). In both studies, SRA patients gave significantly more total associations, significantly fewer normative associations, and significantly more satanic associations than did the other two groups. These results suggest that an experience base is shared by individuals reporting SRA that is not found in individuals who do not report satanic abuse (even if they do report sexual abuse). The implications of these findings are discussed from the perspective of arguments advanced by advocates and critics of SRA.

  18. Patient-Reported Outcomes and Fatigue in Patients with Chronic Hepatitis C Infection.

    Science.gov (United States)

    Golabi, Pegah; Sayiner, Mehmet; Bush, Haley; Gerber, Lynn H; Younossi, Zobair M

    2017-08-01

    Fatigue is a common symptom. Diagnosis is difficult. Fatigue is often a complex symptom. In the recent years, fatigue has gained considerable amount of attention. It has 2 major types, central and peripheral, which may occur together or alone. Although fatigue has many strong relations with depression and sleep disorders, it is a separate entity. For the diagnosis of fatigue, self-reports and patient-reported outcomes are highly valuable tools because these methods can reflect patients' perceptions. Treating the underlying disease with newly developed direct-acting antivirals often improves the perceived fatigue. Healthy lifestyle changes are the cornerstone of the treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Sleep apnea in patients reporting insomnia or restless legs symptoms.

    Science.gov (United States)

    Bianchi, M T; Goparaju, B; Moro, M

    2016-01-01

    Insomnia and restless legs syndrome (RLS) are defined by self-reported symptoms, and polysomnography (PSG) is not routinely indicated. Occult obstructive sleep apnea (OSA), common even in asymptomatic adults, may complicate management of patients presenting with insomnia or restless legs. To this end, we investigated objective sleep apnea metrics in a large retrospective cohort according to self-reported symptom profiles. We compared sleep apnea findings in patients referred to our center according to self-reported symptoms associated with insomnia, sleep apnea, and restless legs. The cohort included over 1900 adults who underwent diagnostic (n = 1418) or split-night (n = 504) PSGs and completed a symptom and medical history questionnaire. More than 30% of patients who did not endorse any OSA symptoms, but did endorse insomnia or restless legs symptoms, were found to have OSA based on apnea-hypopnea index (AHI) >5 during overnight laboratory testing. Regression models of the full cohort showed that the risk of OSA was related, as expected, to older age, male sex, elevated body mass index, and presence of OSA symptoms. The presence of insomnia symptoms did not alter the risk of OSA. The presence of restless legs symptoms showed a small odds ratio for lowered OSA risk. Objective evidence of OSA occurs similarly in those with insomnia or restless legs symptoms, even among those without self-reported OSA symptoms. Providers should be aware of the potential for occult OSA in populations with insomnia and restless legs, which may complicate their management in addition to presenting an independent medical risk itself. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Welfare's Children. Discussion Paper.

    Science.gov (United States)

    Wiseman, Michael

    States with family cap public assistance policies deny or reduce additional welfare benefits to mothers who conceive and give birth to additional children while they are receiving aid. By 1999, 22 states had family cap policies in place. This paper reports estimates of the number and cost implications of infants conceived by mothers receiving…

  1. [Commissioning of the newly constructed Beijing electron-positron collider BEPC, Beijing, China, and visit to SRRC to discuss magnet manufacturing and measurement methods, Taipei, Taiwan, November 11--27, 1988]: Foreign trip report

    International Nuclear Information System (INIS)

    Weng, W.T.

    1988-01-01

    The traveller was invited to IHEP to participate in the commissioning of the newly constructed Beijing electron-positron collider BEPC, give a status report on the AGS Booster Project and to assess the feasibility of sub-contracting booster sextupoles to IHEP. The trip to SRRC was undertaken to discuss magnet manufacturing and measurement methods

  2. Voices from School and Home: Arkansas Parents and Students Talk about Preparing for the World of Work and the Potential for Youth Apprenticeship. A Report on Focus Group Discussions.

    Science.gov (United States)

    Jobs for the Future, Inc., West Somerville, MA.

    This report summarizes several group discussions with parents of high school students, high school students, and nursing students regarding the world of work and the advantages and disadvantages of a youth apprenticeship program. Section I is an executive summary that describes the methodology, summarizes key attitudes toward youth apprenticeships…

  3. Discussion Club "Profitable Heritage"

    Directory of Open Access Journals (Sweden)

    Marina Tkacheva

    2017-09-01

    Full Text Available The authors and participants of the project and the expert community analyze the problems related to the realization of a big-scale concept of renovation of the historical center “Irkutsk Quarters”. They discuss preservation of wooden architecture of the city, changes in social functions of the territory, inclusion of the new facilities in the fabric of the area, as well as the problems of the territory’s tourist function and preservation of the identity of Irkutsk downtown.

  4. Are patient-reported outcomes predictive of patient satisfaction 5 years after anterior cervical spine surgery?

    Science.gov (United States)

    Schroeder, Gregory D; Coric, Dom; Kim, Han Jo; Albert, Todd J; Radcliff, Kris E

    2017-07-01

    Patient satisfaction is becoming an increasing common proxy for surgical quality; however, the correlation between patient satisfaction and surgical outcomes 2 and 5 years after anterior cervical surgery has not been evaluated. The study aimed to determine if patient satisfaction is predicted by improvement in patient-reported outcomes (PRO) 2 and 5 years after anterior cervical spine surgery. This is a retrospective analysis of prospectively collected data. The sample included patients enrolled in the Food and Drug Administration investigational device exemption clinical trial comparing total disc replacement with Mobi-C cervical artificial disc and anterior cervical discectomy and fusion. The outcome measures were visual analog scale (VAS) neck pain score, Neck Disability Index (NDI), and Short-Form 12-Item scores, as well as patient satisfaction. Receiver operating characteristic curves were used to determine if improvement in different PRO metrics can accurately identify patient satisfaction. Additionally, a logistic regression analysis was performed on the results at 24 months and 60 months to identify independent predictors of patient satisfaction. This research was supported by LDR (Zimmer Biomet) 13785 Research Boulevard - Suite 200 Austin, TX 78750. Data were available for 512 patients at 60 months. At 24 months postoperatively, NDI score improvement (area under the curve [AUC]=0.806), absolute NDI score (AUC=0.823), and absolute VAS neck pain score (AUC=0.808) were all excellent predictors of patient satisfaction. At 60 months postoperatively, NDI score improvement (AUC=0.815), absolute NDI score (AUC=0.839), VAS neck pain score improvement (AUC=0.803), and absolute VAS neck pain score (AUC=0.861) were all excellent predictors of patient satisfaction. In patients undergoing one- and two-level anterior cervical spine surgery, between 2 and 5 years postoperatively, patient satisfaction is significantly predicted by PROs, including the VAS neck score and the

  5. Empowerment: a conceptual discussion.

    Science.gov (United States)

    Tengland, Per-Anders

    2008-06-01

    The concept of 'empowerment' is used frequently in a number of professional areas, from psychotherapy to social work. But even if the same term is used, it is not always clear if the concept denotes the same goals or the same practice in these various fields. The purpose of this paper is to clarify the discussion and to find a plausible and useful definition of the concept that is suitable for work in various professions. Several suggestions are discussed in the paper, for example control over life or health, autonomy, ability, self-efficacy, self-esteem, and freedom, and it is concluded that there are two plausible complementary uses, one as a goal and one as a process or approach. Empowerment as a goal is to have control over the determinants of one's quality of life, and empowerment as a process is to create a professional relation where the client or community takes control over the change process, determining both the goals of this process and the means to use.

  6. Report on ISFG SNP Panel Discussion

    DEFF Research Database (Denmark)

    Butler, John M.; Budowle, B.; Gill, P.

    2008-01-01

    Six scientists presented their views and experience with single nucleotide polymorphism (SNP) markers, multiplexes, and methods regarding their potential application in forensic identity and relationship testing. Benefits and limitations of SNPs were reviewed, as were different SNP marker...

  7. A Young Patient with Temporomandibular Joint Osteoarthritis: Case Report

    Directory of Open Access Journals (Sweden)

    Iva Alajbeg

    2017-01-01

    Full Text Available This paper describes a case of a young patient who sought help because of pain in the right temporomandibular joint (TMJ. She also reported increasing of pain during chewing. Clinical examination revealed limited mouth opening with uncorrected deviation to the ipsilateral side. Palpation of the lateral pole of the right condyle discovered crepitus, and maximum assisted opening elicited a report of “familiar pain”. The diagnosis of osteoarthritis of the TMJ (RDC / TMD criteria, Axis I, Group III was confirmed by CBCT of TMJ. There is no “gold standard” for the management of TMD, but the need for TMD treatment has to be based on precise indications related to the presence of pain, limitation in function of the lower jaw and signs of degenerative joint disease. Conservative, reversible therapeutic procedures are considered as the first choice for TMD treatment and their task is to improve the function of the entire masticatory system. In this case patient was treated with the combination of physical therapy and stabilization splint, in order to reduce the pain and restore the normal function of the lower jaw. At 6 months’ follow-up symptoms have almost completely disappeared, while 3 years later, the patient still has no significant subjective symptoms. In the present case non-invasive therapy was sufficient to bring, otherwise recurrent nature of osteoarthritis, in complete remission and keep it like that for years.

  8. Aneurysmal sub-arachnoid haemorrhage in patients with Noonan syndrome: a report of two cases and review of neurovascular presentations in this syndrome

    International Nuclear Information System (INIS)

    Dineen, R.A.; Lenthall, R.K.

    2004-01-01

    To date, intracranial aneurysms have been reported in two patients with Noonan syndrome. We report two unrelated patients with Noonan syndrome who presented with sub-arachnoid haemorrhage secondary to intracranial aneurysms. These cases are discussed and other cerebrovascular abnormalities that have been described in association with Noonan syndrome are reviewed. Ultrastructural and genetic factors contributing to these associations are considered. (orig.)

  9. Aneurysmal sub-arachnoid haemorrhage in patients with Noonan syndrome: a report of two cases and review of neurovascular presentations in this syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Dineen, R.A.; Lenthall, R.K. [Department of Radiology, University Hospital, Queen' s Medical Centre, NG7 2UH, Nottingham (United Kingdom)

    2004-04-01

    To date, intracranial aneurysms have been reported in two patients with Noonan syndrome. We report two unrelated patients with Noonan syndrome who presented with sub-arachnoid haemorrhage secondary to intracranial aneurysms. These cases are discussed and other cerebrovascular abnormalities that have been described in association with Noonan syndrome are reviewed. Ultrastructural and genetic factors contributing to these associations are considered. (orig.)

  10. A recurrent central giant cell granuloma in a young patient and orthodontic treatment: a case report.

    Science.gov (United States)

    Patel, Devaki; Minhas, Gursharan; Johnson, Paul

    2016-12-01

    Central giant cell granuloma (CGCG) is an uncommon benign intraosseous lesion of the jaw, found predominantly in children and young adults below 30 years of age. The purpose of this article was to present a summary of the current literature and a case report of an 11-year-old boy diagnosed with an aggressive CGCG involving the anterior maxilla that was removed in 2004 and subsequently recurred almost 3 years later in 2006. The presenting features of the patient and the effect of combined surgical and orthodontic treatment for this condition are discussed. This case shows how the dentition was successfully maintained with conservative surgery and orthodontic treatment in spite of the extensive destruction of the supporting bone, and the importance of long-term follow-up. The report also reminds orthodontic practitioners that rare pathological conditions can occur in their child patient groups.

  11. Results and discussion

    International Nuclear Information System (INIS)

    1998-01-01

    The author deals with the experimental study of sorption, desorption and vertical migration of radionuclides in Sr-85 and Cs-137 in selected soil samples from around of NPP Bohunice and NPP Mochovce and other localities of the Slovakia. The influence of different materials [concurrent ions (K + , Ca 2+ , NH 4 + , pH), organic matter (peat) and zeolite, humidity] on kinetic of sorption and desorption of strontium and cesium as well as distribution coefficient (K D ) and transfer coefficients in followed samples of soils were followed. Obtained adsorption isotherm are presented and discussed. Using the Tessiere's sequential extraction analysis a gross variability in binding of radionuclides on soils was found. The obtained results were processed with the correlation analysis and the compartment model

  12. Human Rights That Influence The Mentally Ill Patient In South African Medical Law: A Discussion of Sections 9; 27; 30 and 31 of the Constitution

    Directory of Open Access Journals (Sweden)

    M Swanepoel

    2011-12-01

    Full Text Available The personalised nature of mental illness obscures from general view the intolerable burden of private and public distress that people with serious mental illness carry. Invariably the mentally ill person encounters rejection and humiliation that are in some way tantamount to a "second illness." The combination either disrupts or puts beyond reach the usual personal and social life stages of marriage, family life, raising children, sexual relationships, the choice of treatment, affordable housing, transportation, education and gainful employment. As a result of their lack of financial and social support and their experience of rejection from society, persons with mental illness tend to neglect themselves and their diet, and frequently delay seeking treatment. Against this background, this contribution critically focuses on the human rights that influence the mentally ill patient in South African medical law. Specific attention is paid to the relevance and meaning of sections 9 (the equality clause, 27 (access to health care services, 30 and 31 (language, culture and religion of the Constitution of the Republic of South Africa, 1996.

  13. Clinical and patient reported outcomes of bleaching effectiveness.

    Science.gov (United States)

    Klaric Sever, Eva; Budimir, Zrinka; Cerovac, Matea; Stambuk, Mario; Par, Matej; Negovetic Vranic, Dubravka; Tarle, Zrinka

    2018-01-01

    The objective of this study is to evaluate clinical and patient reported outcomes of different bleaching products. Thirty participants were randomly divided into three bleaching groups (n = 10). Bleaching was performed with high concentrations of hydrogen peroxide (HP) - Boost (40%) and Dash (30%), and with prefabricated splints Bite&White (6% HP). Tooth colour was measured before, immediately after, and 1 and 6 months after the bleaching by using classical shade guide and spectrophotometer. Tooth hypersensitivity was self-rated by patients on the Wong-Baker's face scale. Patient satisfaction was evaluated on a 7-point Likert-type scales that measured perceived performance and importance of different characteristics of bleaching treatment. All products were effective in teeth colour change (ΔE > 3.3), which was significantly higher for Boost (p = .016) and Dash (p = .024) than Bite&White treatment. Perception of hypersensitivity was the highest in Boost group, followed by Dash and Bite&White treatment. Most of the patients were satisfied with final tooth colour, length and comfort during treatment, but were dissatisfied with the stability of bleached tooth colour. Materials with the higher concentrations of bleaching agent demonstrated greater bleaching effectiveness than at-home bleaching product, but also a greater hypersensitivity. Lengthening the treatment process, but achieving a more stable tooth colour may improve the perceived value of a bleaching service.

  14. Patient Satisfaction Reporting After Total Hip Arthroplasty: A Systematic Review.

    Science.gov (United States)

    Kahlenberg, Cynthia A; Nwachukwu, Benedict U; Schairer, William W; Steinhaus, Michael E; Cross, Michael B

    2017-05-01

    This review evaluated the quality of patient satisfaction reporting after total hip arthroplasty. The initial search of the MEDLINE database yielded 755 studies. Twenty-four met the inclusion criteria. Most studies provided level III or IV evidence (n=15, 62.5%). The most common method used to assess satisfaction was the 10-point visual analog scale (7 studies, 29.2%), followed by an ordinal satisfaction scale (6 studies, 25.0%). The quality of evidence was poor, and the methods used to assess satisfaction were not standardized. Further research is needed to define the factors that affect patient satisfaction after total hip arthroplasty and how satisfaction is best measured. [Orthopedics. 2017; 40(3):e400-e404.]. Copyright 2017, SLACK Incorporated.

  15. Patient-reported outcome measures in arthroplasty registries

    DEFF Research Database (Denmark)

    Rolfson, Ola; Bohm, Eric; Franklin, Patricia

    2016-01-01

    The International Society of Arthroplasty Registries (ISAR) Patient-Reported Outcome Measures (PROMs) Working Group have evaluated and recommended best practices in the selection, administration, and interpretation of PROMs for hip and knee arthroplasty registries. The 2 generic PROMs in common use...... are the Short Form health surveys (SF-36 or SF-12) and EuroQol 5-dimension (EQ-5D). The Working Group recommends that registries should choose specific PROMs that have been appropriately developed with good measurement properties for arthroplasty patients. The Working Group recommend the use of a 1-item pain...... should consider the absolute level of pain, function, and general health status as well as improvement, missing data, approaches to analysis and case-mix adjustment, minimal clinically important difference, and minimal detectable change. The Working Group recommends data collection immediately before...

  16. Scientists Shaping the Discussion

    Science.gov (United States)

    Abraham, J. A.; Weymann, R.; Mandia, S. A.; Ashley, M.

    2011-12-01

    Scientific studies which directly impact the larger society require an engagement between the scientists and the larger public. With respect to research on climate change, many third-party groups report on scientific findings and thereby serve as an intermediary between the scientist and the public. In many cases, the third-party reporting misinterprets the findings and conveys inaccurate information to the media and the public. To remedy this, many scientists are now taking a more active role in conveying their work directly to interested parties. In addition, some scientists are taking the further step of engaging with the general public to answer basic questions related to climate change - even on sub-topics which are unrelated to scientists' own research. Nevertheless, many scientists are reluctant to engage the general public or the media. The reasons for scientific reticence are varied but most commonly are related to fear of public engagement, concern about the time required to properly engage the public, or concerns about the impact to their professional reputations. However, for those scientists who are successful, these engagement activities provide many benefits. Scientists can increase the impact of their work, and they can help society make informed choices on significant issues, such as mitigating global warming. Here we provide some concrete steps that scientists can take to ensure that their public engagement is successful. These steps include: (1) cultivating relationships with reporters, (2) crafting clear, easy to understand messages that summarize their work, (3) relating science to everyday experiences, and (4) constructing arguments which appeal to a wide-ranging audience. With these steps, we show that scientists can efficiently deal with concerns that would otherwise inhibit their public engagement. Various resources will be provided that allow scientists to continue work on these key steps.

  17. Recognition of patient-reported impairment in oral aesthetics

    DEFF Research Database (Denmark)

    Dannemand Jensen, Katrine; Øzhayat, Esben Boeskov

    2014-01-01

    Scale (OES). Background variables were: gender, age, work-situation, education-level, marital status, number and location of teeth, wearing a removable dental prosthesis (RDP), and smile line. Results: A significant correlation was found between the overall professional evaluation and the OHIP-Aes score...... of prosthodontic replacements. The oral esthetics was professionally evaluated using the Prosthetic Esthetic Index (PEI), compiling 13 different esthetic aspects and an overall evaluation. The patient-reported impairment was evaluated using the Oral Health Impact Profile Aesthetic (OHIP-Aes) and the Oral Esthetic...

  18. Case report : tuberculosis liver abscess in male alcoholism patient

    Science.gov (United States)

    Siahaan, W. P.; Ginting, F.

    2018-03-01

    A liver abscess often occurs in low-middle income countries such as Indonesia. Two most common liver abscesses are amoebic and pyogenic liver abscess. Data that reported tuberculosis liver abscess (TLA) is extremely rare. A diagnostic criterion for tuberculosis liver abscess is rare and remains unclear. A 52-year-old man developed a TLA which was not associated with any pulmonary or gastrointestinal tract foci of tuberculosis. An ultrasonogram and abdominal scan showed an abscess in the right lobe. We performed paracentesis, and the pus from the lesion was positive tubercular bacilli on acid-fast bacilli staining. The patient was started on systemic antitubercular therapy to which he responded favorably. This report emphasizes the fact that, although a TLA is a very rare entity, it should be included in the differential diagnosis of liver abscess especially in Indonesia where the prevalence of tuberculosis is extremely high.

  19. Final plenary discussion

    International Nuclear Information System (INIS)

    Federline, M.

    2004-01-01

    Rapporteur, chose to highlight other themes and issues from the seminar that appeared to be: - important for successful D and D; - worth further work in an international context; - controversial and worthy of further debate. The five main themes selected were as follows: - stakeholder involvement and communication; - strategy selection; - waste management and clearance; - funding and costs; - satisfying social demands. Various issues were identified under each one of these five themes and, in order to make best use of the time available for discussion, participants were invited to vote on the issues of most importance to them. Subsequent discussion was then focussed on the issues so identified. (author)

  20. Patient-Centered Radiology Reporting: Using Online Crowdsourcing to Assess the Effectiveness of a Web-Based Interactive Radiology Report.

    Science.gov (United States)

    Short, Ryan G; Middleton, Dana; Befera, Nicholas T; Gondalia, Raj; Tailor, Tina D

    2017-11-01

    The aim of this study was to evaluate the effectiveness of a patient-centered web-based interactive mammography report. A survey was distributed on Amazon Mechanical Turk, an online crowdsourcing platform. One hundred ninety-three US women ≥18 years of age were surveyed and then randomized to one of three simulated BI-RADS ® 0 report formats: standard report, Mammography Quality Standards Act-modeled patient letter, or web-based interactive report. Survey questions assessed participants' report comprehension, satisfaction with and perception of the interpreting radiologist, and experience with the presented report. Two-tailed t tests and χ 2 tests were used to evaluate differences among groups. Participants in the interactive web-based group spent more than double the time viewing the report than the standard report group (160.0 versus 64.2 seconds, P < .001). Report comprehension scores were significantly higher for the interactive web-based and patient letter groups than the standard report group (P < .05). Scores of satisfaction with the interpreting radiologist were significantly higher for the web-based interactive report and patient letter groups than the standard report group (P < .01). There were no significant differences between the patient letter and web-based interactive report groups. Radiology report format likely influences communication effectiveness. For result communication to a non-medical patient audience, patient-centric report formats, such as a Mammography Quality Standards Act-modeled patient letter or web-based interactive report, may offer advantages over the standard radiology report. Future work is needed to determine if these findings are reproducible in patient care settings and to determine how best to optimize radiology result communication to patients. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  1. Self-Report of Depressive Symptoms in Low Back Pain Patients.

    Science.gov (United States)

    Crisson, James; And Others

    1986-01-01

    Presents two studies designed to examine the self-report of depressive symptoms in low back pain patients (N=134). Both studies found that patients were more likely to report somatic than cognitive symptoms of depression. Patients with multiple physical findings were not more likely to report somatic symptoms than patients with few physical…

  2. Obstructive Sleep Syndrom in Patient with Plonjon Guatr: Case Report

    Directory of Open Access Journals (Sweden)

    Haldun sevketbeyoglu

    2014-08-01

    Full Text Available A large number of predisposing factors (obesity, nasal obstruction, adenoid hypertrophy, macroglossia, etc. are reported to be associated with obstructive sleep apnea syndrome (OUAS. In addition to these factors, the large goiter and hypothyroidism were reported to be associated with OSAS as well. However, this relationship could not yet be fully demonstrated. In our case related to plonjon goiter, we wanted to show the effect of hyroidectomy to OSAS and #8211;if there is- and the relationship between pressure and OSAS. Two years ago, a 72-year-old female with BMI: 26.8 kg/m2 patient was admitted to our clinic with complaints of respiratory standstill during sleep, snoring, morning headaches and drowsiness during daylight. In the chest X-ray, chest computed tomography and ultrasonography applied to the patient, it was detected that the trachea was deviated to the left due to euthyroid plonjon goiter and severe OSAS and polisomnografisi (PSG was diagnosed for the patient. The patients apnea-hypopnea index (AHI was measured 63.1/h. With the aim of treatment, in 7cm H2O pressure, nasal continuous positive airway pressure (nCPAP was applied to the patient and AHI decreased to the level of 11.4/h. Thyroidectomy was performed one month after the diagnosis. AHI was found 34.8 /h on the PSG applied for the purpose of 8 week-postoperative control. There were recovery on the levels of total sleep time, AHI, obstructive apnea index, hypopnea index, average desaturation index, stage 3 and REM as 16%, 44.8%, 84.7%, 19%, 38.3%, 52.4% and 28% respectively when compared the preoperative term with and postoperative term. It was demonstrated that there was no change of the in the degree of OSAS after thyroidectomy but only some partial improvement in the OSAS. The conclusion that there may be some improvements in nCPAP pressures after thyroidectomy and nCPAP treatment should not be stopped was reached. Also, it should be kept in mind that patients who apply to

  3. Fuel ethanol discussion paper

    International Nuclear Information System (INIS)

    1992-01-01

    In recognition of the potential benefits of ethanol and the merits of encouraging value-added agricultural development, a committee was formed to develop options for the role of the Ontario Ministry of Agriculture and Food in the further development of the ethanol industry in Ontario. A consultation with interested parties produced a discussion paper which begins with an outline of the role of ethanol as an alternative fuel. Ethanol issues which require industry consideration are presented, including the function of ethanol as a gasoline oxygenate or octane enhancer, environmental impacts, energy impacts, agricultural impacts, trade and fiscal implications, and regulation. The ethanol industry and distribution systems in Ontario are then described. The current industry consists of one ethanol plant and over 30 retail stations. The key issue for expanding the industry is the economics of producing ethanol. At present, production of ethanol in the short term depends on tax incentives amounting to 23.2 cents/l. In the longer term, a significant reduction in feedstock costs and a significant improvement in processing technology, or equally significant gasoline price increases, will be needed to create a sustainable ethanol industry that does not need incentives. Possible roles for the Ministry are identified, such as support for ethanol research and development, financial support for construction of ethanol plants, and active encouragement of market demand for ethanol-blended gasolines

  4. Gross Instability After Hip Arthroscopy: An Analysis of Case Reports Evaluating Surgical and Patient Factors.

    Science.gov (United States)

    Yeung, Marco; Memon, Muzammil; Simunovic, Nicole; Belzile, Etienne; Philippon, Marc J; Ayeni, Olufemi R

    2016-06-01

    Gross hip instability is a rare complication after hip arthroscopy, and there is limited literature surrounding this topic. This systematic review investigates cases of gross hip instability after arthroscopy and discusses the risk factors associated with this complication. A systematic search was performed in duplicate for studies investigating gross hip instability after hip arthroscopy up to October 2015. Study parameters including sample size, mechanism and type of dislocation, surgical procedure details, patient characteristics, postoperative rehabilitation protocol, and level of evidence were analyzed. The systematic review identified 9 case reports investigating gross hip instability after hip arthroscopy (10 patients). Anterior dislocation occurred in 66.7% of patients, and most injuries occurred with a low-energy mechanism. Common surgical factors cited included unrepaired capsulotomy (77.8%) and iliopsoas release (33.3%), whereas patient factors included female gender (77.8%), acetabular dysplasia (22.2%), and general ligamentous laxity (11.1%). Postoperative restrictions and protocols were variable and inconsistently reported, and their relation to post-arthroscopy instability was difficult to ascertain. This systematic review discussed various patient, surgical, and postoperative risk factors of gross hip instability after arthroscopy. Patient characteristics such as female gender, hip dysplasia, and ligamentous laxity may be risk factors for post-arthroscopy dislocation. Similarly, surgical risk factors for iatrogenic hip instability may include unrepaired capsulotomies and iliopsoas debridement, although the role of capsular closure in iatrogenic instability is not clear. The influences of postoperative restrictions and protocols on dislocation are also unclear in the current literature. Surgeons should be cognizant of these risk factors when performing hip arthroscopy and be mindful that these factors appear to occur in combination. Level IV

  5. Discussing around HYBUC

    CERN Multimedia

    CERN PhotoLab

    1977-01-01

    Charles Roos (right) illustrates HYBUC - HYperon BUbble Chamber - to Gösta Ekspong. Claude Geles stands on the left. HYBUC was a 50 Hz rapid cycling 30 cm, high precision hydrogen chamber, and was operated in a 11.4 Tesla superconducting magnet for more than 5000 hours. It was built by the Max-Planck-Institut (Munich) and the Vanderbilt University. HYBUC was brought to CERN in 1971 and installed in a specially built, 500 MeV/c, electrostatically-separated, K- beam in the PS North Hall (k16), to obtain polarised Sigma+ and hence allow the measurement of the Sigma+ magnetic moment. The photo was taken there shortly before dismantling (?). (See also Annual Report 1979 p. 19, Fiig 3).

  6. Media attention and the influence on the reporting odds ratio in disproportionality analysis : an example of patient reporting of statins

    NARCIS (Netherlands)

    van Hunsel, Florence; van Puijenbroek, Eugene; van den Berg, Lolkje de Jong; van Grootheest, Kees

    Aim To study the influence of media attention about statins and ADRs on the level of disproportionality, expressed as the reporting odds ratio (ROR) for statins in the Lareb database, based on patients' reports. Methods Patient reports about statins, before and after the broadcast of a consumer

  7. 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

  8. An expanded dengue syndrome patient with manifestation myocarditis: case report

    Science.gov (United States)

    Arifijanto, M. V.; Luqmana, H. P.; Rusli, M.; Bramantono

    2018-03-01

    Dengue infection may manifest asymptomatic, dengue fever, dengue hemorrhagic fever, dengue shock syndrome. However, atypical manifestations in other organs have been increasingly reported and called expanded dengue syndrome. One of the cardiac complications in dengue is myocarditis. An 18-year-old woman complains of high fever since 3 days, epistaxis, chest pain, dyspnea, and vomiting. Laboratory examination obtained thrombocytopenia, hemoconcentration, NS1, IgG-IgM dengue positive, CKMB and Troponin- I increase. Electrocardiogram result ischemic anterior-posterior. Echocardiography results hyperechogenic on myocardial suspicious a myocarditis. The patient was diagnosed with acute myocarditis and dengue hemorrhagic fever. Condition improved after five days of treatment. Cardiac complications in dengue are now increasingly observed with the most common case is myocarditis. The main mechanism of dengue myocarditis is still unknown though both direct viral infection and immune mediated damage have been suggested to be the cause of myocardial damage. The low incidence of dengue myocarditis is because it’s asymptomatic and diagnosis is easily missed. Almost all cases of dengue myocarditis are self-limiting and severe myocarditis leading to dilated cardiomyopathy is extremely rare. There have been reported a patient with dengue hemorrhagic fever with manifestation myocarditis. Condition improve with supportive management.

  9. Friedreich's ataxia cardiomyopathy: case based discussion and management issues.

    LENUS (Irish Health Repository)

    Hanley, A

    2010-04-01

    Cardiac involvement is common in Friedreich\\'s Ataxia and is a common cause of premature death. Evidence regarding treatment of congestive heart failure in patients with Friedreich\\'s Ataxia is lacking. The case of a 31-year-old male with advanced Friedreich\\'s Ataxia who presented with an acute diarrhoeal illness and features of acute heart failure is discussed. We then review the reported cardiac manifestations of Friedreich\\'s Ataxia and discuss management options.

  10. Disease burden and patient reported outcomes among patients with moderate to severe psoriasis: an ethnography study

    Directory of Open Access Journals (Sweden)

    Narayanan S

    2014-12-01

    Full Text Available Siva Narayanan,1 Victoria Guyatt,2 Alessandra Franceschetti,3 Emily L Hautamaki1 1Ipsos Healthcare, Columbia, MD, USA; 2Ipsos Ethnography Centre of Excellence (ECE, London, UK; 3Ipsos Healthcare, London, UK Objectives: To assess the impact of psoriasis on health-related quality of life (HRQoL.Methods: An ethnographic study of patients with moderate to severe psoriasis was conducted in the US, France, Germany, Italy, Spain, UK, Brazil, and Canada to explore patients' views on treatment and the impact of psoriasis on HRQoL. Anthropologists and ethnographers spent a minimum of 5.5 hours with each consented patient and filmed their behaviors in everyday situations. Visual data and notes were analyzed to identify HRQoL-related themes.Results: The study included 50 adult patients. Patients described their appearance with disgust and self-loathing. Frustration was expressed due to a perceived lack of control of their lives. Prior to initiation of biologic treatment, daily rituals absorbed a good part of their day, including applying creams, checking one's appearance, and covering the body. Due to a lack of cultural discourse and patient's difficulty in articulating the impact of psoriasis, partners and family did not know how to react nor did they realize the full extent of the problem, and many patients experienced perceived social discrimination due to psoriasis, leaving them with feelings of isolation. Patients established on biologic treatment noticed a significant physical improvement and regained confidence, but psychosocial impacts, including social isolation, remained.Conclusion: This ethnographic study vividly depicted the unarticulated and emotional impact of psoriasis on the everyday lives of patients and presents an effective method of assessing HRQoL in chronic diseases.Keywords: psoriasis, health-related quality of life, ethnography, patient reported outcomes, conceptual model

  11. Total spinal anesthesia in an achondroplasic patient: case report

    Directory of Open Access Journals (Sweden)

    Amiri H R

    2008-06-01

    Full Text Available Background: Total spinal anesthesia is a complication of lumbar epidural anesthesia following undiagnosed subarachnoid or subdural injection of local anesthetic. Although many achondroplastic dwarfs have a normal spine, catheter insertion may be more problematic with a narrow epidural space making a subarachnoid tap more probable.  Other malformations associated with achondroplasia, such as prolapsed intervertebral discs, reduced interpedicular distance, shortened pedicles, and osteophyte formation, combined with a narrow epidural space may make identification of the space difficult and increases the risk of dural puncture. Furthermore, subarachnoid tap or dural puncture may be hard to recognize if a free flow of CSF is difficult to achieve due spinal stenosis. Yet, for those who meet the criteria, epidural regional anesthesia is frequently preferred over other forms, which often have more or more dangerous side effects in this type of patient.Case report: A 22-year-old achondroplastic male dwarf patient was scheduled for pelvic mass resection and was considered a candidate for continuous epidural anesthesia. The anesthesia became complicated by total spinal anesthesia, which was reversed following supportive management for about two hours.Conclusion: There is significant debate over the composition and volume of the test dose, especially for patients with achondroplasia. We nevertheless recommend repeated test-doses during the accomplishment of epidural anesthesia to exclude unintended intravascular, intrathecal or subdural injection, keeping in mind that a test dose of local anesthetic does not completely prevent complications.

  12. Patient reported outcome measures in male incontinence surgery.

    Science.gov (United States)

    Tran, M G B; Yip, J; Uveili, K; Biers, S M; Thiruchelvam, N

    2014-10-01

    Patient reported outcome measures (PROMs) were used to evaluate outcomes of the artificial urinary sphincter (AUS) and the AdVance™ (American Medical Systems, Minnetonka, MN, US) male sling system (AVMS) for the symptomatic management of male stress urinary incontinence. All male patients with stress urinary incontinence referred to our specialist clinic over a two-year period completed the ICIQ-UI SF (International Consultation on Incontinence Questionnaire on Urinary Incontinence Short Form) and the ICIQ-MLUTS LF (International Consultation on Incontinence Questionnaire on Male Lower Urinary Tract Symptoms Long Form) at consultation as well as at subsequent follow-up appointments. The Wilcoxon signed-rank test for non-parametric paired data was used for pre and postoperative comparisons. The chi-squared test was used for categorical variables. Thirty-seven patients (forty surgical cases) completed a preoperative and at least one follow-up questionnaire. There was a statistically significant improvement in PROMs postoperatively, regardless of mode of surgery (p25) had greater improvement with an AUS than with the AVMS (p<0.01). This prospective study shows that completion and collection of PROMs as part of routine clinical practice is achievable and useful in the assessment of male stress incontinence surgery. PROMs are important instruments to assess effectiveness of healthcare intervention and they are useful adjuncts in surgical studies.

  13. Does CPAP Affect Patient-Reported Voice Outcomes?

    Science.gov (United States)

    Hartke, Vance; Gillespie, Amanda; Smith, Libby J; Soose, Ryan J

    2018-04-01

    Upper aerodigestive tract symptoms are common in patients with obstructive sleep apnea (OSA). It remains unclear whether continuous positive airway pressure (CPAP) improves or worsens these otolaryngology symptoms. As therapy-related side effects limit CPAP adherence, this study aimed to determine if CPAP negatively affects voice, sinonasal, and reflux symptoms of the upper airway. Case series with planned data collection was performed at an academic otolaryngology sleep center. Newly diagnosed patients with OSA were evaluated before and 6 months after initiating CPAP therapy. Data collected included CPAP data download, Reflux Symptom Index (RSI), Epworth Sleepiness Scale (ESS), Voice Handicap Index 10 (VHI-10), Sino-Nasal Questionnaire (SNQ), and oral dryness visual analog scale (VAS). For the 11 CPAP-adherent participants, the RSI significantly improved with CPAP (mean RSI, 22.0-9.5; P = .002); however, the VAS, VHI-10, and SNQ did not change after 6 months of CPAP therapy. In a small sample size, patient-reported voice outcomes (VHI-10) and other upper aerodigestive tract symptoms did not worsen with CPAP; rather, CPAP therapy was associated with a reduction in reflux symptoms.

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

    Directory of Open Access Journals (Sweden)

    Eduardo Barbin Zuccolotto

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

  15. Primary Pericardial Mesothelioma: Report of a Patient and Literature Review

    Directory of Open Access Journals (Sweden)

    Åse Nilsson

    2009-07-01

    Full Text Available Primary mesothelioma of the pericardium is a rare tumor and carries a dismal prognosis. This case report presents a 38-year-old man who suffered from recurrent pericardial fluid. Initial symptoms were unspecific, with dry cough and progressing fatigue. Pericardiocentesis was performed, but analyses for malignant cells and tuberculosis were negative. After recurrence a pericardiectomy was planned. At operation, partial resection of tumor tissue surrounding the heart was performed. Histopathologic examination including immunohistochemical staining for calretinin showed a biphasic mesothelioma. During the postoperative period the patient’s condition ameliorated, but symptoms recurred and the patient died 3 months after diagnosis and 15 months after the first symptoms. At autopsy, the pericardium was transformed by the tumor that also expanded into the mediastinum and had set metastases to the liver. A review of 29 cases presented in the recent literature indicates a higher incidence of malignant pericardial mesothelioma among men than women. Median age was 46 (range, 19–76 years. In pleural mesotheliomas, exposure to asbestos is a known risk factor. However, in primary pericardial mesotheliomas the evidence for asbestos as an etiologic factor seems to be less convincing (3 exposed among 14 cases. Symptoms are often unspecific and cytologic examination of pericardial fluid is seldom conclusive (malignant cells demonstrated in 4/17 cases. Partial resection of the tumor can give a period of symptom reduction. Only a few patients have been treated with chemotherapy. Median survival of patients with pericardial mesotheliomas is approximately 6 months.

  16. Report of an accidental exposure of patients in radiation therapy

    International Nuclear Information System (INIS)

    Almeida, C.E. de; Mota, H.C.

    1997-01-01

    Full text. Accident with radiation therapy patients, when they happen, have a high probability of being very severe. This paper reports an accident that occurred last November in Brazil involving several patients submitted to therapy with clinical electron beams from 6 to 12 MeV. A field response team from the Instituto de Radioprotecao e Dosimetria (IRD), and the Laboratorio de Ciencias Radiologicas (LCR/DBB/UERJ), was sent to identify the causes of the accident and evaluate its consequences. The report suggests several actions to be observed by regulatory authorities, licensees and several other legal persons and individuals with subsidiary responsibilities. Evaluation of radiologic accidents is important because it permits to introduce the lessons learned in the radiation protection system, including design of equipment and installations, radiation procedures and personnel qualification and because it renders and attitude of continuous alert so a non usual event will not run into an accident. The accident A 'flat/sym'interlock problem occurred with the electron beam of a Mevatron-74 linear accelerator. After consulting the physicist, the technicians operated the equipment on the 'research mode' (non-clinical). Later the physicist came to verify the equipment and noticed that the dose rate presented high oscillation and that the 'pgm/norm'key was set to 'pgm'. After setting the control to 'norm'the equipment resumed working and some patients were treated in clinical mode and some in research mode. The machine then stops working and the service personnel were called. On 11/28 the maintenance technician fixed the equipment and the physicist measured the dose rate under 'pgm'mode and notice that it was about eight times over the normal value. COnclusion: the working group concluded that the accident could happen only if the equipment were operated on non-clinical mode. It can be summarized as : The event initiator: the flat/sym interlock. The accident promoter: the

  17. A case report of IPA with chronic mass calcification in a neutropenic patient

    Directory of Open Access Journals (Sweden)

    Sudheesh Raveendran

    2017-06-01

    Full Text Available Aspergillosis is a serious pathologic condition caused by Aspergillus organisms and is frequently seen in immunocompromised patients. Invasive pulmonary aspergillosis (IPA which is rare, has been identified as one of the histological subtypes of aspergillosis. It is one of the rare chronic infectious diseases of respiratory system in China, and presents high morbidity, high drug resistance and specific imaging characteristics. This paper focused on a rare case report of invasive pulmonary aspergillosis with chronic mass calcification. CT imaging was discussed by contrast with clinical manifestations, aiming to survey the invasive pulmonary aspergillosis and the mass calcification and to improve the clinical differential diagnosis.

  18. Subarachnoid and Intracerebral Hemorrhage in Patients with Churg-Strauss Syndrome: Two Case Reports

    Science.gov (United States)

    Go, Myeong Hoon; Park, Jeong Un; Kang, Jae Gyu

    2012-01-01

    Churg-Strauss syndrome (CSS) is a systemic necrotizing vasculitis of the small and medium vessels, associated with extravascular eosinophilic granulomas, peripheral eosinophilia, and asthma. The exact etiology of CSS is unknown. This syndrome commonly affects the lungs, peripheral nerves, skin, heart, and gastrointestinal tract, but rarely the central nervous system. Subarachnoid and intracerebral hemorrhage in CSS patients is extremely rare; however, clinicians should consider that CSS may be a cause of intracranial hemorrhage and its high rate of mortality and morbidity. The authors report on two cases of subarachnoid and intracerebral hemorrhage with CSS and discuss a brief review of CSS. PMID:23210058

  19. Anesthesia management for pregnant patient with Arnold-Chiari malformation type I: A case report

    Directory of Open Access Journals (Sweden)

    Şaban Yalçın

    2012-06-01

    Full Text Available The Arnold-Chiari I malformation (ACM is a congenitalanomaly characterized by downward herniation of thecerebellar tonsils into the spinal canal. The anomaly maypresent in a variety of ways with vague symptoms suchas head and limb pains, vertigo, hypoesthesia, weaknessin the extremities. Diagnosis is often difficult and thereforedelayed. Measurement of intracranial pressure in thesepatients is an important measure thus precautions shoulbe taken for avoidance of increased intracranial pressure.In this case report, we discussed the anesthetic managementof a pregnant patient with Arnold Chiari I malformationwho underwent an emergency caesarean section.

  20. Discussion of the dizziness handicap inventory.

    Science.gov (United States)

    Mutlu, Basak; Serbetcioglu, Bulent

    2013-01-01

    A review of the Dizziness Handicap Inventory (DHI). NUMBER OF STUDIES: Seventy-four studies. Articles published between January 1990 and May 2012 were identified by searches in PubMed electronic database. Of the 227 articles meeting the inclusion criteria 74 were reviewed. These articles are discussed under nine topics; Reliability, validity and internal consistency of the original version of DHI, relationship between vestibular/balance tests and DHI, association between DHI and the other scales related to balance impairments, exploratory factor analysis of the DHI, screening version of DHI, translations of DHI into other languages, the role of DHI to assess the success of the treatment of balance disorder, DHI results in various vestibular disorders, general characteristics of DHI in patients with balance impairment. Self reported measures represent unique pieces of the information important for the management of dizzy patients. DHI is the most widely used self reported measurement of patients with dizziness. It has been translated into fourteen languages, so it is widely accepted.

  1. Patient-reported experiences of patient safety incidents need to be utilized more systematically in promoting safe care.

    Science.gov (United States)

    Sahlström, Merja; Partanen, Pirjo; Turunen, Hannele

    2018-04-16

    To analyze patient safety incidents (PSIs) reported by patients and their use in Finnish healthcare organizations. Cross-sectional study. About 15 Finnish healthcare organizations ranging from specialized hospital care to home care, outpatient and inpatient clinics, and geographically diverse areas of Finland. The study population included all Finnish patients who had voluntarily reported PSI via web-based system in 2009-15. Quantitative analysis of patients' safety reports, inductive content analysis of patients' suggestions to prevent the reoccurrence incidents and how those suggestions were used in healthcare organizations. Patients reported 656 PSIs, most of which were classified by the healthcare organizations' analysts as problems associated with information flow (32.6%) and medications (18%). Most of the incidents (65%) did not cause any harm to patients. About 76% of the reports suggested ways to prevent reoccurrence of PSIs, most of which were feasible, system-based amendments of processes for reviewing or administering treatment, anticipating risks or improving diligence in patient care. However, only 6% had led to practical implementation of corrective actions in the healthcare organizations. The results indicate that patients report diverse PSIs and suggest practical systems-based solutions to prevent their reoccurrence. However, patients' reports rarely lead to corrective actions documented in the registering system, indicating that there is substantial scope to improve utilization of patients' reports. There is also a need for strong patient safety management, including willingness and commitment of HCPs and leaders to learn from safety incidents.

  2. Patient-reported outcomes in Danish implantable cardioverter defibrillator patients with a Sprint Fidelis lead advisory notification

    DEFF Research Database (Denmark)

    Pedersen, Susanne S; Versteeg, Henneke; Nielsen, Jens Cosedis

    2011-01-01

    Few studies have investigated the association between implantable cardioverter defibrillators (ICDs) and lead advisory notifications and patient-reported outcomes (PROs). We examined (i) whether the mode used to inform patients about a device advisory is associated with PROs, and (ii) whether...... patients with a lead subject to a device advisory report poorer PROs than non-advisory controls....

  3. AMCP Partnership Forum: Improving Quality, Value, and Outcomes with Patient-Reported Outcomes.

    Science.gov (United States)

    2018-03-01

    Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions. While there have been significant strides by key health care stakeholders to further the development and use of PROs, there are a number of challenges limiting more widespread use. In light of these current challenges and the potential for PROs to improve health care quality and value, on October 19, 2017, the Academy of Managed Care Pharmacy convened a forum of key stakeholders representing patients, payers, providers, government, and pharmaceutical companies to discuss and identify solutions to the current challenges and barriers to further use of PROs. These discussions informed the development of participants' ideal future state in which PROs maximize the goals of all health care stakeholders and the actionable steps required to make the future state a reality. While stakeholders shared unique perspectives throughout the forum, they had consensus on 2 overarching issues: the importance of PROs in defining value, improving patient care, and implementing value-based payment models and the need for strong organizational and operational systems to achieve optimal adoption and use. Participants identified several key challenges in PRO use and adoption: achieving a representative patient population, inclusion of PRO data in medication labels, the necessity for both standardized and customizable PROs, and operational and organizational barriers to collecting and analyzing PROs. To overcome these challenges, participants recommended that

  4. Development and validation of a patient-reported outcome measure for stroke patients.

    Science.gov (United States)

    Luo, Yanhong; Yang, Jie; Zhang, Yanbo

    2015-05-08

    Family support and patient satisfaction with treatment are crucial for aiding in the recovery from stroke. However, current validated stroke-specific questionnaires may not adequately capture the impact of these two variables on patients undergoing clinical trials of new drugs. Therefore, the aim of this study was to develop and evaluate a new stroke patient-reported outcome measure (Stroke-PROM) instrument for capturing more comprehensive effects of stroke on patients participating in clinical trials of new drugs. A conceptual framework and a pool of items for the preliminary Stroke-PROM were generated by consulting the relevant literature and other questionnaires created in China and other countries, and interviewing 20 patients and 4 experts to ensure that all germane parameters were included. During the first item-selection phase, classical test theory and item response theory were applied to an initial scale completed by 133 patients with stroke. During the item-revaluation phase, classical test theory and item response theory were used again, this time with 475 patients with stroke and 104 healthy participants. During the scale assessment phase, confirmatory factor analysis was applied to the final scale of the Stroke-PROM using the same study population as in the second item-selection phase. Reliability, validity, responsiveness and feasibility of the final scale were tested. The final scale of Stroke-PROM contained 46 items describing four domains (physiology, psychology, society and treatment). These four domains were subdivided into 10 subdomains. Cronbach's α coefficients for the four domains ranged from 0.861 to 0.908. Confirmatory factor analysis supported the validity of the final scale, and the model fit index satisfied the criterion. Differences in the Stroke-PROM mean scores were significant between patients with stroke and healthy participants in nine subdomains (P < 0.001), indicating that the scale showed good responsiveness. The Stroke

  5. Predialysis volume overload and patient-reported sleep duration and quality in patients receiving hemodialysis.

    Science.gov (United States)

    Abreo, Adrian P; Dalrymple, Lorien S; Chertow, Glenn M; Kaysen, George A; Herzog, Charles A; Johansen, Kirsten L

    2017-01-01

    Previous studies of patients with end-stage renal disease have examined the role of fluid shifts on apnea-hypopnea episodes, but the association between volume overload and patient-reported sleep quality or duration has not been well-established. We studied the association between predialysis bioimpedance spectroscopy-derived volume estimates and self-reported sleep quality and duration in 638 patients in the United States Renal Data System ACTIVE/ADIPOSE study receiving hemodialysis from 2009 to 2011. We used questionnaires to assess self-reported sleep duration and quality. We used relative hydration status (fluid overload/extracellular water; FO/ECW) as the primary predictor and examined associations with hours of sleep duration using linear regression. We used multivariable ordinal logistic regression to determine the association between categories of relative hydration status (normal hydration [FO/ECW  15%]) and four levels of difficulty with falling asleep, waking, and returning to sleep. Higher relative hydration status was associated with fewer hours of sleep (-0.31 hours per 10%, 95% confidence interval (CI) -0.49 to -0.13). Compared to the normal hydration group, there was a statistically significant association between higher relative hydration status category and more frequent nighttime waking (OR: mild overhydration 1.92 [95% CI 1.23-2.99], hyperhydration 1.87 [95% CI 1.16-2.99]), a trend toward more difficulty returning to sleep (OR: mild overhydration 1.46 [95% CI 0.94-2.27], hyperhydration 1.52 [95% CI 0.95-2.43]), and no association between relative hydration category and difficulty falling asleep. Hydration status was associated with self-reported sleep duration in patients on dialysis. Future studies should prospectively examine the effects of optimizing fluid status on sleep duration and quality. © 2016 International Society for Hemodialysis.

  6. Mining telemonitored physiological data and patient-reported outcomes of congestive heart failure patients.

    Science.gov (United States)

    Mlakar, Miha; Puddu, Paolo Emilio; Somrak, Maja; Bonfiglio, Silvio; Luštrek, Mitja

    2018-01-01

    This paper addresses patient-reported outcomes (PROs) and telemonitoring in congestive heart failure (CHF), both increasingly important topics. The interest in CHF trials is shifting from hard end-points such as hospitalization and mortality, to softer end-points such health-related quality of life. However, the relation of these softer end-points to objective parameters is not well studied. Telemonitoring is suitable for collecting both patient-reported outcomes and objective parameters. Most telemonitoring studies, however, do not take full advantage of the available sensor technology and intelligent data analysis. The Chiron clinical observational study was performed among 24 CHF patients (17 men and 7 women, age 62.9 ± 9.4 years, 15 NYHA class II and 9 class III, 10 of ishaemic, aetiology, 6 dilated, 2 valvular, and 6 of multiple aetiologies or cardiomyopathy) in Italy and UK. A large number of physiological and ambient parameters were collected by wearable and other devices, together with PROs describing how well the patients felt, over 1,086 days of observation. The resulting data were mined for relations between the objective parameters and the PROs. The objective parameters (humidity, ambient temperature, blood pressure, SpO2, and sweeting intensity) could predict the PROs with accuracies up to 86% and AUC up to 0.83, making this the first report providing evidence for ambient and physiological parameters to be objectively related to PROs in CHF patients. We also analyzed the relations in the predictive models, gaining some insights into what affects the feeling of health, which was also generally not attempted in previous investigations. The paper strongly points to the possibility of using PROs as primary end-points in future trials.

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

    DEFF Research Database (Denmark)

    Ibsen, Charlotte; Schiøttz-Christensen, Berit; Nielsen, Claus Vinther

    Background: Low back pain (LBP) is the leading contributor to years lived with disability. It is a complex biopsychosocial phenomenon where complete differential diagnosis and assessment is difficult and needs to be comprehensive. Therefore a biopsychosocial approach is recommended. Substantial...... pain. Methods: The development of the PRO will be based on ICF Comprehensive Core Set for Low Back Pain and Rehabilitation Set and existing items from the The Patient-Reported Outcomes Measurement Information System (PROMIS®). The development process will be divided into five steps: 1. Linking PROMIS....... Conclusion(s) : A PRO instrument is developed to systematise and qualify the description on functioning among patients with lumbar radicular pain. The development process is in progress and next step is to engage patients and clinicians in the development process.  Implications : With development of this PRO...

  8. 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...

  9. The Role of Patient-Reported Outcome Measures in Value-Based Payment Reform.

    Science.gov (United States)

    Squitieri, Lee; Bozic, Kevin J; Pusic, Andrea L

    2017-06-01

    The U.S. health care system is currently experiencing profound change. Pressure to improve the quality of patient care and control costs have caused a rapid shift from traditional volume-driven fee-for-service reimbursement to value-based payment models. Under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act, providers will be evaluated on the basis of quality and cost efficiency and ultimately receive adjusted reimbursement as per their performance. Although current performance metrics do not incorporate patient-reported outcome measures (PROMs), many wonder whether and how PROMs will eventually fit into value-based payment reform. On November 17, 2016, the second annual Patient-Reported Outcomes in Healthcare Conference brought together international stakeholders across all health care disciplines to discuss the potential role of PROs in value-based health care reform. The purpose of this article was to summarize the findings from this conference in the context of recent literature and guidelines to inform implementation of PROs in value-based payment models. Recommendations for evaluating key perspectives and measurement goals are made to facilitate appropriate use of PROMs to best benefit and amplify the voice of our patients. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  10. Metastasis to the penis in a patient with adenocarcinoma of lung, case report and literature review.

    Science.gov (United States)

    Zheng, Fu-Fu; Zhang, Zhong-Yun; Dai, Yu-Ping; Liang, Yue-You; Deng, Chun-Hua; Tao, Yu

    2009-01-01

    Metastasis of lung cancer to the penis is very rare; it causes various clinical symptoms seriously affecting the quality of life. Early recognition and appropriate management will likely enhance survival in these patients. Here, we report a case of penile metastasis secondary to pulmonary carcinoma along with a review of the literature. One case of penile metastasis secondary to pulmonary carcinoma was detected in a 51-year-old patient who was admitted to the First Affiliated Hospital of Sun Yat-Sen University with persistent cough along with swelling of the perineum and penis. The clinical features, diagnosis, and treatment of this disease along with a relevant literature are reviewed and discussed. A MEDLINE search was performed to identify similar reports in the literature. CT scan revealed lung mass, and a glans penis ulcer and enlargement of inguinal lymph nodes was discovered upon physical examination. CT-guided percutaneous puncture of the lung mass revealed adenocarcinoma of lung, and biopsies of the glans penis ulcer and inguinal lymph nodes confirmed metastatic adenocarcinoma. The patients received chemotherapy and died of acute pulmonary embolism in less than 2 months. Metastasis of lung cancer to the penis is extremely rare. It presents an advanced form of lung cancer, and thus survival is extremely short. Although treatment of penile metastasis is almost always palliative, early recognition may enhance survival for these patients.

  11. Interdisciplinary Trauma Management in an Elderly Patient, A Case Report

    Science.gov (United States)

    Felt, George T; Soolari, Ahmad

    2014-01-01

    The current report reviews a case of mixed dental trauma consequent to a fall by an older patient. The patient’s teeth were forced out of alignment by the trauma and suffered pulpal necrosis. Treatment involved not only healing the acute injuries, but also attending to some subtle delayed problems that became apparent during treatment. Treatments involving endodontics, periodontics, orthodontics, and restorative dentistry were used to address all of the patient’s concerns. This insured that the traumatic occlusion was corrected, appropriate esthetics was restored and normal speech and function was regained. All signs of trauma were recognized, every treatment step was documented, and appropriate follow-up was provided throughout the recovery period. PMID:25419251

  12. Scapulothoracic bursitis in a patient with quadriparesis: a case report.

    Science.gov (United States)

    Seol, Seung Jun; Han, Seung Hoon

    2015-04-01

    Scapulothoracic bursitis is a rare disease and presents as pain or swelling around the bursa of the scapulothoracic articulation. It has been reported to be related to chronic repetitive mechanical stress of the periscapular tissue, trauma, overuse, and focal muscle weakness. The authors experienced an atypical case of scapulothoracic bursitis with shoulder and periscapular pain after quadriparesis.This case implies that muscular atrophy around the scapula and chest wall from quadriparesis may contribute to the development of scapulothoracic bursitis with shoulder and periscapular pain. In addition, clinician should be alert to it as a possible cause when a patient with quadriparesis complains of shoulder and periscapular pain and consider proper diagnostic options such as ultrasonography or magnetic resonance imaging.

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

    Science.gov (United States)

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

    2013-01-01

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

  14. Report made on behalf of the parity mixed commission in charge of proposing a text about the dispositions of the project of energy orientation law remaining to be discussed; Rapport fait au nom de la commission mixte paritaire (1) chargee de proposer un texte sur les dispositions restant en discussion du projet de loi d'orientation sur l'energie

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    The project of energy orientation law aims at fixing the main principles of the French energy policy for the next decades. It foresees: the re-launching of the French nuclear program (building of an experimental European pressurized reactor (EPR)), the reinforcement of the mastery of energy demand (3% per year, creation of energy saving certificates and reinforcement of buildings energy efficiency rules), and the sustain of renewable energies development. This document presents, first, a direct comparison, article by article, of the text adopted in second lecture by the House of Commons, with the text adopted in second lecture by the Senate. Then, a text is proposed for the last dispositions that remained to be discussed and is presented in the second part of the report. (J.S.)

  15. The impact of patients reported flares on functional impairment in rheumatoid arthritis patients with low-disease activity

    DEFF Research Database (Denmark)

    Küttel, Dorota Paulina; Christensen, R.; Primdahl, J.

    2015-01-01

    -term outcomes. Objectives: To investigate whether transient patient reported flares can influence functional disability in patients with established low active RA. Methods: Out of 287 patients from the AMBRA trial (1), 268 RA patients with low disease activity (DAS28CRP MCID of 0.22) was compared across three...

  16. Patient-reported outcomes in European spondyloarthritis patients: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Torre-Alonso JC

    2018-05-01

    Full Text Available Juan Carlos Torre-Alonso,1 Rubén Queiro,2 Marta Comellas,3 Luís Lizán,3,4 Carles Blanch5 1Rheumatology Department, Faculty of Medicine and Health Sciences, University of Oviedo, Hospital Monte Naranco, Oviedo, Spain; 2Rheumatology Division, Hospital Universitario Central de Asturias (HUCA, Oviedo, Spain; 3Outcomes 10, Castellón de la Plana, Spain; 4Medicine Department, Jaime I University, Castellón de la Plana, Spain; 5Health Economics & Market Access, Novartis Pharmaceuticals, Barcelona, Spain Objective: This review aims to summarize the current literature on patient-reported outcomes (PROs in spondyloarthritis (SpA. Patients and methods: We performed a systematic literature review to identify studies (original articles and narrative and systematic reviews regarding PROs (health-related quality of life [HRQoL], satisfaction, preferences, adherence/compliance, and persistence in SpA patients published in the European Union through December 2016. International databases (Medline/PubMed, Cochrane Library, ISI Web of Knowledge, Scopus were searched using keywords in English. The methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine criteria. Results: A total of 26 publications met the inclusion criteria. Generally, studies indicated that SpA has a negative impact on patients’ HRQoL. In patients with ankylosing spondylitis, physical domains were more affected than emotional ones, whereas for psoriatic arthritis, both physical and psychological factors were strongly affected by the disease. Data indicated that biological agents (BAs greatly contributed to improvement in HRQoL in both ankylosing spondylitis and psoriatic arthritis patients. Findings on compliance with BAs were heterogeneous. However, persistence rates exceeded 50% irrespective of the BA administered. Results on preferences indicated that most SpA patients prefer being involved in decisions regarding their treatment and that

  17. Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study

    Science.gov (United States)

    Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

    2015-01-01

    Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. PMID:27227131

  18. Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study.

    Science.gov (United States)

    Hung, Man; Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

    2015-01-01

    Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.

  19. [Anterior rectal duplication in adult patient: a case report].

    Science.gov (United States)

    Rodríguez-Cabrera, J; Villanueva-Sáenz, E; Bolaños-Badillo, L E

    2009-01-01

    To report a case of rectal duplication in the adult and make a literature review. The intestinal duplications are injuries of congenital origin that can exist from the base of the tongue to the anal verge, being the most frequent site at level of terminal ileum (22%) and at the rectal level in 5% To date approximately exist 80 reports in world-wide Literature generally in the pediatric population being little frequent in the adult age. Its presentation could be tubular or cystic. The recommended treatment is the surgical resection generally in block with coloanal anastomosis. A case review of rectal duplication in the adult and the conducted treatment. The case of a patient appears with diagnose of rectal duplication with tubular type,whose main symptom was constipation and fecal impactation. In the exploration was detect double rectal lumen (anterior and posterior) that it above initiates by of the anorectal ring with fibrous ulcer of fibrinoid aspect of 3 approx cm of length x 1 cm wide, at level of the septum that separates both rectal lumina. The rectal duplication is a rare pathology in the adult nevertheless is due to suspect before the existence of alterations in the mechanics of the defecation, rectal prolapse and rectal bleeding,the election treatment is a protectomy with colonic pouch in "J" and coloanal anastomosis.

  20. Pectus patient information website has improved access to care and patient reported outcomes.

    Science.gov (United States)

    Tikka, Theofano; Webb, Joanne; Agostini, Paula; Kerr, Amy; Mannion, Glenn; Steyn, Richard S; Bishay, Ehab; Kalkat, Maninder S; Rajesh, Pala B; Naidu, Babu

    2016-04-26

    Pectus is the most common congenital disorder. Awareness amongst primary care physicians and the general public is poor. NHS commissioning bodies plan to withdraw funding for this surgery because they deem a lack of sufficient evidence of benefit. The purpose of this study is to assess the effects of introducing a patient information website on referral and activity patterns and on patients reported outcomes. We produced an innovative information website, www.pectus.co.uk , accessible to the general public, providing information about pectus deformities; management options and advice about surgery. Referral patterns and number of cases where studied before and after the introduction of the website in 2010. Patients' satisfaction post-op was assessed using the Brompton's single step questionnaire (SSQ). The website had considerable traffic with 2179 hits in 2012, 4983 in 2013 and 7416 in 2014. This has led to 1421 contacts and 372 email enquiries. These emails have resulted in an increased number of patients who have been assessed and go on to have surgery. We asked 59 pectus excavatum patients who were operated from 2008 to 2014 to complete the SSQ. We received 32 replies. Eighty-four percent (16/19) of patients who visited the website and then underwent surgery, found the website useful. All patients scored satisfactorily in SSQ. Even though those who visited the website tended to be more satisfied with the surgical outcomes this did not reach statistical significance. This group of patients said that would have the operation again given the option compared to 76.9 % of the group who did not visit the website before surgery (p=0.031). Despite the fact that patients who visited the website experienced more post-operative complications were equally or more satisfied with post-operative outcomes. The overall SSQ obtainable score was not different for the two subgroups, being more widespread in the group that did not visit the website. The introduction of a pectus

  1. Splenic trauma in a patient with portal hypertension and splenomegaly: A case report

    Directory of Open Access Journals (Sweden)

    Ahmet Topçu

    2017-08-01

    Full Text Available The spleen is the most commonly injured organ in cases of blunt abdominal trauma. Currently, 50-80% of adults with blunt splenic injuries are treated nonoperatively. In this report, we present a blunt abdominal trauma patient having a history of portal hypertension and splenomegaly. In grade 3 and even grade 4 splenic injuries non-operative treatment is recommended in current literature. Management of splenic trauma with a patient with history of splenomegaly and portal hypertension is insufficiently discussed in literature. In presented case, hypersplenism and portal hypertension were burden on hemostasis. Even with massive resuscitation, thrombocyte level decreased to 40.000/mm³ after five hours. But, insistence on non-operative treatment in this situation could be fatal.

  2. Associations Between Relative Value Units and Patient-Reported Back Pain and Disability

    Directory of Open Access Journals (Sweden)

    Laura S. Gold PhD

    2017-01-01

    Full Text Available Objective: To describe associations between health care utilization measures and patient-reported outcomes (PROs. Method: Primary data were collected from patients ≥65 years with low back pain visits from 2011 to 2013. Six PROs of pain and functionality were collected 12 and 24 months after the index visits and total and spine-specific relative value units (RVUs from electronic health records were tabulated over 1 year. We calculated correlation coefficients between RVUs and 12- and 24-month PROs and conducted linear regressions with each 12- and 24-month PRO as the outcome variables and RVUs as predictors of interest. Results: We observed very weak correlations between worse PROs at 12 and 24 months and greater 12-month utilization. In regression analyses, we observed slight associations between greater utilization and worse 12- and 24-month PROs. Discussion: We found that 12-month health care utilization is not strongly associated with PROs at 12 or 24 months.

  3. Diagnosis and Management of a Patient with Congenitally Missing Maxillary First Permanent Molars: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Megha Gupta

    2016-01-01

    Full Text Available Congenitally missing teeth are the most commonly seen dental anomalies. Agenesis of the permanent first molar has the least frequency of all the tooth types, and it usually occurs in association with oligodontia or anodontia. Thus, agenesis of the bilateral maxillary first permanent molar is an extremely rare occurrence, and no such case has been reported in ethnic Saudi Arabian population. We hereby report a case of nonsyndromic bilateral congenitally missing maxillary first permanent molar in an eight-year-old Saudi female patient. Comprehensive oral rehabilitation was done for the patient. The implications of the tooth agenesis are also discussed. The prognosis of this case is presented.

  4. Patient-reported Communication Quality and Perceived Discrimination in Maternity Care.

    Science.gov (United States)

    Attanasio, Laura; Kozhimannil, Katy B

    2015-10-01

    High-quality communication and a positive patient-provider relationship are aspects of patient-centered care, a crucial component of quality. We assessed racial/ethnic disparities in patient-reported communication problems and perceived discrimination in maternity care among women nationally and measured racial/ethnic variation in the correlates of these outcomes. Data for this analysis came from the Listening to Mothers III survey, a national sample of women who gave birth to a singleton baby in a US hospital in 2011-2012. Outcomes were reluctance to ask questions and barriers to open discussion in prenatal care, and perceived discrimination during the birth hospitalization, assessed using multinomial and logistic regression. We also estimated models stratified by race/ethnicity. Over 40% of women reported communication problems in prenatal care, and 24% perceived discrimination during their hospitalization for birth. Having hypertension or diabetes was associated with higher levels of reluctance to ask questions and higher odds of reporting each type of perceived discrimination. Black and Hispanic (vs. white) women had higher odds of perceived discrimination due to race/ethnicity. Higher education was associated with more reported communication problems among black women only. Although having diabetes was associated with perceptions of discrimination among all women, associations were stronger for black women. Race/ethnicity was associated with perceived racial discrimination, but diabetes and hypertension were consistent predictors of communication problems and perceptions of discrimination. Efforts to improve communication and reduce perceived discrimination are an important area of focus for improving patient-centered care in maternity services.

  5. Report on the draft of the law No. 1253 concerning the Revamping and Expanding Domestic Electricity Supply. Volume I. General discussion and Examination of the articles; Rapport sur le projet de loi (no. 1253) relatif a la modernisation et au developpement du service public de l'electricite. Tome I. Discussion generale et Examen des articles

    Energy Technology Data Exchange (ETDEWEB)

    Bataille, Christian [Assemblee Nationale, Paris (France)

    1999-02-11

    This report on the draft of the law No. 1253 concerning the Revamping and Expanding Domestic Electricity Supply is composed of three parts. The first part contains the following three sections: I. The electricity, a commodity as others?; II. The stride towards liberalization; III. France and the opening of electricity market. In turn, the first section addresses the following two subjects: A. The 'classic' approach or recognizing the peculiarity of electricity; B. The European approach or the trend of trivializing the electricity. The second section addresses the subjects titled: A. A long and severe bargaining; B. Directive 96/92/CE of 19 December 1996, a new step in achieving a domestic market of electricity; C. The stage of implementation throughout the member states. The third section presents the current juridical framework and the main problems stipulated in the draft of the law concerning the Revamping and Expanding Domestic Electricity Supply. The second part of this report is devoted to the debates in the Commission of Production and Exchanges and contains the following three sections: I. Auditions; II. General discussion; III. The examination of the articles of the law concerning the Revamping and Expanding Domestic Electricity Supply.

  6. Report on the draft of the law No. 1253 concerning the Revamping and Expanding Domestic Electricity Supply. Volume I. General discussion and Examination of the articles; Rapport sur le projet de loi (no. 1253) relatif a la modernisation et au developpement du service public de l'electricite. Tome I. Discussion generale et Examen des articles

    Energy Technology Data Exchange (ETDEWEB)

    Bataille, Christian [Assemblee Nationale, Paris (France)

    1999-02-11

    This report on the draft of the law No. 1253 concerning the Revamping and Expanding Domestic Electricity Supply is composed of three parts. The first part contains the following three sections: I. The electricity, a commodity as others?; II. The stride towards liberalization; III. France and the opening of electricity market. In turn, the first section addresses the following two subjects: A. The 'classic' approach or recognizing the peculiarity of electricity; B. The European approach or the trend of trivializing the electricity. The second section addresses the subjects titled: A. A long and severe bargaining; B. Directive 96/92/CE of 19 December 1996, a new step in achieving a domestic market of electricity; C. The stage of implementation throughout the member states. The third section presents the current juridical framework and the main problems stipulated in the draft of the law concerning the Revamping and Expanding Domestic Electricity Supply. The second part of this report is devoted to the debates in the Commission of Production and Exchanges and contains the following three sections: I. Auditions; II. General discussion; III. The examination of the articles of the law concerning the Revamping and Expanding Domestic Electricity Supply.

  7. Discussion

    International Nuclear Information System (INIS)

    Mittleman, M.H.

    1985-01-01

    The positive energy projection operators, just described by Prof. Sucher, convert the sick Hamiltonian, H/sub DC/, into a more robust one which can support bound states. They are however still a subject of some controversy. Prof. Grant pointed out that existing computer codes produce remarkable accuracy in numerical calculations which start from H/sub DC/ (with no projection operators) and so he questioned whether these operators were indeed necessary. In response, it was pointed out by several people in the audience that the codes implicitly limit the Dirac-Hartee-Fock wave functions to a normalizable sub-space and that this operation can be described as a projection operator which has the effect of eliminating the negative energy states which are not normalizable. This operation is however, not any of the three projection operators described by Sucher and so the question arises as to the sensitivity of the results (for the energy and wave functions) to the particular projection operators which are used. This appears to be an open question

  8. Use of Diabetes Treatment Satisfaction Questionnaire in Diabetes Care: Importance of Patient-Reported Outcomes

    Directory of Open Access Journals (Sweden)

    Yoshifumi Saisho

    2018-05-01

    Full Text Available The efficacy of diabetes treatment should not be evaluated solely by HbA1c levels as they should also focus on patient-reported outcomes (PROs, such as patient satisfaction, wellbeing and quality of life. The Diabetes Treatment Satisfaction Questionnaire (DTSQ has been developed to assess patient satisfaction with diabetes treatment. DTSQ has been translated into more than 100 languages and is widely used in many countries, since it is relatively easy to answer and is used for both patients with and without medical therapy. Novel therapeutic options, such as insulin analogs, incretin-based therapy and sodium-glucose cotransporter 2 (SGLT2 inhibitors, have been shown to improve patient satisfaction using DTSQ for assessments. DTSQ is not only used for comparisons between different medications or treatment strategies, but also can be used to assess the quality of diabetes care in clinical settings. This is important as an improvement in treatment satisfaction may enhance patients’ self-efficacy and adherence to therapy, leading to the achievement of long-term stable glycemic control and reduced risk of diabetic complications. In this review, we summarize the current topics in DTSQ, introducing our own experience, and discuss the role of PROs in diabetes treatment.

  9. Anton-Babinski syndrome in an old patient: a case report and literature review.

    Science.gov (United States)

    Chen, Jiann-Jy; Chang, Hsin-Feng; Hsu, Yung-Chu; Chen, Dem-Lion

    2015-03-01

    Anton-Babinski syndrome is a rare disease featuring bilateral cortical blindness and anosognosia with visual confabulation, but without dementia or any memory impairment. It has a unique neuropsychiatric presentation and should be highly suspected in those with odd visual loss and imaging evidence of occipital lobe injury. In the case discussed herein, a 90-year-old man presented with bilateral blindness, obvious anosognosia, and vivid visual confabulation, which he had had for 3 days. Brain computed tomography demonstrated recent hypodense infarctions at the bilateral occipital lobes. Thus, the patient was diagnosed with Anton-Babinski syndrome. Because of his age and the thrombolytic therapy during the golden 3 hours after ischemic stroke, the patient received aspirin therapy rather than tissue plasminogen activator or warfarin. He gradually realized he was blind during the following week, but died of pneumonia 1 month later. In the literature, it is difficult to establish awareness of blindness in patients with Anton-Babinski syndrome, but optimistically, in one report, a patient was aware of blindness within 2 weeks, without vision improvement. Our case illustrates that elderly patients with Anton-Babinski syndrome can partially recover and that 1 week is the shortest time for the establishment of awareness of blindness for sufferers without vision improvement. © 2014 The Authors. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.

  10. Yellow fever vaccination during treatment with infliximab in a patient with ulcerative colitis: A case report.

    Science.gov (United States)

    Rüddel, J; Schleenvoigt, B T; Schüler, E; Schmidt, C; Pletz, M W; Stallmach, A

    2016-09-01

    We report the case of a 59-year-old patient who accidentally underwent live vaccination against yellow fever during continuous treatment with the TNF-α-antibody (AB) infliximab for ulcerative colitis. The clinical course showed fever of short duration and elevation of liver enzymes without further clinical complications. Yellow fever viremia was not detectable and protective antibodies were developed. A primary vaccination against yellow fever under infliximab has not been reported in the literature before, although vaccination is an important topic in IBD. Live vaccinations, like Stamaril(®) against yellow fever, are contraindicated during TNF-α-AB treatment. Treatment regimens containing TNF-α-AB are of growing importance, not only in gastroenterology, but also in rheumatology and dermatology. We discuss this topic by presenting our case and reviewing the current literature. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Reliability of patient-reported outcomes in rheumatoid arthritis patients: an observational prospective study.

    Science.gov (United States)

    Studenic, Paul; Stamm, Tanja; Smolen, Josef S; Aletaha, Daniel

    2016-01-01

    Patient-reported outcomes (PROs) such as pain, patient global assessment (PGA) and fatigue are regularly assessed in RA patients. In the present study, we aimed to explore the reliability and smallest detectable differences (SDDs) of these PROs, and whether the time between assessments has an impact on reliability. Forty RA patients on stable treatment reported the three PROs daily over two subsequent months. We assessed the reliability of these measures by calculating intraclass correlation coefficients (ICCs) and the SDDs for 1-, 7-, 14- and 28-day test-retest intervals. Overall, SDD and ICC were 25 mm and 0.67 for pain, 25 mm and 0.71 for PGA and 30 mm and 0.66 for fatigue, respectively. SDD was higher with longer time period between assessments, ranging from 19 mm (1-day intervals) to 30 mm (28-day intervals) for pain, 19 to 33 mm for PGA, and 26 to 34 mm for fatigue; correspondingly, ICC was smaller with longer intervals, and ranged between the 1- and the 28-day interval from 0.80 to 0.50 for pain, 0.83 to 0.57 for PGA and 0.76 to 0.58 for fatigue. The baseline simplified disease activity index did not have any influence on reliability. Lower baseline PRO scores led to smaller SDDs. Reliability of pain, PGA and fatigue measurements is dependent on the tested time interval and the baseline levels. The relatively high SDDs, even for patients in the lowest tertiles of their PROs, indicate potential issues for assessment of the presence of remission. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Energy research and development in the United Kingdom. Report of the Group set up by the Council of the Royal Society to examine, discuss and report on the Department of Energy Paper 'Energy R and D in the United Kingdom - A discussion document' (Energy Paper no. 11)

    International Nuclear Information System (INIS)

    1977-01-01

    Following an Introduction and Summary, the report is in sections, entitled: energy supply and demand, and possible economic futures in the United Kingdom; energy sources available to the United Kingdom (coal; offshore oil; nuclear fission power; nuclear fusion power; alternative power sources, e.g. wave power, solar energy, tidal power); energy conservation; consequential energy R and D strategy. In connection with nuclear fission power it is the opinion of the group that sufficient approval for the UK single commercial fast breeder reactor project should be given so that all the necessary planning and practical studies can be started immediately. Safety and environmental problems should be intensively studied. The group would like to see a much stronger R and D programme concerned with the disposal of nuclear wastes. (U.K.)

  13. Exploring practical approaches to maximising data quality in electronic healthcare records in the primary care setting and associated benefits. Report of panel-led discussion held at SAPC in July 2014.

    Science.gov (United States)

    Dungey, Sheena; Glew, Simon; Heyes, Barbara; Macleod, John; Tate, A Rosemary

    2016-09-01

    Electronic healthcare records provide information about patient care over time which not only affords the opportunity to improve patient care directly through effective monitoring and identification of care requirements but also offers a unique platform for both clinical and service-model research essential to the longer-term development of the health service. The quality of the recorded data can, however, be variable and can compromise the validity of data use both for primary and secondary purposes. In order to explore the challenges and benefits of and approaches to recording high quality primary care electronic records, a Clinical Practice Research Datalink (CPRD) sponsored workshop was held at the Society of Academic Primary Care (SAPC) conference in 2014 with the aim of engaging GPs and other data users. The workshop was held as a structured discussion, led by an expert panel and focused around three questions: (1) What are the data quality priorities for clinicians and researchers? How do these priorities differ or overlap? (2) What challenges might GPs face in provision of good data quality both for treating their patients and for research? Do these aims conflict? (3) What tools (such as data metrics and visualisations or software components) could assist the GP in improving data quality and patient management and could this tie in with analytical processes occurring at the research stage? The discussion highlighted both overlap and differences in the perceived data quality priorities and challenges for different user groups. Five key areas of focus were agreed upon and recommendations determined for moving forward in improving quality. The importance of good high quality electronic healthcare records has been set forth along with the need for a practical user-considered and collaborative approach to its improvement.

  14. To what extent are adverse events found in patient records reported by patients and healthcare professionals via complaints, claims and incident reports?

    Directory of Open Access Journals (Sweden)

    van der Wal Gerrit

    2011-02-01

    Full Text Available Abstract Background Patient record review is believed to be the most useful method for estimating the rate of adverse events among hospitalised patients. However, the method has some practical and financial disadvantages. Some of these disadvantages might be overcome by using existing reporting systems in which patient safety issues are already reported, such as incidents reported by healthcare professionals and complaints and medico-legal claims filled by patients or their relatives. The aim of the study is to examine to what extent the hospital reporting systems cover the adverse events identified by patient record review. Methods We conducted a retrospective study using a database from a record review study of 5375 patient records in 14 hospitals in the Netherlands. Trained nurses and physicians using a method based on the protocol of The Harvard Medical Practice Study previously reviewed the records. Four reporting systems were linked with the database of reviewed records: 1 informal and 2 formal complaints by patients/relatives, 3 medico-legal claims by patients/relatives and 4 incident reports by healthcare professionals. For each adverse event identified in patient records the equivalent was sought in these reporting systems by comparing dates and descriptions of the events. The study focussed on the number of adverse event matches, overlap of adverse events detected by different sources, preventability and severity of consequences of reported and non-reported events and sensitivity and specificity of reports. Results In the sample of 5375 patient records, 498 adverse events were identified. Only 18 of the 498 (3.6% adverse events identified by record review were found in one or more of the four reporting systems. There was some overlap: one adverse event had an equivalent in both a complaint and incident report and in three cases a patient/relative used two or three systems to complain about an adverse event. Healthcare professionals

  15. Sexual Functions in Obsessive Compulsive Disorder Patients: A Case Report

    Directory of Open Access Journals (Sweden)

    Nergis LAPSEKÝLÝ

    2012-12-01

    and ejeculation time of the male patient was 15 minutes. Conclusion: Sexual dysfunction is a common problem in patients with OCD. Patient may have avoidance that may adversely affect her sexuality. If a patient has avoidance about sexuality, the reason of this avoidance may or may not be the usual and expected thought content like avoidance of contamination. The evaluations of OCD patients about control may also adversely affect their sexuallity. The thought leading to avoidance behavior, may vary from patient to patient. However, to identify these thoughts with cognitive interventions and work with them will improve.the patient. [JCBPR 2012; 1(3.000: 178-183

  16. Summary of presentations and discussions

    International Nuclear Information System (INIS)

    Takeuchi, Mitsuo

    2008-01-01

    In December 2007, the Forum on Stakeholder Confidence discussed its theme entitled 'Link between research, development and demonstration (RD and D) and stakeholder confidence'. It was remarked that regulators need a technical demonstration to aid in evaluating the safety case. Local stakeholders appreciate the opportunity to visualise technological arrangements. In both cases, demonstration adds to confidence in the feasibility of solutions. Some believe there is an important role for analogues in communication with stakeholders, if handled with integrity. To explore and benchmark current practices, it was decided to hold a topical session at the 9. regular meeting of the FSC on 4 June 2008 regarding the use of analogues for confidence building. The session opened with an introductory presentation by the session rapporteur. This incorporated input provided for the purpose by FSC members in cooperation with their country's representative to the NEA RWMC 'Integration Group on the Safety Case'. Three speakers then presented the various uses of analogues by implementers, regulators and scientists to build their own confidence; a fourth speaker dealt with the experience of using natural analogues in public information. The presentations addressed the use of analogues in the field of geological disposal of high-level waste (HLW) and long-lived intermediate level (ILW-LL) radioactive waste. Then the FSC participants split into two working groups for discussion. The outcome of these discussions was reported in plenary on 6 June 2008 and it was agreed to publish proceedings of the session. The present summary, prepared by the session rapporteur with input from the NEA Secretariat, captures the main points heard in the course of the event. It combines data from the formal presentations and remarks made in discussion. The latter represent viewpoints expressed by a group whose primary focus is not natural analogues but rather stakeholder interests. The summary and viewpoints

  17. Use of patient-reported outcomes in outpatient settings as a means of patient involvement and self-management support

    DEFF Research Database (Denmark)

    Mejdahl, Caroline; Nielsen, Berit Kjærside; Hjøllund, Niels Henrik Ingvar

    2016-01-01

    Rationale, aims and objectives: Patient-reported outcomes (PROs) are being implemented in clinical practice across different healthcare settings with varying purposes. Involving patients in reporting outcomes may increase their attention to symptoms and thereby support their self-management. The ...... to strengthen patient involvement and securing benefit from PROs.......Rationale, aims and objectives: Patient-reported outcomes (PROs) are being implemented in clinical practice across different healthcare settings with varying purposes. Involving patients in reporting outcomes may increase their attention to symptoms and thereby support their self......-management. The aim of the present study was to describe patients’ experiences with a web-based PRO system where patients complete a PRO questionnaire at home or in the outpatient clinic prior to a consultation. Moreover, the study aimed to explore how PROs influenced the interaction between patients and clinicians...

  18. Oncology patient-reported claims: maximising the chance for success.

    Science.gov (United States)

    Kitchen, H; Rofail, D; Caron, M; Emery, M-P

    2011-01-01

    To review Patient Reported Outcome (PRO) labelling claims achieved in oncology in Europe and in the United States and consider the benefits, and challenges faced. PROLabels database was searched to identify oncology products with PRO labelling approved in Europe since 1995 or in the United States since 1998. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) websites and guidance documents were reviewed. PUBMED was searched for articles on PRO claims in oncology. Among all oncology products approved, 22 were identified with PRO claims; 10 in the United States, 7 in Europe, and 5 in both. The language used in the labelling was limited to benefit (e.g. "…resulted in symptom benefits by significantly prolonging time to deterioration in cough, dyspnoea, and pain, versus placebo") and equivalence (e.g. "no statistical differences were observed between treatment groups for global QoL"). Seven products used a validated HRQoL tool; two used symptom tools; two used both; seven used single-item symptom measures (one was unknown). The following emerged as likely reasons for success: ensuring systematic PRO data collection; clear rationale for pre-specified endpoints; adequately powered trials to detect differences and clinically significant changes; adjusting for multiplicity; developing an a priori statistical analysis plan including primary and subgroup analyses, dealing with missing data, pooling multiple-site data; establishing clinical versus statistical significance; interpreting failure to detect change. End-stage patient drop-out rates and cessation of trials due to exceptional therapeutic benefit pose significant challenges to demonstrating treatment PRO improvement. PRO labelling claims demonstrate treatment impact and the trade-off between efficacy and side effects ultimately facilitating product differentiation. Reliable and valid instruments specific to the desired language, claim, and target population are required. Practical

  19. Developing physician consensus on the reporting of patients with mild cognitive impairment and mild dementia to transportation authorities in a region with mandatory reporting legislation.

    Science.gov (United States)

    Rapoport, Mark J; Naglie, Gary; Herrmann, Nathan; Zucchero Sarracini, Carla; Mulsant, Benoit H; Frank, Christopher; Kiss, Alex; Seitz, Dallas; Vrkljan, Brenda; Masellis, Mario; Tang-Wai, David; Pimlott, Nicholas; Molnar, Frank

    2014-12-01

    To establish consensus among dementia experts about which patients with mild cognitive impairment (MCI) or mild dementia should be reported to transportation authorities. We conducted a literature review of predictors of driving safety in patients with dementia and combined these into 26 case scenarios. Using a modified Delphi technique, case scenarios were reviewed by 38 dementia experts (geriatric psychiatrists, geriatricians, cognitive neurologists and family physicians with expertise in elder care) who indicated whether or not they would report the patient in each scenario to regional transportation authorities and recommend a specialized on-road driving test. Scenarios were presented up to five times to achieve consensus, defined as 85% agreement, and discrepancies were discussed anonymously online. By the end of the fifth iteration, there was cumulative consensus on 18 scenarios (69%). The strongest predictors of decision to report were the combination of caregiver concern about the patient's driving and abnormal Clock Drawing Test, which accounted for 62% of the variance in decision to report at the same time as or without a road test (p driving safety is uncertain for patients with MCI and emphasizes the importance of assessing executive dysfunction and caregiver concern about driving. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  20. Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Englund, Martin; Christensen, Robin

    2017-01-01

    OBJECTIVES: To compare patient reported outcomes from before surgery to 52 weeks after surgery between individuals undergoing arthroscopic partial meniscectomy for traumatic meniscal tears and those for degenerative meniscal tears. DESIGN: Comparative prospective cohort study. SETTING: Four public......-55, and undergoing arthroscopic partial meniscectomy for a traumatic or degenerative meniscal tear (defined by a combination of age and symptom onset). INTERVENTIONS: Both participant groups underwent arthroscopic partial meniscectomy for a meniscal tear, with operating surgeons recording relevant information......% women) with a traumatic or degenerative meniscal tear (n=141, mean age 38.7 years (standard deviation 10.9); n=256, 46.6 years (6.4); respectively) were included in the main analysis. At 52 weeks after arthroscopic partial meniscectomy, 55 (14%) patients were lost to follow-up. Statistically...

  1. Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Englund, Martin; Christensen, Robin

    2017-01-01

    orthopaedic departments in the Region of Southern Denmark. Participants were recruited between 1 February 2013 and 31 January 2014, and at one of the original four hospitals from 1 February 2014 to 31 January 2015. PARTICIPANTS: Individuals selected from Knee Arthroscopy Cohort Southern Denmark, aged 18...... on knee pathology. Patient reported outcomes were recorded via online questionnaires. MAIN OUTCOME MEASURES: Primary outcome was the average between-group difference in change on four of five subscales of the knee injury and osteoarthritis outcome score (KOOS). The four subscales covered pain, symptoms...

  2. The patient-physician partnership in asthma: real-world observations associated with clinical and patient-reported outcomes.

    Science.gov (United States)

    Small, M; Vickers, A; Anderson, P; Kay, S

    2010-09-01

    It is hypothesized that a good partnership between asthma patients and their physicians has a direct and positive influence on the patients' clinical and patient-reported outcomes. Conversely, poor partnership has a detrimental effect on clinical and patient-reported outcomes. This paper uses data from a real-world observational study to define partnership through matched physician and patient data and correlate the quality of partnership with observed clinical and patient-reported outcomes. Data were drawn from Adelphi's Respiratory Disease Specific Programme, a cross-sectional study of consulting patients in five European countries undertaken between June and September 2009. A range of clinical and patient-reported outcomes were observed allowing analysis of the partnership between 2251 asthma patients and their physicians. Analysis demonstrates that the better the partnership between patient and physician, the more likely the patient is to have their asthma condition controlled (PPartnership is also associated with lower impact on lifestyle (Ppartnership is a contributory factor in the improvement of asthma treatment, and patient education may lead to improvement in a patient's ability to contribute to this. Device satisfaction is one of the markers of good partnership.

  3. Cancer-related direct-to-consumer advertising: awareness, perceptions, and reported impact among patients undergoing active cancer treatment.

    Science.gov (United States)

    Abel, Gregory A; Burstein, Harold J; Hevelone, Nathanael D; Weeks, Jane C

    2009-09-01

    Although cancer-related direct-to-consumer advertising (CR-DTCA) is prevalent, little is known about cancer patients' experiences with this controversial medium of medical communication. We administered a 41-item, mailed questionnaire to consecutive patients with breast and hematologic malignancies who were undergoing active treatment at our institution. We assessed awareness of CR-DTCA within the prior year, perceptions of CR-DTCA, and CR-DTCA-prompted patient and provider behaviors. We received 348 completed questionnaires (response rate, 75.0%). Overall, 86.2% reported being aware of CR-DTCA, most frequently from television (77.7%). Awareness did not vary with clinical or sociodemographic factors except that patients were more likely to be aware of CR-DTCA for products specific to their cancer types (P advertised medication, although less than one fifth of those reported receiving a prescription for the advertised medication. The patients in our cohort were highly aware of CR-DTCA. CR-DTCA was found to be accessible and useful; however, it decreased some patients' confidence in their providers' judgment. CR-DTCA prompted a modest amount of patient-provider discussion but infrequent patient-reported changes in therapy.

  4. Delayed Diagnosis of Osteonecrosis of the Jaw (ONJ Associated with Bevacizumab Therapy in Colorectal Cancer Patients: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Francesco Erovigni

    2016-10-01

    Full Text Available Medication-induced Osteonecrosis of the Jaw (MRONJ has been reported not only after use of antiresorptive agents (bisphosphonates and denosumab, but also in cancer patients receiving antiangiogenic agents, alone or combined with antiresorptive drugs. We report two cases of MRONJ observed in colorectal cancer patients after bevacizumab therapy only. MRONJ was diagnosed, respectively, two and seven months after a tooth extraction; both the patients had received two courses of bevacizumab infusions (for a total of 29 and 10 administrations, respectively. We discuss if tooth extraction during or after antiangiogenic therapy could be a potential trigger of MRONJ, but also if an underlying bone disease not evident before oral surgery might be a possible cause. A careful drug history has to be registered by dental specialists in cancer patients before oral surgery and adequate imaging might be obtained to avoid a delayed diagnosis.

  5. The impact of patient and physician computer mediated communication skill training on reported communication and patient satisfaction.

    Science.gov (United States)

    Roter, Debra L; Wexler, Randy; Naragon, Phyllis; Forrest, Brian; Dees, Jason; Almodovar, Astrid; Wood, Julie

    2012-09-01

    The objective was to evaluate parallel patient and physician computer-mediated communication skill training on participants' report of skill use and patient satisfaction. Separate patient and clinician web-tools comprised of over 500, 10-s video clips demonstrating patient-centered skills in various ways. Four clinician members of the American Academy of Family Physicians National Research Network participated by enrolling 194 patients into a randomized patient trial and 29 physicians into a non-randomized clinician trial of respective interventions. All participants completed baseline and follow-up self-report measures of visit communication and satisfaction. Intervention patients reported using more skills than controls in five of six skill areas, including identification of problems/concerns, information exchange, treatment adherence, shared decision-making and interpersonal rapport (all ppost intervention, physicians reported using more skills in the same 5 areas (all pCommunication skill training delivered in a computer mediated format had a positive and parallel impact on both patient and clinician reported use of patient-centered communication and in patient satisfaction. Computer-mediated interventions are cost and time effective thereby increasing patient and clinician willingness to undertake training. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. Structural pathology is not related to patient-reported pain and function in patients undergoing meniscal surgery

    DEFF Research Database (Denmark)

    Christensen, Simon Tornbjerg; Nissen, Nis; Englund, Martin

    2017-01-01

    BACKGROUND: The relationship between meniscal tears and other joint pathologies with patient-reported symptoms is not clear. We investigated associations between structural knee pathologies identified at surgery with preoperative knee pain and function in patients undergoing arthroscopic meniscal...... of meniscal tears questionnaire, supplemented with information extracted from surgery reports. Following hypothesis-driven preselection of candidate variables, backward elimination regressions were performed to investigate associations between patient-reported outcomes and structural knee pathologies. RESULTS...... surgery. METHODS: This study included 443 patients from the Knee Arthroscopy Cohort Southern Denmark (KACS), a prospective cohort following patients 18 years or older undergoing arthroscopic meniscal surgery at 4 hospitals between 1 February 2013 and 31 January 2014. Patient-reported outcomes, including...

  7. An introduction to patient-reported outcome measures (PROMs) in physiotherapy.

    Science.gov (United States)

    Kyte, D G; Calvert, M; van der Wees, P J; ten Hove, R; Tolan, S; Hill, J C

    2015-06-01

    The use of patient-reported outcome measures (PROMs) is set to rise in physiotherapy. PROMs provide additional 'patient-centred' data which is unique in capturing the patient's own opinion on the impact of their disease or disorder, and its treatment, on their life. Thus, PROMs are increasingly used by clinicians to guide routine patient care, or for the purposes of audit, and are already firmly embedded in clinical research. This article seeks to summarise the key aspects of PROM use for physiotherapists, both in routine clinical practice and in the research setting, and highlights recent developments in the field. Generic and condition-specific PROMs are defined and examples of commonly used measures are provided. The selection of appropriate PROMs, and their effective use in the clinical and research settings is discussed. Finally, existing barriers to PROM use in practice are identified and recent physiotherapy PROM initiatives, led by the Royal Dutch Society for Physical Therapy are explored. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. The collective construction of a guide for caregivers of bedridden patients: experience report.

    Science.gov (United States)

    Mendes, Vera Lucia Ferreira; Molini-Avejonas, Daniela Regina; Ribeiro, Allyne; Souza, Luiz Augusto de Paula

    2011-09-01

    This is a qualitative descriptive-exploratory study that adopts as data gathering method the participant observation of healthcare processes carried out by caregivers of bedridden patients from the coverage area of a Family Health Team of a Basic Health Unit (BHU) in São Paulo (SP), Brazil. The aim of this study was to report the construction of a guide for caregivers of bedridden patients and/or patients confined to the home. This guide was prepared based in a partnership among the Family Healthcare (FHT) and the speech-language pathologists and audiologists teams, and the caregivers of patients from the BHU. The guide was motivated by the construction of a common knowledge, with the aim to contribute with the creation of collaborative networks, apt to be places of discussion and exchange of knowledge, in order to optimize the ability of caregivers to early identify situations that require intervention. The networks also contributed to the valorization of caregivers' role; their knowledge on how to perform in daily living activities; overcoming of limitations; demonstration of actions aimed at the physical and mental well-being of the sick person; expansion of the capacity of ownership of processes of illnesses, autonomy and co-responsibility in healthcare. The guide was printed and delivered to FHT members, healthcare professionals and the community. The feedback was positive and, therefore, the guide was successful for the proposed objective.

  9. Human Cloning: Let's Discuss It.

    Science.gov (United States)

    Taras, Loretta; Stavroulakis, Anthea M.; Ortiz, Mary T.

    1999-01-01

    Describes experiences with holding discussions on cloning at a variety of levels in undergraduate biology courses. Discusses teaching methods used and student reactions to the discussions. Contains 12 references. (WRM)

  10. Prevalence of self-reported medical conditions among dental patients

    Directory of Open Access Journals (Sweden)

    Mukhatar A Javali

    2017-01-01

    Conclusion: The results of our study found a high prevalence of medical conditions among patients seeking periodontal treatment, thereby highlighting the need to record patients' medical and dental care history in detail.

  11. [Paroxysmal perceptual alteration in comparison with hallucination--a review of its clinical reports and discussion of its pathophysiological mechanism in the present day, when second generation antipsychotics are widely used].

    Science.gov (United States)

    Watanabe, Ken

    2009-01-01

    The syndrome of paroxysmal perceptual alteration (PPA) was first described by Yamaguchi in 1985. Since then, many PPA cases have been reported, and its pathophysiological mechanism has been proposed: a suppressed (blocked) mesolimbic and mesocortical dopaminergic system and sequential compensatory increase of noradrenergic neuronal activity are crucial for the occurrence of PPA. PPA is characterized by hypersensitivity of perception, psychedelic experience (brightening of colors, sharpening of contrast, visual distortion, etc.), and somatic schema disorder (one feels that one is floating, one's extremities are being pulled and elongated, etc.). PPA in chronic schizophrenic patients occurs abruptly like an attack mainly in the evening, often precipitated by fatigue. During the attack, patients also suffer from mood and thought alteration (anxiety, agitation, depressive mood, and inability to distract their thoughts from one thing), but they are aware that symptoms of PPA are not real and apprehensive about them. The attack ceases gradually and spontaneously while the patient rests or sleeps. These clinical features are clearly different from those of schizophrenic hallucinations. It is believed that PPA is closely related to neuroleptic treatment by conventional antipsychotics. I reported the prevalence of PPA as 4.0% in 1991 when high potential D2 blocking agents were prevailing. The occurrence of PPA has been significantly reduced to the present, when second generation (atypical) antipsychotics are prevailing. However, in my inquiry in 2004, the prevalence of PPA was 3.6% in cases treated with risperidone (RIS), while the rates were 0 in cases treated with olanzapine (OLZ), quetiapine (QTP), and perospirone (PRS). Several cases of PPA have been reported in patients who were treated with OLZ and PRS. Until now, no cases of PPA have been reported who were treated with QTP and aripiprazole (APZ). The prevalence of PPA among cases treated with these second generation

  12. ANANKASTIK PERSONALITY DISORDER IN SCHIZOPHRENIA PARANOID PATIENT: A CASE REPORT

    OpenAIRE

    Damarnegara ..; A. A. Ngr. Andika

    2014-01-01

    Anankastik personality disorder is a health problem that can disturb the activities of person and can accompany a variety of other mental health problems. The patient in thiscase is a patient with an anankastik or obsessive compulsive personality disorder withthe axis I diagnoses is Paranoid Schizophrenia and was given haloperidol 2x5mg, buthave not done psychotherapy because the patient has not been cooperative. Theprognosis is dependent on patient compliance in taking medication and control...

  13. Patient experiences with oily skin: the qualitative development of content for two new patient reported outcome questionnaires.

    Science.gov (United States)

    Arbuckle, Robert; Atkinson, Mark J; Clark, Marci; Abetz, Linda; Lohs, Jan; Kuhagen, Ilka; Harness, Jane; Draelos, Zoe; Thiboutot, Diane; Blume-Peytavi, Ulrike; Copley-Merriman, Kati

    2008-10-16

    To develop the content for two new patient reported outcome (PRO) measures to: a) assess the severity of symptoms; and b) the impact of facial skin oiliness on emotional wellbeing using qualitative data from face to face, and internet focus groups in Germany and the US. Using input from initial treatment satisfaction focus groups (n = 42), a review of relevant literature and expert clinicians (n = 3), a discussion guide was developed to guide qualitative inquiry using Internet focus groups (IFGs). IFGs were conducted with German (n = 26) and US (n = 28) sufferers of oily skin. Questionnaire items were generated using coded transcript data from the focus groups. Cognitive debriefing was conducted online with 42 participants and face to face with an additional five participants to assess the comprehension of the items. There were equal numbers of male and female participants; mean age was 35.4 (SD 9.3) years. On average, participants had had oily skin for 15.2 years, and 74% (n = 40) reported having mild-moderate acne. Participants reported using visual, tactile and sensory (feel without touching their face) methods to evaluate the severity of facial oiliness. Oily facial skin had both an emotional and social impact, and was associated with feelings of unattractiveness, self-consciousness, embarrassment, irritation and frustration. Items were generated for a measure of oily skin severity (Oily Skin Self-Assessment Scale) and a measure of the impact of oily skin on emotional well-being (Oily Skin Impact Scale). Cognitive debriefing resulted in minor changes to the draft items and confirmed their face and content validity. The research provides insight into the experience of having oily skin and illustrates significant difficulties associated with the condition. Item content was developed for early versions of two PRO measures of the symptoms and emotional impact of oily facial skin. The psychometric validation of these measures reported elsewhere.

  14. Patient experiences with oily skin: The qualitative development of content for two new patient reported outcome questionnaires

    Directory of Open Access Journals (Sweden)

    Draelos Zoe

    2008-10-01

    Full Text Available Abstract Objective To develop the content for two new patient reported outcome (PRO measures to: a assess the severity of symptoms; and b the impact of facial skin oiliness on emotional wellbeing using qualitative data from face to face, and internet focus groups in Germany and the US. Methods Using input from initial treatment satisfaction focus groups (n = 42, a review of relevant literature and expert clinicians (n = 3, a discussion guide was developed to guide qualitative inquiry using Internet focus groups (IFGs. IFGs were conducted with German (n = 26 and US (n = 28 sufferers of oily skin. Questionnaire items were generated using coded transcript data from the focus groups. Cognitive debriefing was conducted online with 42 participants and face to face with an additional five participants to assess the comprehension of the items. Results There were equal numbers of male and female participants; mean age was 35.4 (SD 9.3 years. On average, participants had had oily skin for 15.2 years, and 74% (n = 40 reported having mild-moderate acne. Participants reported using visual, tactile and sensory (feel without touching their face methods to evaluate the severity of facial oiliness. Oily facial skin had both an emotional and social impact, and was associated with feelings of unattractiveness, self-consciousness, embarrassment, irritation and frustration. Items were generated for a measure of oily skin severity (Oily Skin Self-Assessment Scale and a measure of the impact of oily skin on emotional well-being (Oily Skin Impact Scale. Cognitive debriefing resulted in minor changes to the draft items and confirmed their face and content validity. Conclusion The research provides insight into the experience of having oily skin and illustrates significant difficulties associated with the condition. Item content was developed for early versions of two PRO measures of the symptoms and emotional impact of oily facial skin. The psychometric validation of

  15. Parsonage-Turner syndrome in a patient with bilateral shoulder pain: A case report.

    Science.gov (United States)

    Ohta, Ryuichi; Shimabukuro, Akira

    2017-11-01

    Objective: Parsonage-Turner syndrome is a peripheral neuropathy characterized by acute onset shoulder pain, myalgia, and sensory disturbances. The present report discusses a rare case of Parsonage-Turner syndrome and highlights the importance of accurate history recording and thorough physical examination for the diagnosis of the disease in rural areas. Patient: A 28-year-old woman presented to our clinic with acute bilateral shoulder pain and difficulty moving her right arm. A diagnosis of Parsonage-Turner syndrome was suspected based on the progression of symptoms, severity of pain, and lack of musculoskeletal inflammation. The diagnosis was confirmed by neurological specialists, and the patient was treated with methylprednisolone, after which her symptoms gradually improved. Discussion: The differential diagnosis of shoulder pain is complicated due to the wide variety of conditions sharing similar symptoms. Accurate history recording and thorough physical examination are required to differentiate among conditions involving the central nerves, peripheral nerves, and nerve plexuses. Conclusion: Although the symptoms of Parsonage-Turner syndrome vary based on disease progression and the location of impairment, proper diagnosis of acute shoulder pain without central neurological symptoms can be achieved in rural areas via thorough examination.

  16. Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study.

    Science.gov (United States)

    Panagioti, Maria; Blakeman, Thomas; Hann, Mark; Bower, Peter

    2017-05-30

    Increasing evidence suggests that patient safety is a serious concern for older patients with long-term conditions. Despite this, there is a lack of research on safety incidents encountered by this patient group. In this study, we sought to examine patient reports of safety incidents and factors associated with reports of safety incidents in older patients with long-term conditions. The baseline cross-sectional data from a longitudinal cohort study were analysed. Older patients (n=3378 aged 65 years and over) with a long-term condition registered in general practices were included in the study. The main outcome was patient-reported safety incidents including availability and appropriateness of medical tests and prescription of wrong types or doses of medication. Binary univariate and multivariate logistic regression analyses were undertaken to examine factors associated with patient-reported safety incidents. Safety incidents were reported by 11% of the patients. Four factors were significantly associated with patient-reported safety incidents in multivariate analyses. The experience of multiple long-term conditions (OR=1.09, 95% CI 1.05 to 1.13), a probable diagnosis of depression (OR=1.36, 95% CI 1.06 to 1.74) and greater relational continuity of care (OR=1.28, 95% CI 1.08 to 1.52) were associated with increased odds for patient-reported safety incidents. Perceived greater support and involvement in self-management was associated with lower odds for patient-reported safety incidents (OR=0.95, 95% CI 0.93 to 0.97). We found that older patients with multimorbidity and depression are more likely to report experiences of patient safety incidents. Improving perceived support and involvement of patients in their care may help prevent patient-reported safety incidents. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Medical students’ experiences of resuscitation and discussions surrounding resuscitation status

    Directory of Open Access Journals (Sweden)

    Aggarwal AR

    2018-01-01

    Full Text Available Asha R Aggarwal, Iqbal Khan Department of Medical Education, Northampton General Hospital, Northampton, UK Objectives: In the UK, cardiopulmonary resuscitation (CPR should be undertaken in the event of cardiac arrest unless a patient has a “Do Not Attempt CPR” document. Doctors have a legal duty to discuss CPR with patients or inform them that CPR would be futile. In this study, final-year medical students were interviewed about their experiences of resuscitation on the wards and of observing conversations about resuscitation status to explore whether they would be equipped to have an informed discussion about resuscitation in the future. Methods: Twenty final-year medical students from two medical schools were interviewed about their experiences on the wards. Interviews were transcribed verbatim, and thematic analysis was undertaken.Results: Students who had witnessed CPR on the wards found that aspects of it were distressing. A significant minority had never seen resuscitation status being discussed with a patient. No students reported seeing a difficult conversation. Half of the students interviewed reported being turned away from difficult conversations by clinicians. Only two of the twenty students would feel comfortable raising the issue of resuscitation with a patient. Conclusion: It is vital that doctors are comfortable talking to patients about resuscitation. Given the increasing importance of this aspect of communication, it should be considered for inclusion in the formal communication skills teaching during medical school. Keywords: undergraduate, communication, DNACPR, palliative care, end of life care

  18. Integrating patient reported outcomes with clinical cancer registry data: a feasibility study of the electronic Patient-Reported Outcomes From Cancer Survivors (ePOCS) system.

    Science.gov (United States)

    Ashley, Laura; Jones, Helen; Thomas, James; Newsham, Alex; Downing, Amy; Morris, Eva; Brown, Julia; Velikova, Galina; Forman, David; Wright, Penny

    2013-10-25

    Routine measurement of Patient Reported Outcomes (PROs) linked with clinical data across the patient pathway is increasingly important for informing future care planning. The innovative electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system was developed to integrate PROs, collected online at specified post-diagnostic time-points, with clinical and treatment data in cancer registries. This study tested the technical and clinical feasibility of ePOCS by running the system with a sample of potentially curable breast, colorectal, and prostate cancer patients in their first 15 months post diagnosis. Patients completed questionnaires comprising multiple Patient Reported Outcome Measures (PROMs) via ePOCS within 6 months (T1), and at 9 (T2) and 15 (T3) months, post diagnosis. Feasibility outcomes included system informatics performance, patient recruitment, retention, representativeness and questionnaire completion (response rate), patient feedback, and administration burden involved in running the system. ePOCS ran efficiently with few technical problems. Patient participation was 55.21% (636/1152) overall, although varied by approach mode, and was considerably higher among patients approached face-to-face (61.4%, 490/798) than by telephone (48.8%, 21/43) or letter (41.0%, 125/305). Older and less affluent patients were less likely to join (both Pplanning and for targeting service provision.

  19. Donor leucocyte imaging in patients with AIDS: A preliminary report

    International Nuclear Information System (INIS)

    O'Doherty, M.J.; Kent and Canterbury Hospital; Revell, P.; Page, C.J.; Nunan, T.O.; Lee, S.; Mountford, P.J.

    1990-01-01

    Four patients with the acquired immunodeficiency syndrome (AIDS) and fever were investigated using donor leucocyte scans. The lung/liver and lung/spleen uptake ratios in these patients were compared with the uptake ratios in donor leucocyte scans in seven neutropenic (non-AIDS) patients and five patients who had autologous leucocyte scans performed over the same time period. All scans used indium oxine In 111 labelled leucocytes except that for one AIDS patient which used technetium hexamethyl-propylene amine oxide Tc99m labelled donor leucocytes. There were no adverse reactions to the donor cell infusions. Two patients had repeat studies 8 weeks apart (from different donors) without ill effect. There were no differences in the 111 In uptake ratios between the three groups. There were three positive studies in the patients with AIDS, and these elucidated the cause of the pyrexia in all three. The negative case is more difficult to confirm, but the clinical course and the absence of focal disease on post-mortem have been taken to support the scan findings. There was no difference in the acceptibility of the technique or the distribution of the labelled leucocytes between the AIDS and non-AIDS patients. Donor leucocyte imaging of patients with AIDS is probably more effective and considerably less hazardous for technical staff than autologous leucocyte methods. This study demonstrates that the technique can be applied successfully to patients with AIDS. (orig.)

  20. Improved patient-reported health impact of multiple sclerosis

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  1. Report made on behalf of the parity mixed commission in charge of proposing a text about the dispositions of the project of energy orientation law remaining to be discussed

    International Nuclear Information System (INIS)

    2005-01-01

    The project of energy orientation law aims at fixing the main principles of the French energy policy for the next decades. It foresees: the re-launching of the French nuclear program (building of an experimental European pressurized reactor (EPR)), the reinforcement of the mastery of energy demand (3% per year, creation of energy saving certificates and reinforcement of buildings energy efficiency rules), and the sustain of renewable energies development. This document presents, first, a direct comparison, article by article, of the text adopted in second lecture by the House of Commons, with the text adopted in second lecture by the Senate. Then, a text is proposed for the last dispositions that remained to be discussed and is presented in the second part of the report. (J.S.)

  2. Prosthetic rehabilitation for a patient with microstomia: a case report

    Directory of Open Access Journals (Sweden)

    Moslehifard E

    2011-04-01

    Full Text Available "nFabrication of dental prosthesis for patients with microstomia has long been a problem for dentists. Microstomia is defined as an abnormally small oral orifice. Prosthetic rehabilitation of microstomia patients presents difficulties at all stages, from the preliminary impressions to fabrication of prosthesis. This study described a method for making impressions for patients with limited opening of the oral cavity which the use of a full-size impression tray was not possible.

  3. ANANKASTIK PERSONALITY DISORDER IN SCHIZOPHRENIA PARANOID PATIENT: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Damarnegara ..

    2014-02-01

    Full Text Available Anankastik personality disorder is a health problem that can disturb the activities of person and can accompany a variety of other mental health problems. The patient in thiscase is a patient with an anankastik or obsessive compulsive personality disorder withthe axis I diagnoses is Paranoid Schizophrenia and was given haloperidol 2x5mg, buthave not done psychotherapy because the patient has not been cooperative. Theprognosis is dependent on patient compliance in taking medication and controls for thesetting of the dose, and the support of her family. 

  4. Interviewing to develop Patient-Reported Outcome (PRO) measures for clinical research: eliciting patients’ experience

    Science.gov (United States)

    2014-01-01

    Patient-reported outcome (PRO) measures must provide evidence that their development followed a rigorous process for ensuring their content validity. To this end, the collection of data is performed through qualitative interviews that allow for the elicitation of in-depth spontaneous reports of the patients’ experiences with their condition and/or its treatment. This paper provides a review of qualitative research applied to PRO measure development. A clear definition of what is a qualitative research interview is given as well as information about the form and content of qualitative interviews required for developing PRO measures. Particular attention is paid to the description of interviewing approaches (e.g., semi-structured and in-depth interviews, individual vs. focus group interviews). Information about how to get prepared for a qualitative interview is provided with the description of how to develop discussion guides for exploratory or cognitive interviews. Interviewing patients to obtain knowledge regarding their illness experience requires interpersonal and communication skills to facilitate patients’ expression. Those skills are described in details, as well as the skills needed to facilitate focus groups and to interview children, adolescents and the elderly. Special attention is also given to quality assurance and interview training. The paper ends on ethical considerations since interviewing for the development of PROs is performed in a context of illness and vulnerability. Therefore, it is all the more important that, in addition to soliciting informed consent, respectful interactions be ensured throughout the interview process. PMID:24499454

  5. Primary breast lymphoma in an immunocompromised male patient: A case report

    International Nuclear Information System (INIS)

    Yim, Bong Guk; Park, Jeong Seon; Koo, Hye Ryoung; Kim, Soo Yeon; Jang, Ki Seok; Kim, Jin Young; Choi, Yun Young

    2015-01-01

    Primary breast lymphoma in a male patient is extremely rare. We report a case of primary breast lymphoma in an immunocompromised male patient, after renal transplantation. The sonographic and histological features are described in depth

  6. Primary breast lymphoma in an immunocompromised male patient: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Bong Guk; Park, Jeong Seon; Koo, Hye Ryoung; Kim, Soo Yeon; Jang, Ki Seok [Hanyang University Medical Center, Hanyang University College of Medicine, Seoul (Korea, Republic of); Kim, Jin Young; Choi, Yun Young [Dept. of Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri (Korea, Republic of)

    2015-10-15

    Primary breast lymphoma in a male patient is extremely rare. We report a case of primary breast lymphoma in an immunocompromised male patient, after renal transplantation. The sonographic and histological features are described in depth.

  7. Ultrasonography findings of thyroid metastasis in a patient with hepatocellular carcinoma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Ho; Park, Noh Hyuck; Lim, Jae Hoon; Park, Chan Sub; Seong, Su Ok; Kwon, Tae Jung [Myongji Hospital, Goyang (Korea, Republic of)

    2015-03-15

    Although the thyroid gland is one of the most vascular organs of the body, metastatic disease in the thyroid is encountered infrequently. However, at autopsy, the incidence rate of thyroid metastasis ranges from 1.25% to 24%. The primary sites are the kidney, lung, breast, and gastrointestinal tract. We report a rare case of a hepatocellular carcinoma metastatic to the thyroid gland. The patient had multiple palpable masses in the anterior and left lateral neck along the internal jugular chain on physical examination 9 months after the initial diagnosis of liver tumor. These masses were confirmed as metastasis from hepatocellular carcinoma by ultrasonography-guided 16-G core needle biopsy. We discuss the sonographic findings of thyroid metastasis and their use as an additional aid for differentiating between unknown primary tumor and thyroid metastasis.

  8. Five Simultaneous Primary Tumors in a Single Patient: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Casey W. Williamson

    2015-10-01

    Full Text Available Multiple primary malignancies (MPMs are present when a patient is diagnosed with more than one primary malignancy and when each tumor is histologically unrelated to the others. MPMs are considered synchronous when they present within 6 months of one another. Here, we report the case of a 57-year-old woman with a past medical history significant for melanoma in 1988, who presented in 2014 with 5 distinct tumors within 4 months: malignant melanoma of the right popliteal fossa, invasive lobular breast carcinoma, diffuse large B cell lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, and a giant cell tumor of tendon sheath/pigmented villonodular synovitis. We discuss her treatment and also present a brief review of the literature. The incidence of MPMs appears to be on the rise, which demands an interdisciplinary, multimodal, and personalized approach to care.

  9. The Impact of a Patient Safety Program on Medical Error Reporting

    Science.gov (United States)

    2005-05-01

    307 The Impact of a Patient Safety Program on Medical Error Reporting Donald R. Woolever Abstract Background: In response to the occurrence of...a sentinel event—a medical error with serious consequences—Eglin U.S. Air Force (USAF) Regional Hospital developed and implemented a patient safety...communication, teamwork, and reporting. Objective: To determine the impact of a patient safety program on patterns of medical error reporting. Methods: This

  10. Physicians' opinions about partner notification methods: case reporting, patient referral, and provider referral.

    Science.gov (United States)

    Hogben, M; St Lawrence, J S; Montaño, D E; Kasprzyk, D; Leichliter, J S; Phillips, W R

    2004-02-01

    The United States has relied upon partner notification strategies to help break the chain of infection and re-infection for sexually transmitted diseases (STD). Physicians are a vital link in the system of STD control, but little is known of physician opinions about partner notification strategies. We collected opinions about partner notification from a national probability sample of physicians in specialties diagnosing STDs. Physicians responded to 17 questions about three relevant forms of STD partner notification: patient based referral, provider based referral, and case reporting. Exploratory factor analyses showed that responses for each form of partner notification could be grouped into four categories: perceived practice norms, infection control, patient relationships, and time/money. Multivariate analyses of the factors showed that physicians endorsed patient based referral most favourably and provider based referral least favourably. Physicians' opinions about partner notification strategies appear to reflect objective reality in some areas, but not in others. Strategies that improve the fit between physicians' opinions and effective notification are needed: some are discussed here.

  11. Atomoxetine for Orthostatic Hypotension in an Elderly Patient Over 10 Weeks: A Case Report.

    Science.gov (United States)

    Hale, Genevieve M; Brenner, Michael

    2015-09-01

    Several nonpharmacologic strategies for orthostatic hypotension exist including avoiding large carbohydrate-rich meals; limiting alcohol consumption; maintaining adequate hydration; adding salt to foods; and using compression stockings, tilt-table exercises, or abdominal binders. If these fail, however, only limited evidence-based pharmacologic treatment options are available including the use of fludrocortisone, midodrine, pyridostigmine, and droxidopa as well as pseudoephedrine, ocetreotide, and atomoxetine. This report discusses a case of atomoxetine use for 10 weeks in an elderly patient with primary orthostatic hypotension. An 84-year-old man with long-standing primary orthostatic hypotension presented to our ambulatory cardiology pharmacotherapy clinic after several unsuccessful pharmacologic therapies including fludrocortisone, midodrine, and pyridostigmine. Nonpharmacologic strategies were also implemented. Atomoxetine was initiated, and the patient showed gradual improvements in symptoms and blood pressure control over the course of 10 weeks. Our data suggest that low-dose atomoxetine is an effective and safe agent for symptom improvement and blood pressure control in elderly patients with primary orthostatic hypotension. © 2015 Pharmacotherapy Publications, Inc.

  12. Short Report: Anxiety and Depression in Hypertensive Patients ...

    African Journals Online (AJOL)

    Background The aim of this study was determine the pattern the levels of anxiety and depression among patients attending the hypertensive clinic of the department of medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. Method Two hundred consecutive patients receiving treatment at the hypertensive ...

  13. Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery

    DEFF Research Database (Denmark)

    Kemp, Joanne L; Collins, Natalie J; Roos, Ewa M.

    2013-01-01

    Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown.......Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown....

  14. Appearance of Systemic Lupus Erythematosus in Patients with Myasthenia Gravis following Thymectomy: Two Case Reports

    OpenAIRE

    Park, Mi-Jeong; Kim, Yun-A; Lee, Shin-Seok; Kim, Byeong-Chae; Kim, Myeong-Kyu; Cho, Ki-Hyun

    2004-01-01

    We report two cases of systemic lupus erythematosus (SLE) in myasthenia gravis (MG) patients who had undergone thymectomy. SLE developed in the patients 3 months or 13 yr after thymectomy, and polyarthritis was the main clinical manifestation of SLE. Both patients fulfilled at least four of the revised criteria for the classification of SLE. In this report, we describe two postthymectomy lupus patients and perform a comparative review of previous cases.

  15. Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature

    Science.gov (United States)

    Hoffman, Aubri S; Abhyankar, Purva; Sheridan, Stacey; Bekker, Hilary; LeBlanc, Annie; Levin, Carrie; Ropka, Mary; Shaffer, Victoria; Stacey, Dawn; Stalmeier, Peep; Vo, Ha; Wills, Celia; Thomson, Richard

    2018-01-01

    This Explanation and Elaboration (E&E) article expands on the 26 items in the Standards for UNiversal reporting of Decision Aid Evaluations guidelines. The E&E provides a rationale for each item and includes examples for how each item has been reported in published papers evaluating patient decision aids. The E&E focuses on items key to reporting studies evaluating patient decision aids and is intended to be illustrative rather than restrictive. Authors and reviewers may wish to use the E&E broadly to inform structuring of patient decision aid evaluation reports, or use it as a reference to obtain details about how to report individual checklist items. PMID:29467235

  16. Understanding Patient Adherence and Concerns with STatins and MedicatION Discussions with Physicians (ACTION): A Survey on the Patient Perspective of Dialogue with Healthcare Providers Regarding Statin Therapy.

    Science.gov (United States)

    Brinton, Eliot A

    2018-05-10

    Statin therapy is used first-line for cholesterol lowering and prevention of atherosclerotic cardiovascular disease (CVD), but side effects and the potential for drug-drug interactions may complicate its use. Provider-patient communication is essential for shared decision-making, which, in turn, is recommended by guidelines to reduce or overcome these challenges. Unfortunately, relatively little is known about provider-patient communication surrounding statin use. We conducted an online survey of 5,014 patients, U.S. residents over age 45 years, who had been prescribed a statin for hypercholesterolemia, to learn their perspectives on their disease state, medication use, side effects and, most importantly, recall of communication with their provider, especially at the time they were first diagnosed with hypercholesterolemia. Results were weighted to reflect the racial/ethnic composition of the general U.S. Ninety-four percent of patients said they were currently taking a statin and 6% said they had stopped. Past users vs current users were more likely to be female (64% vs 47%), younger than age 65 (57% vs 49%), and to have fewer CVD-related comorbidities (hypertension 58% vs 69%, Type 2 diabetes 17% vs 27%, and coronary heart disease 4% vs 9%, respectively; all pright statin," but 73% and 76%, respectively, said the choice of their statin was made with little or no input from them. Further, among current users, only 45% said that they communicate "openly" with their provider about statin-related challenges, and 39% said they usually don't ask questions about their statin. Forty-three percent of current users had switched a statin at least once and 47% of past statin users had switched statins at least once before stopping. Current users were more likely than past users to switch due to "it was recommended" (27% vs 8%), medication costs (14 vs 7%), lack of insurance coverage (10% vs 2%), desire for a generic statin (14 vs 2%), lack of cholesterol efficacy (13% vs 6

  17. 33 CFR 240.5 - Discussion.

    Science.gov (United States)

    2010-07-01

    ... CREDIT FOR FLOOD CONTROL § 240.5 Discussion. Discussion of this legislation is contained in the Conference Report, H.R. Rpt. No. 99-1013, which accompanies H.R. 6. The House passed version of the bill... compatible work completed by local interests. The Senate passed version authorized crediting of compatible...

  18. Discussion paper 'Natural Gas for Sale'

    International Nuclear Information System (INIS)

    1995-04-01

    The information in this report must support a discussion on policy starting points for the structure of natural gas tariffs in the Netherlands. The discussion will be held within EnergieNed (the association for energy distribution companies in the Netherlands) in the light of recent developments in the energy distribution sector in Europe

  19. Discussion on Soft Computing at FLINS '96

    NARCIS (Netherlands)

    Ruan, D.; Wal, A.J. van der

    1998-01-01

    This is a report on the discussion about soft computing (SC) during FLINS'96. The discussion is based on the five questions formulated by X. Li, viz. (1) What is SC? (2) What are the characteristics of SC? (3) What are the principal achievements of SC? (4) What are the typical problems of SC and

  20. Intertextuality in Text-Based Discussions

    Science.gov (United States)

    Ismail, Hamidah Mohd; Majid, Faizah Abd

    2011-01-01

    One of the main issues often discussed among academics is how to encourage active participation by students during classroom discussions. This applies particularly to students at the tertiary level who are expected to possess creative and critical thinking skills. Hence, this paper reports on a study that examined how these skills were…

  1. Peroral endoscopic myotomy for the treatment of achalasia in a patient with esophageal varices. A case report.

    Science.gov (United States)

    Shen, Naning; Wang, Xin; Zhang, Xiaoyin; Yao, Liping; Xie, Huahong; Zhang, Hongbo

    2017-06-01

    Achalasia is very uncommon, and rarely does achalasia co-exist with esophageal varices. We present a 62-year-old woman who was diagnosed with both achalasia and esophageal varices in December 2014 and had a past history of hematemesis. The patient's achalasia symptoms' Eckardt score was 9, and her hepatic function was Child-Pugh grade A6. After comprehensive assessment of the patient's health and discussion of the pros and cons of various therapies for achalasia, the patient underwent a peroral endoscopic myotomy. She was symptom-free after the operation and had no recurrence of achalasia symptoms at 20-month follow-up. No adverse events were reported. Peroral endoscopic myotomy for achalasia with esophageal varices has not been previously reported in the English literature.

  2. Influenza A/H1N1 septic shock in a patient with systemic lupus erythematosus. A case report

    Directory of Open Access Journals (Sweden)

    Tselios Konstantinos

    2011-12-01

    Full Text Available Abstract Background Immunocompromised patients, such as systemic lupus erythematosus (SLE sufferers have an increased risk of mortality, following influenza infection. In the recent pandemic, influenza A H1NI virus caused 18449 deaths, mainly because of adult respiratory distress syndrome or bacterial co-infections. Case Presentation In this case report, an SLE patient with viral-induced septic shock, without overt pulmonary involvement, is discussed. The patient was administered oseltamivir and supportive treatment, including wide-spectrum antibiotics, vasopressors and steroids, according to the guidelines proposed for bacterial sepsis and septic shock. She finally survived and experienced a lupus flare soon after intensive care unit (ICU discharge. Conclusions To our knowledge, this is the first case to report severe septic shock from influenza A/H1N1 virus, without overt pulmonary involvement.

  3. Periodontal treatment in a generalized severe chronic periodontitis patient: A case report with 7-year follow-up.

    Science.gov (United States)

    Agrali, Omer Birkan; Kuru, Bahar Eren

    2015-01-01

    The aim of the periodontal treatment is to provide healthy and functional dentition all through a lifetime. In this report, periodontal treatment of a 42-year-old male patient with generalized severe chronic periodontitis is presented. He received initial periodontal treatment together with adjunctive antimicrobials. The devital teeth were endodontically treated, and free gingival grafts were placed at the inadequate keratinized tissue zones before regenerative surgery. Following the surgical treatment using enamel matrix derivatives and xenogenic bone graft combination, the patient was put on a strict recall program. After 12 months, favorable clinical and radiographical improvements were obtained. The 7-year maintenance of the present case with several initially hopeless teeth has been shown and discussed in this report. It can be concluded that optimum oral hygiene level as well as the positive cooperation of the patient enhanced the success of periodontal treatment results even in extremely severe periodontal destruction.

  4. Proceedings of the workshop ''Decarbonisation. 100 % renewable energy and more''. A report to document the presentations and discussions during the course of the event

    Energy Technology Data Exchange (ETDEWEB)

    Donat, Lena; Duwe, Matthias; Roberts, Ennid [Ecologic Institut fuer Internationale und Europaeische Umweltpolitik, Berlin (Germany)

    2016-04-15

    The workshop ''Decarbonisation - 100% Renewable Energy and more'', was held on 9 November 2015 in Berlin, hosted by the German Environment Agency and organised by Ecologic Institute. It offered a valuable opportunity for decision-makers, academia, business and civil society from EU Member States, to exchange ideas and lessons learned on the design and implementation of longterm decarbonisation strategies and discuss how industrialised nations, regions and cities can mitigate greenhouse gas emissions in various economic sectors. Workshop participants, Source: Ecologic Institute. The workshop generated important momentum for raising awareness on the topic and advancing the debate at EU level. This report gives an overview of the key presentations of the workshop and outcomes of the debate, clustered along the following topics: - Introduction: the case for action - National long-term strategies - Experience with implementation of national strategies - Local and regional examples The report's structure follows the internal logic and outline of the workshop agenda. Substituting for the presentations made on the day, it is made up of articles written by the original presenters, which contain the main facts and summarise their key messages. These are complemented by background and conclusions prepared by researchers from Ecologic Institute, the organisation that implemented the workshop on behalf of the German Environment Agency.

  5. Proceedings of the workshop ''Decarbonisation. 100 % renewable energy and more''. A report to document the presentations and discussions during the course of the event

    International Nuclear Information System (INIS)

    Donat, Lena; Duwe, Matthias; Roberts, Ennid

    2016-01-01

    The workshop ''Decarbonisation - 100% Renewable Energy and more'', was held on 9 November 2015 in Berlin, hosted by the German Environment Agency and organised by Ecologic Institute. It offered a valuable opportunity for decision-makers, academia, business and civil society from EU Member States, to exchange ideas and lessons learned on the design and implementation of longterm decarbonisation strategies and discuss how industrialised nations, regions and cities can mitigate greenhouse gas emissions in various economic sectors. Workshop participants, Source: Ecologic Institute. The workshop generated important momentum for raising awareness on the topic and advancing the debate at EU level. This report gives an overview of the key presentations of the workshop and outcomes of the debate, clustered along the following topics: - Introduction: the case for action - National long-term strategies - Experience with implementation of national strategies - Local and regional examples The report's structure follows the internal logic and outline of the workshop agenda. Substituting for the presentations made on the day, it is made up of articles written by the original presenters, which contain the main facts and summarise their key messages. These are complemented by background and conclusions prepared by researchers from Ecologic Institute, the organisation that implemented the workshop on behalf of the German Environment Agency.

  6. A research framework for pharmacovigilance in health social media: Identification and evaluation of patient adverse drug event reports.

    Science.gov (United States)

    Liu, Xiao; Chen, Hsinchun

    2015-12-01

    Social media offer insights of patients' medical problems such as drug side effects and treatment failures. Patient reports of adverse drug events from social media have great potential to improve current practice of pharmacovigilance. However, extracting patient adverse drug event reports from social media continues to be an important challenge for health informatics research. In this study, we develop a research framework with advanced natural language processing techniques for integrated and high-performance patient reported adverse drug event extraction. The framework consists of medical entity extraction for recognizing patient discussions of drug and events, adverse drug event extraction with shortest dependency path kernel based statistical learning method and semantic filtering with information from medical knowledge bases, and report source classification to tease out noise. To evaluate the proposed framework, a series of experiments were conducted on a test bed encompassing about postings from major diabetes and heart disease forums in the United States. The results reveal that each component of the framework significantly contributes to its overall effectiveness. Our framework significantly outperforms prior work. Published by Elsevier Inc.

  7. Relevance of a laboratory physician's report to patient care in a ...

    African Journals Online (AJOL)

    Nigerian Journal of Clinical Practice ... When both are provided for a test done, reports offer in depth information, explanation and clarification of results. ... benefits such an investigation reporting system will have on patient management.

  8. Patient safety event reporting in critical care: a study of three intensive care units.

    Science.gov (United States)

    Harris, Carolyn B; Krauss, Melissa J; Coopersmith, Craig M; Avidan, Michael; Nast, Patricia A; Kollef, Marin H; Dunagan, W Claiborne; Fraser, Victoria J

    2007-04-01

    To increase patient safety event reporting in three intensive care units (ICUs) using a new voluntary card-based event reporting system and to compare and evaluate observed differences in reporting among healthcare workers across ICUs. Prospective, single-center, interventional study. A medical ICU (19 beds), surgical ICU (24 beds), and cardiothoracic ICU (17 beds) at a 1,371-bed urban teaching hospital. Adult patients admitted to these three study ICUs. Use of a new, internally designed, card-based reporting program to solicit voluntary anonymous reporting of medical errors and patient safety concerns. During a 14-month period, 714 patient safety events were reported using a new card-based reporting system, reflecting a significant increase in reporting compared with pre-intervention Web-based reporting (20.4 reported events/1,000 patient days pre-intervention to 41.7 reported events/1,000 patient days postintervention; rate ratio, 2.05; 95% confidence interval, 1.79-2.34). Nurses submitted the majority of reports (nurses, 67.1%; physicians, 23.1%; other reporters, 9.5%); however, physicians experienced the greatest increase in reporting among their group (physicians, 43-fold; nurses, 1.7-fold; other reporters, 4.3-fold) relative to pre-intervention rates. There were significant differences in the reporting of harm by job description: 31.1% of reports from nurses, 36.2% from other staff, and 17.0% from physicians described events that did not reach/affect the patient (p = .001); and 33.9% of reports from physicians, 27.2% from nurses, and 13.0% from other staff described events that caused harm (p = .005). Overall reported patient safety events per 1,000 patient days differed by ICU (medical ICU = 55.5, cardiothoracic ICU = 25.3, surgical ICU = 40.2; p reporting system increased reporting significantly compared with pre-intervention Web-based reporting and revealed significant differences in reporting by healthcare worker and ICU. These differences may reveal

  9. Sarcoidosis in Melanoma Patients: Case Report and Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Beutler, Bryce D., E-mail: brycebeutler@hotmail.com [School of Allied Health Sciences, University of Nevada, Las Vegas, 1060 Wiegand Road, Encinitas, CA 92024 (United States); Cohen, Philip R., E-mail: brycebeutler@hotmail.com [Department of Dermatology, University of California San Diego, 10991 Twinleaf Court, San Diego, CA 92131 (United States)

    2015-06-15

    Sarcoidosis is a systemic inflammatory disease characterized by the development of noncaseating granulomas in multiple organ systems. Many hematologic malignancies and solid tumors, including melanoma, have been associated with sarcoidosis. We describe the clinical and pathologic findings of a 54-year-old man with melanoma-associated sarcoidosis. In addition, we not only review the literature describing characteristics of other melanoma patients with sarcoidosis, but also the features of melanoma patients with antineoplastic therapy-associated sarcoidosis. Sarcoidosis has been described in 80 melanoma patients; sufficient information for analysis was provided in 39 of these individuals. In 43.6% of individuals (17 out of 39), sarcoidosis was directly associated with melanoma; in 56.4% of oncologic patients (22 out of 39), sarcoidosis was induced by antineoplastic therapy that had been administered for the treatment of their metastatic melanoma. The discovery of melanoma preceded the development of sarcoidosis in 12 of the 17 (70.5%) individuals who did not receive systemic treatment. Pulmonary and/or cutaneous manifestations of sarcoidosis were common among both groups of patients. Most patients did not require treatment for sarcoidosis. Melanoma patients—either following antineoplastic therapy or without systemic treatment—may be at an increased risk to develop sarcoidosis. In antineoplastic therapy naive melanoma patients, a common etiologic factor—such as exposure to ultraviolet light—may play a role in their developing melanoma and sarcoidosis.

  10. Systematic Review of Radiation Therapy Toxicity Reporting in Randomized Controlled Trials of Rectal Cancer: A Comparison of Patient-Reported Outcomes and Clinician Toxicity Reporting

    Energy Technology Data Exchange (ETDEWEB)

    Gilbert, Alexandra, E-mail: a.gilbert@leeds.ac.uk [Leeds Institute of Cancer & Pathology, University of Leeds, Leeds (United Kingdom); Ziegler, Lucy; Martland, Maisie [Leeds Institute of Cancer & Pathology, University of Leeds, Leeds (United Kingdom); Davidson, Susan [The Christie Hospital, Manchester (United Kingdom); Efficace, Fabio [Italian Group for Adult Hematologic Diseases, Rome (Italy); Sebag-Montefiore, David; Velikova, Galina [Leeds Institute of Cancer & Pathology, University of Leeds, Leeds (United Kingdom)

    2015-07-01

    The use of multimodal treatments for rectal cancer has improved cancer-related outcomes but makes monitoring toxicity challenging. Optimizing future radiation therapy regimens requires collection and publication of detailed toxicity data. This review evaluated the quality of toxicity information provided in randomized controlled trials (RCTs) of radiation therapy in rectal cancer and focused on the difference between clinician-reported and patient-reported toxicity. Medline, EMBASE, and the Cochrane Library were searched (January 1995-July 2013) for RCTs reporting late toxicity in patients treated with regimens including preoperative (chemo)radiation therapy. Data on toxicity measures and information on toxicity reported were extracted using Quantitative Analyses of Normal Tissue Effects in the Clinic recommendations. International Society for Quality of Life Research standards on patient-reported outcomes (PROs) were used to evaluate the quality of patient-reported toxicity. Twenty-one RCT publications met inclusion criteria out of 4144 articles screened. All PRO studies reported higher rates of toxicity symptoms than clinician-reported studies and reported on a wider range and milder symptoms. No clinician-reported study published data on sexual dysfunction. Of the clinician-reported studies, 55% grouped toxicity data related to an organ system together (eg “Bowel”), and 45% presented data only on more-severe (grade ≥3) toxicity. In comparison, all toxicity grades were reported in 79% of PRO publications, and all studies (100%) presented individual symptom toxicity data (eg bowel urgency). However, PRO reporting quality was variable. Only 43% of PRO studies presented baseline data, 28% did not use any psychometrically validated instruments, and only 29% of studies described statistical methods for managing missing data. Analysis of these trials highlights the lack of reporting standards for adverse events and reveals the differences between clinician and

  11. The value of patient reporting to the pharmacovigilance system: a systematic review.

    Science.gov (United States)

    Inácio, Pedro; Cavaco, Afonso; Airaksinen, Marja

    2017-02-01

    Current trends in pharmacovigilance systems are veering towards patient involvement in spontaneous reporting of adverse drug reactions (ADRs). The aim of the current systematic review was to identify what is known and what remains unknown with respect to patient reporting to pharmacovigilance systems. A systematic literature search was conducted in PubMed, CINAHL, Journals@Ovid and the Cochrane Library. Studies were included if they contained: (i) reviews about patient reporting; (ii) evaluation of patient reports to national or supranational pharmacovigilance authorities; (iii) a comparison between patient and healthcare professional (HCP) reports submitted to pharmacovigilance authorities; and (iv) surveys of patient experiences, opinions and awareness about reporting ADRs. The methodological quality of the studies was assessed according to principles of Grading of Recommendations, Assessment, Development and Evaluations (GRADE). A total of thirty four studies were included. Five of the studies were reviews (two of which systematic reviews), fourteen retrospective observational studies, nine surveys and six applied mixed research methods. Patient reporting has the advantages of bringing novel information about ADRs. It provides a more detailed description of ADRs, and reports about different drugs and system organ classes when compared with HCP reporting. In addition, patients describe the severity and impact of ADRs on daily life, complementing information derived from HCPs. Patient reporting is relatively rare in most countries. Patient reporting adds new information, and perspective about ADRs in a way otherwise unavailable. This can contribute to better decision-making processes in regulatory activities. The present review identified gaps in knowledge that should be addressed to improve our understanding of the full potential and drawbacks of patient reporting. © 2016 The British Pharmacological Society.

  12. Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database

    DEFF Research Database (Denmark)

    Andersen, Peter Oluf; Maaløe, Rikke; Andersen, Henning Boje

    2010-01-01

    Background Critical incident reports can identify areas for improvement in resuscitation practice. The Danish Patient Safety Database is a mandatory reporting system and receives critical incident reports submitted by hospital personnel. The aim of this study is to identify, analyse and categorize...... critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. Methods The search terms “cardiac arrest” and “resuscitation” were used to identify reports in the Danish Patient Safety Database. Identified critical incidents were then classified into categories. Results One...

  13. To discuss illicit nuclear trafficking

    Energy Technology Data Exchange (ETDEWEB)

    Balatsky, Galya I [Los Alamos National Laboratory; Severe, William R [Los Alamos National Laboratory; Wallace, Richard K [Los Alamos National Laboratory

    2010-01-01

    The Illicit nuclear trafficking panel was conducted at the 4th Annual INMM workshop on Reducing the Risk from Radioactive and Nuclear Materials on February 2-3, 2010 in Washington DC. While the workshop occurred prior to the Nuclear Security Summit, April 12-13 2010 in Washington DC, some of the summit issues were raised during the workshop. The Communique of the Washington Nuclear Security Summit stated that 'Nuclear terrorism is one of the most challenging threats to international security, and strong nuclear security measures are the most effective means to prevent terrorists, criminals, or other unauthorized actors from acquiring nuclear materials.' The Illicit Trafficking panel is one means to strengthen nuclear security and cooperation at bilateral, regional and multilateral levels. Such a panel promotes nuclear security culture through technology development, human resources development, education and training. It is a tool which stresses the importance of international cooperation and coordination of assistance to improve efforts to prevent and respond to incidents of illicit nuclear trafficking. Illicit trafficking panel included representatives from US government, an international organization (IAEA), private industry and a non-governmental organization to discuss illicit nuclear trafficking issues. The focus of discussions was on best practices and challenges for addressing illicit nuclear trafficking. Terrorism connection. Workshop discussions pointed out the identification of terrorist connections with several trafficking incidents. Several trafficking cases involved real buyers (as opposed to undercover law enforcement agents) and there have been reports identifying individuals associated with terrorist organizations as prospective plutonium buyers. Some specific groups have been identified that consistently search for materials to buy on the black market, but no criminal groups were identified that specialize in nuclear materials or isotope

  14. Round Table Discussion on EASTWEST

    Directory of Open Access Journals (Sweden)

    Marina Tkacheva

    2017-12-01

    Full Text Available The discussion is focused on various aspects of interrelations between East and West. Its participants discuss the problems of the increasing tourist flows from China and the specific characteristics of Chinese tourists. The future development of tourism in the Baikal region is formulated, and the peculiarities of ethno tourism and its prospects are discussed.

  15. The case for an international patient-reported outcomes measurement information system (PROMIS®) initiative.

    Science.gov (United States)

    Alonso, Jordi; Bartlett, Susan J; Rose, Matthias; Aaronson, Neil K; Chaplin, John E; Efficace, Fabio; Leplège, Alain; Lu, Aiping; Tulsky, David S; Raat, Hein; Ravens-Sieberer, Ulrike; Revicki, Dennis; Terwee, Caroline B; Valderas, Jose M; Cella, David; Forrest, Christopher B

    2013-12-20

    Patient-reported outcomes (PROs) play an increasingly important role in clinical practice and research. Modern psychometric methods such as item response theory (IRT) enable the creation of item banks that support fixed-length forms as well as computerized adaptive testing (CAT), often resulting in improved measurement precision and responsiveness. Here we describe and discuss the case for developing an international core set of PROs building from the US PROMIS® network.PROMIS is a U.S.-based cooperative group of research sites and centers of excellence convened to develop and standardize PRO measures across studies and settings. If extended to a global collaboration, PROMIS has the potential to transform PRO measurement by creating a shared, unifying terminology and metric for reporting of common symptoms and functional life domains. Extending a common set of standardized PRO measures to the international community offers great potential for improving patient-centered research, clinical trials reporting, population monitoring, and health care worldwide. Benefits of such standardization include the possibility of: international syntheses (such as meta-analyses) of research findings; international population monitoring and policy development; health services administrators and planners access to relevant information on the populations they serve; better assessment and monitoring of patients by providers; and improved shared decision making.The goal of the current PROMIS International initiative is to ensure that item banks are translated and culturally adapted for use in adults and children in as many countries as possible. The process includes 3 key steps: translation/cultural adaptation, calibration, and validation. A universal translation, an approach focusing on commonalities, rather than differences across versions developed in regions or countries speaking the same language, is proposed to ensure conceptual equivalence for all items. International item

  16. A new internet-based tool for reporting and analysing patient-reported outcomes and the feasibility of repeated data collection from patients with myeloproliferative neoplasms

    DEFF Research Database (Denmark)

    Brochmann, Nana; Zwisler, Ann-Dorthe; Kjerholt, Mette

    2016-01-01

    PURPOSE: An Internet-based tool for reporting and analysing patient-reported outcomes (PROs) has been developed. The tool enables merging PROs with blood test results and allows for computation of treatment responses. Data may be visualized by graphical analysis and may be exported for downstream...

  17. Consensus of microbiology reporting of ear swab results to primary care clinicians in patients with otitis externa.

    Science.gov (United States)

    Geyer, M; Howell-Jones, R; Cunningham, R; McNulty, C

    2011-01-01

    Otitis externa is a ubiquitous inflammatory disease; although it arises most commonly from an infection, there is no consensus in the UK for the reporting of ear swab culture results. This study aims to review current microbiology laboratory reporting of ear swab specimens to primary care and reach an evidence-based consensus for a reporting policy. Fifty consecutive ear swab reports were reviewed from each of 12 laboratories in the South West region to determine and discuss reporting practice. The Health Protection Agency (HPA) GP Microbiology Laboratory Use Group reviewed the underlying evidence and worked towards a consensus of expert microbiology opinion for laboratory reporting of ear swab results using a modified version of the Delphi technique. A total of 487 reports from primary care were reviewed (54% female; 46% male). Cultures most commonly yielded Pseudomonas species (36%), Staphylococcus species (21%), Streptococcus species (15%) and fungi (11%). Five reporting policies were agreed: Policy 1: Common pathogens such as group A beta-haemolytic streptococci, Streptococcus pneumoniae, Staphylococcus aureus - Always reported by name with antibiotic susceptibilities. Policy 2: Pseudomonas species - Always reported, but antibiotic susceptibilities only reported in severe disease. Policy 3: Aspergillus, Candida, coliforms and Proteus species, as well as non-group A streptococci and anaerobes - Only reported if moderate numbers of colonies and it is the predominant organism present; if appropriate report antibiotic susceptibilities. Policy 4: Coagulase-negative staphylococci, diphtheroids and enterococci - Not reported by name; generic terms used and antibiotic susceptibilities not reported. Policy 5: When antibiotic susceptibilities reported these must include susceptibility to a topical antibiotic. It is suggested that laboratories should consider adopting this evidence-based reporting consensus for ear swab culture results from primary care patients with

  18. Report of seven neurological patients with misidentification syndrome

    Directory of Open Access Journals (Sweden)

    Edson José Amâncio

    2004-12-01

    Full Text Available Objective: To present clinical, neuropsychological and laboratorydata on 7 patients with misidentification syndrome and to discussits possible etiologies and pathophysiology. Methods: Sevenpatients presenting misidentification syndrome, 6 female and 1male, aged 64-78 years were studied. All had a brain diseasediagnosed by clinical and laboratory data. All patients weresubmitted to general clinical examination, neurological andneuropsychological examinations, and brain magnetic resonanceimaging. Results: All patients were capable to recognizephotographs of relatives or famous persons. They presented goodvisual acuity that allowed them reading texts with small print andpreserved visual field. The etiologies of brain lesions were ischemicstroke, left temporal lobe tumor, idiopathic hydrocephalus in elderlypatients, Parkinson’s disease and probable Alzheimer’s disease.None presented enough cognitive disorders to characterize seniledementia. Conclusion: Misidentification syndromes are notnecessarily related to one single psychogenic etiology; on thecontrary, many organic causes may be related with the clinicalpicture. Most patients improved when submitted to treatmentwith typical or atypical neuroleptic drugs.

  19. Meier-Gorlin syndrome: Report of an additional patient with ...

    African Journals Online (AJOL)

    Rabah M. Shawky

    2014-05-16

    May 16, 2014 ... which functions during replication can cause Seckel syndrome, a clinically related ... brain, and growth hormone provocation test were normal. Skeletal survey ... atrial defect with left–right shunt [17]. Also our patient suf-.

  20. Transient hypoglycemic hemiparesis: Report of two patients with ...

    African Journals Online (AJOL)

    The pathophysiology of hypoglycemic-hemiparesis is hinged on metabolic injury to selected vulnerable cerebral neurons. It is also ... Blood glucose should be checked in all patients with altered states of consciousness. Hypoglycemia should ...

  1. How patient outcomes are reported in drug advertisements.

    Science.gov (United States)

    Lexchin, J

    1999-05-01

    To examine how changes in outcomes are reported in drug advertisements in medical journals. Advertisements from a convenience sample of 38 issues of Canadian Family Physician, Canadian Journal of Anaesthesia, Canadian Journal of Psychiatry, Canadian Medical Association Journal, and the New England Journal of Medicine. Method of reporting changes in clinical outcomes (relative risk reduction [RRR], absolute risk reduction [ARR], number needed to treat [NNT]), name of product, and company marketing product were sought. In the 22 advertisements included in the analysis, 11 reported results as RRRs; two reported results as RRRs, but readers could calculate ARRs or NNTs from figures given in the advertisement; and nine gave no measure of results, but readers could calculate RRRs, ARRs, or NNTs from figures given. Most companies report changes in outcomes as RRRs, and this bias could influence the way physicians prescribe. Changes to the rules governing journal advertising and increased emphasis on critical appraisal skills would help mitigate this bias.

  2. Hazards of antihistamine dependence in psychiatric patients: a case report.

    Science.gov (United States)

    Rao, Mukund G; Varambally, Shivarama; Venkatasubramanian, Ganesan; Gangadhar, Bangalore N

    2015-01-01

    Excessive use of over-the-counter (OTC) medications has been a growing public health problem. We present the case of a patient with avoidant personality disorder, social phobia, and dull normal intelligence, with dependence to pheniramine maleate. His anxiety symptoms, initially unresponsive to conventional treatment, reduced only after stopping pheniramine during inpatient care. This case emphasizes the need for awareness and regular monitoring of the use of OTC medications in vulnerable patient populations.

  3. Exploring the Influence of Nurse Work Environment and Patient Safety Culture on Attitudes Toward Incident Reporting.

    Science.gov (United States)

    Yoo, Moon Sook; Kim, Kyoung Ja

    2017-09-01

    The aim of this study was to explore the influence of nurse work environments and patient safety culture on attitudes toward incident reporting. Patient safety culture had been known as a factor of incident reporting by nurses. Positive work environment could be an important influencing factor for the safety behavior of nurses. A cross-sectional survey design was used. The structured questionnaire was administered to 191 nurses working at a tertiary university hospital in South Korea. Nurses' perception of work environment and patient safety culture were positively correlated with attitudes toward incident reporting. A regression model with clinical career, work area and nurse work environment, and patient safety culture against attitudes toward incident reporting was statistically significant. The model explained approximately 50.7% of attitudes toward incident reporting. Improving nurses' attitudes toward incident reporting can be achieved with a broad approach that includes improvements in work environment and patient safety culture.

  4. A systematic review of patient-reported outcome measures in paediatric otolaryngology.

    Science.gov (United States)

    Powell, J; Powell, S; Robson, A

    2018-01-01

    Recently, there has been increased emphasis on the development and application of patient-reported outcome measures. This drive to assess the impact of illness or interventions, from the patient's perspective, has resulted in a greater number of available questionnaires. The importance of selecting an appropriate patient-reported outcome measure is specifically emphasised in the paediatric population. The literature on patient-reported outcome measures used in paediatric otolaryngology was reviewed. A comprehensive literature search was conducted using the databases Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo, using the terms: 'health assessment questionnaire', 'structured questionnaire', 'questionnaire', 'patient reported outcome measures', 'PROM', 'quality of life' or 'survey', and 'children' or 'otolaryngology'. The search was limited to English-language articles published between 1996 and 2016. The search yielded 656 articles, of which 63 were considered relevant. This included general paediatric patient-reported outcome measures applied to otolaryngology, and paediatric otolaryngology disease-specific patient-reported outcome measures. A large collection of patient-reported outcome measures are described in the paediatric otolaryngology literature. Greater standardisation of the patient-reported outcome measures used in paediatric otolaryngology would assist in pooling of data and increase the validation of tools used.

  5. Patients' Attitude toward Breaking Bad News; a Brief Report.

    Science.gov (United States)

    Aminiahidashti, Hamed; Mousavi, Seyed Jaber; Darzi, Mohammad Mehdi

    2016-01-01

    Delivering bad news is a stressful moment for both physicians and patients. The purpose of this investigation was to explore the patients' preferences and attitudes toward being informed about the bad news. This cross-sectional study was done on patients admitted to Imam Khomeini Hospital, Sari, Iran, from September 2014 to February 2015. Patient attitude regarding breaking bad news was evaluated using a reliable and valid questionnaire. 130 patients were evaluated (61.5% male, mean age = 46.21 ± 12.1 years). 118 (90.76%) participants believed that the patient himself/herself should be informed about the disease's condition. 120 (92.30%) preferred to hear the news from a skillful physician and 105 (80.76%) believed that emergency department is not a proper place for breaking bad news. Based on the results of the present study, most participants believed that the most experienced and skillful physician should inform them completely regarding their medical condition. At the same time they declared that, it is best to hear bad news in a calm and suitable place and time rather than emergency department or hospital corridors during teaching rounds.

  6. Provider Factors and Patient-Reported Healthcare Discrimination in the Diabetes Study of California (DISTANCE)

    Science.gov (United States)

    Lyles, Courtney R.; Karter, Andrew J.; Young, Bessie A.; Spigner, Clarence; Grembowski, David; Schillinger, Dean; Adler, Nancy

    2011-01-01

    Objective We examined provider-level factors and reported discrimination in the healthcare setting. Methods With data from the Diabetes Study of Northern California (DISTANCE)—a race-stratified survey of diabetes patients in Kaiser Permanente Northern California—we analyzed patient-reported racial/ethnic discrimination from providers. Primary exposures were characteristics of the primary care provider (PCP, who coordinates care in this system), including specialty/type, and patient-provider relationship variables including racial concordance. Results Subjects (n=12,151) included 20% black, 20% Latino, 23% Asian, 30% white, and 6% other patients, with 2% to 8% reporting discrimination by racial/ethnic group. Patients seeing nurse practitioners as their PCP (OR=0.09; 95% CI: 0.01–0.67), those rating their provider higher on communication (OR=0.70; 95% CI: 0.66–0.74) were less likely to report discrimination, while those with more visits (OR=1.10; 95% CI: 1.03–1.18) were more likely to report discrimination. Racial concordance was not significant once adjusting for patient race/ethnicity. Conclusions Among diverse diabetes patients in managed care, provider type and communication were significantly related to patient-reported discrimination. Practice Implications Given potential negative impacts on patient satisfaction and treatment decisions, future studies should investigate which interpersonal aspects of the provider-patient relationship reduce patient perceptions of unfair treatment. PMID:21605956

  7. Ten years after the IOM report: Engaging residents in quality and patient safety by creating a House Staff Quality Council.

    Science.gov (United States)

    Fleischut, Peter M; Evans, Adam S; Nugent, William C; Faggiani, Susan L; Lazar, Eliot J; Liebowitz, Richard S; Forese, Laura L; Kerr, Gregory E

    2011-01-01

    Ten years after the 1999 Institute of Medicine report, it is clear that despite significant progress, much remains to be done to improve quality and patient safety (QPS). Recognizing the critical role of postgraduate trainees, an innovative approach was developed at New York-Presbyterian Hospital, Weill Cornell Medical Center to engage residents in QPS by creating a Housestaff Quality Council (HQC). HQC leaders and representatives from each clinical department communicate and partner regularly with hospital administration and other key departments to address interdisciplinary quality improvement (QI). In support of the mission to improve patient care and safety, QI initiatives included attaining greater than 90% compliance with medication reconciliation and reduction in the use of paper laboratory orders by more than 70%. A patient safety awareness campaign is expected to evolve into a transparent environment where house staff can openly discuss patient safety issues to improve the quality of care.

  8. Phelan-McDermid syndrome data network: Integrating patient reported outcomes with clinical notes and curated genetic reports.

    Science.gov (United States)

    Kothari, Cartik; Wack, Maxime; Hassen-Khodja, Claire; Finan, Sean; Savova, Guergana; O'Boyle, Megan; Bliss, Geraldine; Cornell, Andria; Horn, Elizabeth J; Davis, Rebecca; Jacobs, Jacquelyn; Kohane, Isaac; Avillach, Paul

    2017-09-01

    The heterogeneity of patient phenotype data are an impediment to the research into the origins and progression of neuropsychiatric disorders. This difficulty is compounded in the case of rare disorders such as Phelan-McDermid Syndrome (PMS) by the paucity of patient clinical data. PMS is a rare syndromic genetic cause of autism and intellectual deficiency. In this paper, we describe the Phelan-McDermid Syndrome Data Network (PMS_DN), a platform that facilitates research into phenotype-genotype correlation and progression of PMS by: a) integrating knowledge of patient phenotypes extracted from Patient Reported Outcomes (PRO) data and clinical notes-two heterogeneous, underutilized sources of knowledge about patient phenotypes-with curated genetic information from the same patient cohort and b) making this integrated knowledge, along with a suite of statistical tools, available free of charge to authorized investigators on a Web portal https://pmsdn.hms.harvard.edu. PMS_DN is a Patient Centric Outcomes Research Initiative (PCORI) where patients and their families are involved in all aspects of the management of patient data in driving research into PMS. To foster collaborative research, PMS_DN also makes patient aggregates from this knowledge available to authorized investigators using distributed research networks such as the PCORnet PopMedNet. PMS_DN is hosted on a scalable cloud based environment and complies with all patient data privacy regulations. As of October 31, 2016, PMS_DN integrates high-quality knowledge extracted from the clinical notes of 112 patients and curated genetic reports of 176 patients with preprocessed PRO data from 415 patients. © 2017 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc.

  9. Patient Drug Safety Reporting: Diabetes Patients' Perceptions of Drug Safety and How to Improve Reporting of Adverse Events and Product Complaints.

    Science.gov (United States)

    Patel, Puja; Spears, David; Eriksen, Betina Østergaard; Lollike, Karsten; Sacco, Michael

    2018-03-01

    Global health care manufacturer Novo Nordisk commissioned research regarding awareness of drug safety department activities and potential to increase patient feedback. Objectives were to examine patients' knowledge of pharmaceutical manufacturers' responsibilities and efforts regarding drug safety, their perceptions and experiences related to these efforts, and how these factors influence their thoughts and behaviors. Data were collected before and after respondents read a description of a drug safety department and its practices. We conducted quantitative survey research across 608 health care consumers receiving treatment for diabetes in the United States, Germany, United Kingdom, and Italy. This research validated initial, exploratory qualitative research (across 40 comparable consumers from the same countries) which served to guide design of the larger study. Before reading a drug safety department description, 55% of respondents were unaware these departments collect safety information on products and patients. After reading the description, 34% reported the department does more than they expected to ensure drug safety, and 56% reported "more confidence" in the industry as a whole. Further, 66% reported themselves more likely to report an adverse event or product complaint, and 60% reported that they were more likely to contact a drug safety department with questions. The most preferred communication methods were websites/online forums (39%), email (27%), and telephone (25%). Learning about drug safety departments elevates consumers' confidence in manufacturers' safety efforts and establishes potential for patients to engage in increased self-monitoring and reporting. Study results reveal potentially actionable insights for the industry across patient and physician programs and communications.

  10. Managing acute pain in