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Sample records for prelingually deafened patients

  1. Regional homogeneity changes in prelingually deafened patients: a resting-state fMRI study

    Science.gov (United States)

    Li, Wenjing; He, Huiguang; Xian, Junfang; Lv, Bin; Li, Meng; Li, Yong; Liu, Zhaohui; Wang, Zhenchang

    2010-03-01

    Resting-state functional magnetic resonance imaging (fMRI) is a technique that measures the intrinsic function of brain and has some advantages over task-induced fMRI. Regional homogeneity (ReHo) assesses the similarity of the time series of a given voxel with its nearest neighbors on a voxel-by-voxel basis, which reflects the temporal homogeneity of the regional BOLD signal. In the present study, we used the resting state fMRI data to investigate the ReHo changes of the whole brain in the prelingually deafened patients relative to normal controls. 18 deaf patients and 22 healthy subjects were scanned. Kendall's coefficient of concordance (KCC) was calculated to measure the degree of regional coherence of fMRI time courses. We found that regional coherence significantly decreased in the left frontal lobe, bilateral temporal lobes and right thalamus, and increased in the postcentral gyrus, cingulate gyrus, left temporal lobe, left thalamus and cerebellum in deaf patients compared with controls. These results show that the prelingually deafened patients have higher degree of regional coherence in the paleocortex, and lower degree in neocortex. Since neocortex plays an important role in the development of auditory, these evidences may suggest that the deaf persons reorganize the paleocortex to offset the loss of auditory.

  2. Amplitude Modulation Detection and Speech Recognition in Late-Implanted Prelingually and Postlingually Deafened Cochlear Implant Users.

    Science.gov (United States)

    De Ruiter, Anke M; Debruyne, Joke A; Chenault, Michelene N; Francart, Tom; Brokx, Jan P L

    2015-01-01

    Many late-implanted prelingually deafened cochlear implant (CI) patients struggle to obtain open-set speech understanding. Because it is known that low-frequency temporal-envelope information contains important cues for speech understanding, the goal of this study was to compare the temporal-envelope processing abilities of late-implanted prelingually and postlingually deafened CI users. Furthermore, the possible relation between temporal processing abilities and speech recognition performances was investigated. Amplitude modulation detection thresholds were obtained in eight prelingually and 18 postlingually deafened CI users, by means of a sinusoidally modulated broadband noise carrier, presented through a loudspeaker to the CI user's clinical device. Thresholds were determined with a two-down-one-up three-interval oddity adaptive procedure, at seven modulation frequencies. Phoneme recognition (consonant-nucleus-consonant [CNC]) scores (percentage correct at 65 dB SPL) were gathered for all CI users. For the prelingually deafened group, scores on two additional speech tests were obtained: (1) a closed-set monosyllable-trochee-spondee test (percentage correct scores at 65 dB SPL on word recognition and categorization of the suprasegmental word patterns), and (2) a speech tracking test (number of correctly repeated words per minute) with texts specifically designed for this population. The prelingually deafened CI users had a significantly lower sensitivity to amplitude modulations than the postlingually deafened CI users, and the attenuation rate of their temporal modulation transfer function (TMTF) was greater. None of the prelingually deafened CI users were able to detect modulations at 150 and 200 Hz. High and significant correlations were found between the results on the amplitude modulation detection test and CNC phoneme scores, for the entire group of CI users. In the prelingually deafened group, CNC phoneme scores, word scores on the monosyllable

  3. Acoustic properties of vocal singing in prelingually-deafened children with cochlear implants or hearing aids.

    Science.gov (United States)

    Mao, Yitao; Zhang, Mengchao; Nutter, Heather; Zhang, Yijing; Zhou, Qixin; Liu, Qiaoyun; Wu, Weijing; Xie, Dinghua; Xu, Li

    2013-11-01

    The purpose of the present study was to investigate vocal singing performance of hearing-impaired children with cochlear implants (CI) and hearing aids (HA) as well as to evaluate the relationship between demographic factors of those hearing-impaired children and their singing ability. Thirty-seven prelingually-deafened children with CIs and 31 prelingually-deafened children with HAs, and 37 normal-hearing (NH) children participated in the study. The fundamental frequencies (F0) of each note in the recorded songs were extracted and the duration of each sung note was measured. Five metrics were used to evaluate the pitch-related and rhythm-based aspects of singing accuracy. Children with CIs and HAs showed significantly poorer performance in either the pitch-based assessments or the rhythm-based measure than the NH children. No significant differences were seen between the CI and HA groups in all of these measures except for the mean deviation of the pitch intervals. For both hearing-impaired groups, length of device use was significantly correlated with singing accuracy. There is a marked deficit in vocal singing ability either in pitch or rhythm accuracy in a majority of prelingually-deafened children who have received CIs or fitted with HAs. Although an increased length of device use might facilitate singing performance to some extent, the chance for the hearing-impaired children fitted with either HAs or CIs to reach high proficiency in singing is quite slim. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  4. Audio-visual speech perception in prelingually deafened Japanese children following sequential bilateral cochlear implantation.

    Science.gov (United States)

    Yamamoto, Ryosuke; Naito, Yasushi; Tona, Risa; Moroto, Saburo; Tamaya, Rinko; Fujiwara, Keizo; Shinohara, Shogo; Takebayashi, Shinji; Kikuchi, Masahiro; Michida, Tetsuhiko

    2017-11-01

    An effect of audio-visual (AV) integration is observed when the auditory and visual stimuli are incongruent (the McGurk effect). In general, AV integration is helpful especially in subjects wearing hearing aids or cochlear implants (CIs). However, the influence of AV integration on spoken word recognition in individuals with bilateral CIs (Bi-CIs) has not been fully investigated so far. In this study, we investigated AV integration in children with Bi-CIs. The study sample included thirty one prelingually deafened children who underwent sequential bilateral cochlear implantation. We assessed their responses to congruent and incongruent AV stimuli with three CI-listening modes: only the 1st CI, only the 2nd CI, and Bi-CIs. The responses were assessed in the whole group as well as in two sub-groups: a proficient group (syllable intelligibility ≥80% with the 1st CI) and a non-proficient group (syllable intelligibility effect in each of the three CI-listening modes. AV integration responses were observed in a subset of incongruent AV stimuli, and the patterns observed with the 1st CI and with Bi-CIs were similar. In the proficient group, the responses with the 2nd CI were not significantly different from those with the 1st CI whereas in the non-proficient group the responses with the 2nd CI were driven by visual stimuli more than those with the 1st CI. Our results suggested that prelingually deafened Japanese children who underwent sequential bilateral cochlear implantation exhibit AV integration abilities, both in monaural listening as well as in binaural listening. We also observed a higher influence of visual stimuli on speech perception with the 2nd CI in the non-proficient group, suggesting that Bi-CIs listeners with poorer speech recognition rely on visual information more compared to the proficient subjects to compensate for poorer auditory input. Nevertheless, poorer quality auditory input with the 2nd CI did not interfere with AV integration with binaural

  5. Auditory-cognitive training improves language performance in prelingually deafened cochlear implant recipients.

    Science.gov (United States)

    Ingvalson, Erin M; Young, Nancy M; Wong, Patrick C M

    2014-10-01

    Phonological and working memory skills have been shown to be important for the development of spoken language. Children who use a cochlear implant (CI) show performance deficits relative to normal hearing (NH) children on all constructs: phonological skills, working memory, and spoken language. Given that phonological skills and working memory have been shown to be important for spoken language development in NH children, we hypothesized that training these foundational skills would result in improved spoken language performance in CI-using children. Nineteen prelingually deafened CI-using children aged 4- to 7-years-old participated. All children had been using their implants for at least one year and were matched on pre-implant hearing thresholds, hearing thresholds at study enrollment, and non-verbal IQ. Children were assessed on expressive vocabulary, listening language, spoken language, and composite language. Ten children received four weeks of training on phonological skills including rhyme, sound blending, and sound discrimination and auditory working memory. The remaining nine children continued with their normal classroom activities for four weeks. Language assessments were repeated following the training/control period. Children who received combined phonological-working memory training showed significant gains on expressive and composite language scores. Children who did not receive training showed no significant improvements at post-test. On average, trained children had gain scores of 6.35 points on expressive language and gain scores of 6.15 points whereas the untrained children had test-retest gain scores of 2.89 points for expressive language and 2.56 for composite language. Our results suggest that training to improve the phonological and working memory skills in CI-using children may lead to improved language performance. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Cochlear implant outcomes and quality of life in adults with prelingual deafness

    NARCIS (Netherlands)

    Klop, W. Martin C.; Briaire, Jeroen J.; Stiggelbout, Anne M.; Frijns, Johan H. M.

    2007-01-01

    OBJECTIVES: To evaluate sound and speech perception and quality of life in prelingually deafened adults implanted with state of the art devices. To investigate which patient factors influence postoperative performance. STUDY DESIGN: Prospective intervention study. METHODS: Eight prelingually

  7. Lexical tone recognition in noise in normal-hearing children and prelingually deafened children with cochlear implants.

    Science.gov (United States)

    Mao, Yitao; Xu, Li

    2017-01-01

    The purpose of the present study was to investigate Mandarin tone recognition in background noise in children with cochlear implants (CIs), and to examine the potential factors contributing to their performance. Tone recognition was tested using a two-alternative forced-choice paradigm in various signal-to-noise ratio (SNR) conditions (i.e. quiet, +12, +6, 0, and -6 dB). Linear correlation analysis was performed to examine possible relationships between the tone-recognition performance of the CI children and the demographic factors. Sixty-six prelingually deafened children with CIs and 52 normal-hearing (NH) children as controls participated in the study. Children with CIs showed an overall poorer tone-recognition performance and were more susceptible to noise than their NH peers. Tone confusions between Mandarin tone 2 and tone 3 were most prominent in both CI and NH children except for in the poorest SNR conditions. Age at implantation was significantly correlated with tone-recognition performance of the CI children in noise. There is a marked deficit in tone recognition in prelingually deafened children with CIs, particularly in noise listening conditions. While factors that contribute to the large individual differences are still elusive, early implantation could be beneficial to tone development in pediatric CI users.

  8. Audiovisual spoken word training can promote or impede auditory-only perceptual learning: prelingually deafened adults with late-acquired cochlear implants versus normal hearing adults.

    Science.gov (United States)

    Bernstein, Lynne E; Eberhardt, Silvio P; Auer, Edward T

    2014-01-01

    Training with audiovisual (AV) speech has been shown to promote auditory perceptual learning of vocoded acoustic speech by adults with normal hearing. In Experiment 1, we investigated whether AV speech promotes auditory-only (AO) perceptual learning in prelingually deafened adults with late-acquired cochlear implants. Participants were assigned to learn associations between spoken disyllabic C(=consonant)V(=vowel)CVC non-sense words and non-sense pictures (fribbles), under AV and then AO (AV-AO; or counter-balanced AO then AV, AO-AV, during Periods 1 then 2) training conditions. After training on each list of paired-associates (PA), testing was carried out AO. Across all training, AO PA test scores improved (7.2 percentage points) as did identification of consonants in new untrained CVCVC stimuli (3.5 percentage points). However, there was evidence that AV training impeded immediate AO perceptual learning: During Period-1, training scores across AV and AO conditions were not different, but AO test scores were dramatically lower in the AV-trained participants. During Period-2 AO training, the AV-AO participants obtained significantly higher AO test scores, demonstrating their ability to learn the auditory speech. Across both orders of training, whenever training was AV, AO test scores were significantly lower than training scores. Experiment 2 repeated the procedures with vocoded speech and 43 normal-hearing adults. Following AV training, their AO test scores were as high as or higher than following AO training. Also, their CVCVC identification scores patterned differently than those of the cochlear implant users. In Experiment 1, initial consonants were most accurate, and in Experiment 2, medial consonants were most accurate. We suggest that our results are consistent with a multisensory reverse hierarchy theory, which predicts that, whenever possible, perceivers carry out perceptual tasks immediately based on the experience and biases they bring to the task. We

  9. Recurrent variants in OTOF are significant contributors to prelingual nonsydromic hearing loss in Saudi patients

    Science.gov (United States)

    Almontashiri, Naif A M; Alswaid, Abdulrahman; Oza, Andrea; Al-Mazrou, Khalid A; Elrehim, Omnia; Tayoun, Ahmad Abou; Rehm, Heidi L; Amr, Sami S

    2018-01-01

    Purpose Hearing loss is more prevalent in the Saudi Arabian population than in other populations; however, the full range of genetic etiologies in this population is unknown. We report the genetic findings from 33 Saudi hearing-loss probands of tribal ancestry, with predominantly prelingual severe to profound hearing loss. Methods Testing was performed over the course of 2012–2016, and involved initial GJB2 sequence and GJB6-D13S1830 deletion screening, with negative cases being reflexed to a next-generation sequencing panel with 70, 71, or 87 hearing-loss genes. Results A “positive” result was reached in 63% of probands, with two recurrent OTOF variants (p.Glu57* and p.Arg1792His) accountable for a third of all “positive” cases. The next most common cause was pathogenic variants in MYO7A and SLC26A4, each responsible for three “positive” cases. Interestingly, only one “positive” diagnosis had a DFNB1-related cause, due to a homozygous GJB6-D13S1830 deletion, and no sequence variants in GJB2 were detected. Conclusion Our findings implicate OTOF as a potential major contributor to hearing loss in the Saudi population, while highlighting the low contribution of GJB2, thus offering important considerations for clinical testing strategies for Saudi patients. Further screening of Saudi patients is needed to characterize the genetic spectrum in this population. PMID:29048421

  10. Cochlear implantation in late-implanted adults with prelingual deafness.

    Science.gov (United States)

    Most, Tova; Shrem, Hadas; Duvdevani, Ilana

    2010-01-01

    The purpose of this study was to examine the effect of cochlear implantation (CI) on prelingually deafened participants who were implanted as adults. The effect of the CI was examined with regard to the following variables: communication, family, social skills, education, and work satisfaction with one's life, loneliness, and self-esteem. Thirty-eight adults participated. Four self-report questionnaires were used at 2 points in time: before and after CI. The research findings show significant differences in the reports of most variables before and after implantation. The participants felt better with regard to communication, social skills, education, and work and satisfaction with one's life after implantation in comparison to their feelings before implantation. Furthermore, they felt less lonely after implantation. However, there were no significant differences before and after implantation regarding their feelings within the family and regarding their self-esteem. The results demonstrated the need to evaluate the benefits resulting from the CI not only with traditional clinical measures but with additional measures as well. Furthermore, they demonstrated the benefit of the CI on the positive psychosociological implications of prelingually deafened adults. Copyright © 2010 Elsevier Inc. All rights reserved.

  11. Psychoacoustic Performance and Music and Speech Perception in Prelingually Deafened Children with Cochlear Implants

    OpenAIRE

    Jung, Kyu Hwan; Won, Jong Ho; Drennan, Ward R.; Jameyson, Elyse; Miyasaki, Gary; Norton, Susan J.; Rubinstein, Jay T.

    2012-01-01

    The number of pediatric cochlear implant (CI) recipients has increased substantially over the past 10 years, and it has become more important to understand the underlying mechanisms of the variable outcomes in this population. In this study, psychoacoustic measures of spectral-ripple and Schroeder-phase discrimination, the Clinical Assessment of Music Perception, and consonant-nucleus-consonant (CNC) word recognition in quiet and spondee reception threshold (SRT) in noise tests have been pres...

  12. Working with Students Who Are Late-Deafened. PEPNet Tipsheet

    Science.gov (United States)

    Clark, Mary

    2010-01-01

    Late-deafness means deafness that happened postlingually, any time after the development of speech and language in a person who has identified with hearing society through schooling, social connections, etc. Students who are late-deafened cannot understand speech without visual aids such as speechreading, sign language, and captioning (although…

  13. Preoperative cerebral metabolic difference related to the outcome of cochlear implantation in prelingually deaf children

    International Nuclear Information System (INIS)

    Lee, J. H.; Lim, G. C.; Ahn, J. H.; Lee, K. S.; Jeong, J. W.; Kim, J. S.

    2007-01-01

    The outcome of cochlear implantation (CI) has known to be variable. The aim of this study was to evaluate the preoperative regional glucose metabolism difference related to the speech perception outcome after CI in prelingually deaf children. Forty-one prelingually deaf children who underwent CI at age 2∼10 years were included. All patients underwent F-18 FDG brain PET within one month before CI and measured speech perception using the institute version of the CID at 2 years after CI. Patients were classified into younger (2∼6 years) and older (7∼10 years) groups. Each group was also divided into a GOOD (CID scores>80) and a BAD (CID scores<60) subgroup. We assessed regional metabolic difference according to CID scores and age by voxel based analysis (SPM2) comparing normal controls (n =8, 20∼30 years). Speech perception was good in 19 (68%) of 28 younger patients and 5 (38%) of 13 older patients after CI. Regional metabolism of both younger and older GOOD subgroup was significantly decreased in right temporal, left cerebellar and right frontal regions compared to normal controls (uncorrected p<0.001). In younger GOOD subgroup, left frontotemporal and both parietal regions showed decreased metabolism and right frontal, left temporal and anterior cingulate regions showed increased metabolism compared to BAD subgroup (uncorrected p<0.005). In younger group, regional metabolism in left superior frontal, right temporal and right occipital regions showed a significant negative correlation with CID scores (uncorrected p<0.005). In older group, the pattern of regional metabolic difference correlated with CID score was not similar to that of younger group. Preoperative regional cerebral metabolism is decreased in several brain regions related to the language in preligually deaf patients and the neuralplasty of younger patients are different according to the outcome of speech perception after CI

  14. Preoperative cerebral metabolic difference related to the outcome of cochlear implantation in prelingually deaf children

    Energy Technology Data Exchange (ETDEWEB)

    Lee, J. H.; Lim, G. C.; Ahn, J. H.; Lee, K. S.; Jeong, J. W.; Kim, J. S. [Asan Medical Center, Seoul (Korea, Republic of)

    2007-07-01

    The outcome of cochlear implantation (CI) has known to be variable. The aim of this study was to evaluate the preoperative regional glucose metabolism difference related to the speech perception outcome after CI in prelingually deaf children. Forty-one prelingually deaf children who underwent CI at age 2{approx}10 years were included. All patients underwent F-18 FDG brain PET within one month before CI and measured speech perception using the institute version of the CID at 2 years after CI. Patients were classified into younger (2{approx}6 years) and older (7{approx}10 years) groups. Each group was also divided into a GOOD (CID scores>80) and a BAD (CID scores<60) subgroup. We assessed regional metabolic difference according to CID scores and age by voxel based analysis (SPM2) comparing normal controls (n =8, 20{approx}30 years). Speech perception was good in 19 (68%) of 28 younger patients and 5 (38%) of 13 older patients after CI. Regional metabolism of both younger and older GOOD subgroup was significantly decreased in right temporal, left cerebellar and right frontal regions compared to normal controls (uncorrected p<0.001). In younger GOOD subgroup, left frontotemporal and both parietal regions showed decreased metabolism and right frontal, left temporal and anterior cingulate regions showed increased metabolism compared to BAD subgroup (uncorrected p<0.005). In younger group, regional metabolism in left superior frontal, right temporal and right occipital regions showed a significant negative correlation with CID scores (uncorrected p<0.005). In older group, the pattern of regional metabolic difference correlated with CID score was not similar to that of younger group. Preoperative regional cerebral metabolism is decreased in several brain regions related to the language in preligually deaf patients and the neuralplasty of younger patients are different according to the outcome of speech perception after CI.

  15. Grey matter connectivity within and between auditory, language and visual systems in prelingually deaf adolescents.

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    Li, Wenjing; Li, Jianhong; Wang, Zhenchang; Li, Yong; Liu, Zhaohui; Yan, Fei; Xian, Junfang; He, Huiguang

    2015-01-01

    Previous studies have shown brain reorganizations after early deprivation of auditory sensory. However, changes of grey matter connectivity have not been investigated in prelingually deaf adolescents yet. In the present study, we aimed to investigate changes of grey matter connectivity within and between auditory, language and visual systems in prelingually deaf adolescents. We recruited 16 prelingually deaf adolescents and 16 age-and gender-matched normal controls, and extracted the grey matter volume as the structural characteristic from 14 regions of interest involved in auditory, language or visual processing to investigate the changes of grey matter connectivity within and between auditory, language and visual systems. Sparse inverse covariance estimation (SICE) was utilized to construct grey matter connectivity between these brain regions. The results show that prelingually deaf adolescents present weaker grey matter connectivity within auditory and visual systems, and connectivity between language and visual systems declined. Notably, significantly increased brain connectivity was found between auditory and visual systems in prelingually deaf adolescents. Our results indicate "cross-modal" plasticity after deprivation of the auditory input in prelingually deaf adolescents, especially between auditory and visual systems. Besides, auditory deprivation and visual deficits might affect the connectivity pattern within language and visual systems in prelingually deaf adolescents.

  16. Is cochlear implantation a good treatment method for profoundly deafened elderly?

    Directory of Open Access Journals (Sweden)

    Lachowska M

    2013-10-01

    Full Text Available Magdalena Lachowska, Agnieszka Pastuszka, Paulina Glinka, Kazimierz Niemczyk Department of Otolaryngology, Hearing Implant Center, Medical University of Warsaw, Warsaw, Poland Purpose: To assess the benefits of cochlear implantation in the elderly. Patients and methods: A retrospective analysis of 31 postlingually deafened elderly (≥60 years of age with unilateral cochlear implants was conducted. Audiological testing included preoperative and postoperative pure-tone audiometry and a monosyllabic word recognition test presented from recorded material in free field. Speech perception tests included Ling's six sound test (sound detection, discrimination, and identification, syllable discrimination, and monosyllabic and multisyllabic word recognition (open set without lip-reading. Everyday life benefits from cochlear implantation were also evaluated. Results: The mean age at the time of cochlear implantation was 72.4 years old. The mean post-implantation follow-up time was 2.34 years. All patients significantly improved their audiological and speech understanding performances. The preoperative mean pure-tone average threshold for 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz was 110.17 dB HL. Before cochlear implantation, all patients scored 0% on the monosyllabic word recognition test in free field at 70 dB SPL intensity level. The postoperative pure-tone average was 37.14 dB HL (the best mean threshold was 17.50 dB HL, the worst was 58.75 dB HL. After the surgery, mean monosyllabic word recognition reached 47.25%. Speech perception tests showed statistically significant improvement in speech recognition. Conclusion: The results of this study showed that cochlear implantation is indeed a successful treatment for improving speech recognition and offers a great help in everyday life to deafened elderly patients. Therefore, they can be good candidates for cochlear implantation and their age alone should not be a relevant or excluding factor when choosing

  17. Music and Quality of Life in Early-Deafened Late-Implanted Adult Cochlear Implant Users

    NARCIS (Netherlands)

    Fuller, Christina; Mallinckrodt, Lisa; Maat, Bert; Başkent, Deniz; Free, Rolien

    Hypothesis and Background: The early-deafened, late-implanted (EDLI) CI users constitute a relatively new and understudied clinical population. To contribute to a better understanding of the implantation outcome, this study evaluated this population for self-reported enjoyment and perception of

  18. Music appreciation and music listening in prelingual and postlingually deaf adult cochlear implant recipients.

    Science.gov (United States)

    Moran, Michelle; Rousset, Alexandra; Looi, Valerie

    2016-01-01

    To explore the music appreciation of prelingually deaf adults using cochlear implants (CIs). Cohort study. Adult CI recipients were recruited based on hearing history and asked to complete the University of Canterbury Music Listening Questionnaire (UCMLQ) to assess each individual's music listening and appreciation. Results were compared to previous responses to the UCMLQ from a large cohort of postlingually deaf CI recipients. Fifteen prelingually deaf and 15 postlingually deaf adult cochlear implant recipients. No significant differences were found between the prelingual and postlingual participants for amount of music listening or music listening enjoyment with their CI. Sound quality of common instruments was favourable for both groups, with no significant difference in the pleasantness/naturalness of instrument sounds between the groups. Prelingually deaf CI recipients rated themselves as significantly less able to follow a melody line and identify instrument styles compared to their postlingual peers. The results suggest that the pre- and postlingually deaf CI recipients demonstrate equivalent levels of music appreciation. This finding is of clinical importance, as CI clinicians should be actively encouraging all of their recipients to explore music listening as a part of their rehabilitation.

  19. Perception of environmental sounds by experienced cochlear implant patients

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    Shafiro, Valeriy; Gygi, Brian; Cheng, Min-Yu; Vachhani, Jay; Mulvey, Megan

    2011-01-01

    CNC scores in quiet moderately correlated with the temporal order for tones. However, the correlation between speech and environmental sounds changed little after partialing out the variance due to other variables. Conclusions Present findings indicate that environmental sound identification is difficult for CI patients. They further suggest that speech and environmental sounds may overlap considerably in their perceptual processing. Certain spectro-temproral processing abilities are separately associated with speech and environmental sound performance. However, they do not appear to mediate the relationship between speech and environmental sounds in CI patients. Environmental sound rehabilitation may be beneficial to some patients. Environmental sound testing may have potential diagnostic applications, especially with difficult-to-test populations, and could be predictive of speech performance for prelingually deafened patients with cochlear implants. PMID:21248643

  20. Visual Processing Recruits the Auditory Cortices in Prelingually Deaf Children and Influences Cochlear Implant Outcomes.

    Science.gov (United States)

    Liang, Maojin; Chen, Yuebo; Zhao, Fei; Zhang, Junpeng; Liu, Jiahao; Zhang, Xueyuan; Cai, Yuexin; Chen, Suijun; Li, Xianghui; Chen, Ling; Zheng, Yiqing

    2017-09-01

    Although visual processing recruitment of the auditory cortices has been reported previously in prelingually deaf children who have a rapidly developing brain and no auditory processing, the visual processing recruitment of auditory cortices might be different in processing different visual stimuli and may affect cochlear implant (CI) outcomes. Ten prelingually deaf children, 4 to 6 years old, were recruited for the study. Twenty prelingually deaf subjects, 4 to 6 years old with CIs for 1 year, were also recruited; 10 with well-performing CIs, 10 with poorly performing CIs. Ten age and sex-matched normal-hearing children were recruited as controls. Visual ("sound" photo [photograph with imaginative sound] and "nonsound" photo [photograph without imaginative sound]) evoked potentials were measured in all subjects. P1 at Oz and N1 at the bilateral temporal-frontal areas (FC3 and FC4) were compared. N1 amplitudes were strongest in the deaf children, followed by those with poorly performing CIs, controls and those with well-performing CIs. There was no significant difference between controls and those with well-performing CIs. "Sound" photo stimuli evoked a stronger N1 than "nonsound" photo stimuli. Further analysis showed that only at FC4 in deaf subjects and those with poorly performing CIs were the N1 responses to "sound" photo stimuli stronger than those to "nonsound" photo stimuli. No significant difference was found for the FC3 and FC4 areas. No significant difference was found in N1 latencies and P1 amplitudes or latencies. The results indicate enhanced visual recruitment of the auditory cortices in prelingually deaf children. Additionally, the decrement in visual recruitment of auditory cortices was related to good CI outcomes.

  1. Divergence of fine and gross motor skills in prelingually deaf children: implications for cochlear implantation.

    Science.gov (United States)

    Horn, David L; Pisoni, David B; Miyamoto, Richard T

    2006-08-01

    The objective of this study was to assess relations between fine and gross motor development and spoken language processing skills in pediatric cochlear implant users. The authors conducted a retrospective analysis of longitudinal data. Prelingually deaf children who received a cochlear implant before age 5 and had no known developmental delay or cognitive impairment were included in the study. Fine and gross motor development were assessed before implantation using the Vineland Adaptive Behavioral Scales, a standardized parental report of adaptive behavior. Fine and gross motor scores reflected a given child's motor functioning with respect to a normative sample of typically developing, normal-hearing children. Relations between these preimplant scores and postimplant spoken language outcomes were assessed. In general, gross motor scores were found to be positively related to chronologic age, whereas the opposite trend was observed for fine motor scores. Fine motor scores were more strongly correlated with postimplant expressive and receptive language scores than gross motor scores. Our findings suggest a disassociation between fine and gross motor development in prelingually deaf children: fine motor skills, in contrast to gross motor skills, tend to be delayed as the prelingually deaf children get older. These findings provide new knowledge about the links between motor and spoken language development and suggest that auditory deprivation may lead to atypical development of certain motor and language skills that share common cortical processing resources.

  2. [Emotional response to music by postlingually-deafened adult cochlear implant users].

    Science.gov (United States)

    Wang, Shuo; Dong, Ruijuan; Zhou, Yun; Li, Jing; Qi, Beier; Liu, Bo

    2012-10-01

    To assess the emotional response to music by postlingually-deafened adult cochlear implant users. Munich music questionnaire (MUMU) was used to match the music experience and the motivation of use of music between 12 normal-hearing and 12 cochlear implant subjects. Emotion rating test in Musical Sounds in Cochlear Implants (MuSIC) test battery was used to assess the emotion perception ability for both normal-hearing and cochlear implant subjects. A total of 15 pieces of music phases were used. Responses were given by selecting the rating scales from 1 to 10. "1" represents "very sad" feeling, and "10" represents "very happy feeling. In comparison with normal-hearing subjects, 12 cochlear implant subjects made less active use of music for emotional purpose. The emotion ratings for cochlear implant subjects were similar to normal-hearing subjects, but with large variability. Post-lingually deafened cochlear implant subjects on average performed similarly in emotion rating tasks relative to normal-hearing subjects, but their active use of music for emotional purpose was obviously less than normal-hearing subjects.

  3. Intracochlear electrical stimulation suppresses apoptotic signaling in rat spiral ganglion neurons after deafening in vivo.

    Science.gov (United States)

    Kopelovich, Jonathan C; Cagaanan, Alain P; Miller, Charles A; Abbas, Paul J; Green, Steven H

    2013-11-01

    To establish the intracellular consequences of electrical stimulation to spiral ganglion neurons after deafferentation. Here we use a rat model to determine the effect of both low and high pulse rate acute electrical stimulation on activation of the proapoptotic transcription factor Jun in deafferented spiral ganglion neurons in vivo. Experimental animal study. Hearing research laboratories of the University of Iowa Departments of Biology and Otolaryngology. A single electrode was implanted through the round window of kanamycin-deafened rats at either postnatal day 32 (P32, n = 24) or P60 (n = 22) for 4 hours of stimulation (monopolar, biphasic pulses, amplitude twice electrically evoked auditory brainstem response [eABR] threshold) at either 100 or 5000 Hz. Jun phosphorylation was assayed by immunofluorescence to quantitatively assess the effect of electrical stimulation on proapoptotic signaling. Jun phosphorylation was reliably suppressed by 100 Hz stimuli in deafened cochleae of P32 but not P60 rats. This effect was not significant in the basal cochlear turns. Stimulation frequency may be consequential: 100 Hz was significantly more effective than was 5 kHz stimulation in suppressing phospho-Jun. Suppression of Jun phosphorylation occurs in deafferented spiral ganglion neurons after only 4 hours of electrical stimulation. This finding is consistent with the hypothesis that electrical stimulation can decrease spiral ganglion neuron death after deafferentation.

  4. Enhancing Parent-Child Communication and Parental Self-Esteem with a Video-Feedback Intervention: Outcomes with Prelingual Deaf and Hard-of-Hearing Children

    Science.gov (United States)

    Lam-Cassettari, Christa; Wadnerkar-Kamble, Meghana B.; James, Deborah M.

    2015-01-01

    Evidence on best practice for optimizing communication with prelingual deaf and hard-of-hearing (DHH) children is lacking. This study examined the effect of a family-focused psychosocial video intervention program on parent-child communication in the context of childhood hearing loss. Fourteen hearing parents with a prelingual DHH child…

  5. [Effect of rehabilitation for prelingual deaf children who use cochlear implants in conjunction with hearing aids in the opposite ears].

    Science.gov (United States)

    Tian, Yanjing; Zhou, Huifang; Zhang, Jing; Yang, Dong; Xu, Yi; Guo, Yuxi

    2012-10-01

    To compare the effect of rehabilitation of prelingual deaf children who used a cochlear implant (CI) in one ear and a hearing aids in the opposite ear while the hearing level of the opposite ears are different. Hearing ability, language ability and learning ability was included in the content. The aim of this research is to investigate better style of rehabilitation, and to offer the best help to the prelingual deaf children. Accord ing to the hearing level of the ear opposite to the one wearing a cochlear implant and whether the opposite ear wear a hearing aid or not, 30 prelingual deaf children were divided into three groups, including cochlear implant with opposite severe hearing loss and hearing aid ear (CI+SHA), cochlear implant with opposite profound hearing loss and hearing aid ear (CI+PHA), cochlear implant only (CI). The effect of rehabilitation was assessed in six different times (3,6,9,12,15 and 18 months after the cochlear implants and hearing aids began to work). The longer time the rehabilitation spends, the better the hearing ability,language ability and the learning ability were. The hearing ability of CI+SHA was better than those of CI+PHA (Pdeaf children should take much more time on rehabilitation. The effect of rehabilitation for prelingual deaf children who used cochlear implant in one ear and hearing aid in the other depend on the residual hearing level of the other ear. If a prelingual deaf children still has any residual hearing level in the ear opposite to the cochlear implant ear, it is better for him/her to wear a hearing aid in the ear.

  6. Effects of brain-derived neurotrophic factor (BDNF) on the cochlear nucleus in cats deafened as neonates.

    Science.gov (United States)

    Kandathil, Cherian K; Stakhovskaya, Olga; Leake, Patricia A

    2016-12-01

    Many previous studies have shown significant neurotrophic effects of intracochlear delivery of BDNF in preventing degeneration of cochlear spiral ganglion (SG) neurons after deafness in rodents and our laboratory has shown similar results in developing cats deafened prior to hearing onset. This study examined the morphology of the cochlear nucleus (CN) in a group of neonatally deafened cats from a previous study in which infusion of BDNF elicited a significant improvement in survival of the SG neurons. Five cats were deafened by systemic injections of neomycin sulfate (60 mg/kg, SQ, SID) starting one day after birth, and continuing for 16-18 days until auditory brainstem response (ABR) testing demonstrated profound bilateral hearing loss. The animals were implanted unilaterally at about 1 month of age using custom-designed electrodes with a drug-delivery cannula connected to an osmotic pump. BDNF (94 μg/ml; 0.25 μl/hr) was delivered for 10 weeks. The animals were euthanized and studied at 14-23 weeks of age. Consistent with the neurotrophic effects of BDNF on SG survival, the total CN volume in these animals was significantly larger on the BDNF-treated side than on the contralateral side. However, total CN volume, both ipsi- and contralateral to the implants in these deafened juvenile animals, was markedly smaller than the CN in normal adult animals, reflecting the severe effects of deafness on the central auditory system during development. Data from the individual major CN subdivisions (DCN, Dorsal Cochlear Nucleus; PVCN, Posteroventral Cochlear Nucleus; AVCN, Anteroventral Cochlear Nucleus) also were analyzed. A significant difference was observed between the BDNF-treated and control sides only in the AVCN. Measurements of the cross-sectional areas of spherical cells showed that cells were significantly larger in the AVCN ipsilateral to the implant than on the contralateral side. Further, the numerical density of spherical cells was significantly lower in

  7. Recognition and Comprehension of "Narrow Focus" by Young Adults With Prelingual Hearing Loss Using Hearing Aids or Cochlear Implants.

    Science.gov (United States)

    Segal, Osnat; Kishon-Rabin, Liat

    2017-12-20

    The stressed word in a sentence (narrow focus [NF]) conveys information about the intent of the speaker and is therefore important for processing spoken language and in social interactions. The ability of participants with severe-to-profound prelingual hearing loss to comprehend NF has rarely been investigated. The purpose of this study was to assess the recognition and comprehension of NF by young adults with prelingual hearing loss compared with those of participants with normal hearing (NH). The participants included young adults with hearing aids (HA; n = 10), cochlear implants (CI; n = 12), and NH (n = 18). The test material included the Hebrew Narrow Focus Test (Segal, Kaplan, Patael, & Kishon-Rabin, in press), with 3 subtests, which was used to assess the recognition and comprehension of NF in different contexts. The following results were obtained: (a) CI and HA users successfully recognized the stressed word, with the worst performance for CI; (b) HA and CI comprehended NF less well than NH; and (c) the comprehension of NF was associated with verbal working memory and expressive vocabulary in CI users. Most CI and HA users were able to recognize the stressed word in a sentence but had considerable difficulty understanding it. Different factors may contribute to this difficulty, including the memory load during the task itself and linguistic and pragmatic abilities. https://doi.org/10.23641/asha.5572792.

  8. Enhancing Parent-Child Communication and Parental Self-Esteem With a Video-Feedback Intervention: Outcomes With Prelingual Deaf and Hard-of-Hearing Children.

    Science.gov (United States)

    Lam-Cassettari, Christa; Wadnerkar-Kamble, Meghana B; James, Deborah M

    2015-07-01

    Evidence on best practice for optimizing communication with prelingual deaf and hard-of-hearing (DHH) children is lacking. This study examined the effect of a family-focused psychosocial video intervention program on parent-child communication in the context of childhood hearing loss. Fourteen hearing parents with a prelingual DHH child (Mage = 2 years 8 months) completed three sessions of video interaction guidance intervention. Families were assessed in spontaneous free play interactions at pre and postintervention using the Emotional Availability (EA) Scales. The Rosenberg Self-esteem Scale was also used to assess parental report of self-esteem. Compared with nontreatment baselines, increases were shown in the EA subscales: parental sensitivity, parental structuring, parental nonhostility, child responsiveness, and child involvement, and in reported self-esteem at postintervention. Video-feedback enhances communication in families with prelingual DHH children and encourages more connected parent-child interaction. The results raise implications regarding the focus of early intervention strategies for prelingual DHH children. © The Author 2015. Published by Oxford University Press.

  9. Adeno-associated virus-mediated gene delivery into the scala media of the normal and deafened adult mouse ear.

    Science.gov (United States)

    Kilpatrick, L A; Li, Q; Yang, J; Goddard, J C; Fekete, D M; Lang, H

    2011-06-01

    Murine models are ideal for studying cochlear gene transfer, as many hearing loss-related mutations have been discovered and mapped within the mouse genome. However, because of the small size and delicate nature, the membranous labyrinth of the mouse is a challenging target for the delivery of viral vectors. To minimize injection trauma, we developed a procedure for the controlled release of adeno-associated viruses (AAVs) into the scala media of adult mice. This procedure poses minimal risk of injury to structures of the cochlea and middle ear, and allows for near-complete preservation of low and middle frequency hearing. In this study, transduction efficiency and cellular specificity of AAV vectors (serotypes 1, 2, 5, 6 and 8) were investigated in normal and drug-deafened ears. Using the cytomegalovirus promoter to drive gene expression, a variety of cell types were transduced successfully, including sensory hair cells and supporting cells, as well as cells in the auditory nerve and spiral ligament. Among all five serotypes, inner hair cells were the most effectively transduced cochlear cell type. All five serotypes of AAV vectors transduced cells of the auditory nerve, though serotype 8 was the most efficient vector for transduction. Our findings indicate that efficient AAV inoculation (via the scala media) can be performed in adult mouse ears, with hearing preservation a realistic goal. The procedure we describe may also have applications for intra-endolymphatic drug delivery in many mouse models of human deafness.

  10. Epidemiology of prelingual sensorineural hearing impairment at a children’s center in Bogotá, Colombia between 1997 and 2008

    OpenAIRE

    Claudia Talero-Gutiérrez; Liliana Romero; Irma Carvajalino; Milciades Ibáñez

    2011-01-01

    Introduction: Hearing loss is a frequent problem in childhood with an incidence of about one case per 1000 births. Control of deafness should be aimed at prevention and early diagnosis in efforts to provide appropriate treatment and stimulate adequate communication in children affected. The objective of this study was to determine the prevalence of different etiologies among deaf children with a diagnosis of prelingual sensorineural hearing loss referred to the Fundación CINDA in Bogotá, Colo...

  11. The Music Experiences and Attitudes Of A First Cohort of Prelingually-Deaf Adolescents and Young Adults CI Recipients

    Science.gov (United States)

    Gfeller, Kate; Driscoll, Virginia; Smith, Rachel See; Scheperle, Christina

    2012-01-01

    The purpose of this study was to examine the musical engagement (participation and attitude) of pediatric CI recipients who were implanted during early childhood and who have reached age 15 or older. A questionnaire was administered to a group of 31 prelingually deaf CI users who receive annual follow up services and assessment in a clinical research center. The questionnaire was used to examine involvement in and attitudes toward music in school, the community, and in the home; social affiliation (hearing, Deaf, both) and mode of communication (oral, manual, both) were also examined. Despite the technical limitations of cochlear implants in transmitting pitch, melody, and tone quality, over two thirds of this sample described music as being important or very important in their lives. A high level of past and present familial involvement in music was associated with higher levels of current involvement and importance of music in the lives of adolescent and young adult CI users. Comparisons were noted with data from prior studies of persons with hearing loss who were non-CI users. PMID:23565029

  12. Identification of a Novel TECTA mutation in a Chinese DFNA8/12 family with prelingual progressive sensorineural hearing impairment.

    Directory of Open Access Journals (Sweden)

    Zhengyue Li

    Full Text Available Tectorial membrane, an extracellular matrix of the cochlea, plays a crucial role in the transmission of sound to the sensory hair cells. Alpha-tectorin is the most important noncollagenous component of the tectorial membrane and the otolith membrane in the maculae of the vestibular system. Defects in TECTA, the gene encodes alpha-tectorin, are cause of both dominant (DFNA8/12 and recessive (DFNB21 forms of deafness. Here, we report a three-generation Chinese family characterized by prelingual progressive sensorineural hearing impairment. We mapped the disease locus to chromosome 11q23-24 region, overlapping with the DFNA8/12 locus. Sequencing of candidate gene TECTA revealed a heterozygous c.5945C>A substitution in exon 19, causing amino acid substitution of Ala to Asp at a conservative position 1982. The A1982D substitution is consistent with hearing loss in this Chinese family and has not been found in 200 random control chromosomes. To our knowledge, this is the first TECTA mutation identified in Chinese population. Our data provides additional molecular and clinical information for establishing a better genotype-phenotype understanding of DFNA8/12.

  13. Frequency of Congenital Heart Diseases in Prelingual Sensory-Neural Deaf Children

    Directory of Open Access Journals (Sweden)

    Masoud Motasaddi Zarandy

    2016-03-01

    Full Text Available Introduction: Hearing impairment is the most frequent sensorial congenital defect in newborns and has increased to 2–4 cases per 1,000 live births. Sensory-neural hearing loss (SNHL accounts for more than 90% of all hearing loss. This disorder is associated with other congenital disorders such as renal, skeletal, ocular, and cardiac disorders. Given that congenital heart diseases are life-threatening, we decided to study the frequency of congenital heart diseases in children with congenital sensory-neural deafness.  Materials and Methods: All children who had undergone cochlear implantation surgery due to SNHL and who had attended our hospital for speech therapy during 2008–2011 were evaluated by Doppler echocardiography.  Results: Thirty-one children (15 boys and 16 girls with a mean age of 55.70 months were examined, and underwent electrocardiography (ECG and echocardiography. None of the children had any signs of heart problems in their medical records. Most of their heart examinations were normal, one patient had expiratory wheeze, four (12% had mid-systolic click, and four (12% had an intensified S1 sound. In echocardiography, 15 children (46% had mitral valve prolapse (MVP and two (6% had minimal mitral regurgitation (MR. Mean ejection fraction (EF was 69% and the mean fractional shortening (FS was 38%.  Conclusion:  This study indicates the need for echocardiography and heart examinations in children with SNHL.

  14. Epidemiología de la pérdida auditiva neurosensorial pre-lingual en un centro de atención a niños de Bogotá, Colombia entre 1997 y 2008

    OpenAIRE

    Claudia Talero-Gutiérrez; Liliana Romero; Irma Carvajalino; Milciades Ibáñez

    2011-01-01

    Introduction: Hearing loss is a frequent problem in childhood with an incidence of about one case per 1000 births. Control of deafness should be aimed at prevention and early diagnosis in efforts to provide appropriate treatment and stimulate adequate communication in children affected. The objective of this study was to determine the prevalence of different etiologies among deaf children with a diagnosis of prelingual sensorineural hearing loss referred to the Fundación CINDA in Bogotá, Colo...

  15. Long-Term Speech and Language Outcomes in Prelingually Deaf Children, Adolescents and Young Adults Who Received Cochlear Implants in Childhood

    Science.gov (United States)

    Ruffin, Chad V.; Kronenberger, William G.; Colson, Bethany G.; Henning, Shirley C.; Pisoni, David B.

    2013-01-01

    This study investigated long-term speech and language outcomes in 51 prelingually deaf children, adolescents, and young adults who received cochlear implants (CIs) prior to 7 years of age and used their implants for at least 7 years. Average speech perception scores were similar to those found in prior research with other samples of experienced CI users. Mean language test scores were lower than norm-referenced scores from nationally representative normal-hearing, typically-developing samples, although a majority of the CI users scored within one standard deviation of the normative mean or higher on the Peabody Picture Vocabulary Test, Fourth Edition (63%) and Clinical Evaluation of Language Fundamentals, Fourth Edition (69%). Speech perception scores were negatively associated with a meningitic etiology of hearing loss, older age at implantation, poorer pre-implant unaided pure tone average thresholds, lower family income, and the use of Total Communication. Users of CIs for 15 years or more were more likely to have these characteristics and were more likely to score lower on measures of speech perception compared to users of CIs for 14 years or less. The aggregation of these risk factors in the > 15 years of CI use subgroup accounts for their lower speech perception scores and may stem from more conservative CI candidacy criteria in use at the beginning of pediatric cochlear implantation. PMID:23988907

  16. Non-syndromic sensorineural prelingual deafness: the importance of genetic counseling in demystifying parents' beliefs about the cause of their children's deafness.

    Science.gov (United States)

    Rodrigues, Fidjy; Paneque, Milena; Reis, Cláudia; Venâncio, Margarida; Sequeiros, Jorge; Saraiva, Jorge

    2013-08-01

    Recent advances in molecular genetics have allowed the determination of the genetic cause of some childhood non-syndromic deafness. In Portugal only a small proportion of families are referred to a clinical genetics service in order to clarify the etiology of the deafness and to provide genetic counseling. Consequently, there are no published studies of the prior beliefs of parents about the causes of hereditary deafness of their children and their genetic knowledge after receipt of genetic counseling. In order to evaluate the impact of genetic counseling, 44 parents of 24 children with the diagnosis of non-syndromic sensorineural prelingual deafness due to mutations in the GJB2 (connexin 26), completed surveys before and after genetic counseling. Before counseling 13.6 % of the parents knew the cause of deafness; at a post-counseling setting this percentage was significantly higher, with 84.1 % of the parents accurately identifying the etiology. No significant differences were found between the answers of mothers and fathers either before or after genetic counseling. Parents' level of education was a significant factor in pre-test knowledge. After genetic counseling 95.5 % of the parents stated that the consultation had met their expectations, 70.5 % remembered correctly the inheritance pattern, and 93.2 % correctly recalled the chance of risk of deafness. These results underline the importance of genetic counseling in demystifying parents' beliefs about the etiology of their children's deafness.

  17. Profound, prelingual nonsyndromic deafness maps to chromosome 10q21 and is caused by a novel missense mutation in the Usher syndrome type IF gene PCDH15.

    Science.gov (United States)

    Doucette, Lance; Merner, Nancy D; Cooke, Sandra; Ives, Elizabeth; Galutira, Dante; Walsh, Vanessa; Walsh, Tom; MacLaren, Linda; Cater, Tracey; Fernandez, Bridget; Green, Jane S; Wilcox, Edward R; Shotland, Lawrence I; Shotland, Larry; Li, Xiaoyan Cindy; Li, X C; Lee, Ming; King, Mary-Claire; Young, Terry-Lynn

    2009-05-01

    We studied a consanguineous family (Family A) from the island of Newfoundland with an autosomal recessive form of prelingual, profound, nonsyndromic sensorineural hearing loss. A genome-wide scan mapped the deafness trait to 10q21-22 (max LOD score of 4.0; D10S196) and fine mapping revealed a 16 Mb ancestral haplotype in deaf relatives. The PCDH15 gene was mapped within the critical region and was an interesting candidate because truncating mutations cause Usher syndrome type IF (USH1F) and two missense mutations have been previously associated with isolated deafness (DFNB23). Sequencing of the PCDH15 gene revealed 33 sequencing variants. Three of these variants were homozygous exclusively in deaf siblings but only one of them was not seen in ethnically matched controls. This novel c.1583 T>A transversion predicts an amino-acid substitution of a valine with an aspartic acid at codon 528 (V528D). Like the two DFNB23 mutations, the V528D mutation in Family A occurs in a highly conserved extracellular cadherin (EC) domain of PCDH15 and is predicted to be more deleterious than the previously identified DFNB23 missense mutations (R134G and G262D). Physical assessment, vestibular and visual function testing in deaf adults ruled out syndromic deafness because of Usher syndrome. This study validates the DFNB23 designation and supports the hypothesis that missense mutations in conserved motifs of PCDH15 cause nonsyndromic hearing loss. This emerging genotype-phenotype correlation in USH1F is similar to that in several other USH1 genes and cautions against a prognosis of a dual sensory loss in deaf children found to be homozygous for hypomorphic mutations at the USH1F locus.

  18. Assessment of auditory skills in 140 cochlear implant children using the EARS protocol.

    Science.gov (United States)

    Sainz, Manuel; Skarzynski, Henryk; Allum, John H J; Helms, Jan; Rivas, Adriana; Martin, Jane; Zorowka, Patrick Georg; Phillips, Lucy; Delauney, Joseph; Brockmeyer, Steffi Johanna; Kompis, Martin; Korolewa, Inna; Albegger, Klaus; Zwirner, Petra; Van De Heyning, Paul; D'Haese, Patrick

    2003-01-01

    Auditory performance of cochlear implant (CI) children was assessed with the Listening Progress Profile (LiP) and the Monosyllabic-Trochee-Polysyllabic-Word Test (MTP) following the EARS protocol. Additionally, the 'initial drop' phenomenon, a recently reported decrease of auditory performance occurring immediately after first fitting, was investigated. Patients were 140 prelingually deafened children from various clinics and centers worldwide implanted with a MEDEL COMBI 40/40+. Analysis of LiP data showed a significant increase after 1 month of CI use compared to preoperative scores (p < 0.01). No initial decrease was observed with this test. Analysis of MTP data revealed a significant improvement of word recognition after 6 months (p < 0.01), with a significant temporary decrease after initial fitting (p < 0.01). With both tests, children's auditory skills improved up to 2 years. Amount of improvement was negatively correlated with age at implantation. Copyright 2003 S. Karger AG, Basel

  19. Effect of gender on the hearing performance of adult cochlear implant patients.

    Science.gov (United States)

    Lenarz, Minoo; Sönmez, Hasibe; Joseph, Gert; Büchner, Andreas; Lenarz, Thomas

    2012-05-01

    To evaluate the role of gender on the hearing performance of postlingually deafened adult patients with cochlear implants. Individual retrospective cohort study. There were 638 postlingually deafened adults (280 men and 358 women) selected for a retrospective evaluation of their hearing performance with cochlear implants. Both genders underwent the same surgical and rehabilitative procedures and benefited from the latest technological advances available. There was no significant difference in the age, duration of deafness, and preoperative hearing performance between the genders. The test battery was composed of the Freiburger Monosyllabic Test, Speech Tracking, and the Hochmair-Schulz-Moser (HSM) sentence test in quiet and in 10-dB noise. The results of 5 years of follow-up are presented here. Genders showed a similar performance in Freiburger Monosyllabic Test and Speech Tracking Test. However, in the HSM test in noise, men performed slightly better than women in all of the follow-up sessions, which was statistically significant at 2 and 4 years after implantation. Although normal-hearing women use more predictive cognitive strategies in speech comprehension and are supposed to have a more efficient declarative memory system, this may not necessarily lead to a better adaptation to the altered auditory information delivered by a cochlear implant. Our study showed that in more complex listening situations such as speech tests in noise, men tend to perform slightly better than women. Gender may have an influence on the hearing performance of postlingually deafened adults with cochlear implants. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  20. The Deafening of Resonance of Love

    DEFF Research Database (Denmark)

    Bonde, Lisbeth

    2015-01-01

    In his new exhibition 'Book of Love', Kasper Eistrup focuses on the idea of love being the very foundation of life. Th first piece we see is a giant book sharing its title with the exhibiton. His paintings and drawings - primarely paper works mounted on wood are extremely time consuming....

  1. Assessment of auditory cortical function in cochlear implant patients using 15O PET

    International Nuclear Information System (INIS)

    Young, J.P.; O'Sullivan, B.T.; Gibson, W.P.; Sefton, A.E.; Mitchell, T.E.; Sanli, H.; Cervantes, R.; Withall, A.; Royal Prince Alfred Hospital, Sydney,

    1998-01-01

    Full text: Cochlear implantation has been an extraordinarily successful method of restoring hearing and the potential for full language development in pre-lingually and post-lingually deaf individuals (Gibson 1996). Post-lingually deaf patients, who develop their hearing loss later in life, respond best to cochlear implantation within the first few years of their deafness, but are less responsive to implantation after several years of deafness (Gibson 1996). In pre-lingually deaf children, cochlear implantation is most effect in allowing the full development language skills when performed within a critical period, in the first 8 years of life. These clinical observations suggest considerable neural plasticity of the human auditory cortex in acquiring and retaining language skills (Gibson 1996, Buchwald 1990). Currently, electrocochleography is used to determine the integrity of the auditory pathways to the auditory cortex. However, the functional integrity of the auditory cortex cannot be determined by this method. We have defined the extent of activation of the auditory cortex and auditory association cortex in 6 normal controls and 6 cochlear implant patients using 15 O PET functional brain imaging methods. Preliminary results have indicated the potential clinical utility of 15 O PET cortical mapping in the pre-surgical assessment and post-surgical follow up of cochlear implant patients. Copyright (1998) Australian Neuroscience Society

  2. Evaluation of glucose metabolic abnormality in postlingually deaf patients using F-18-FDG positron emission tomography and statistical parametric mapping

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Sung; Lee, Dong Soo; Oh, Seung Ha; Kim, Chong Sun; Park, Kwang Suk; Chung, June Key; Lee, Myung Chul [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    2000-07-01

    We have previously reported the prognostic relevance of cross-modal cortical plasticity in prelingual deaf patients revealed by F-18-FDG PET and SPM analysis. In this study, we investigated metabolic abnormality in postlingual deaf patients, whose clinical features are different from prelingual deafness. Nine postlingual deaf patients (age: 30.5 {+-}14.0) were performed on F-18-FDG brain PET. We compared their PET images with those of age-matched 20 normal controls (age: 27.1 {+-}8.6), and performed correlation analysis to investigate the relationship between glucose metabolism and deaf duration using SPM99. Glucose metabolism of deaf patients was significantly (p<0.05, corrected) decreased in both anterior cingulate, inferior frontal cortices, and superior temporal cortices, and left hippocampus. Metabolism in both superior temporal cortices and association area in inferior parietal cortices showed significant (p<0.01, uncorrected) positive correlation with deaf duration. Decreased metabolism in hippocampus accompanied with hypometabolism in auditory related areas can be explained by recent finding of anatomical connectivity between them, and may be the evidence indicating their functional connectivity. Metabolism recovery in auditory cortex after long deaf duration suggests that cortical plasticity takes place also in postlingual deafness.

  3. Evaluation of glucose metabolic abnormality in postlingually deaf patients using F-18-FDG positron emission tomography and statistical parametric mapping

    International Nuclear Information System (INIS)

    Lee, Jae Sung; Lee, Dong Soo; Oh, Seung Ha; Kim, Chong Sun; Park, Kwang Suk; Chung, June Key; Lee, Myung Chul

    2000-01-01

    We have previously reported the prognostic relevance of cross-modal cortical plasticity in prelingual deaf patients revealed by F-18-FDG PET and SPM analysis. In this study, we investigated metabolic abnormality in postlingual deaf patients, whose clinical features are different from prelingual deafness. Nine postlingual deaf patients (age: 30.5 ±14.0) were performed on F-18-FDG brain PET. We compared their PET images with those of age-matched 20 normal controls (age: 27.1 ±8.6), and performed correlation analysis to investigate the relationship between glucose metabolism and deaf duration using SPM99. Glucose metabolism of deaf patients was significantly (p<0.05, corrected) decreased in both anterior cingulate, inferior frontal cortices, and superior temporal cortices, and left hippocampus. Metabolism in both superior temporal cortices and association area in inferior parietal cortices showed significant (p<0.01, uncorrected) positive correlation with deaf duration. Decreased metabolism in hippocampus accompanied with hypometabolism in auditory related areas can be explained by recent finding of anatomical connectivity between them, and may be the evidence indicating their functional connectivity. Metabolism recovery in auditory cortex after long deaf duration suggests that cortical plasticity takes place also in postlingual deafness

  4. Significant Artifact Reduction at 1.5T and 3T MRI by the Use of a Cochlear Implant with Removable Magnet: An Experimental Human Cadaver Study.

    Science.gov (United States)

    Wagner, Franca; Wimmer, Wilhelm; Leidolt, Lars; Vischer, Mattheus; Weder, Stefan; Wiest, Roland; Mantokoudis, Georgios; Caversaccio, Marco D

    2015-01-01

    Cochlear implants (CIs) are standard treatment for postlingually deafened individuals and prelingually deafened children. This human cadaver study evaluated diagnostic usefulness, image quality and artifacts in 1.5T and 3T magnetic resonance (MR) brain scans after CI with a removable magnet. Three criteria (diagnostic usefulness, image quality, artifacts) were assessed at 1.5T and 3T in five cadaver heads with CI. The brain magnetic resonance scans were performed with and without the magnet in situ. The criteria were analyzed by two blinded neuroradiologists, with focus on image distortion and limitation of the diagnostic value of the acquired MR images. MR images with the magnet in situ were all compromised by artifacts caused by the CI. After removal of the magnet, MR scans showed an unequivocal artifact reduction with significant improvement of the image quality and diagnostic usefulness, both at 1.5T and 3T. Visibility of the brain stem, cerebellopontine angle, and parieto-occipital lobe ipsilateral to the CI increased significantly after magnet removal. The results indicate the possible advantages for 1.5T and 3T MR scanning of the brain in CI carriers with removable magnets. Our findings support use of CIs with removable magnets, especially in patients with chronic intracranial pathologies.

  5. Language Practices in the Ci-Classroom

    DEFF Research Database (Denmark)

    Mourtou, Eleni

    2014-01-01

    Prelingually deafened children are nowadays likely to receive a cochlear implant (ci). As these children do their language acquisition with a cochlear implant they require a constant rehabilitation and support. Educational staff is instructed on how to work with children with ci in form...... of guidelines and workshops. This paper discusses language practices used in the setting of a school for cochlear-implanted children. These children encounter language and pronunciation problems that accompany prelingual deafness and hearing with a cochlear implant. I examine two practices, which are used...

  6. Cochlear implantation in patients with bilateral cochlear trauma.

    Science.gov (United States)

    Serin, Gediz Murat; Derinsu, Ufuk; Sari, Murat; Gergin, Ozgül; Ciprut, Ayça; Akdaş, Ferda; Batman, Cağlar

    2010-01-01

    Temporal bone fracture, which involves the otic capsule, can lead to complete loss of auditory and vestibular functions, whereas the patients without fractures may experience profound sensorineural hearing loss due to cochlear concussion. Cochlear implant is indicated in profound sensorineural hearing loss due to cochlear trauma but who still have an intact auditory nerve. This is a retrospective review study. We report 5 cases of postlingually deafened patients caused by cochlear trauma, who underwent cochlear implantation. Preoperative and postoperative hearing performance will be presented. These patients are cochlear implanted after the cochlear trauma in our department between 2001 and 2006. All patients performed very well with their implants, obtained open-set speech understanding. They all became good telephone users after implantation. Their performance in speech understanding was comparable to standard postlingual adult patients implanted. Cochlear implantation is an effective aural rehabilitation in profound sensorineural hearing loss caused by temporal bone trauma. Preoperative temporal bone computed tomography, magnetic resonance imaging, and promontorium stimulation testing are necessary to make decision for the surgery and to determine the side to be implanted. Surgery could be challenging and complicated because of anatomical irregularity. Moreover, fibrosis and partial or total ossification within the cochlea must be expected. Copyright 2010. Published by Elsevier Inc.

  7. A deafening flash! Visual interference of auditory signal detection.

    Science.gov (United States)

    Fassnidge, Christopher; Cecconi Marcotti, Claudia; Freeman, Elliot

    2017-03-01

    In some people, visual stimulation evokes auditory sensations. How prevalent and how perceptually real is this? 22% of our neurotypical adult participants responded 'Yes' when asked whether they heard faint sounds accompanying flash stimuli, and showed significantly better ability to discriminate visual 'Morse-code' sequences. This benefit might arise from an ability to recode visual signals as sounds, thus taking advantage of superior temporal acuity of audition. In support of this, those who showed better visual relative to auditory sequence discrimination also had poorer auditory detection in the presence of uninformative visual flashes, though this was independent of awareness of visually-evoked sounds. Thus a visually-evoked auditory representation may occur subliminally and disrupt detection of real auditory signals. The frequent natural correlation between visual and auditory stimuli might explain the surprising prevalence of this phenomenon. Overall, our results suggest that learned correspondences between strongly correlated modalities may provide a precursor for some synaesthetic abilities. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. A Deafening Silence: Hizballah After the American Invasion of Iraq

    National Research Council Canada - National Science Library

    Wrona, Jr, Richard M

    2007-01-01

    ... American servicemen and twenty-three French soldiers. Further bombings, murders, and kidnappings greatly contributed to the American decision months later that the carnage and anarchy in Lebanon were not worth additional American lives...

  9. Scar formation in mice deafened with kanamycin and furosemide

    NARCIS (Netherlands)

    Zak, Magdalena; van der Linden, Cynthia A; Bezdjian, Aren; Hendriksen, Ferry G; Klis, Sjaak F L; Grolman, Wilko

    In mammals, hair cell loss is irreversible and leads to hearing loss. To develop and test the functioning of different strategies aiming at hair cell regeneration, animal models of sensorineural hearing loss are essential. Although cochleae of these animals should lack hair cells, supporting cells

  10. Clinical outcomes of scala vestibuli cochlear implantation in children with partial labyrinthine ossification.

    Science.gov (United States)

    Lin, Yung-Song

    2009-03-01

    Cochlear implantation via the scala vestibuli is a viable approach in those with ossification in the scala tympani. With extended cochlear implant experience, there is no significant difference in the mapping parameters and auditory performance between those implanted via scala vestibuli and via scala tympani. To assess the clinical outcomes of cochlear implantation via scala vestibuli. In a cohort follow-up study, 11 prelingually deafened children who received cochlear implantation between age 3 and 10 years through the scala vestibuli served as participants. The mapping parameters (i.e. comfortable level (C), threshold level (T), dynamic range) and auditory performance of each participant were evaluated following initial cochlear implant stimulation, then at 3 month intervals for 2 years, then semi-annually. The follow-up period lasted for 9 years 9 months on average, with a minimum of 8 years 3 months. The clinical results of the mapping parameters and auditory performance of children implanted via the scala vestibuli were comparative to those who were implanted via the scala tympani. No balance problem was reported by any of these patients. One child exhibited residual low frequency hearing after implantation.

  11. Speech feature discrimination in deaf children following cochlear implantation

    Science.gov (United States)

    Bergeson, Tonya R.; Pisoni, David B.; Kirk, Karen Iler

    2002-05-01

    Speech feature discrimination is a fundamental perceptual skill that is often assumed to underlie word recognition and sentence comprehension performance. To investigate the development of speech feature discrimination in deaf children with cochlear implants, we conducted a retrospective analysis of results from the Minimal Pairs Test (Robbins et al., 1988) selected from patients enrolled in a longitudinal study of speech perception and language development. The MP test uses a 2AFC procedure in which children hear a word and select one of two pictures (bat-pat). All 43 children were prelingually deafened, received a cochlear implant before 6 years of age or between ages 6 and 9, and used either oral or total communication. Children were tested once every 6 months to 1 year for 7 years; not all children were tested at each interval. By 2 years postimplant, the majority of these children achieved near-ceiling levels of discrimination performance for vowel height, vowel place, and consonant manner. Most of the children also achieved plateaus but did not reach ceiling performance for consonant place and voicing. The relationship between speech feature discrimination, spoken word recognition, and sentence comprehension will be discussed. [Work supported by NIH/NIDCD Research Grant No. R01DC00064 and NIH/NIDCD Training Grant No. T32DC00012.

  12. Knowledge of display rules in prelingually deaf and hearing children.

    Science.gov (United States)

    Hosie, J A; Russell, P A; Gray, C D; Scott, C; Hunter, N; Banks, J S; Macaulay, M C

    2000-03-01

    Deaf children of elementary and secondary school age participated in a study designed to examine their understanding of display rules, the principles governing the expression and concealment of emotion in social situations. The results showed that deaf children's knowledge of display rules, as measured by their reported concealment of emotion, was comparable to that of hearing children of the same age. However, deaf children were less likely to report that they would conceal happiness and anger. They were also less likely to produce reasons for concealing emotion and a smaller proportion of their reasons were prosocial, that is, relating to the feelings of others. The results suggest that the understanding of display rules (which function to protect the feelings of other people) may develop more gradually in deaf children raised in a spoken language environment than it does in hearing children.

  13. Cortical activation in profoundly deaf patients during cochlear implant stimulation demonstrated by H2(15)O PET

    International Nuclear Information System (INIS)

    Herzog, H.; Lamprecht, A.; Kuehn, A.R.; Roden, W.; Vosteen, K.H.; Feinendegen, L.E.

    1991-01-01

    Cochlear implants (CIs) are used to provide sensations of sound to profoundly deaf patients. The performance of the CI is assessed mainly by the subjective reports of patients. The aim of this study was to look for objective cortical responses to the stimulation of the CI. Two postlingually and two prelingually deaf patients were investigated by positron emission tomography (PET) using 15 O-labeled water (H 2 15 O) to determine the regional cerebral blood flow (rCBF). Instead of quantifying rCBF in absolute terms, it was estimated by referring the regional tissue concentration of H 2 15 O to the mean whole brain concentration. CI stimulation encoded from white noise and sequential words led to an increased rCBF in the primary and secondary (Wernicke) auditory cortex. Relative elevations of up to 33% were observed bilaterally, although they were higher contralateral to the CI. These results were obtained not only in the postlingually deaf patients but also in two patients who had never been able to hear. Thus, it could be demonstrated that PET measurements of cerebral H 2 15 O distribution yield objective responses of the central auditory system during electrical stimulation by CIs in profoundly deaf patients

  14. Visual Temporal Acuity Is Related to Auditory Speech Perception Abilities in Cochlear Implant Users.

    Science.gov (United States)

    Jahn, Kelly N; Stevenson, Ryan A; Wallace, Mark T

    Despite significant improvements in speech perception abilities following cochlear implantation, many prelingually deafened cochlear implant (CI) recipients continue to rely heavily on visual information to develop speech and language. Increased reliance on visual cues for understanding spoken language could lead to the development of unique audiovisual integration and visual-only processing abilities in these individuals. Brain imaging studies have demonstrated that good CI performers, as indexed by auditory-only speech perception abilities, have different patterns of visual cortex activation in response to visual and auditory stimuli as compared with poor CI performers. However, no studies have examined whether speech perception performance is related to any type of visual processing abilities following cochlear implantation. The purpose of the present study was to provide a preliminary examination of the relationship between clinical, auditory-only speech perception tests, and visual temporal acuity in prelingually deafened adult CI users. It was hypothesized that prelingually deafened CI users, who exhibit better (i.e., more acute) visual temporal processing abilities would demonstrate better auditory-only speech perception performance than those with poorer visual temporal acuity. Ten prelingually deafened adult CI users were recruited for this study. Participants completed a visual temporal order judgment task to quantify visual temporal acuity. To assess auditory-only speech perception abilities, participants completed the consonant-nucleus-consonant word recognition test and the AzBio sentence recognition test. Results were analyzed using two-tailed partial Pearson correlations, Spearman's rho correlations, and independent samples t tests. Visual temporal acuity was significantly correlated with auditory-only word and sentence recognition abilities. In addition, proficient CI users, as assessed via auditory-only speech perception performance, demonstrated

  15. Music Appreciation after Cochlear Implantation in Adult Patients: A Systematic Review.

    Science.gov (United States)

    Riley, Phoebe E; Ruhl, Douglas S; Camacho, Macario; Tolisano, Anthony M

    2018-06-01

    Objective The cochlear implant (CI) improves quality of life for people who are severely and profoundly deafened, allowing implantees to perceive speech at levels similar to those of individuals with normal hearing. However, patients with CIs generally report a reduced appreciation of music after implantation. We aimed to systematically review the English-language literature for studies evaluating music enjoyment and perception among adult patients with CIs. Data Sources A systematic review of PubMed/MEDLINE, Scopus, Embase, and the Cochrane Library. Review Methods The PRISMA statement was utilized to identify English-language studies reporting music appreciation among adults with CIs. Two independent reviewers performed searches through May 2017. Included studies investigated parameters related to music enjoyment and music perception, including (1) pitch and timbre perception, (2) noise-canceling algorithms, and (3) the presence of dissonant chords, lyrics, or visual cues. Results A total of 508 articles were screened for relevance. Forty-one full-text articles were evaluated, and 18 met final inclusion criteria. Studies used heterogeneous methods of outcome measurement for identifying music appreciation. The outcome measures suggest that rhythm and lyrics are important components of enjoyment. Patients with CIs had difficulty with pitch and timbre perception. Conclusion The heterogeneous outcome measures identified in this systematic review suggest that rhythm and lyrics are important components of enjoyment, while patients with CIs had difficulty with pitch and timbre perception. Because there is no standardized reporting metric for music appreciation among adult patients with CIs, a standardized validated outcome-measuring tool is warranted.

  16. Frequency of c.35delG Mutation in GJB2 Gene (Connexin 26 in Syrian Patients with Nonsyndromic Hearing Impairment

    Directory of Open Access Journals (Sweden)

    Hazem Kaheel

    2017-01-01

    Full Text Available Background. Hearing impairments (HI are the most common birth defect worldwide. Very large numbers of genes have been identified but the most profound is GJB2. The clinical interest regarding this gene is very pronounced due to its high carrier frequency (0.5–5.4% across different ethnic groups. This study aimed to determine the prevalence of common GJB2 mutations in Syrian patients with profound sensorineural HI. Methods. We carried out PCR, restriction enzyme based screening, and sequencing of 132 Syrian patients diagnosed clinically with hereditary deafness for different GJB2 mutations. Results. The result revealed that, in GJB2 gene, c.35delG is the most prevalent among affected studied subjects (13.64%, followed by c.457G>A (2.4%. Conclusion. The benefit of this study on the one hand is its first report of prelingual deafness causative gene mutations identified by sequencing technology in the Syrian families. It is obvious from the results that the deployment in biomedical research is highly effective and has a great impact on the ability to uncover the cause of genetic variation in different genetic diseases.

  17. Magnet dislocation: an increasing and serious complication following MRI in patients with cochlear implants.

    Science.gov (United States)

    Hassepass, F; Stabenau, V; Arndt, S; Beck, R; Bulla, S; Grauvogel, T; Aschendorff, A

    2014-07-01

    Cochlear implantation (CI) represents the gold standard in the treatment of children born deaf and postlingually deafened adults. Initial magnetic resonance imaging (MRI) was contraindicated in CI users. Meanwhile, there are specific recommendations concerning MRI compatibility depending on the type of CI system and the device manufacturer. Some CI systems are even approved for MRI with the internal magnet left in place. The aim of this study was to analyze all magnet revision surgeries in CI patients at one CI center and the relationship to MRI scans over time. Between 2000 and 2013, a total of 2027 CIs were implanted. The number of magnet dislocation (MD) surgeries and their causes was assessed retrospectively. In total 12 cases of MD resulting from an MRI scan (0.59 %) were observed, accounting for 52.2 % of all magnetic revision surgeries. As per the labeling, it was considered safe to leave the internal magnet in place during MRI while following specific manufacturer recommendations: MRI intensity of 1.5 Tesla (T) and compression head bandage during examination. A compression head bandage in a 1.5 T MRI unit does not safely prevent MD and the related serious complications in CI recipients. We recommend a Stenvers view radiograph after MRI with the internal magnet in place for early identification of MD, at least in the case of pain during or after MRI examination. MRI in CI patients should be indicated with restraint and patients should be explicitly informed about the possible risks. Recommendations regarding MRI compatibility and the handling of CI patients issued with MRI for the most common CI systems are summarized. © Georg Thieme Verlag KG Stuttgart · New York.

  18. The Relationship Between Spectral Modulation Detection and Speech Recognition: Adult Versus Pediatric Cochlear Implant Recipients.

    Science.gov (United States)

    Gifford, René H; Noble, Jack H; Camarata, Stephen M; Sunderhaus, Linsey W; Dwyer, Robert T; Dawant, Benoit M; Dietrich, Mary S; Labadie, Robert F

    2018-01-01

    Adult cochlear implant (CI) recipients demonstrate a reliable relationship between spectral modulation detection and speech understanding. Prior studies documenting this relationship have focused on postlingually deafened adult CI recipients-leaving an open question regarding the relationship between spectral resolution and speech understanding for adults and children with prelingual onset of deafness. Here, we report CI performance on the measures of speech recognition and spectral modulation detection for 578 CI recipients including 477 postlingual adults, 65 prelingual adults, and 36 prelingual pediatric CI users. The results demonstrated a significant correlation between spectral modulation detection and various measures of speech understanding for 542 adult CI recipients. For 36 pediatric CI recipients, however, there was no significant correlation between spectral modulation detection and speech understanding in quiet or in noise nor was spectral modulation detection significantly correlated with listener age or age at implantation. These findings suggest that pediatric CI recipients might not depend upon spectral resolution for speech understanding in the same manner as adult CI recipients. It is possible that pediatric CI users are making use of different cues, such as those contained within the temporal envelope, to achieve high levels of speech understanding. Further investigation is warranted to investigate the relationship between spectral and temporal resolution and speech recognition to describe the underlying mechanisms driving peripheral auditory processing in pediatric CI users.

  19. Availability of binaural cues for pediatric bilateral cochlear implant recipients.

    Science.gov (United States)

    Sheffield, Sterling W; Haynes, David S; Wanna, George B; Labadie, Robert F; Gifford, René H

    2015-03-01

    Bilateral implant recipients theoretically have access to binaural cues. Research in postlingually deafened adults with cochlear implants (CIs) indicates minimal evidence for true binaural hearing. Congenitally deafened children who experience spatial hearing with bilateral CIs, however, might perceive binaural cues in the CI signal differently. There is limited research examining binaural hearing in children with CIs, and the few published studies are limited by the use of unrealistic speech stimuli and background noise. The purposes of this study were to (1) replicate our previous study of binaural hearing in postlingually deafened adults with AzBio sentences in prelingually deafened children with the pediatric version of the AzBio sentences, and (2) replicate previous studies of binaural hearing in children with CIs using more open-set sentences and more realistic background noise (i.e., multitalker babble). The study was a within-participant, repeated-measures design. The study sample consisted of 14 children with bilateral CIs with at least 25 mo of listening experience. Speech recognition was assessed using sentences presented in multitalker babble at a fixed signal-to-noise ratio. Test conditions included speech at 0° with noise presented at 0° (S0N0), on the side of the first CI (90° or 270°) (S0N1stCI), and on the side of the second CI (S0N2ndCI) as well as speech presented at 0° with noise presented semidiffusely from eight speakers at 45° intervals. Estimates of summation, head shadow, squelch, and spatial release from masking were calculated. Results of test conditions commonly reported in the literature (S0N0, S0N1stCI, S0N2ndCI) are consistent with results from previous research in adults and children with bilateral CIs, showing minimal summation and squelch but typical head shadow and spatial release from masking. However, bilateral benefit over the better CI with speech at 0° was much larger with semidiffuse noise. Congenitally deafened

  20. Magnet discolation - An increasing and serious complication following MRI in patients with chochlear implants; Magnetdiskolation - eine zunehmende und folgenreiche Komplikation nach MRT bei Patienten mit Cochlea Implantat

    Energy Technology Data Exchange (ETDEWEB)

    Hassepass, F.; Staubenau, V.; Arndt, S.; Beck, R.; Grauvogel, T.; Aschendorff, A. [Univ. Medical Center Freiburg (Germany). Dept. of Otorhinolaryngology-Head and Neck Surgery; Bulla, S. [Univ. Medical Center Freiburg (Germany). Dept. of Diagnostic Radiology

    2014-07-15

    Cochlear implantation (CI) represents the gold standard in the treatment of children born deaf and postlingually deafened adults. Initial magnetic resonance imaging (MRI) was contraindicated in CI users. Meanwhile, there are specific recommendations concerning MRI compatibility depending on the type of CI system and the device manufacturer. Some CI systems are even approved for MRI with the internal magnet left in place. The aim of this study was to analyze all magnet revision surgeries in CI patients at one CI center and the relationship to MRI scans over time. Between 2000 and 2013, a total of 2027 CIs were implanted. The number of magnet dislocation (MD) surgeries and their causes was assessed retrospectively. In total 12 cases of MD resulting from an MRI scan (0.59 %) were observed, accounting for 52.2 % of all magnetic revision surgeries. As per the labeling, it was considered safe to leave the internal magnet in place during MRI while following specific manufacturer recommendations: MRI intensity of 1.5 Tesla (T) and compression head bandage during examination. A compression head bandage in a 1.5 T MRI unit does not safely prevent MD and the related serious complications in CI recipients. We recommend a Stenvers view radiograph after MRI with the internal magnet in place for early identification of MD, at least in the case of pain during or after MRI examination. MRI in CI patients should be indicated with restraint and patients should be explicitly informed about the possible risks. Recommendations regarding MRI compatibility and the handling of CI patients issued with MRI for the most common CI systems are summarized.

  1. Deafening silence? Time to reconsider whether organisations are silent or deaf when things go wrong.

    Science.gov (United States)

    Jones, Aled; Kelly, Daniel

    2014-09-01

    Several public inquiries into healthcare failings in the UK have noted that employees of failing organizations attempt to raise concerns about shortcomings in care, often over a prolonged period of time, only for those concerns to be ignored. However, healthcare literature has largely focused on how organizations and their employees are silent in the face of such failings, positioning employees as daring not to speak in response to serious workplace problems or issues. We argue that only focussing on organizational silence is a critical mistake which misrepresents actual events and overly-simplifies the complexities of workplace culture. The disregard shown by academics, practitioners and policy makers to employee voice strategies, which do not amount to whistle-blowing, but equally cannot either be defined as "silence", results in signals being ignored that can be effective in preventing and ending wrongdoing by others. In addition to understanding silence we suggest therefore that better understanding of why organizations are deaf to, or disregard, employee concerns are needed. We propose that a virtuous cycle is possible, whereby the introduction of systems that result in better listening and valuing of employee concerns reinforces a culture of speaking up and, in turn, organizational learning. Similarly, organizations that disregard employees concerns are destined not to learn, ultimately falling silent and failing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. The Deafening Silence: Discussing Children's Drawings for Understanding and Addressing Marginalization

    Science.gov (United States)

    Angelides, Panayiotis; Michaelidou, Antonia

    2009-01-01

    Researchers who deal with inclusive education have made great efforts to listen to the voices of children in order to understand marginalization. Despite the fact that these efforts take place, the voices of many children fail to be heard and hence many children continue to be marginalized. In this article we will develop and implement a technique…

  3. Gated Word Recognition by Postlingually Deafened Adults with Cochlear Implants: Influence of Semantic Context

    Science.gov (United States)

    Patro, Chhayakanta; Mendel, Lisa Lucks

    2018-01-01

    Purpose: The main goal of this study was to investigate the minimum amount of sensory information required to recognize spoken words (isolation points [IPs]) in listeners with cochlear implants (CIs) and investigate facilitative effects of semantic contexts on the IPs. Method: Listeners with CIs as well as those with normal hearing (NH)…

  4. Neurotrophic treatment of the degenerating auditory nerve; cochlear implants in deafened guinea pigs

    NARCIS (Netherlands)

    Agterberg, M.J.H.

    2009-01-01

    To date, the cochlear implant is the most successful sensorineural prosthesis. The device consists of a small array with a number of electrodes implanted in the cochlea of profoundly hearing impaired people. Some people with an implant are able to use the telephone. Unfortunately, others hardly

  5. Behavioral responses of deafened guinea pigs to intracochlear electrical stimulation: a new rapid psychophysical procedure

    NARCIS (Netherlands)

    Agterberg, M.J.H.; Versnel, H.

    2014-01-01

    In auditory research the guinea pig is often preferred above rats and mice because of the easily accessible cochlea and because the frequency range of its hearing is more comparable to that of humans. Studies of the guinea-pig auditory system primarily apply histological and electrophysiological

  6. [Correlation of auditory-verbal skills in patients with cochlear implants and their evaluation in positone emission tomography (PET)].

    Science.gov (United States)

    Łukaszewicz, Zuzanna; Soluch, Paweł; Niemczyk, Kazimierz; Lachowska, Magdalena

    2010-06-01

    An assumption was taken that in central nervous system (CNS) in patients above 15 years of age there are possible mechanisms of neuronal changes. Those changes allow for reconstruction or formation of natural activation pattern of appropriate brain structures responsible for auditory speech processing. The aim of the study was to observe if there are any dynamic functional changes in central nervous system and their correlation to the auditory-verbal skills of the patients. Nine right-handed patients between 15 and 36 years of age were examined, 6 females and 3 males. All of them were treated with cochlear implantation and are in frequent follow-up in the Department of Otolaryngology at the Medical University of Warsaw due to profound sensorineural hearing loss. In present study the patients were examined within 24 hours after the first fitting of the speech processor of the cochlear implant, and 1 and 2 years subsequently. Combination of performed examinations consisted of: positone emission tomography of the brain, and audiological tests including speech assessment. In the group of patients 4 were postlingually deaf, and 5 were prelinqually deaf. Postlingually deaf patients achieved great improvement of hearing and speech understanding. In their first PET examination very intensive activation of visual cortex V1 and V2 (BA17 and 18) was observed. There was no significant activation in the dominant (left) hemisphere of the brain. In PET examination performed 1 and 2 years after the cochlear implantation no more V1 and V2 activation region was observed. Instead particular regions of the left hemisphere got activated. In prelingually deaf patients no significant changes in central nervous system were noticeable neither in PET nor in speech assessment, although their hearing possibilities improved. Positive correlation was observed between the level of speech understanding, linguistic skills and the activation of appropriate areas of the left hemisphere of the brain

  7. Sarcasm and Advanced Theory of Mind Understanding in Children and Adults with Prelingual Deafness

    Science.gov (United States)

    O'Reilly, Karin; Peterson, Candida C.; Wellman, Henry M.

    2014-01-01

    Two studies addressed key theoretical debates in theory of mind (ToM) development by comparing (a) deaf native signers (n = 18), (b) deaf late signers (n = 59), and (c) age-matched hearing persons (n = 74) in childhood (Study 1: n = 81) and adulthood (Study 2: n = 70) on tests of first- and second-order false belief and conversational sarcasm.…

  8. Benefits of simultaneous bilateral cochlear implantation on verbal reasoning skills in prelingually deaf children

    NARCIS (Netherlands)

    Jacobs, Evi; Langereis, Margreet C.; Frijns, Johan H. M.; Free, Rolien H.; Goedegebure, Andre; Smits, Cas; Stokroos, Robert J.; Ariens-Meijer, Saskia A. M.; Mylanus, Emmanuel A. M.; Vermeulen, Anneke M.

    2016-01-01

    Background: Impaired auditory speech perception abilities in deaf children with hearing aids compromised their verbal intelligence enormously. The availability of unilateral cochlear implantation (Cl) auditory speech perception and spoken vocabulary enabled them to reach near ageappropriate levels.

  9. Benefits of simultaneous bilateral cochlear implantation on verbal reasoning skills in prelingually deaf children

    NARCIS (Netherlands)

    Jacobs, E.; Langereis, M.C.; Frijns, J.H.; Free, R.H.; Goedegebure, A.; Smits, C.; Stokroos, R.J.; Ariens-Meijer, S.A.; Mylanus, E.A.M.; Vermeulen, A.M.J.

    2016-01-01

    BACKGROUND: Impaired auditory speech perception abilities in deaf children with hearing aids compromised their verbal intelligence enormously. The availability of unilateral cochlear implantation (CI) auditory speech perception and spoken vocabulary enabled them to reach near ageappropriate levels.

  10. Identification of vowel length, word stress and compound words and phrases by postlingually-deafened cochlear implant listeners

    DEFF Research Database (Denmark)

    Morris, David Jackson; Magnusson, Lennart; Faulkner, Andrew

    2013-01-01

    Background: The accurate perception of prosody assists a listener in deriving meaning from natural speech. Few studies have addressed the ability of cochlear implant (CI) listeners to perceive the brief duration prosodic cues involved in contrastive vowel length, word stress, and compound word...... word stress, vowel length, and compound words or phrases all of which were presented with minimal-pair response choices. Tests were performed in quiet and in speech-spectrum shaped noise at a 10 dB signal- to-noise ratio. Also, discrimination thresholds for four acoustic properties of a synthetic vowel...... recipients’ ability to perceive brief prosodic cues. This is of interest in the preparation of rehabilitation materials used in training and in developing realistic expectations for potential CI candidates. Key Words: Cochlear implants, speech acoustics, speech intelligibility...

  11. Patient satisfaction

    Directory of Open Access Journals (Sweden)

    Bhanu Prakash

    2010-01-01

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

  12. Patient satisfaction.

    Science.gov (United States)

    Prakash, Bhanu

    2010-09-01

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

  13. Patient opinion

    DEFF Research Database (Denmark)

    Zurita, Laura; Nøhr, Christian

    2004-01-01

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

  14. NESB patients.

    Science.gov (United States)

    Charles, Janice; Britt, Helena; Fahridin, Salma

    2010-04-01

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

  15. Patient life

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    2004-01-01

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

  16. Influence of signal processing strategy in auditory abilities.

    Science.gov (United States)

    Melo, Tatiana Mendes de; Bevilacqua, Maria Cecília; Costa, Orozimbo Alves; Moret, Adriane Lima Mortari

    2013-01-01

    The signal processing strategy is a parameter that may influence the auditory performance of cochlear implant and is important to optimize this parameter to provide better speech perception, especially in difficult listening situations. To evaluate the individual's auditory performance using two different signal processing strategy. Prospective study with 11 prelingually deafened children with open-set speech recognition. A within-subjects design was used to compare performance with standard HiRes and HiRes 120 in three different moments. During test sessions, subject's performance was evaluated by warble-tone sound-field thresholds, speech perception evaluation, in quiet and in noise. In the silence, children S1, S4, S5, S7 showed better performance with the HiRes 120 strategy and children S2, S9, S11 showed better performance with the HiRes strategy. In the noise was also observed that some children performed better using the HiRes 120 strategy and other with HiRes. Not all children presented the same pattern of response to the different strategies used in this study, which reinforces the need to look at optimizing cochlear implant clinical programming.

  17. Effects of residual hearing on cochlear implant outcomes in children: A systematic-review.

    Science.gov (United States)

    Chiossi, Julia Santos Costa; Hyppolito, Miguel Angelo

    2017-09-01

    to investigate if preoperative residual hearing in prelingually deafened children can interfere on cochlear implant indication and outcomes. a systematic-review was conducted in five international databases up to November-2016, to locate articles that evaluated cochlear implantation in children with some degree of preoperative residual hearing. Outcomes were auditory, language and cognition performances after cochlear implant. The quality of the studies was assessed and classified according to the Oxford Levels of Evidence table - 2011. Risk of biases were also described. From the 30 articles reviewed, two types of questions were identified: (a) what are the benefits of cochlear implantation in children with residual hearing? (b) is the preoperative residual hearing a predictor of cochlear implant outcome? Studies ranged from 04 to 188 subjects, evaluating populations between 1.8 and 10.3 years old. The definition of residual hearing varied between studies. The majority of articles (n = 22) evaluated speech perception as the outcome and 14 also assessed language and speech production. There is evidence that cochlear implant is beneficial to children with residual hearing. Preoperative residual hearing seems to be valuable to predict speech perception outcomes after cochlear implantation, even though the mechanism of how it happens is not clear. More extensive researches must be conducted in order to make recommendations and to set prognosis for cochlear implants based on children preoperative residual hearing. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Labelling patients

    International Nuclear Information System (INIS)

    Strudwick, R.M.

    2016-01-01

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

  19. disease patient

    Directory of Open Access Journals (Sweden)

    Setareh Mamishi

    2016-09-01

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

  20. Patient empowerment

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  1. chemotherapy patients

    Directory of Open Access Journals (Sweden)

    Katarzyna Augustyniuk

    2016-02-01

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

  2. diabetic patients

    Directory of Open Access Journals (Sweden)

    Mehraban Falahati

    2016-09-01

    candiduria and female gender, high FBS and urine glucose, uncontrolled diabetes (HbA1c ≥8, and acidic urine pH (P<0.05. Conclusion: Considering the high incidence rate of candiduria in diabetic patients, control of diabetes, predisposing factors, and causal relationships between diabetes and candiduria should be highlighted.

  3. First language acquisition differs from second language acquisition in prelingually deaf signers: evidence from sensitivity to grammaticality judgement in British Sign Language.

    Science.gov (United States)

    Cormier, Kearsy; Schembri, Adam; Vinson, David; Orfanidou, Eleni

    2012-07-01

    Age of acquisition (AoA) effects have been used to support the notion of a critical period for first language acquisition. In this study, we examine AoA effects in deaf British Sign Language (BSL) users via a grammaticality judgment task. When English reading performance and nonverbal IQ are factored out, results show that accuracy of grammaticality judgement decreases as AoA increases, until around age 8, thus showing the unique effect of AoA on grammatical judgement in early learners. No such effects were found in those who acquired BSL after age 8. These late learners appear to have first language proficiency in English instead, which may have been used to scaffold learning of BSL as a second language later in life. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. Cochlear Implantation (CI for prelingual deafness: the relevance of studies of brain organization and the role of first language acquisition in considering outcome success.

    Directory of Open Access Journals (Sweden)

    Ruth eCampbell

    2014-10-01

    Full Text Available Cochlear implantation (CI for profound congenital hearing impairment, while often successful in restoring hearing to the deaf child, does not always result in effective speech processing. Exposure to non-auditory signals during the pre-implantation period is widely held to be responsible for such failures. Here, we question the inference that such exposure irreparably distorts the function of auditory cortex, negatively impacting the efficacy of cochlear implantation. Animal studies suggest that in congenital early deafness there is a disconnection between (disordered activation in primary auditory cortex (A1 and activation in secondary auditory cortex (A2. In humans, one factor contributing to this functional decoupling is assumed to be abnormal activation of A1 by visual projections – including exposure to sign language. In this paper we show that that this abnormal activation of A1 does not routinely occur, while A2 functions effectively supramodally and multimodally to deliver spoken language irrespective of hearing status. What, then, is responsible for poor outcomes for some individuals with CI and for apparent abnormalities in cortical organization in these people? Since infancy is a critical period for the acquisition of language, deaf children born to hearing parents are at risk of developing inefficient neural structures to support skilled language processing. A sign language, acquired by a deaf child as a first language in a signing environment, is cortically organized like a heard spoken language in terms of specialization of the dominant perisylvian system. However, very few deaf children are exposed to sign language in early infancy. Moreover, no studies to date have examined sign language proficiency in relation to cortical organization in individuals with CI. Given the paucity of such relevant findings, we suggest that the best guarantee of good language outcome after CI is the establishment of a secure first language pre-implant – however tha

  5. 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.

  6. Communicating with patients

    Science.gov (United States)

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

  7. Patients' preferences for patient-centered communication

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  8. Patient notes

    Directory of Open Access Journals (Sweden)

    Pádraig Ó Tuama

    2017-05-01

    Full Text Available Here’s the thing. While I have my asthma under control and my sleeping is no worse than usual, I am still near the uaigh. That’s the word for grave in Irish, and it’s also part of the word for loneliness. I’m near one or the other, or both. There was a time when my health was the only thing I talked about, and my friends from that time ask me now, and I remember that that was the person I was; when health was a fear, because pain was my first language. But what’s really bothering me is the way I use the possessive when it comes to my asthma, my insomnia, my thinning hair, my symptoms. It makes me think I think I am these things. Am I? I wilt therefore I am? If they are me, where will I go if I lose them? I remember when I learned the word ontology – the study of the nature of being. If I am sad, is sad me? If sad is me then what happens when someone treats my sadness? If we were all speaking Irish we would say that sadness is on me. But we’re not. Because when I was five I asked where English came from and my parents introduced me to stair. If we all spoke Irish we would say stair instead of history. But we speak English, mostly, and so stair is relegated to something we use to get up or down, never a story. Did you know that I carry my people’s history in my bones? People didn’t believe me when I said that but then scientists wrote about it, and discovered what was already there — inherited in the blood, the bones, the DNA, the genomes, the chromosomes, like thinning curly hair, like weak lungs, like poetry, like insomnia — and it’s all the rage now, that codified stairstory inside us. Once when I was waiting on a trolley I kept on trying to get up even though I knew I’d fall down. So they put an orderly to mind me. Well, he was there to restrain me, but I didn’t mind. He was young and eager to be seen to be good with patients. I asked him how long his shift had been and he said it was his first. After a bit of this

  9. Spatial channel interactions in cochlear implants

    Science.gov (United States)

    Tang, Qing; Benítez, Raul; Zeng, Fan-Gang

    2011-08-01

    The modern multi-channel cochlear implant is widely considered to be the most successful neural prosthesis owing to its ability to restore partial hearing to post-lingually deafened adults and to allow essentially normal language development in pre-lingually deafened children. However, the implant performance varies greatly in individuals and is still limited in background noise, tonal language understanding, and music perception. One main cause for the individual variability and the limited performance in cochlear implants is spatial channel interaction from the stimulating electrodes to the auditory nerve and brain. Here we systematically examined spatial channel interactions at the physical, physiological, and perceptual levels in the same five modern cochlear implant subjects. The physical interaction was examined using an electric field imaging technique, which measured the voltage distribution as a function of the electrode position in the cochlea in response to the stimulation of a single electrode. The physiological interaction was examined by recording electrically evoked compound action potentials as a function of the electrode position in response to the stimulation of the same single electrode position. The perceptual interactions were characterized by changes in detection threshold as well as loudness summation in response to in-phase or out-of-phase dual-electrode stimulation. To minimize potentially confounding effects of temporal factors on spatial channel interactions, stimulus rates were limited to 100 Hz or less in all measurements. Several quantitative channel interaction indexes were developed to define and compare the width, slope and symmetry of the spatial excitation patterns derived from these physical, physiological and perceptual measures. The electric field imaging data revealed a broad but uniformly asymmetrical intracochlear electric field pattern, with the apical side producing a wider half-width and shallower slope than the basal

  10. Spectral-Temporal Modulated Ripple Discrimination by Children With Cochlear Implants.

    Science.gov (United States)

    Landsberger, David M; Padilla, Monica; Martinez, Amy S; Eisenberg, Laurie S

    A postlingually implanted adult typically develops hearing with an intact auditory system, followed by periods of deafness (or near deafness) and adaptation to the implant. For an early implanted child whose brain is highly plastic, the auditory system matures with consistent input from a cochlear implant. It is likely that the auditory system of early implanted cochlear implant users is fundamentally different than postlingually implanted adults. The purpose of this study is to compare the basic psychophysical capabilities and limitations of these two populations on a spectral resolution task to determine potential effects of early deprivation and plasticity. Performance on a spectral resolution task (Spectral-temporally Modulated Ripple Test [SMRT]) was measured for 20 bilaterally implanted, prelingually deafened children (between 5 and 13 years of age) and 20 hearing children within the same age range. Additionally, 15 bilaterally implanted, postlingually deafened adults, and 10 hearing adults were tested on the same task. Cochlear implant users (adults and children) were tested bilaterally, and with each ear alone. Hearing listeners (adults and children) were tested with the unprocessed SMRT and with a vocoded version that simulates an 8-channel cochlear implant. For children with normal hearing, a positive correlation was found between age and SMRT score for both the unprocessed and vocoded versions. Older hearing children performed similarly to hearing adults in both the unprocessed and vocoded test conditions. However, for children with cochlear implants, no significant relationship was found between SMRT score and chronological age, age at implantation, or years of implant experience. Performance by children with cochlear implants was poorer than performance by cochlear implanted adults. It was also found that children implanted sequentially tended to have better scores with the first implant compared with the second implant. This difference was not

  11. Achieving patient satisfaction: resolving patient complaints.

    Science.gov (United States)

    Oxler, K F

    1997-07-01

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

  12. Patient life in hospital

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

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

  13. Preoperative patient education: evaluating postoperative patient outcomes.

    Science.gov (United States)

    Meeker, B J

    1994-04-01

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

  14. Awake craniotomy. A patient`s perspective.

    Science.gov (United States)

    Bajunaid, Khalid M; Ajlan, Abdulrazag M

    2015-07-01

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

  15. Patient Assessment File (PAF)

    Data.gov (United States)

    Department of Veterans Affairs — The Patient Assessment File (PAF) database compiles the results of the Patient Assessment Instrument (PAI) questionnaire filled out for intermediate care Veterans...

  16. Transfer Out Patient Not Abandon The Patient

    Directory of Open Access Journals (Sweden)

    Deepak Gupta

    2015-12-01

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

  17. [The application of artificial neural network on the assessment of lexical tone production of pediatric cochlear implant users].

    Science.gov (United States)

    Mao, Y T; Chen, Z M; Xu, L

    2017-08-07

    Objective: The present study was carried out to explore the tone production ability of the Mandarin-speaking children with cochlear implants (CI) by using an artificial neural network model and to examine the potential contributing factors underlining their tone production performance. The results of this study might provide useful guidelines for post-operative rehabilitation processes of pediatric CI users. Methods: Two hundred and seventy-eight prelingually deafened children who received unilateral CI participated in this study. As controls, 170 similarly-aged children with normal hearing (NH) were recruited. A total of 36 Chinese monosyllabic words were selected as the tone production targets. Vocal production samples were recorded and the fundamental frequency (F0) contour of each syllable was extracted using an auto-correlation algorithm followed by manual correction. An artificial neural network was created in MATLAB to classify the tone production. The relationships between tone production and several demographic factors were evaluated. Results: Pediatric CI users produced Mandarin tones much less accurately than did the NH children (58.8% vs. 91.5% correct). Tremendous variability in tone production performance existed among the CI children. Tones 2 and 3 were produced less accurately than tones 1 and 4 for both groups. For the CI group, all tones when in error tended to be judged as tone 1. The tone production accuracy was negatively correlated with age at implantation and positively correlated with CI use duration with correlation coefficients ( r ) of -0.215 ( P =0.003) and 0.203 ( P =0.005), respectively. Age was one of the determinants of tonal ability for NH children. Conclusions: For children with severe to profound hearing loss, early implantation and persistent use of CI are beneficial to their tone production development. Artificial neural network is a convenient and reliable assessment tool for the development of tonal ability of hearing

  18. Comparison of speech perception performance between Sprint/Esprit 3G and Freedom processors in children implanted with nucleus cochlear implants.

    Science.gov (United States)

    Santarelli, Rosamaria; Magnavita, Vincenzo; De Filippi, Roberta; Ventura, Laura; Genovese, Elisabetta; Arslan, Edoardo

    2009-04-01

    To compare speech perception performance in children fitted with previous generation Nucleus sound processor, Sprint or Esprit 3G, and the Freedom, the most recently released system from the Cochlear Corporation that features a larger input dynamic range. Prospective intrasubject comparative study. University Medical Center. Seventeen prelingually deafened children who had received the Nucleus 24 cochlear implant and used the Sprint or Esprit 3G sound processor. Cochlear implantation with Cochlear device. Speech perception was evaluated at baseline (Sprint, n = 11; Esprit 3G, n = 6) and after 1 month's experience with the Freedom sound processor. Identification and recognition of disyllabic words and identification of vowels were performed via recorded voice in quiet (70 dB [A]), in the presence of background noise at various levels of signal-to-noise ratio (+10, +5, 0, -5) and at a soft presentation level (60 dB [A]). Consonant identification and recognition of disyllabic words, trisyllabic words, and sentences were evaluated in live voice. Frequency discrimination was measured in a subset of subjects (n = 5) by using an adaptive, 3-interval, 3-alternative, forced-choice procedure. Identification of disyllabic words administered at a soft presentation level showed a significant increase when switching to the Freedom compared with the previously worn processor in children using the Sprint or Esprit 3G. Identification and recognition of disyllabic words in the presence of background noise as well as consonant identification and sentence recognition increased significantly for the Freedom compared with the previously worn device only in children fitted with the Sprint. Frequency discrimination was significantly better when switching to the Freedom compared with the previously worn processor. Serial comparisons revealed that that speech perception performance evaluated in children aged 5 to 15 years was superior with the Freedom than previous generations of Nucleus

  19. Dentist-Patient Relationship

    Directory of Open Access Journals (Sweden)

    Gheorghe Raftu

    2016-01-01

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

  20. A good patient?

    DEFF Research Database (Denmark)

    Campbell, Catherine; Scott, Kerry; Skovdal, Morten

    2015-01-01

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

  1. Patient-centred Prevention among PAD Patients

    DEFF Research Database (Denmark)

    Pii, Kathrine Hoffmann

    2015-01-01

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

  2. Ergonomics and patient handling.

    Science.gov (United States)

    McCoskey, Kelsey L

    2007-11-01

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

  3. The Angry Dying Patient.

    Science.gov (United States)

    Houston, Robert E.

    1999-02-01

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

  4. Patient Safety Culture

    DEFF Research Database (Denmark)

    Kristensen, Solvejg

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

  5. Organizing Patient Involvement

    DEFF Research Database (Denmark)

    Brehm Johansen, Mette

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

  6. National Patient Safety Foundation

    Science.gov (United States)

    ... News Member Testimonials Lifetime Members Stand Up for Patient Safety Welcome Stand Up Members Stand Up e-News ... PLS Webcast Archives Stand Up Templates and Logos Patient Safety Coalition Coalition Overview Coalition Member Roster Members-Only ...

  7. Praying for patients.

    Science.gov (United States)

    Sutton, Julie; Macey, Nicola

    2017-01-04

    I feel sad for the nurse who was sacked for praying for a patient. Whatever happened to freedom of speech? What is wrong with offering to pray with patients? I pray this nurse finds a job where people appreciate her.

  8. Wooing patients with technology.

    Science.gov (United States)

    Myers, Michael

    2013-04-01

    Technologies that can give healthcare organizations a marketing advantage with patients include: Registration kiosks that request payment automatically, in a more comfortable environment for both patients and registration staff. Emails that enable patients to schedule initial visits and follow-up care. Secure online messaging platforms that enable patients to obtain timely answers to questions they have for their providers both before and after receiving services.

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

    Science.gov (United States)

    Al-Hinnawi, M F

    2009-06-01

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

  10. Learning from patients

    DEFF Research Database (Denmark)

    Henriksen, Ann-Helen; Ringsted, Charlotte

    2011-01-01

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

  11. The elderly patients' dignity

    DEFF Research Database (Denmark)

    Høy, Bente; Hall, E.O.C.; Wagner, L.

    2007-01-01

    the principles of nursing practice, protecting, enhancing and promoting the elderly patient's health potential. It is suggested that these themes of dignity provide a frame of reference in elder care; they shape the understanding of when health issues become a concern for health-promoting care for the elderly...... patient and what goals should be defined. Key words: Dignity, elderly patient, phenomenological hermeneutical method....

  12. Does patient satisfaction affect patient loyalty?

    Science.gov (United States)

    Kessler, Daniel P; Mylod, Deirdre

    2011-01-01

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

  13. Remote Patient Management for Home Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Eric L. Wallace

    2017-11-01

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

  14. Displacing the patient

    DEFF Research Database (Denmark)

    Pors, Anja Svejgaard

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

  15. Learning the Patient's Story.

    Science.gov (United States)

    Ragan, Sandra L; Kanter, Elisa

    2017-12-01

    To provide a brief history on narrative medicine and highlight its importance in providing quality patient care. Explains narrative medicine using published, peer-reviewed literature and highlights some of the literary, medical, sociological, and communication perspectives that contributed to the narrative medicine movement. A commitment to the patient-provider relationship and knowing the patient's story is a critical aspect in providing quality cancer care. Teaching oncology nurses skills that are grounded in narrative medicine will improve health care by increasing the nurses' knowledge of their patients and strengthening the nurse-patient relationship. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Displacing the patient

    DEFF Research Database (Denmark)

    Pors, Anja Svejgaard

    2014-01-01

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

  17. Depression in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Beyhan Bag

    2014-06-01

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

  18. Measuring the patient experience.

    Science.gov (United States)

    Lees, Carolyn

    2011-01-01

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

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

    African Journals Online (AJOL)

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

  20. Understanding patient experience

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  1. Music for Hemodialysis patients

    DEFF Research Database (Denmark)

    Gross, B; Ketema Wassie, F; Agnholt, Hanne

    Music for hemodialysis patients Background Patients starting a new regimen of dialysis often experience anxiety and other psychological disturbances. They struggle with the unknown situation, feelings of uncertainty and on top of that, a high level of sophisticated technological equipment. Music...... is known from literature to influence and dampen anxiety and tension and has been used for millennia in the treatment of illness. Here we report a study on the influence of music on patients undergoing dialysis and whether music has a potential for lowering discomfort in patients during first-time dialysis.......   Purpose To investigate whether music can reduce feelings of anxiety, tension and restlessness in patients new to dialysis treatment and make them more relaxed during the treatment.   Method Twenty patients aged 42-84 were selected for participation in the study, which took place over two separate dialysis...

  2. Displacing the Patient

    DEFF Research Database (Denmark)

    Pors, Anja Svejgaard

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

  3. Why measure patient satisfaction?

    Science.gov (United States)

    Riskind, Patty; Fossey, Leslie; Brill, Kari

    2011-01-01

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

  4. Acknowledging the back patient

    DEFF Research Database (Denmark)

    Damsgaard, Janne Brammer; Bastrup, Lene; Norlyk, Annelise

    the back patient the narrative must be complemented by a different perspective that includes the issue of ethical responsibility. It is therefore also a question of adopting certain norms as binding; to be bound by obligation or loyalty. Thus, the literature review argues for a more process......-oriented patient approach that incorporates patients' narratives as an integral and ethical part of the care and treatment....

  5. Patients and radiotherapy

    International Nuclear Information System (INIS)

    Eardley, A.

    1986-01-01

    The results of interviews with thirty discharged patients who had undergone radical radiotherapy for cancer of the head and neck are presented. Patients were asked whether their side-effects had got worse or had stayed the same, what effect their side effects had had on eating and drinking and whether they had felt depressed during this period. Measures which could be taken to improve patients' experiences of radiotherapy are discussed. (U.K.)

  6. Keeping our patients' secrets.

    Science.gov (United States)

    Clough, J D; Rowan, D W; Nickelson, D E

    1999-10-01

    Protecting the privacy of the patient's medical record is a central issue in current discussions about a patient bill of rights, and controversy over a proposed "unique health identifier" has raised the decibel level of these discussions. At the heart of the debate is how best to resolve the inherent conflict between the individual's right to privacy and the need for access to patients' health information for reasons of public health, research, and health care management.

  7. Patient tracking system

    International Nuclear Information System (INIS)

    Chapman, L.J.; Hakimi, R.; Salehi, D.; McCord, T.; Zionczkowski, B.; Churchill, R.

    1987-01-01

    This exhibit describes computer applications in monitoring patient tracking in radiology and the collection of management information (technologist productivity, patient waiting times, repeat rate, room utilization) and quality assurance information. An analysis of the reports that assist in determining staffing levels, training needs, and patient scheduling is presented. The system is designed to require minimal information input and maximal information output to assist radiologists, quality assurance coordinators, and management personnel in departmental operations

  8. Patients Are Our Teachers

    Directory of Open Access Journals (Sweden)

    Robert E. Becker

    2018-04-01

    Full Text Available In the patient-physician encounter, physicians hone their skills while alleviating the patient’s suffering. Both benefit. Leaning on the work of Hippocrates, Darwin, and William Osler, the authors sketch out the case for honoring patients as indispensable teachers of the art and science of medicine. They argue that this tradition of Hippocratic medicine both anticipates modern precision medicine and reawakens a focus on public health medicine, each a benefit to the patients and communities served by physicians. A community that compromises the learning relationship of physician to patient and population undermines quality of care.

  9. Patient-Ventilator Dyssynchrony

    Directory of Open Access Journals (Sweden)

    Elvira-Markela Antonogiannaki

    2017-11-01

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

  10. Patients' thoughts on patient- retained medical records

    African Journals Online (AJOL)

    was also thought to motivate the patients to act on the advice given, and the records also served as a reminder to take their ... to use it and to standardise the information that is recorded; and health planners should be motivated to implement .... Table I: Combined list of themes identified and quotations supporting them.

  11. Patients Provide Recommendations for Improving Patient Satisfaction.

    Science.gov (United States)

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

    2016-04-01

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

  12. Knowing Patients: Turning Patient Knowledge into Science

    NARCIS (Netherlands)

    Pols, Jeannette

    2014-01-01

    Science and technology studies concerned with the study of lay influence on the sciences usually analyze either the political or the normative epistemological consequences of lay interference. Here I frame the relation between patients, knowledge, and the sciences by opening up the question: How can

  13. Radiological protection of patients

    International Nuclear Information System (INIS)

    Niroomand-Rad, A.

    2003-01-01

    The benefits of ionizing radiation in the diagnosis and treatment of cancer, as well as other conditions such as cardiac ablation, are well established. However determination, monitoring, and evaluation of patient doses is not as easy task. Furthermore, radiation doses for individual patients may vary greatly from one radiological procedure to another. Attention is needed to reduce unnecessary radiation exposure to patients from All types of radiation producing machines and equipment. The patient risk from radiation injury-stochastic and/or deterministic must be weighted against the benefits of a proper medical examination or treatment as well as the risk of depriving the patient from the necessary medical care. Arbitrary reduction of radiological patient doses without regard to final outcome is determined to proper medical care provided to the patient. Sacrificing image quality in order to reduce patient dose is potentially harmful to the patient as well. Furthermore, the role of radiation exposure incurred from screening procedures such as mammography, needs to be properly considered and differentiated from medically indicated procedures. A known radiation induced risk needs to be balanced against diagnostic efficacy of a screening procedure. In these cases, regulations on standards and guidelines for determination, monitoring, and evaluation of patient doses may be appropriate. In this paper, the technical data collected in the United States have been compared with the corresponding data in Canada. However, even here, it has been recognized that we can not assume that one dose limit fits all. It is advisable to consider individual patient specifics if it means the difference between detection and miss

  14. Visual patient records

    NARCIS (Netherlands)

    Luu, M.D.

    2015-01-01

    Patient information is often complex and fragmented; visualization can help to obtain and communicate insights. To move from paper medical records to interactive and visual patient records is a big challenge. This project aims to move towards this ultimate goal by providing an interactive prototype

  15. Withholding truth from patients.

    LENUS (Irish Health Repository)

    O'Sullivan, Elizabeth

    2012-01-31

    The issue of whether patients should always be told the truth regarding their diagnosis and prognosis has afforded much debate in healthcare literature. This article examines telling the truth from an ethical perspective. It puts forward arguments for and against being honest with patients, using a clinical example to illustrate each point.

  16. Excluding the typical patient

    DEFF Research Database (Denmark)

    Odlaug, Brian Lawrence; Weinhandl, Eric; Mancebo, Maria C

    2014-01-01

    Over the past 30 years, clinical trials have resulted in several successful pharmacotherapies for obsessive-compulsive disorder (OCD), yet patients in clinical settings often report inadequate response. This study compares clinical characteristics of treatment-seeking OCD patients to the inclusion...

  17. Lejringsskader hos rygopererede patienter

    DEFF Research Database (Denmark)

    Sestoft, Bodil; Larsen, Birgit; Erlandsen, Mogens

    2009-01-01

    INTRODUCTION: The aim of this study was to answer the questions: Which kind of positioning injuries occurred in anaesthetized orthopaedic patients undergoing spine surgery who were prone-positioned for more than two hours? What was the incidence of positioning injuries? Which patients were at par...

  18. Patient dosimetry in hysterosalpingography

    International Nuclear Information System (INIS)

    Khoury, H.J.; Maia, A.; Oliveira, M.; Kramer, R.; Drexler, G.

    2001-01-01

    The objectives of this study were to determine the entrance surface dose to the patient and to estimate the dose to the uterus and ovaries due to hysterosalpingography (HSG) diagnostic examinations performed in Recife-Pe, Brazil. The entrance doses were measured using four thermoluminescent dosimeters per patient, attached to anatomical landmarks on the patient's skin. The study was carried out on 25 patients between 21 and 45 years of age who underwent the HSG examinations in two training hospitals and one private radiodiagnostic institute. The number of exposures performed ranged from 4 to 15 radiographs per patient measured. Entrance surface doses varied between 4.99 and 36.6 mGy, with an average of 12.6mGy. The doses to the ovaries and uterus ranged from 0.80 mGy to 5.8 mGy and 1.10mGy to 8.05 mGy, respectively. (author)

  19. [Physiotherapy of cancer patients].

    Science.gov (United States)

    Gomez, Izabella; Szekanecz, Éva; Szekanecz, Zoltán; Bender, Tamás

    2016-07-01

    Physiotherapy of cancer patients is one of the most controversial issues in our country. Malignant diseases are firstly mentioned as a contraindication of physiotherapy. Until now, physiotherapy was not suggested (or only in limited accessibility) for those patients who had malignant disease in medical history. International medical practice was less restrictive in managing this topic. The development of imaging techniques put this question in a new light. On the basis of evidence, the majority of articles have reported beneficial effects of physiotherapy in cancer patients, and only few articles mentioned it as harmful. Of course, each patient requires an individual assessment, however, if we exclude the possibility of tumor recurrence and metastasis, most of physiotherapy procedures can be used safely. One of the aims of this review is to support the physicians' decisions when to prescribe treatments, in such a way, that more patients could receive physiotherapy. Orv. Hetil., 2016, 157(31), 1224-1231.

  20. Patient Delay in Colorectal Cancer Patients

    DEFF Research Database (Denmark)

    Pedersen, Anette Fischer; Hansen, Rikke P; Vedsted, Peter

    2013-01-01

    Blødning fra endetarmen ses normalt som et alarmsymptom på kolorektalkræft. Alligevel vælger mange patienter at lade være med at opsøge lægen. Denne artikel ser nærmere på sammenhængen mellem et alarmsymptom (rektal blødning), forsinkelser i patientforløbet og tanker om kræft. Resultaterne viser,...

  1. A New Triage Support Tool in Case of Explosion.

    Science.gov (United States)

    Yavari-Sartakhti, Olivier; Briche, Frédérique; Jost, Daniel; Michaud, Nicolas; Bignand, Michel; Tourtier, Jean-Pierre

    2018-04-01

    Deafness frequently observed in explosion victims, currently following terrorist attack, is a barrier to communication between victims and first responders. This may result in a delay in the initial triage and evacuation. In such situations, Paris Fire Brigade (Paris, France) proposes the use of assistance cards to help conscious, but deafened patients at the site of an attack where there may be numerous victims. Yavari-Sartakhti O , Briche F , Jost D , Michaud N , Bignand M , Tourtier JP . A new triage support tool in case of explosion. Prehosp Disaster Med. 2018;33(2):213-214.

  2. NRPB patient dosimetry service

    International Nuclear Information System (INIS)

    Shrimpton, P.; Hillier, M.; Bungay, D.; Wall, B.

    1994-01-01

    For nearly 20 years, thermoluminescent dosemeters (TLDs) have been used by NRPB to investigate the doses received by patients undergoing diagnostic examinations with x-rays, and these measurements have formed the basis for national recommendations on patient protection. Monitoring typical levels of patient dose should represent an essential element of routine quality assurance in x-ray departments. In order to promote more widespread measurements in hospitals, NRPB has drawn on a wealth of experience to establish a high-quality service providing TLDs for medical dosimetry by post. (author)

  3. Identitetskonstruktioner af patienter

    DEFF Research Database (Denmark)

    Lassen, Inger; Ottesen, Aase Marie; Strunck, Jeanne

    2015-01-01

    of New Public Management affects the welfare model and creates increasing inequality among citizens. These developments make it relevant to study how underlying ideologies may affect the construction of patient identity and health in the Danish welfare system. This would imply studying the role...... of identity at societal level, and in this paper we therefore ask whether the Danish Health Act constructs persons in need of care as vulnerable patients or as empowered citizens in line with recommendations by policy makers. The question we ask is whether the construction of patient identity in the Danish...

  4. Patient Dosimetry. Chapter 22

    Energy Technology Data Exchange (ETDEWEB)

    Dance, D. R. [Royal Surrey County Hospital, Guildford (United Kingdom); Castellano, I. [The Royal Marsden Hospital, London (United Kingdom)

    2014-09-15

    Patient exposures arising from radiological procedures form the largest part of the population exposure from artificial sources of radiation. According to United Nations Scientific Committee on the Effects of Atomic Radiation, the annual frequency of X ray examinations is 360 per 1000 individuals worldwide. Owing to the associated risk of radiation detriment to the patient, there is a clear need to monitor and control these exposures, and to optimize the design and use of the X ray imaging equipment so that the patient dose is reduced as far as possible, consistent with achieving the required clinical image quality.

  5. IMPROVING PATIENT SAFETY:

    DEFF Research Database (Denmark)

    Bagger, Bettan; Taylor Kelly, Hélène; Hørdam, Britta

    Improving patient safety is both a national and international priority as millions of patients Worldwide suffer injury or death every year due to unsafe care. University College Zealand employs innovative pedagogical approaches in educational design. Regional challenges related to geographic......, social and cultural factors have resulted in a greater emphasis upon digital technology. Attempts to improve patient safety by optimizing students’ competencies in relation to the reporting of clinical errors, has resulted in the development of an interdisciplinary e-learning concept. The program makes...

  6. Medicare, physicians, and patients.

    Science.gov (United States)

    Hacker, Joseph F

    2004-05-01

    There are many other provisions to the MMA. It is important to remind our patients that these changes are voluntary. If patients are satisfied with their current Medicare benefits and plan, they need not change to these new plans. However, as physicians we should familiarize ourselves with these new Medicare options so as to better advise our patients. For more information, visit www.ama-assn.org. The Medical Society of Delaware will strive to keep you informed as these new changes are implemented.

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

    Science.gov (United States)

    Pors, Anja Svejgaard

    2016-01-01

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

  8. JALFHCC - Patient Registration Service

    Data.gov (United States)

    Department of Veterans Affairs — The Captain James A. Lovell Federal Health Care Center (JALFHCC) Patient Registration Service supports the operation of the first VA/Navy Federal Health Care Center...

  9. Sygepleje til trakeostomerede patienter

    DEFF Research Database (Denmark)

    Christensen, Dorthe Wiinholdt; Richard, René; Rydahl Hansen, Susan

    2016-01-01

    Der er ikke enighed om principperne bag plejen af trakeostomerede patienter, når de er i risiko for dysfagi og silent aspiration. Uenigheden har ført til udarbejdelse af en klinisk retningslinje med evidensbaserede anbefalinger....

  10. Patient survey (HCAHPS) - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The national average for the HCAHPS survey categories. HCAHPS is a national, standardized survey of hospital patients about their experiences during a recent...

  11. Positioning devices for patients

    International Nuclear Information System (INIS)

    Heavens, M.

    1981-01-01

    It has been suggested that it is very important to position patients reproducibly at different stages of radiotherapy treatment planning and treatment, or similar procedures. Devices have been described for positioning a patient's upper and lower thorax. This invention provides reproducible positioning for a female patient's breasts, for example in planning treatment of and treating breast tumours. The patient is placed prone, using for example an upper thorax device. A support device is placed central to and beneath her breasts to partially displace them outwards. The device may be triangular in section with one apex contacting the chest wall at the sternum. Restraining straps may be provided to hold the breasts against the support device. Means may be provided to take a healthy breast from the path of radiation through the tumour. (author)

  12. USU Patient Simulation Center

    Data.gov (United States)

    Federal Laboratory Consortium — he National Capital Area (NCA) Medical Simulation Center is a state-of-the-art training facility located near the main USU campus. It uses simulated patients (i.e.,...

  13. Patient survey (ICH CAHPS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — In-Center Hemodialysis Facilites Patient evaluations from the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) Survey. The...

  14. Patient Treatment File (PTF)

    Data.gov (United States)

    Department of Veterans Affairs — This database is part of the National Medical Information System (NMIS). The Patient Treatment File (PTF) contains a record for each inpatient care episode provided...

  15. Doctors and patients.

    Science.gov (United States)

    Gillon, R

    1986-02-15

    Gillon outlines some prima facie moral duties of physicians to patients that have emerged from his previous articles in a series on philosophical medical ethics. These duties follow from four general ethical principles--respect for autonomy, beneficence, non-maleficence, and justice--plus the self-imposed supererogatory duty of medical beneficence. From these principles the author derives such duties as providing adequate information and advice on treatment options, encouraging patient participation leading to informed decisions, maintaining competence and exposing incompetence, admitting errors, disclosing personal medico-moral standards, and acknowledging that other interests may occasionally supersede those of the individual patient. Gillon concludes that, where self interest conflicts with medical beneficence, the claim of medicine as a profession requires that the patient's interests take priority.

  16. Woe patient is purple

    Directory of Open Access Journals (Sweden)

    Hatice Dogan

    2014-08-01

    Conclusion: Traumatic asphyxia is a clinical condition caused by blunt thoracoabdominal trauma, and with good trauma management patients can be discharged with less mortality and morbidity. [Cukurova Med J 2014; 39(4.000: 914-917

  17. Nurse-patient collaboration

    DEFF Research Database (Denmark)

    Sørensen, Dorthe; Frederiksen, Kirsten; Groefte, Thorbjoern

    2013-01-01

    Objectives: This paper provides a theoretical account of nurses’ collaboration with patients with chronic obstructive pulmonary disease during non-invasive ventilation treatment in hospital. Background: Despite strong evidence for the effect of non-invasive ventilation treatment, success remains...... a huge challenge. Nurse-patient collaboration may be vital for treatment tolerance and success. A better understanding of how nurses and patients collaborate during non-invasive ventilation may therefore contribute to improvement in treatment success. Design: A constant comparative classical grounded...... at three intensive care units and one general respiratory ward in Denmark. Results: Succeeding emerged as the nurses’ main concern in the nurse-patient collaboration during non-invasive ventilation treatment. Four collaborative typologies emerged as processing their main concern: (1) twofold oriented...

  18. MRSA Information for Patients

    Science.gov (United States)

    ... with soap and water or an alcohol-based hand sanitizer before and after caring for every patient. Carefully ... with soap and water or an alcohol-based hand sanitizer before and after touching you. If you do ...

  19. Cirrhosis: A Patient's Guide

    Science.gov (United States)

    ... A Patient's Guide Viral Hepatitis Menu Menu Viral Hepatitis Viral Hepatitis Home For Veterans and the Public Veterans and the Public Home Hepatitis A Hepatitis B Hepatitis C Hepatitis C Home Getting ...

  20. Optimizing patient nutrition

    DEFF Research Database (Denmark)

    Geiker, Nina Rica Wium

    (Paper I). The present study is, to my knowledge, the only study investigating the validity of performed nutritional risk screenings by comparing them with medical records. Eight per cent of patients were correctly screened for nutritional risk. A total of 24% of 2393 patients were nutritionally screened......Malnutrition, under-nutrition and/or obesity, may develop due to disease but may also cause disease. The prevalence of under-nutrition among hospitalized patients is high: 40-60% are either already under-nourished on admittance or at-risk of becoming malnourished. As in the general population...... of prescription medication, and take longer to recover. Acknowledging the adverse effects of malnutrition on health, since 2006 it has been mandatory to screen all patients for nutritional risk within 24 hours of admittance at all hospitals in the Capital Region, Denmark. The compliance to and the validity...

  1. Participating in patient education

    DEFF Research Database (Denmark)

    Kristiansen, Tine Mechlenborg; Antoft, Rasmus

    2015-01-01

    point is applied in order to illustrate two central status passages taking place at the locally developed patient education programme: 1) The status passage from novice to an experienced person with chronic illness, and 2) The transformation from adolescence to adulthood living with a chronic illness......The paper builds on previous ethnographic research in Denmark focusing on the significance of participating in a locally developed patient education programme for everyday life (Kristiansen et.al. 2015). It presents a secondary analysis. Group based patient education can be understood as a health...... studies within the field of patient education and how it can enhance our understanding of the social practices at play and the identity transitions occurring as a result of the chronic illness itself and the participation at the programme. Further we reflect on potential practical implications of our...

  2. Tinnitus Patient Navigator

    Science.gov (United States)

    ... Cure About Us Initiatives News & Events Professional Resources Tinnitus Patient Navigator Want to get started on the ... unique and may require a different treatment workflow. Tinnitus Health-Care Providers If you, or someone you ...

  3. Anaesthesia for trauma patients

    African Journals Online (AJOL)

    casualty incident, or a natural disaster. ... Exposure/environmental control: completely undress the ... E. Figure 1: Advance Trauma Life Support® management priorities ..... requiring operative intervention: the patient too sick to anesthetize.

  4. Patient care in radiography

    International Nuclear Information System (INIS)

    Ehrlich, R.A.; McCloskey, E.D.

    1989-01-01

    This book focuses on patient care procedures for radiographers. The authors focus on the role of the radiographer as a member of the health care team. The authors report on such topics as communication in patient care: safety, medico-legal considerations, transfer and positioning; physical needs; infection control; medication; CPR standards, acute situations; examination of the GI tract; contrast media; special imaging techniques and bedside radiography

  5. "Patient care in radiology"

    DEFF Research Database (Denmark)

    Bro Brask, Kirsten; Birkelund, Regner

    2014-01-01

    The aim of this study was to research how the staff experience care expressed during the brief encounter with the patients in a diagnostic imaging department. This was a qualitative study with a phenomenological and hermeneutical frame of reference. The data were collected using field observation...... was electronically forwarded. And, care expressed in between was perceived as care in the traditional sense and termed as “patient care in radiology.”...

  6. Medical Services: Patient Administration

    Science.gov (United States)

    2001-03-12

    5–16, page 41 Final disposition procedures for military patients • 5–17, page 42 Military patients requiring continued hospitalization or nursing ...general anesthetic, intravenous sedation , or nitrous oxide sedation . (3) All nonoperative procedures that involve more than a slight risk of harm to the...aid or palliative treatment, (b) Is likely to result in any disability for work beyond the day or occurrence, (c) Appears to require prolonged

  7. Depression in hemodialysis patients

    International Nuclear Information System (INIS)

    Anees, M.; Barki, H.; Masood, M.

    2008-01-01

    To measure the frequency of depression and its risk factors in patients under going hemodialysis. It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1/sup st/ January 2006 to 30/sup th/ April 2006. All patients getting regular hemodialysis for more than three months were included. Beck's Depression Inventory- II (BDI-II; adapted in Urdu) was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers (Anti HCV and HbsAg). Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) for correlation of psychological variables with clinical, hematological and biochemical parameters. Eighty nine patients were enrolled which included fifty two (58.4%) were male and seventy seven (86.5%) were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 +- 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty (56.1%) were moderately to severely depressed and there was no gender difference in the prevalence of depression. Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters. (author)

  8. Patient loyalty model.

    Science.gov (United States)

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

    2015-07-06

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

  9. Patient-Centered Research

    Science.gov (United States)

    Wicki, J; Perneger, TV; Junod, AF; Bounameaux, H; Perrier, A

    2000-01-01

    PURPOSE We aimed to develop a simple standardized clinical score to stratify emergency ward patients with clinically suspected PE into groups with a high, intermediate, or low probability of PE, in order to improve and simplify the diagnostic approach. METHODS Analysis of a database of 1090 consecutive patients admitted to the emergency ward for suspected PE, in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. RESULTS 296 out of 1090 patients (27%) were found to have PE. The optimal estimate of clinical probability was based on eight variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis or elevation of a hemidiaphragm on chest X-ray. A probability score was calculated by adding points assigned to these variables. A cut-off score of 4 best identified patients with low probability of PE. 486 patients (49%) had a low clinical probability of PE (score 9). CONCLUSION This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to emergency ward patients suspected of PE could allow a more efficient diagnostic process.

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

    Science.gov (United States)

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

    2012-02-01

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

  11. [Patient blood management].

    Science.gov (United States)

    Folléa, G

    2016-11-01

    In a context of regular review of transfusion practice, the aim of this review is to present an update of the scientific basis of the so-called "patient blood management" (PBM), the state of its development in Europe, and possible ways to progress its development further in France. Analysis and synthesis of the data from scientific literature on the scientific basis of PBM (methods, indications, efficacy, risks, efficiency). PBM appears as an evidence-based, patient centred, multidisciplinary approach, aiming to optimise the care of patients who might need transfusion and, consequently, the use of blood products. PBM is based on three pillars: optimise the patient's own blood supplies, minimise blood loss, optimise patient's tolerance of anaemia. Available scientific evidence can be considered as sufficient to consider PBM guidelines and practices as an indispensable complement to the transfusion medicine guidelines and practices. Several countries have launched PBM programmes (alternatives to allogeneic transfusion and optimisation of the use of blood components). Although current French national transfusion guidelines contain some PBM measures, PBM programmes should be further developed in France, primarily for medical reasons. Possible ways, using the existing basis having proved to be effective, are proposed to further develop PBM in France, as a complement to transfusion medicine, with the participation of involved stakeholders, including experts from relevant medical specialties, both at local and national levels. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Cachexia Syndrome, anorexia patient

    International Nuclear Information System (INIS)

    Roldán, G.; Musé, I.

    2004-01-01

    Introduction: Two thirds of patients (ptes) cancer present slimming recognized a negative prognostic factor. Anorexia cachexia syndrome (SCA) results from the interaction of multiple factors and causes death of 22% of these patients. Nutritional support produces a moderate recovery weight without affecting the underlying metabolic disorders. Objectives: Conduct a review of current knowledge of the underlying pathophysiology and management the cachexia-anorexia syndrome in cancer patients. Designing indications possible policy interventions in the management of these patients. Method: Performed an a literature review on SCA. Conclusions: We identify patients at risk for early implementation of non-pharmacological measures preventive. The control side effects to treatment oncospecific with particular attention to the need for antiemetics, laxatives / antidiarrheal control dental and proper pain management is fundamental. Keep track enteral is a priority. In those with swallowing disorders or dysphagia, nasogastric feeding tube should be considered early. Indications for gastrostomy / jejunostomy and total parenteral nutrition (TPN) are very limited. The NPT is a complementary treatment maneuver a temporary and reversible complication, in order to prevent deterioration

  13. Glaucoma in patients with uveitis.

    OpenAIRE

    Panek, W C; Holland, G N; Lee, D A; Christensen, R E

    1990-01-01

    The records of 100 patients (161 eyes) with uveitis were reviewed retrospectively to determine the prevalence of increased intraocular pressure, the forms of uveitis most commonly associated with glaucoma, and the forms that require specific glaucoma therapy. Secondary glaucoma was present in 23 patients (31 eyes): three of 24 patients with acute uveitis (three eyes, 12% of acute uveitis patients) and 20 of 76 patients with chronic uveitis (28 eyes, 26% of chronic uveitis patients). Eighteen ...

  14. Patient-centred outcomes research: perspectives of patient stakeholders.

    Science.gov (United States)

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

    2017-11-01

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

  15. Patient satisfaction with cataract surgery

    Directory of Open Access Journals (Sweden)

    Wasfi Ehab I

    2008-10-01

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

  16. Robotherapy with Dementia Patients

    Directory of Open Access Journals (Sweden)

    Francisco Martín

    2013-01-01

    Full Text Available Humanoids have increasingly become the focus of attention in robotics research in recent years, especially in service and personal assistance robotics. This paper presents the application developed for humanoid robots in the therapy of dementia patients as a cognitive stimulation tool. The behaviour of the robot during the therapy sessions is visually programmed in a session script that allows music to play, physical movements (dancing, exercises, etc., speech synthesis and interaction with the human monitor. The application includes the control software on board the robot and some tools like the visual script generator or a monitor to supervise the robot behaviour during the sessions. The robot application's impact on the patient's health has been studied. Experiments with real patients have been performed in collaboration with a centre of research in neurodegenerative diseases. Initial results show a slight or mild improvement in neuropsychiatric symptoms over other traditional therapy methods.

  17. Acknowledging the back patient

    DEFF Research Database (Denmark)

    Damsgaard, Janne Brammer; Bastrup Jørgensen, Lene; Norlyk, Annelise

    , Silkeborg Regional Hospital, Regional Hospital Central Jutland, Silkeborg, Denmark 2. Health, Section for Nursing, Aarhus University, Aarhus, Denmark 3. University of Southern Denmark & Vejle Sygehus, Vejle, Denmark keywords:Back Patient, Narrative, Biomedical, Marginalisation, Self-Identity, Ethical......#296 Acknowledging The Back Patient. A Thematic Synthesis Of Qualitative Research. A Systematic Literature Review. Janne Brammer Damsgaard1, Lene Bastrup Jørgensen1, Annelise Norlyk2, Regner Birkelund3 1. Health, Section for Nursing, Aarhus University & Research Unit, Elective Surgery Centre....... Therefore, telling about experiences and perceptions is important for back patients in order to feel accepted and acknowledged. But selfhood cannot be reduced to narrative identity since the identity of the self is only fully revealed the moment we include the ethical dimension including certain norms...

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

    Science.gov (United States)

    Bishop, Andrea C; Macdonald, Marilyn

    2017-06-01

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

  19. Teleophthalmology: improving patient outcomes?

    Directory of Open Access Journals (Sweden)

    Sreelatha OK

    2016-02-01

    Full Text Available Omana Kesary Sreelatha,1 Sathyamangalam VenkataSubbu Ramesh2 1Ophthalmology Department, Sultan Qaboos University Hospital, Muscat, Oman; 2Department of Optometry, School of Allied Health Sciences, Manipal University, Manipal, India Abstract: Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP. Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR, glaucoma, age-related macular degeneration (ARMD, and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time

  20. Patient support systems

    International Nuclear Information System (INIS)

    Braden, A.B.; McBride, T.R.; Styblo, D.J.; Taylor, S.K.; Richey, J.B.

    1979-01-01

    A patient support system for use in computerized tomography (CT) is described. The system is particularly useful for CT scanning of the brain and also of the abdominal area. The support system consists of two moveable tables which may be translated into position for X-ray scanning of the patient's body and which may be translated incrementally and automatically to obtain scans at adjacent locations. For use with brain scans, the second table is replaced by a detachable restraint assembly which is described in detail. The support system is so designed that only a small volume of low density material will intercept the X-ray beam. (UK)

  1. Visually Evoked Visual-Auditory Changes Associated with Auditory Performance in Children with Cochlear Implants

    Directory of Open Access Journals (Sweden)

    Maojin Liang

    2017-10-01

    Full Text Available Activation of the auditory cortex by visual stimuli has been reported in deaf children. In cochlear implant (CI patients, a residual, more intense cortical activation in the frontotemporal areas in response to photo stimuli was found to be positively associated with poor auditory performance. Our study aimed to investigate the mechanism by which visual processing in CI users activates the auditory-associated cortex during the period after cochlear implantation as well as its relation to CI outcomes. Twenty prelingually deaf children with CI were recruited. Ten children were good CI performers (GCP and ten were poor (PCP. Ten age- and sex- matched normal-hearing children were recruited as controls, and visual evoked potentials (VEPs were recorded. The characteristics of the right frontotemporal N1 component were analyzed. In the prelingually deaf children, higher N1 amplitude was observed compared to normal controls. While the GCP group showed significant decreases in N1 amplitude, and source analysis showed the most significant decrease in brain activity was observed in the primary visual cortex (PVC, with a downward trend in the primary auditory cortex (PAC activity, but these did not occur in the PCP group. Meanwhile, higher PVC activation (comparing to controls before CI use (0M and a significant decrease in source energy after CI use were found to be related to good CI outcomes. In the GCP group, source energy decreased in the visual-auditory cortex with CI use. However, no significant cerebral hemispheric dominance was found. We supposed that intra- or cross-modal reorganization and higher PVC activation in prelingually deaf children may reflect a stronger potential ability of cortical plasticity. Brain activity evolution appears to be related to CI auditory outcomes.

  2. Visually Evoked Visual-Auditory Changes Associated with Auditory Performance in Children with Cochlear Implants.

    Science.gov (United States)

    Liang, Maojin; Zhang, Junpeng; Liu, Jiahao; Chen, Yuebo; Cai, Yuexin; Wang, Xianjun; Wang, Junbo; Zhang, Xueyuan; Chen, Suijun; Li, Xianghui; Chen, Ling; Zheng, Yiqing

    2017-01-01

    Activation of the auditory cortex by visual stimuli has been reported in deaf children. In cochlear implant (CI) patients, a residual, more intense cortical activation in the frontotemporal areas in response to photo stimuli was found to be positively associated with poor auditory performance. Our study aimed to investigate the mechanism by which visual processing in CI users activates the auditory-associated cortex during the period after cochlear implantation as well as its relation to CI outcomes. Twenty prelingually deaf children with CI were recruited. Ten children were good CI performers (GCP) and ten were poor (PCP). Ten age- and sex- matched normal-hearing children were recruited as controls, and visual evoked potentials (VEPs) were recorded. The characteristics of the right frontotemporal N1 component were analyzed. In the prelingually deaf children, higher N1 amplitude was observed compared to normal controls. While the GCP group showed significant decreases in N1 amplitude, and source analysis showed the most significant decrease in brain activity was observed in the primary visual cortex (PVC), with a downward trend in the primary auditory cortex (PAC) activity, but these did not occur in the PCP group. Meanwhile, higher PVC activation (comparing to controls) before CI use (0M) and a significant decrease in source energy after CI use were found to be related to good CI outcomes. In the GCP group, source energy decreased in the visual-auditory cortex with CI use. However, no significant cerebral hemispheric dominance was found. We supposed that intra- or cross-modal reorganization and higher PVC activation in prelingually deaf children may reflect a stronger potential ability of cortical plasticity. Brain activity evolution appears to be related to CI auditory outcomes.

  3. Using Patient Portals to Increase Engagement in Patients with Cancer.

    Science.gov (United States)

    Rodriguez, Elizabeth S

    2018-04-03

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

  4. Inappropriate requests from patients

    African Journals Online (AJOL)

    doctors continue to provide these patients with life-sustaining .... mentally different judgments about the best interests of ... ed suicide is legal. While it is clear ... Epidemiological studies have mainly been used to assess the risk of lung cancer in ...

  5. Do patients initiate therapy?

    DEFF Research Database (Denmark)

    Thengilsdóttir, G; Pottegård, Anton; Linnet, K

    2015-01-01

    BACKGROUND: Primary non-adherence occurs when a drug has been prescribed but the patient fails to have it dispensed at the pharmacy. AIMS: To assess primary non-adherence to statins and antidepressants in Iceland, the association of demographic factors with primary non-adherence, and the time fro...

  6. Acute Myocardial Infarction Patients

    Directory of Open Access Journals (Sweden)

    Bruce Ovbiagele

    2011-01-01

    Full Text Available Background. Diabetes mellitus (DM confers high vascular risk and is a growing national epidemic. We assessed clinical characteristics and prevalence of diagnosed DM among patients hospitalized with acute myocardial infarction (AMI in the US over the last decade. Methods. Data were obtained from all states within the US that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 2006 with a primary discharge diagnosis of AMI were included. Time trends in the proportion of these patients with DM diagnosis were computed. Results. The portion of patients with comorbid diabetes among AMI hospitalizations increased substantially from 18% in 1997 to 30% in 2006 (<.0001. Absolute numbers of AMI hospitalizations in the US decreased 8% (from 729, 412 to 672, 243, while absolute numbers of AMI hospitalizations with coexisting DM rose 51% ((131, 189 to 198, 044, both (<.0001. Women with AMI were significantly more likely to have DM than similarly aged men, but these differences diminished with increasing age. Conclusion. Although overall hospitalizations for AMI in the US diminished over the last decade, prevalence of diabetes rose substantially. This may have important consequences for the future societal vascular disease burden.

  7. Rehabilitation of schizophrenic patients.

    Science.gov (United States)

    Gunatilake, S; Ananth, J; Parameswaran, S; Brown, S; Silva, W

    2004-01-01

    Schizophrenia is a maldevelopmental disorder of the brain that manifests in positive, negative, cognitive and affective symptoms. Currently, the mainstay of treatment involves pharmacotherapy. The limitations of antipsychotic treatment are that they can only control symptoms and cannot cure the illness, and 20% of patients do not respond, thus leading to the requirement of maintenance treatment. Patients that do respond continue to have disabling residual symptoms such as amotivation and isolation, maladaptive behavior, and impaired social functioning. These symptoms prevent patients from attaining educational, occupational, and social roles. Psychosocial interventions and models of quality of life in schizophrenia are based on the notion that increases in psychosocial functioning will be related to improvement in subjective experiences, such as self-esteem and satisfaction with life. The comparative effect of specific treatment methods and the additional benefits of multiple treatments need to be explored. Diversified techniques have also been employed, such as shaping, cognitive process therapy, mastery-oriented skill training, motivation and enhancement. Issues in designing psychosocial interventions and the role of various professionals in providing such interventions need to be carefully considered. Predictor variables and the indications for particular therapies in an individual need to be explored. Generalizability of the gains made by rehabilitation/recovery is also an important consideration. Patients in jail, chronic mental hospitals, private facilities, and the Veterans Administration system are all different in their ability to benefit, their motivations, and the severity of their psychopathology. Therefore, it is very difficult to generalize findings from one setting to another.

  8. Assemblages of Patient Safety

    DEFF Research Database (Denmark)

    Balatsas Lekkas, Angelos

    2016-01-01

    This thesis identifies how design processes emerge during the use of devices in healthcare, by attending to assemblages where contingencies of risk and harm co-exist with the contribution of healthcare professionals to the safe care of patients. With support from the field of Science and Technology...... practices of interdisciplinary care....

  9. [Healthcare patient loyalty].

    Science.gov (United States)

    Ameri, Cinzia; Fiorini, Fulvio

    2016-01-01

    If the "old economy" preached standardization of products/services in order to reduce costs, the "new economy" is based on the recognition of the needs and the management of information. It is aimed at providing better and more usable services. One scenario is a national health service with regional management but based on competition between hospitals/companies.This led to a different handling of the user/patient, which has become the center of the health system: marketing seeks to retain the patient, trying to push a client-patient to not change their healthcare service provider. In costs terms, it is more economical to retain a customer rather than acquire a new one: a satisfied customer is also the best sounding board for each company. Customer equity is the management of relations with patients which can result in a greater customer value: it is possible to recognize an equity of the value, of the brand and of the report. Loyalty uses various marketing activities (basic, responsive, responsible, proactive and collaborative): each hospital/company chooses different actions depending on how many resources it plans to invest in loyalty.

  10. Right patient, Right blood

    DEFF Research Database (Denmark)

    Selberg, Hanne; Madsen, Trine Stougaard

    2014-01-01

    Right patient, Right Blood Simulation based training in blood transfusion practice in nursing education Background: In spite of strict checking procedures to handling transfusion of blood severe adverse reactions are likely to happen and the major cause of morbidity occurs to be liable to human...

  11. Depression in CADASIL patients

    Directory of Open Access Journals (Sweden)

    Lačković Maja

    2014-01-01

    Full Text Available Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL is a hereditary neurological disease accompanied by recurrent ischemic events, characterized by the presence of psychiatric disorders. The aim of this study was to examine the occurrence of depression and its severity among patients with CADASIL. Sixteen patients with diffuse white matter changes on MRI and clinical signs suggesting CADASIL were included in the study. Definitive diagnosis of CADASIL was obtained by electron microscopic analysis of skin biopsies. Testing of the patients’ affective status was primarily devoted to detecting depression. Electron microscopic examinations of all skin biopsies revealed numerous granular osmiophilic material (GOM deposits embedded into the basal lamina around altered or degenerated vascular smooth muscle cells (VSMCs. Clinical symptoms of depression were present in a great number of examined CADASIL patients. The frequency of depression was higher than previously reported. Psychiatric disturbances might also represent the onset of CADASIL, especially in young patients, and should be evaluated by differential diagnosis. [Projekat Ministarstva nauke Republike Srbije, br. 41002

  12. Patients who challenge.

    Science.gov (United States)

    Ward, Michael; Savulescu, Julian

    2006-12-01

    Individuals have different values. They seek to express their individuality even when receiving medical care. It is a part of modern medical practice and respect for patient autonomy to show respect for different values. We give an account of what it means to respect different values and challenging patients in medical practice. Challenging choices are often choices which are perceived by many to be either irrational or against a person's interests, such as engaging in harmful or excessively risky activities. When the medical profession is involved in such choices, the basic medical principle of acting in a person's best interests is challenged. Often doctors refuse to respect controversial choices on paternalistic grounds. We should all respect and facilitate the controversial choices of competent individuals, subject to resource limitations, our own and others well-being and autonomy, and the public interest. But more importantly, sometimes such choices make for a better, more autonomous life. Sometimes, such choices reflect considerations of global well-being or altruism, or idiosyncratic attitudes to risk. Sometimes, they reflect unusual values. However, in some other cases, controversial choices are irrational and are not expressions of our autonomy. Doctors should assist patients to make rational if individual choices. The patient also bears the responsibility for bringing his beliefs to the attention of the clinician.

  13. Acknowledging the back patient

    DEFF Research Database (Denmark)

    Damsgaard, Janne Brammer; Bastrup, Lene; Norlyk, Annelise

    and reluctant to speak out. Therefore, telling about experiences and perceptions is important for back patients in order to feel accepted and acknowledged. The health professionals must incorporate the patients’ narratives as an integral part of the care and treatment. Conclusions: In order to acknowledge...

  14. Patient Belief in Miracles

    DEFF Research Database (Denmark)

    Hvidt, Niels Christian

    2011-01-01

    Faith and hope in divine healing figure in most religious traditions. This chapter looks at faith in healing miracles and explores how following that faith may involve both risks and advantages. On the one hand, it may imply a risk by camouflaging a deferring attitude as when patients decline...

  15. Patient-Centered Research

    Science.gov (United States)

    Shridharani, KV; Yuen, W; Huang, D; Pan, C

    2000-01-01

    PURPOSE Complementary and Alternative Medicine (CAM) can be defined as medical practices not taught widely at US medical schools or generally available at US hospitals. National studies suggest that between 30–40% of the general US population use CAM. These users tend to be more educated, have higher incomes, and are more likely to be between the ages of 30–49. However, to date, no study has documented the use of CAM among the homebound population, patients who are usually elderly, debilitated, and have less access to medical care. We studied the use of alternative therapies in homebound patients of the Mount Sinai Visiting Doctors Program serving the inner city of New York. METHODS Eligibility for the study was limited to patients who are in the Visiting Doctors Program, and whose mini-mental status exam score was greater than 20 or who were deemed competent to complete the survey by their primary care provider. Participant's CAM use was assessed by a survey administered by an interviewer at the patient's home. RESULTS Forty-nine consecutive, eligible patients were interviewed and a survey completed. Among the respondents, 84% were women, the mean age was 78.6 (STD = 14.1). Respondents were 51% Caucasian, 27% African-American, 14% Hispanic and 8% other. On rating their own health, 69% rated it as poor to fair, 22% rated it as good, and 8% rated it as very good to excellent. Sixty-nine percent of the respondents reported using one or more CAM in the past 12 months. Commonly used CAM included: vitamins/minerals (33%) [excluding MVI, calcium], spiritual healing (27%), and herbal remedies (20%). Spiritual healing included prayer and faith healing. The most common herbal remedies were garlic, ginger, and chamomile tea. Among CAM users, their main sources of information about CAM came from their own physicians (32%), family/friends/co-workers (18%), and newspaper/radio/TV (18%). CONCLUSION The use of CAM in this elderly, debilitated, homebound population was

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

    Science.gov (United States)

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

    2011-12-01

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

  17. Psychotherapy for cancer patients.

    Science.gov (United States)

    Chong Guan, Ng; Mohamed, Salina; Kian Tiah, Lai; Kar Mun, Teoh; Sulaiman, Ahmad Hatim; Zainal, Nor Zuraida

    2016-07-01

    Objective Psychotherapy is a common non-pharmacological approach to help cancer patients in their psychological distress. The benefit of psychotherapies was documented, but the types of psychotherapies proposed are varied. Given that the previous literature review was a decade ago and no quantitative analysis was done on this topic, we again critically and systematically reviewed all published trials on psychotherapy in cancer patients. Method We identified 17 clinical trials on six types of psychotherapy for cancer patients by searching PubMed and EMBASE. Result There were four trials involved adjunct psychological therapy which were included in quantitative analysis. Each trial demonstrated that psychotherapy improved the quality of life and coping in cancer patients. There was also a reduction in distress, anxiety, and depression after a psychological intervention. However, the number and quality of clinical trials for each type of psychotherapy were poor. The meta-analysis of the four trials involved adjunct psychological therapy showed no significant change in depression, with only significant short-term improvement in anxiety but not up to a year-the standardized mean differences were -0.37 (95% confidence interval (CI) = -0.57, -0.16) at 2 months, -0.21 (95% CI = -0.42, -0.01) at 4 months, and 0.03 (95 % CI = -0.19, 0.24) at 12 months. Conclusion The evidence on the efficacy of psychotherapy in cancer patients is unsatisfactory. There is a need for more rigorous and well-designed clinical trials on this topic.

  18. Cancer patients' evaluation of communication

    DEFF Research Database (Denmark)

    Ross, Lone; Petersen, Morten Aagaard; Johnsen, Anna Thit

    2013-01-01

    The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication.......The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication....

  19. User interface and patient involvement.

    Science.gov (United States)

    Andreassen, Hege Kristin; Lundvoll Nilsen, Line

    2013-01-01

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

  20. Effect of technological advances on cochlear implant performance in adults.

    Science.gov (United States)

    Lenarz, Minoo; Joseph, Gert; Sönmez, Hasibe; Büchner, Andreas; Lenarz, Thomas

    2011-12-01

    To evaluate the effect of technological advances in the past 20 years on the hearing performance of a large cohort of adult cochlear implant (CI) patients. Individual, retrospective, cohort study. According to technological developments in electrode design and speech-processing strategies, we defined five virtual intervals on the time scale between 1984 and 2008. A cohort of 1,005 postlingually deafened adults was selected for this study, and their hearing performance with a CI was evaluated retrospectively according to these five technological intervals. The test battery was composed of four standard German speech tests: Freiburger monosyllabic test, speech tracking test, Hochmair-Schulz-Moser (HSM) sentence test in quiet, and HSM sentence test in 10 dB noise. The direct comparison of the speech perception in postlingually deafened adults, who were implanted during different technological periods, reveals an obvious improvement in the speech perception in patients who benefited from the recent electrode designs and speech-processing strategies. The major influence of technological advances on CI performance seems to be on speech perception in noise. Better speech perception in noisy surroundings is strong proof for demonstrating the success rate of new electrode designs and speech-processing strategies. Standard (internationally comparable) speech tests in noise should become an obligatory part of the postoperative test battery for adult CI patients. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  1. Patient activation and use of an electronic patient portal.

    Science.gov (United States)

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

    2015-01-01

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

  2. Handover of patients

    DEFF Research Database (Denmark)

    Jensen, S M; Lippert, A; Ostergaard, D

    2013-01-01

    that implementing a structured handover format holds the possibilities for improving the process. Electronic equipment could play a part in reducing problems. Cultural and organizational factors impact the process in different ways. The professions perceive the value and quality of information given differently......Handover has major implications for patient care. The handover process between ambulance and emergency department (ED) staff has been sparsely investigated. The purpose of this paper is, based on a literature review, to identify and elaborate on the major factors influencing the ambulance to ED....... Giving and taking over responsibility is an important issue. The handover of patients to the ED has the potential to be improved. Cultural issues and a lack of professional recognition of handover importance need to be approached. Multidisciplinary training in combination with a structured tool may have...

  3. Mucormycosis in immunochallenged patients

    Directory of Open Access Journals (Sweden)

    Pak Jane

    2008-01-01

    Full Text Available Mucorales species are deadly opportunistic fungi with a rapidly invasive nature. A rare disease, mucormycosis is most commonly reported in patients with diabetes mellitus, because the favorable carbohydrate-rich environment allows the Mucorales fungi to flourish, especially in the setting of ketoacidosis. However, case reports over the past 20 years show that a growing number of cases of mucormycosis are occurring during treatment following bone marrow transplants (BMT and hematological malignancies (HM such as leukemia and lymphoma. This is due to the prolonged treatment of these patients with steroids and immunosuppressive agents. Liposomal amphotericin B treatment and posaconazole are two pharmacologic agents that seem to be effective against mucormycosis, but the inherently rapid onset and course of the disease, in conjunction with the difficulty in correctly identifying it, hinder prompt institution of appropriate antifungal therapy. This review of the literature discusses the clinical presentation, diagnosis, and treatment of mucormycosis among the BMT and HM populations.

  4. COPD: the patient perspective

    Directory of Open Access Journals (Sweden)

    Jones PW

    2016-02-01

    Full Text Available Paul W Jones,1 Henrik Watz,2 Emiel FM Wouters,3 Mario Cazzola4 1Division of Clinical Science, St George’s, University of London, London, UK; 2Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North (ARCN, Member of the German Center for Lung Research (DZL, Grosshansdorf, Germany; 3CIRO+, Department of Respiratory Medicine, Maastricht University, Maastricht, the Netherlands; 4Unit of Respiratory Clinical Pharmacology, Department of Systemic Medicine, University of Rome ‘Tor Vergata,’ Rome, Italy Abstract: Chronic obstructive pulmonary disease (COPD is a highly prevalent disease characterized by nonreversible airway obstruction. Well-characterized symptoms such as exertional dyspnea and fatigue have a negative impact on patients’ quality of life (QoL and restrict physical activity in daily life. The impact of COPD symptoms on QoL is often underestimated; for example, 36% of patients who describe their symptoms as being mild-to-moderate also admit to being too breathless to leave the house. Additionally, early morning and nighttime symptoms are a particular problem. Methods are available to allow clinicians to accurately assess COPD symptoms, including patient questionnaires. Integrated approaches to COPD management, particularly pulmonary rehabilitation, are effective strategies for addressing symptoms, improving exercise capacity and, potentially, also increasing physical activity. Inhaled bronchodilators continue to be the mainstay of drug therapy in COPD, where options can be tailored to meet patients’ needs with careful selection of the inhaled medication and the device used for its delivery. Overall, an integrated approach to disease management should be considered for improving QoL and subsequent patient outcomes in COPD. Keywords: COPD, patients, physical actiity levels, pulmonary rehabilitation

  5. X-linked Charcot-Marie-Tooth disease, Arts syndrome, and prelingual non-syndromic deafness form a disease continuum: evidence from a family with a novel PRPS1 mutation

    NARCIS (Netherlands)

    Synofzik, Matthis; Müller Vom Hagen, Jennifer; Haack, Tobias B.; Wilhelm, Christian; Lindig, Tobias; Beck-Wödl, Stefanie; Nabuurs, Sander B.; van Kuilenburg, André B. P.; de Brouwer, Arjan P. M.; Schöls, Ludger

    2014-01-01

    X-linked Charcot-Marie-Tooth disease type 5 (CMTX5), Arts syndrome, and non-syndromic sensorineural deafness (DFN2) are allelic syndromes, caused by reduced activity of phosphoribosylpyrophosphate synthetase 1 (PRS-I) due to loss-of-function mutations in PRPS1. As only few families have been

  6. [Sport for pacemaker patients].

    Science.gov (United States)

    Israel, C W

    2012-06-01

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

  7. Diabetic patients: Psychological aspects.

    Science.gov (United States)

    Adili, Fatemeh; Larijani, Bagher; Haghighatpanah, Mohammadreza

    2006-11-01

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

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

    Science.gov (United States)

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

    2017-08-01

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

  9. Patient (customer) expectations in hospitals.

    Science.gov (United States)

    Bostan, Sedat; Acuner, Taner; Yilmaz, Gökhan

    2007-06-01

    The expectations of patient are one of the determining factors of healthcare service. The purpose of this study is to measure the Patients' Expectations, based on Patient's Rights. This study was done with Likert-Survey in Trabzon population. The analyses showed that the level of the expectations of the patient was high on the factor of receiving information and at an acceptable level on the other factors. Statistical meaningfulness was determined between age, sex, education, health insurance, and the income of the family and the expectations of the patients (pstudy, the current legal regulations have higher standards than the expectations of the patients. The reason that the satisfaction of the patients high level is interpreted due to the fact that the level of the expectation is low. It is suggested that the educational and public awareness studies on the patients' rights must be done in order to increase the expectations of the patients.

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

    African Journals Online (AJOL)

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

  11. Communication with patients and colleagues

    DEFF Research Database (Denmark)

    Nørgaard, Birgitte

    2012-01-01

    Although patient-centred communication has provided a focus point in health care for many years, patient surveys continuously reveal serious communication problems as experienced by patients, due to poor communication. Likewise, poor inter-collegial communication can cause problems for both health...... care staff and patients. So, knowing that patient-centred communication and good inter-collegial communication is for the benefit of both health professionals and patients, the relevance of improving health care professionals' communication skills and investigating the effect on both professionals...

  12. Patient identification and tube labelling

    DEFF Research Database (Denmark)

    van Dongen-Lases, Edmée C; Cornes, Michael P; Grankvist, Kjell

    2016-01-01

    of phlebotomy procedures with the CLSI H3-A6 guideline was unacceptably low, and that patient identification and tube labelling are amongst the most critical steps in need of immediate attention and improvement. The process of patient identification and tube labelling is an essential safety barrier to prevent...... patient identity mix-up. Therefore, the EFLM Working Group aims to encourage and support worldwide harmonisation of patient identification and tube labelling procedures in order to reduce the risk of preanalytical errors and improve patient safety. With this Position paper we wish to raise awareness...... and provide recommendations for proper patient and sample identification procedures....

  13. Socioemotional selectivity in cancer patients.

    Science.gov (United States)

    Pinquart, Martin; Silbereisen, Rainer K

    2006-06-01

    This study analyzed the contact preferences of newly diagnosed cancer patients and healthy control group participants. In line with the theory of socioemotional selectivity, patients were more likely than control participants to prefer contact with familiar social partners, but this difference was stronger in younger and middle-aged patients than in older patients. Across a 6-month interval, patients' contact preferences changed according to the perceived success of therapy. For example, if therapy was perceived to be successful, patients showed an increasing interest in contacts with unfamiliar social partners. Results indicate that contact preferences are adapted to the perception of limited versus extended future lifetime. Copyright (c) 2006 APA, all rights reserved.

  14. Patient participation in transitional care of older patients

    OpenAIRE

    Dyrstad, Dagrunn Nåden

    2016-01-01

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

  15. Participation in online patient support groups endorses patients' empowerment

    NARCIS (Netherlands)

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

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

  16. Patterns of Physician-Patient Communication Associated with Patient Satisfaction.

    Science.gov (United States)

    Williams, M. Lee; Clampitt, Phillip G.

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

  17. Patient satisfaction after receiving dental treatment among patients ...

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

  19. High patient satisfaction after secondary rhinoplasty in cleft lip patients

    NARCIS (Netherlands)

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

    2011-01-01

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

  20. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Shah U

    2015-04-01

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

  1. Heartburn in patients with achalasia.

    Science.gov (United States)

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

    1995-01-01

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

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

    Science.gov (United States)

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

    2016-10-01

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

  3. Why patients mutilate themselves.

    Science.gov (United States)

    Favazza, A R

    1989-02-01

    Self-mutilation, the deliberate destruction or alteration of body tissue without conscious suicidal intent, occurs in a variety of psychiatric disorders. Major self-mutilation includes eye enucleation and amputation of limbs or genitals. Minor self-mutilation includes self-cutting and self-hitting. The author examines patients' explanations for self-mutilation which frequently focus on religions or sexual themes, and discusses scientific explanations that draw on biological, psychological, social, and cultural theories. Although no one approach adequately solves the riddle of such behaviors, habitual self-mutilation may best be thought of as a purposeful, if morbid, act of self-help.

  4. [What is patient autonomy?

    Science.gov (United States)

    Durand, Guillaume

    What does patient autonomy mean? If an autonomous choice is defined as an objective and rational choice, is the doctor's prescription not always the best route? Our contemporary democracies are marked by moral and religious pluralism which obliges society to respect a multiplicity of choices of existence. Three levels are important in terms of autonomy: a range of intellectual capacities, freedom with regard to constraints (external and internal), the capacity to be in control of one's existence. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. Readmissions of medical patients

    DEFF Research Database (Denmark)

    Cooksley, T.; Nanayakkara, P. W. B.; Nickel, C. H.

    2016-01-01

    of readmission but have not been validated in international populations. AIM: To perform an external independent validation of the HOSPITAL and LACE scores. DESIGN: An unplanned secondary cohort study. METHODS: Patients admitted to the medical admission unit at the Hospital of South West Jutland (10...... power of both scores decreased with increasing age. CONCLUSION: Readmissions are a complex phenomenon with not only medical conditions contributing but also system, cultural and environmental factors exerting a significant influence. It is possible that the heterogeneity of the population and health...

  6. Sleep Tips for Sjogren's Patients

    Science.gov (United States)

    ... Sjögren’s Patients.” Dr. Fisher reminds patients that adequate sleep is especially important for those with Sjögren’s syndrome, saying that sleep deprivation exacerbates daytime fatigue and can affect the ...

  7. Septic bursitis in immunocompromised patients.

    Science.gov (United States)

    Roschmann, R A; Bell, C L

    1987-10-01

    A retrospective analysis of 29 patients with septic bursitis was undertaken to ascertain if immunocompromised patients differed in their clinical presentations, type of organisms cultured, and outcome when compared with their non-immunocompromised cohorts. Thirty episodes of septic bursitis occurred in 29 patients, 43 percent of which occurred in immunocompromised patients. Despite similar clinical presentations, the bursae of immunocompromised patients took three times longer to sterilize and had a much higher bursal white blood cell count when compared with the bursae of non-immunocompromised patients. The bacteriologic spectrum was essentially identical in both groups; there were no cases in which gram-negative organisms were recovered from infected bursae. No cases of septic bursitis were seen in neutropenic patients. The most common factors contributing to an immunocompromised state were alcoholism or steroid therapy. A successful resolution of septic bursitis was seen in all the patients in the immunocompromised groups.

  8. Medical and Dental Patient Issues

    Science.gov (United States)

    ... A RadiationAnswers.org Ask the Experts Medical and Dental Patient Issues What's My Risk? The risks of ... developed by our topic editors for this category: Dental-Patient Issues Medical CT Reference Books and Articles ...

  9. Health literacy and patient portals.

    Science.gov (United States)

    Gu, Yulong; Orr, Martin; Warren, Jim

    2015-06-01

    Health literacy has been described as the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Improving health literacy may serve to promote concordance with therapy, engage patients in their own health care, and improve health outcomes. Patient portal technology aims at enabling patients and families to have easy access to key information in their own medical records and to communicate with their health care providers electronically. However, there is a gap in our understanding of how portals will improve patient outcome. The authors believe patient portal technology presents an opportunity to improve patient concordance with prescribed therapy, if adequate support is provided to equip patients (and family/carers) with the knowledge needed to utilise the health information available via the portals. Research is needed to understand what a health consumer will use patient portals for and how to support a user to realise the technology's potential.

  10. Patient Safety Threat - Syringe Reuse

    Science.gov (United States)

    ... Safety Stakeholder Meeting December 2009 The One & Only Campaign Patient Notification Toolkit Developing Documents for a Patient Notification Planning Media and Communication Strategies Writing for the Media Spokesperson Preparation Planning the ...

  11. Implications for patient-centeredness

    African Journals Online (AJOL)

    Kate H

    participation in decision-making, but in responding to questions asked. ... Also of particular relevance is the need to take into account the importance of patients' .... preliminary data and information about the patient, as well as to prepare ...

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

    Science.gov (United States)

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

    2014-01-01

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

  13. Anxiety disorders in dialysis patients

    OpenAIRE

    Novaković Milan

    2007-01-01

    Introduction. Anxiety, as a primary symptom, includes all conditions of indefinite fear and psychic disorders dominated by fear. All dialysis patients suffer from anxiety as an independent phenomenon, or as part of another disease. Material and Methods. This study included 753 patients on chronic hemodialysis in Bosnia and Herzegovina (B&H) in the period 1999-2004. The patients were divided into two groups: the first group included 348 patients with Balkan Endemic Nephropathy (BEN), and t...

  14. Caring for Latino patients.

    Science.gov (United States)

    Juckett, Gregory

    2013-01-01

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

  15. Sleep in obese patients

    Directory of Open Access Journals (Sweden)

    2014-08-01

    Full Text Available Objectives: The aim of the study was to investigate the influence of duration and individual characteristics of sleep and chronotype on body weight, eating behavior, anxiety, depression, life quality, metabolic and hormonal parameters of obese patients. Materials and methods: 200 patients with primary obesity were studied: 83 men and 117 women at age from 18 to 61 years old, median age 41,5 years [31,0; 50,0]; body weight 107 kg [94; 128,5], waist circumference 112 cm [102; 124]; neck circumference 41 cm [38; 46], body mass index (BMI 36,9 [32,8; 42,3]. Results: We found an association between sleep duration, chronotype and the emotional eating. Significant sleep reduction (to less than 6 hours was associated with high level of anxiety, depression, emotional eating and insomnia. Younger age, early onset and shorter duration of obesity and brisk weight gain during last is connected to the evening chronotype. The emotional eating associated with hypersomnolence in the absence of statistically significant increase of anxiety and depression in individuals with evening chronotype. Sleep duration and chronotype have no significant effect on the body weight, metabolic, hormonal parameters and the dynamics of body. weight after 7±1 months of treatment of obesity.

  16. A Community Patient Demographic System

    OpenAIRE

    Gabler, James M.; Simborg, Donald W.

    1985-01-01

    A Community Patient Demographic System is described. Its purpose is to link patient identification, demographic and insurance information among multiple organizations in a community or among multiple registration systems within the same organization. This function requires that there be a competent patient identification methodology and clear definition of local responsibilities for number assignment and database editing.

  17. Patient care and radiation protection

    International Nuclear Information System (INIS)

    Sharko, G.A.

    1987-01-01

    This chapter deals with important aspects of patient care, which may become the radiographer's responsibility in the absence of dedicated nursing staff. Although large pediatric centers usually employ nurses for bedside patient management, the general radiographer should be familiar with some aspects of routine patient care. This knowledge guarantees the safety and well-being of children entrusted to the technologist

  18. Polysomnographic findings in craniopharyngioma patients.

    Science.gov (United States)

    Pickering, Line; Klose, Marianne; Feldt-Rasmussen, Ulla; Jennum, Poul

    2017-12-01

    The purpose of this study is to evaluate whether damage to the hypothalamus due to craniopharyngioma or consequent surgery may involve the sleep-wake regulatory system, resulting in sleep disturbances and sleepiness. Seven craniopharyngioma patients and 10 healthy controls were evaluated with sleep questionnaires including the Epworth Sleepiness Scale, polysomnography, and a multiple sleep latency test (MSLT). Five patients and eight controls had lumbar puncture performed to determine hypocretin-1 levels. Patients tended to feel sleepier than control individuals of the same age (p = 0.09). No subjects had symptoms of hypnagogic hallucinations, sleep paralyses, or cataplexies. Four patients and one control had periodic leg movements (PLMs). One patient had fragmented sleep pattern, rapid eye movement (REM) sleep without atonia, and PLMs. One patient had short sleep periods during the daytime. Four patients had fragmented sleep pattern. With the MSLT, four patients and two controls had mean sleep latency of < 8 min. One patient and three controls had sudden onset of REM sleep in 2/5 and 3/5 sleep periods, respectively. All subjects showed normal hypocretin-1 levels. Four patients had electrophysiological findings indicative of central hypersomnia including one patient meeting the criteria of narcolepsy. The sleep-wake regulatory system may be involved in craniopharyngioma patients.

  19. Patient restraining strap for scintiphotography

    International Nuclear Information System (INIS)

    Kay, T.D.; Harper, J.W.

    1976-01-01

    A patient restraining strap for scintiphotography having a pair of expandable cloth-like bags joined together is presented. The strap encompasses the head of a patient and is then secured to a Gamma Scintillation Camera. Once inflated the restraining strap immobilizes the head without discomfort to the patient during the scintiphotography procedure. 1 claim, 1 drawing figure

  20. [Observation of critically ill patients

    DEFF Research Database (Denmark)

    Fuhrmann, L.; Hesselfeldt, R.; Lippert, A.

    2009-01-01

    . MATERIAL AND METHODS: Prospective observational study at Herlev Hospital, Copenhagen, Denmark. Study personnel measured vital signs on all patients present on five wards during the evening and night and interviewed nursing staff about patients with abnormal vital signs. Subsequently, patient records were...

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

    Science.gov (United States)

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

    2006-08-01

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

  2. 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...

  3. 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.

  4. Patients' attitudes towards animal testing

    DEFF Research Database (Denmark)

    Masterton, Malin; Renberg, Tobias; Kälvemark Sporrong, Sofia

    2014-01-01

    stakeholders. This study compared the attitudes of patients and researchers on animal testing. Focus-group interviews were held with patients suffering from chronic inflammatory diseases, resulting in a questionnaire that was distributed January–May 2011. The questionnaire was posted to patient members...... of support is comparable to those held by the general public found in national surveys. A clear majority of researchers were positive towards animal testing, and large statistical differences between patients and researchers were found regarding their attitudes towards testing animals commonly held as pets...... (Pattitude towards animal testing is not shared to an equal degree with patients, who are the intended end-users and beneficiaries of medical...

  5. Nursing care of Jewish Patients

    Directory of Open Access Journals (Sweden)

    Anna Maria Kostka

    2017-07-01

    Full Text Available Everyone has the right to equal treatment irrespective of color, culture, origin or religion. Jewish patients obey many rules. The use of proper diet, adherence to the principles of purity, prayer, performing rituals is very important for them. Medical staff is committed to providing patients with safety, regardless of the differences. Understanding the most important values, ethics and practices of Judaism will help to provide professional care for the patient of Jewish faith. Appropriate communication, understanding and tolerance are essential for creating a relationship with the patient, through which it will be possible to achieve the desired therapeutic effect and improve the quality of life of patients.

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

    Science.gov (United States)

    Van Slyck, A; Johnson, K R

    2001-01-01

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

  7. CT-docking patient stretcher

    International Nuclear Information System (INIS)

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

    1990-01-01

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

  8. Patient dosimetry in diagnostic radiology

    International Nuclear Information System (INIS)

    Rweyemamu, M.

    2013-04-01

    The objective of this project was to review patient dosimetry aiming at reducing the patient dose during diagnostic procedures while maintaining the best image quality in order to protect patients from ionizing radiation. CT examination was selected in this study to represent imaging protocols with high patient doses used in diagnostic radiology. Dosimetric parameters in CT which are CTDI, CTDIW, DLP, MSAD, organ dose and effective dose were discussed. Parameters such as tube current, tube voltage, filtration, scan volume and slice thickness were found to affect patient dose, therefore proper management of these factors was recommended. For optimization of protection of the patient, application of the “as low as reasonably achievable” (ALARA) principle was recommended as an important key for avoiding overexposure and minimizing patient doses. Also it was recommended that CT examinations should be performed if and only if is the only suitable option when weighed against other options which do not involve ionizing radiation exposure. (author)

  9. Autonomy and the akratic patient.

    Science.gov (United States)

    McKnight, C J

    1993-01-01

    I argue that the distinction which is current in much writing on medical ethics between autonomous and non-autonomous patients cannot cope comfortably with weak-willed (incontinent) patients. I describe a case involving a patient who refuses a blood transfusion even though he or she agrees that it would be in his or her best interests. The case is discussed in the light of the treatment of autonomy by B Brody and R Gillon. These writers appear to force us to treat an incontinent patient either as autonomous, just like a rational agent whose decisions are in accordance with his beliefs or as non-autonomous, like comatose patients or children. Though neither is entirely satisfactory I opt for describing such patients as autonomous but point out that in cases like this the principle of respect for autonomy does not give a determinate answer about how the patient ought to be treated. PMID:8308874

  10. [Laparoscopic cholecystectomy in transplant patients].

    Science.gov (United States)

    Coelho, Júlio Cezar Uili; Contieri, Fabiana L C; de Freitas, Alexandre Coutinho Teixeira; da Silva, Fernanda Cristina; Kozak, Vanessa Nascimento; da Silva Junior, Alzemir Santos

    2010-02-01

    This study reviews our experience with laparoscopic cholecystectomy in the treatment of cholelithiasis in transplant patients. Demographic data, medications used, and operative and postoperative data of all transplant recipients who were subjected to laparoscopic cholecystectomy for cholelithiasis at our hospital were obtained. A total of 15 transplant patients (13 renal transplantation and 2 bone marrow transplantation) underwent laparoscopic cholecystectomy. All patients were admitted to the hospital on the day of the operation. The immunosuppressive regimen was not modified during hospitalization. Clinical presentation of cholelithiasis was biliary colicky (n=12), acute cholecystitis (n=2), and jaundice (n=1). The operation was uneventful in all patients. Postoperative complications were nausea and vomiting in 2 patients, prolonged tracheal intubation in 1, wound infection in 1 and large superficial hematoma in 1 patient. Laparoscopic cholecystectomy is associated to a low morbidity and mortality and good postoperative outcome in transplant patients with uncomplicated cholecystitis.

  11. Spirituality in adolescent patients.

    Science.gov (United States)

    Weaver, Meaghann S; Wratchford, Dale

    2017-07-01

    Adolescence, the transition between childhood and adulthood, represents a time of rapid biological, neurocognitive, and psychosocial changes. These changes have important implications for the development and evolution of adolescent spirituality, particularly for adolescents with chronic or life-limiting illnesses. To contribute positively to adolescent spiritual formation, palliative care teams benefit from understanding the normative changes expected to occur during adolescence. This paper provides a narrative review of adolescent spirituality while recognizing the role of religious, familial, and cultural influences on spiritual development during the teenage years. By giving explicit attention to the contextual norms surrounding adolescence and still recognizing each adolescent-aged patient as unique, palliative care teams can help adolescents transition toward meaningful and sustainable spiritual growth. This paper reviews the clinical and research implications relevant to integrating adolescent spiritual health as part of comprehensive palliative care.

  12. Prosthesis-patient mismatch

    Directory of Open Access Journals (Sweden)

    Philippe Pibarot

    2011-04-01

    Full Text Available Prosthesis-patient mismatch (PPM is present when the effective orifice area of the inserted prosthetic valve is too small in relation to body size. Its main hemodynamic consequence is to generate higher than expected gradients through normally functioning prosthetic valves. The purpose of this review is to present an update on the present state of knowledge with regards to diagnosis, prognosis and prevention of PPM. PPM is a frequent occurrence (20%–70% of aortic valve replacements that has been shown to be associated with worse hemodynamics, less regression of left ventricular hypertrophy, more cardiac events, and lower survival. Moreover, as opposed to most other risk factors, PPM can largely be prevented by using a prospective strategy at the time of operation.

  13. 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

  14. Der Patient als Experte.

    Science.gov (United States)

    Dubs

    1998-01-01

    Patients as Experts: Determining Benefit by Using Assessments of Ability (ICIDH)When health economy and quality mangement are dealing with the cost-benefit relationship, to this day description, calculation, and assessment of the benefit are missing to a great extent. Deliberations in terms of cause and effect do not go beyond the model of pathogenesis (etiology - pathology - manifestation) and descriptions on the organ level (ICD). Only the international classification of impairments, disabilities, and handicaps (ICIDH) as a separate estimation of the resulting manifestations of illness on the levels of organ, individual, and society is capable to elucidate this benefit. It is the patient who is the expert to decide what he needs, what he wants, and what he can do, thus, evaluating on an individual level his loss of capability. The ICIDH is regarded as the key for the management of chronic diseases. The characteristics of being chronically ill require the integration of salutogenesis and the consideration of the hierarchy of needs. The specially developed MARA model serves as pragmatic basis for the description of the benefits of carried out and omitted interventions as changes of abilities by using the MARA curve (mean age-related ability) as ethical guideline. In quality circles the MARA model, which is based on ICIDH, hierarchy of needs and salutogenesis, can offer apatient-oriented basis of discussion for benefit assessments, and, in a pragmatical way, it can facilitate the introduction of evidence-based medicine. By the change of view from the organ level with multifactorial aspects to the individual level, in which the abilities can be understood as a monofactor, a high consensus potential between several participants of discussion in health service is possible.

  15. Genital reconstruction in exstrophy patients

    Directory of Open Access Journals (Sweden)

    R B Nerli

    2012-01-01

    Full Text Available Introduction: Surgery for bladder exstrophy has been evolving over the last four to five decades. Because survival has become almost universal, the focus has changed in the exstrophy-epispadias complex to improving quality of life. The most prevalent problem in the long-term function of exstrophy patients is the sexual activity of the adolescent and adult males. The penis in exstrophy patients appears short because of marked congenital deficiency of anterior corporal tissue. Many patients approach for genital reconstruction to improve cosmesis as well as to correct chordee. We report our series of male patients seeking genital reconstruction following exstrophy repair in the past. Materials and Methods: Fourteen adolescent/adult male patients attended urology services during the period January 2000-December 2009 seeking genital reconstruction following exstrophy repair in the past. Results: Three patients underwent epispadias repair, four patients had chordee correction with cosmetic excision of skin tags and seven patients underwent chordee correction with penile lengthening. All patients reported satisfaction in the answered questionnaire. Patients undergoing penile lengthening by partial corporal dissection achieved a mean increase in length of 1.614 ± 0.279 cm dorsally and 1.543 ± 0.230 cm ventrally. The satisfactory rate assessed by the Short Form-36 (SF-36 showed that irrespective of the different genital reconstructive procedures done, the patients were satisfied with cosmetic and functional outcome. Conclusions: Surgical procedures have transformed the management in these patients with bladder exstrophy. Bladders can be safely placed within the pelvis, with most patients achieving urinary continence and cosmetically acceptable external genitalia. Genital reconstruction in the form of correction of chordee, excision of ugly skin tags and lengthening of penis can be performed to give the patients a satisfactory cosmetic and functional

  16. Patient information in radiooncology. Results of a patient survey

    International Nuclear Information System (INIS)

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

    2002-01-01

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

  17. Neurotrophin gene therapy for sustained neural preservation after deafness.

    Science.gov (United States)

    Atkinson, Patrick J; Wise, Andrew K; Flynn, Brianna O; Nayagam, Bryony A; Hume, Clifford R; O'Leary, Stephen J; Shepherd, Robert K; Richardson, Rachael T

    2012-01-01

    The cochlear implant provides auditory cues to profoundly deaf patients by electrically stimulating the residual spiral ganglion neurons. These neurons, however, undergo progressive degeneration after hearing loss, marked initially by peripheral fibre retraction and ultimately culminating in cell death. This research aims to use gene therapy techniques to both hold and reverse this degeneration by providing a sustained and localised source of neurotrophins to the deafened cochlea. Adenoviral vectors containing green fluorescent protein, with or without neurotrophin-3 and brain derived neurotrophic factor, were injected into the lower basal turn of scala media of guinea pigs ototoxically deafened one week prior to intervention. This single injection resulted in localised and sustained gene expression, principally in the supporting cells within the organ of Corti. Guinea pigs treated with adenoviral neurotrophin-gene therapy had greater neuronal survival compared to contralateral non-treated cochleae when examined at 7 and 11 weeks post injection. Moreover; there was evidence of directed peripheral fibre regrowth towards cells expressing neurotrophin genes after both treatment periods. These data suggest that neurotrophin-gene therapy can provide sustained protection of spiral ganglion neurons and peripheral fibres after hearing loss.

  18. Patient representatives? views on patient information in clinical cancer trials

    OpenAIRE

    Dellson, Pia; Nilbert, Mef; Carlsson, Christina

    2016-01-01

    Background Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informed consent is possible to provide. We explored patient representatives? views and perceptions on the written trial information used in clinical cancer trials. Methods Written patient information leaflet...

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

    Science.gov (United States)

    Cho, Sumi; Lee, Eunjoo

    2017-12-01

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

  20. [Electroconvulsive therapy in nonconsenting patients].

    Science.gov (United States)

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

    2017-01-01

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

  1. Patient's rights charter in Iran.

    Directory of Open Access Journals (Sweden)

    Alireza Parsapoor

    2014-01-01

    Full Text Available Given the importance of patient's rights in healthcare, special attention has been given to the concept of patient's rights by the Ministry of Health and Medical Education in Iran. Iranian patient's rights charter has been compiled with a novel and comprehensive approach. This charter aims to elucidate rights of recipients of health services as well as observing ethical standards in medicine. This paper presents the Iranian patient's rights charter. Based on a study done from 2007 to 2009, the charter has been finalized through an extensive consultation involving all stakeholders, patients, physicians, nurses, lawyers, patient associations and health policy makers. The developed charter was adopted by the Ministry of Health in December 2009. Iranian patient's rights charter has been formulated in the framework of 5 chapters and 37 articles including vision and an explanatory note. The five chapters concern right to receiving appropriate services, right to access desired and enough information, right to choose and decide freely about receiving healthcare, right to privacy and confidentiality, and finally right to access an efficient system of dealing with complaints which have been explained in 14, 9, 7, 4 and 3 articles, respectively.  The paper concludes that, adopting the patient's rights charter is a valuable measure to meet patient's rights; however, a serious challenge is how to implement and acculturate observing patient's rights in practice in our healthcare system in Iran.

  2. Creating the ideal patient experience.

    Science.gov (United States)

    Purcărea, Th.V

    2016-01-01

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

  3. Patient-centered medical homes for patients with disabilities.

    Science.gov (United States)

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

    2015-01-01

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

  4. The Effect of Learning Modality and Auditory Feedback on Word Memory: Cochlear-Implanted versus Normal-Hearing Adults.

    Science.gov (United States)

    Taitelbaum-Swead, Riki; Icht, Michal; Mama, Yaniv

    2017-03-01

    In recent years, the effect of cognitive abilities on the achievements of cochlear implant (CI) users has been evaluated. Some studies have suggested that gaps between CI users and normal-hearing (NH) peers in cognitive tasks are modality specific, and occur only in auditory tasks. The present study focused on the effect of learning modality (auditory, visual) and auditory feedback on word memory in young adults who were prelingually deafened and received CIs before the age of 5 yr, and their NH peers. A production effect (PE) paradigm was used, in which participants learned familiar study words by vocal production (saying aloud) or by no-production (silent reading or listening). Words were presented (1) in the visual modality (written) and (2) in the auditory modality (heard). CI users performed the visual condition twice-once with the implant ON and once with it OFF. All conditions were followed by free recall tests. Twelve young adults, long-term CI users, implanted between ages 1.7 and 4.5 yr, and who showed ≥50% in monosyllabic consonant-vowel-consonant open-set test with their implants were enrolled. A group of 14 age-matched NH young adults served as the comparison group. For each condition, we calculated the proportion of study words recalled. Mixed-measures analysis of variances were carried out with group (NH, CI) as a between-subjects variable, and learning condition (aloud or silent reading) as a within-subject variable. Following this, paired sample t tests were used to evaluate the PE size (differences between aloud and silent words) and overall recall ratios (aloud and silent words combined) in each of the learning conditions. With visual word presentation, young adults with CIs (regardless of implant status CI-ON or CI-OFF), showed comparable memory performance (and a similar PE) to NH peers. However, with auditory presentation, young adults with CIs showed poorer memory for nonproduced words (hence a larger PE) relative to their NH peers. The

  5. Patient-centered blood management.

    Science.gov (United States)

    Hohmuth, Benjamin; Ozawa, Sherri; Ashton, Maria; Melseth, Richard L

    2014-01-01

    Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care. We present a patient-centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient-centered decision making. PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes. PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front-line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM. © 2013 Society of Hospital Medicine.

  6. Improving Patient Safety: Improving Communication.

    Science.gov (United States)

    Bittner-Fagan, Heather; Davis, Joshua; Savoy, Margot

    2017-12-01

    Communication among physicians, staff, and patients is a critical element in patient safety. Effective communication skills can be taught and improved through training and awareness. The practice of family medicine allows for long-term relationships with patients, which affords opportunities for ongoing, high-quality communication. There are many barriers to effective communication, including patient factors, clinician factors, and system factors, but tools and strategies exist to address these barriers, improve communication, and engage patients in their care. Use of universal precautions for health literacy, appropriate medical interpreters, and shared decision-making are evidence-based tools that improve communication and increase patient safety. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  7. Lung cancer in younger patients

    DEFF Research Database (Denmark)

    Abbasowa, Leda; Madsen, Poul Henning

    2016-01-01

    INTRODUCTION: Lung cancer remains a leading cause of cancer-related death. The incidence increases with age and the occurrence in young patients is relatively low. The clinicopathological features of lung cancer in younger patients have not been fully explored previously. METHODS: To assess the age...... differences in the clinical characteristics of lung cancer, we conducted a retrospective analysis comparing young patients ≤ 65 years of age with an elderly group > 65 years of age. Among 1,232 patients evaluated due to suspicion of lung cancer in our fast-track setting from January-December 2013, 312 newly...... diagnosed lung cancer patients were included. RESULTS: Patients ≤ 65 years had a significantly higher representation of females (p = 0.0021), more frequent familial cancer aggregation (p = 0.028) and a lower incidence of squamous cell carcinoma (p = 0.0133). When excluding pure carcinoid tumours...

  8. The critically ill injured patient.

    Science.gov (United States)

    Cereda, Maurizio; Weiss, Yoram G; Deutschman, Clifford S

    2007-03-01

    Patients admitted to the ICU after severe trauma require frequent procedures in the operating room, particularly in cases where a damage control strategy is used. The ventilatory management of these patients in the operating room can be particularly challenging. These patients often have severely impaired respiratory mechanics because of acute lung injury and abdominal compartment syndrome. Consequently, the pressure and flow generation capabilities of standard anesthesia ventilators may be inadequate to support ventilation and gas exchange. This article presents the problems that may be encountered in patients who have severe abdominal and lung injuries, and the current management concepts used in caring for these patients in the critical care setting, to provide guidelines for the anesthetist faced with these patients in the operating room.

  9. Polysomnographic findings in craniopharyngioma patients

    DEFF Research Database (Denmark)

    Pickering, Line; Klose, Marianne; Feldt-Rasmussen, Ulla

    2017-01-01

    of the same age (p = 0.09). No subjects had symptoms of hypnagogic hallucinations, sleep paralyses, or cataplexies. Four patients and one control had periodic leg movements (PLMs). One patient had fragmented sleep pattern, rapid eye movement (REM) sleep without atonia, and PLMs. One patient had short sleep...... periods during the daytime. Four patients had fragmented sleep pattern. With the MSLT, four patients and two controls had mean sleep latency of REM sleep in 2/5 and 3/5 sleep periods, respectively. All subjects showed normal hypocretin-1 levels......PURPOSE: The purpose of this study is to evaluate whether damage to the hypothalamus due to craniopharyngioma or consequent surgery may involve the sleep-wake regulatory system, resulting in sleep disturbances and sleepiness. METHODS: Seven craniopharyngioma patients and 10 healthy controls were...

  10. [Hyperthyroidism in older patients].

    Science.gov (United States)

    Brun, R; Jenny, M; Junod, J P

    1978-09-30

    This study comprises 81 thyrotoxic patients with onset after the age of 60. In elderly persons, toxic multinodular goiter is the most common cause (68%) of hyperthyroidism, followed by solitary thyroid nodules (16%) and Graves' disease (16%). Cardiovascular disorders (cardiac failure, arrythmias etc.) constitute the first and often the only symptom in 62% of the cases. The other forms of appearance are both various and deceptive: depression, slight fever, asthenia or nausea. Separate analysis of the three forms of hyperthyroidism did not reveal clinical, biological or therapeutic differences between them, except an inferior rate of captation for the toxic nodules. Isolated measurement of T3 or T4 is often insufficient to confirm the diagnosis because either of these hormones may appear at a normal rate. In three cases only the free thyroxin index was pathological on first determination. The authors have established that the autonomous nodules are larger and more active after, rather than before, 60 years of age, and have attempted to define their morphological identity. The results of the treatment are analyzed and preference is expressed for radioactive iodine in every form of hyperthyroidism.

  11. Pneumoniae in immunocompromised patients

    International Nuclear Information System (INIS)

    Jacobi, Volkmar; Lehnert, Thomas; Thalhammer, Axel

    2009-01-01

    Due to the large surface area, heat, high humidity and high oxygen supply in the lung makes an ideal environment for the propagation of germs. The purpose of the immune system is to establish and maintain the balance between saprophytes and immune defense so as to depress and ultimately kill germs as they infiltrate the body. This usually is achieved by the use of a highly complex immune system. It is a perfect combination of non-specific, cellular and humoral immune mechanisms with very specific immune cells and antibodies, which are specialized on particular pathogens. The specific defenses potentiate the effect of the nonspecific defense in a large extent so as to prevent re-infection and ultimately eliminate recognized pathogens. The causes of immune deficiency can be related to either the cellular or humoral level and affect both the specific and nonspecific defenses. There is a different excitation spectrum depending on the type of immune deficiency. Immune deficiency can prevalently cause complications in the course of infections, decelerate the healing and allow the occurrence of rare pathogens. In particular, the radiological characteristics of typical and atypical pneumonia in immunocompromised patients will be discussed. Particular emphasis is placed on the appearance of bacterial infections, mycobacterioses, PCP, CMV, and laid fungual pneumonia. Even it is not possible to identify certain pathogens radiologically, it is often possible to narrow the spectrum of germs causing pulmonary infections significantly by comparing with other pulmonary complications such as lymphoma or kaposisarcomas. (orig.)

  12. Patient safety: lessons learned

    International Nuclear Information System (INIS)

    Bagian, James P.

    2006-01-01

    The traditional approach to patient safety in health care has ranged from reticence to outward denial of serious flaws. This undermines the otherwise remarkable advances in technology and information that have characterized the specialty of medical practice. In addition, lessons learned in industries outside health care, such as in aviation, provide opportunities for improvements that successfully reduce mishaps and errors while maintaining a standard of excellence. This is precisely the call in medicine prompted by the 1999 Institute of Medicine report ''To Err Is Human: Building a Safer Health System.'' However, to effect these changes, key components of a successful safety system must include: (1) communication, (2) a shift from a posture of reliance on human infallibility (hence ''shame and blame'') to checklists that recognize the contribution of the system and account for human limitations, and (3) a cultivation of non-punitive open and/or de-identified/anonymous reporting of safety concerns, including close calls, in addition to adverse events. (orig.)

  13. Patient-Centeredness as Physician Behavioral Adaptability to Patient Preferences.

    Science.gov (United States)

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

    2018-05-01

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

  14. Patient Safety and Healthcare Quality

    OpenAIRE

    Aikaterini Toska; Panagiotis Kyloudis; Maria Rekleiti; Maria Saridi

    2012-01-01

    Introduction: Due to a variety of circumstances and world-wide research findings, patient safety andquality care during hospitalization have emerged as major issues. Patient safety deficits may burdenhealth systems as well as allocated resources. The international community has examined severalproposals covering general and systemic aspects in order to improve patient safety; several long-termprograms and strategies have also been implemented promoting the participation of health-relatedagent...

  15. Fingerprints identification of radiotherapy patients

    International Nuclear Information System (INIS)

    Lartigau, E.F.; Forrest, M.; Audebaud, S.; Dewitte, A.; Giscard, S.; Leclercq, B.

    2012-01-01

    The identification of patient plays a key role in the quality and safety of radiotherapy. It does impact on all professional staff and on patients. After the regulatory authority approval (Cnil), a pilot study has been performed on 1901 patients. Acceptance has been very high (> 93%) with a low risk of mis-identification (< 0.1%). The next step will be to implement and test a bimodal system in order to improve registration capacity and sensitivity. (authors)

  16. Cryptococcosis infection among HIV patients

    Directory of Open Access Journals (Sweden)

    Zineb Tlamcani

    2016-06-01

    Full Text Available Cryptococcosis is commonly known as a central nervous system infection due to Cryptococcus neoformans. It is one of the most frequent infections in AIDS patients. Disseminated cryptococcosis appears in almost one third of these patients. In this review, we will discuss the clinical presentation of cryptococcal infections among HIV patients and various methods of diagnosis, such as India ink, latex agglutination test and culture.

  17. Parenteral nutrition in malnourished patients

    International Nuclear Information System (INIS)

    Lichvarova, I.

    2011-01-01

    Parenteral nutrition became a routine therapeutic option in malnourished patients, if conventional nutritional enteral support is not effective. Cachexia and malnutrition prolong the wound healing, contribute to immunosuppression, increase morbidity and the cost of treatment. Using of a malnutrition protocol as a screening tool is necessary to sort out malnourished patients. Parenteral nutrition is therefore an important part of the multimodal therapy and from the medical and the ethical point of view is a great mistake not to feed a patient. (author)

  18. Evaluation of therapeutic patient education

    OpenAIRE

    D'Ivernois , Jean-François; Gagnayre , Rémi; Assal , Jean-Philippe; Golay , Alain; Libion , France; Deccache , Alain

    2006-01-01

    9 pages; These guidelines mainly focus on the principles of evaluating Therapeutic Patient Education; Over the past thirty years, therapeutic patient education (TPE) has become an essential part of the treatment of long-term diseases. Evaluations of this new practice are expected, and are sometimes imposed according to protocols and criteria that do not always reflect the complexity of changes taking place within patients and healthcare providers. Sometimes, expected results are not achieved ...

  19. Biological therapy in geriatric patients

    International Nuclear Information System (INIS)

    Mego, M.

    2012-01-01

    Targeted biological therapy, alone or in combination with conventional chemotherapy, make significant progress in the treatment of patients with malignancy. Its use as opposed to high-dose chemotherapy is not limited by age, nevertheless, we have relatively little knowledge of the toxicity and effectiveness in geriatric patients. Aim of this article is to give an overview of the biological effectiveness and toxicity of anticancer therapy in geriatric patients, based on published data. (author)

  20. Patients with multiple contact allergies

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  1. Endodontic treatment in geriatric patients

    Directory of Open Access Journals (Sweden)

    Milly Armilya Andang

    2007-11-01

    Full Text Available With the increased number of geriatric population, it is predicted that the need for dental treatment also increases. The needs for esthetic factors and function of geriatric patient are maybe similar to young patient. The number of geriatric patients who refuse dental extraction is increasing if there are still other alternative. They can be more convinced when the clinician said that the dental disease experienced is a focal infection so that the loss of the tooth can be accepted as the best option. But if it is possible, they will prefer endodontic treatment, because they want to keep their teeth according to the treatment plan or based on patient's request, as a less traumatic alternative compared to extraction.Endodontic treatment consideration for geriatric patient is quite similar to younger patients. The technique is also the same, although the problem may be bigger. The problem or obstacle that may arise in endodontic treatment for geriatric patient relates to the visit duration, problems during x-ray, problems in defining root canal location, vertical root fracture, and in some cases, decreased pulp tissue recovery ability. Due to the fact that the challenge is quite big, the success of endodontic treatment in geriatric patients needs to be considered. This paper will explain the endodontic treatment prognosis for geriatric patients.

  2. Nurse Burnout and Patient Satisfaction

    Science.gov (United States)

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

    2010-01-01

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

  3. Mandibulotomy in the irradiated patient

    International Nuclear Information System (INIS)

    Davidson, J.; Freeman, J.; Birt, D.

    1989-01-01

    Though the mandibular swing, as an approach to certain upper aerodigestive tract malignancies, has been gaining popularity in recent years, there has been little reported as to the feasibility of this procedure in subjects who have received radical preoperative radiotherapy. We have recently reported the results of 23 such patients, and we now present an update. The results presented are of a retrospective analysis of 44 patients, 50% of whom received radical preoperative radiotherapy to fields including the osteotomy site. As in the previous study, there were no statistically significant differences between the complication rates in the irradiated and nonirradiated patient populations. All the patients were orally rehabilitated

  4. 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

  5. [Nutritional assessment for hospitalized patients].

    Science.gov (United States)

    Henríquez Martínez, T; Armero Fuster, M

    1991-01-01

    A review of the following points was performed: Factors favouring the development and presence of malnutrition among hospitalized patients. Useful parameters in nutritional evaluation. Types of malnutrition. The Chang nutritional evaluation protocol is used in our Hospital, which is simple, inexpensive, reliable, specific and easily reproduced. This is based on five variables (three anthropometric and two biochemical), randomized and based on reference tables and values. A study was made on data corresponding to 70 patients, in whom a prevalence of malnutrition was observed in critical patients. The patients were classified based on three different definitive possibilities (Marasmo, Kwashiorkor and combined), and three grades of malnutrition (slight, moderate and severe).

  6. Patient adherence with COPD therapy

    Directory of Open Access Journals (Sweden)

    C. S. Rand

    2005-12-01

    Full Text Available Although there are very few published studies on adherence to treatment regimens in chronic obstructive pulmonary disease (COPD, the evidence that exists suggests that, as with asthma therapy, adherence is poor. Patient beliefs about COPD, as well as their motivation and expectations about the likelihood of success of medical interventions, can influence adherence rates. Other critical factors include the patient's understanding of their illness and therapy, and the complexity of the prescribed treatment regimen. Incorrect inhaler technique is also a common failing. When prescribing in primary or specialist care, healthcare professionals should address adherence as a vital part of the patient consultation. Improved patient education may also increase adherence rates.

  7. [Integral treatment for bedridden patients].

    Science.gov (United States)

    García-Verdugo, M Fernanda Arroyo; Garrido Hernández, M Teresa; Rosell Palomo, Ricardo

    2007-05-01

    Spinal cord injuries are one of the traumatic injuries which produce the greatest number of patients who are bedridden or incapacitated. Physical effects acquire such importance that one can not forget to attend to aspects as basic as hygiene, correct posture during their bedridden stay or the daily task to transfer patients to the various support elements they need to utilize. Nursing care for patients suffering spinal cord injuries comprise the fundamental axis on which a correct recuperation rotates. At the same time, proper treatment care will lead to a future improvement in a patient's quality of life.

  8. Patient delay and associated factors among breast cancer patients

    International Nuclear Information System (INIS)

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

    2015-01-01

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

  9. Provider and patient perception of psychiatry patient health literacy

    Directory of Open Access Journals (Sweden)

    Bacon O

    2017-06-01

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

  10. Importance of patient centred care for various patient groups.

    NARCIS (Netherlands)

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

    2010-01-01

    Background: Though patient centred care is a somewhat ‘fuzzy’ concept, in general it is considered as something to strive for. However, preliminary evidence suggests that the importance of elements of patient-centred care (PCC), such as communication, information and shared decision making, may vary

  11. Identifying Patients at Risk and Patients in Need

    DEFF Research Database (Denmark)

    Schmidt, Thomas

    2015-01-01

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

  12. Patient Education Leads to Better Care for Heart Patients.

    Science.gov (United States)

    Rosenberg, Stanley G.

    The staff of a heart and circulatory disease program of a State department of health conducted a special project at a city hospital which showed that a well-organized treatment and education program for patients with congestive heart failure increased the patient's knowledge of his disease, medication, and diet as well as his adherence to a…

  13. Cultural competence: reflections on patient autonomy and patient good.

    Science.gov (United States)

    Leever, Martin G

    2011-07-01

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

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

    Science.gov (United States)

    Ripamonti, C; Bruera, E

    1997-03-01

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

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

    DEFF Research Database (Denmark)

    Dellson, Pia; Nilbert, Mef; Carlsson, Christina

    2016-01-01

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

  16. Depression in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Badema Čengić

    2010-04-01

    Full Text Available Depression is the most frequent psychological complication of haemodialysis (HD patients (pts and has been associated with impaired Quality of Life (QoL. The aim of our study was to investigate the prevalence of depression in HD pts in relation to sociodemographic factors and the relationship between depression and QoL.200 pts from Clinic for haemodialysis in Sarajevo, B&H were participating in the study. Mean age was S7,26±13,78 years and mean HD duration was 64’26±58,18 months. From the test material we applied BDI and SF-36.51% of our pts have shown depression (BDI>11 in various degrees (30%-mild depression, 8,5%-moderate depression and 12,5%-severe depression. As we could expect, the most emphasized symptoms of depression were somatic symptoms. 55,5% of pts have shown QoL lower then average. Sociodemographic data such as gender, marital status and HD duration did not influence significantly on pt’s QoL and occurrence of depression (p>0,05. As the age of the pts increased, level of depression increased too and QoL significantly decreased (p<0,05. Employed pts have shown significantly better QoL and lower level of depression in relation to unemployed pts (p<0,05. As the educational level of pts increased, QoL increased too and level of depression significantly decreased (p<0,05. Pts in 1st HD shift were significantly more depressed and have significantly worse mental health in compare to pts in 3rd HD shift (p<0,05. Our results showed a high prevalence of depressive symptoms among the study group that was linked to trend of poor QoL.

  17. [Preoperative structured patient education].

    Science.gov (United States)

    Lamarche, D

    1993-04-01

    This article describes the factors that motivated the nursing staff of the cardiac surgery unit at the Royal Victoria Hospital in Montreal, to revise their preoperative teaching program. The motivating factors described are the length of the preoperative waiting period; the level of preoperative anxiety; the decreased length of hospital stay; the dissatisfaction of the nursing staff with current patient teaching practices; and the lack of available resources. The reorganization of the teaching program was based upon the previously described factors combined with a review of the literature that demonstrated the impact of preoperative anxiety, emotional support and psycho-educational interventions upon the client's recovery. The goals of the new teaching program are to provide the client and the family with cognitive and sensory information about the client's impending hospitalization, chronic illness and necessary lifestyle modifications. The program consists of a system of telephone calls during the preoperative waiting period; a videotape viewing; a tour of the cardiac surgery unit; informal discussion groups; and the availability of nursing consultation to decrease preoperative anxiety. The end result of these interventions is more time for client support and integration of necessary information by the client and family. This kind of program has the potential to provide satisfaction at many levels by identifying client's at risk; increasing client knowledge; increasing support; decreasing anxiety during the preoperative waiting period; and decreasing the length of hospital stay. The nursing staff gained a heightened sense of accomplishment because the program was developed according to the nursing department's philosophy, which includes primary nursing.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Patients as Rights Holders.

    Science.gov (United States)

    Brännmark, Johan

    2017-07-01

    Autonomy and consent have been central values in Western moral and political thought for centuries. One way of understanding the bioethical models that started to develop, especially in the 1970s, is that they were about the fusion of a long-standing professional ethics with the core values underpinning modern political institutions. That there was a need for this kind of fusion is difficult to dispute, especially since the provision of health care has in most developed countries become an ever more important concern of our political institutions, with governments playing a significant role in regulating and facilitating the provision of health care and in many countries even largely organizing it. There is, nevertheless, still room for dispute about how best to achieve this fusion and how to best think about autonomy and consent in a biomedical context. The simplest model we can have is probably about how being a person is largely about having the capacity of autonomous choice and that the main mode through which we exercise autonomy is by providing informed consent. Yet, liberal democracy's core idea that human beings have a high and equal value is also found in other accounts of the person. The human-rights framework provides an alternative model for thinking about personhood and about patient care. The human-rights approach is grounded, not in an account of autonomy (although it has something to say about autonomy), but in an account of the moral and political personhood that people possess merely by being human beings. In this approach, values like dignity and integrity, both highly relevant in a bioethical context, are identified as distinct values rather than being derived from and therefore reduced to respect for autonomous choice. The human-rights approach can supplement the problematic notion of autonomy that has been central to bioethics by placing this notion in a broader, strongly pluralistic framework. © 2017 The Hastings Center.

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

    Science.gov (United States)

    Bhakta, Hemangini C; Marco, Catherine A

    2014-04-01

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

  20. Erectile dysfunction in haemodialysis patients

    International Nuclear Information System (INIS)

    Mumtaz, A.; Hussain, S.; Nazir, M.

    2009-01-01

    There is a very high prevalence of Erectile Dysfunction (ED) in dialysis patients. There is no as such available data on ED and factors affecting it in our patients. Analytical, cross-sectional, hospital based study conducted from January to March 2008, Haemodialysis unit of Shalimar and Mayo Hospital, Lahore. All male patients of end stage renal disease (ESRD) on maintenance haemodialysis therapy, whose spouses are alive and able to perform intercourse, were included in the study. Patient with cognitive and communication deficits were excluded from study. International index of erectile function-5 (IIEF-5), adopted in Urdu was used for the determination of prevalence of erectile function. Categorization of erectile dysfunction was done as mild, moderate and severe. Demographic data were collected and certain laboratory parameters (haemoglobin, haematocrit, urea, HBsAg and Anti HCV) were sent. Total numbers of patient were fifty. Major cause of ESRD was diabetes mellitus 28 (56%). Most of the patients 33 (66%) have passed 10th grade or they were under 10th grade. Prevalence of ED was 86% with mean IIEF-5 score of 10.36+-7.13. Majority of patients 33 (64.7%) were suffering from severe degree of ED. Factors responsible for ED are diabetes mellitus, age more than 50 year, high pre dialysis urea and Anti HCV positive patients. In this study, smoking, duration of dialysis and monthly spending is not related with ED. Majority of the patients suffering from ESRD, on maintenance haemodialysis are having ED. None of the patients suffering from ED were taking any treatment for it. Haemodialysis does not improve sexual dysfunction. Major factors responsible for ED are diabetes mellitus, age more than 50 years, high pre dialysis urea and Anti HCV positive patients. (author)

  1. OPCAB in patients on hemodialysis.

    Science.gov (United States)

    Milani, Rodrigo; Brofman, Paulo Roberto Slud; Souza, José Augusto Moutinho de; Barboza, Laura; Guimarães, Maximiliano Ricardo; Barbosa, Alexandre; Varela, Alexandre Manoel; Ravagnelli, Marcel Rogers; Silva, Francisco Maia da

    2007-01-01

    To analyze the hospital outcomes of patients, with chronic renal insufficiency in the hemodialysis, submitted to OPCAB. Fifty-one patients with chronic renal insufficiency were submitted to OPCAB. Hemodialysis was performed on the day before and the day after the operation. Myocardial revascularization was performed using LIMA's suture and suction stabilization. Fifty-one patients, with an average of 61.28+/-11.09 years, were analyzed. Thirty patients (58.8%) were female. The predominant functional class was IV in 21 (41.1%) of the patients. The left ventricle ejection fraction was dire in 21 (41.1%) patients. The mean EUROSCORE of this series was 7.65+/-3.83 and the mean number of distal anastomosis was 3.1+/-0.78 per patient. The average time of mechanical ventilation was 3.78+/-4.35 hours and the mean ICU stay was 41.9+/-13.8 hours, while the average hospitalization was 6.5+/-1.31 days. In respect to complications, nine (17.6%) of the patients developed atrial fibrilation, and one (1.9%) patient presented with a case of ischemic stroke but had a good recovery during hospitalization. There were no deaths in this series. Chronic renal patients submitted to hemodialysis were always a high risk population for myocardial revascularization. In this series, the absence of extracorporeal circulation appeared to be safe and efficient in this special subgroup of patients. The operations were performed with low indices of complications, absence of deaths and relatively low stays in the ICU and in hospital.

  2. Patient safety culture among nurses.

    Science.gov (United States)

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

    2015-03-01

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

  3. Patient acceptance of awake craniotomy.

    Science.gov (United States)

    Wrede, Karsten H; Stieglitz, Lennart H; Fiferna, Antje; Karst, Matthias; Gerganov, Venelin M; Samii, Madjid; von Gösseln, Hans-Henning; Lüdemann, Wolf O

    2011-12-01

    The aim of this study was to objectively assess the patients' acceptance for awake craniotomy in a group of neurosurgical patients, who underwent this procedure for removal of lesions in or close to eloquent brain areas. Patients acceptance for awake craniotomy under local anesthesia and conscious sedation was assessed by a formal questionnaire (PPP33), initially developed for general surgery patients. The results are compared to a group of patients who had brain surgery under general anesthesia and to previously published data. The awake craniotomy (AC) group consisted of 37 male and 9 female patients (48 craniotomies) with age ranging from 18 to 71 years. The general anesthesia (GA) group consisted of 26 male and 15 female patients (43 craniotomies) with age ranging from 26 to 83 years. All patients in the study were included in the questionnaire analysis. In comparison to GA the overall PPP33 score for AC was higher (p=0.07), suggesting better overall acceptance for AC. The subscale scores for AC were also significantly better compared to GA for the two subscales "postoperative pain" (p=0.02) and "physical disorders" (p=0.01) and equal for the other 6 subscales. The results of the overall mean score and the scores for the subscales of the PPP33 questionnaire verify good patients' acceptance for AC. Previous studies have shown good patients' acceptance for awake craniotomy, but only a few times using formal approaches. By utilizing a formal questionnaire we could verify good patient acceptance for awake craniotomy for the treatment of brain tumors in or close to eloquent areas. This is a novel approach that substantiates previously published experiences. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. Patient Perspectives on Biosimilar Insulin.

    Science.gov (United States)

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

    2014-01-01

    Given that a new wave of biosimilar insulins will likely enter the market in coming years, it is important to understand patient perspectives on these biosimilars. A survey (N = 3214) conducted by the market research company dQ&A, which maintains a 10 000-patient panel of people with type 1 or type 2 diabetes in roughly equal measure, investigated these perspectives. The survey asked whether patients would switch to a hypothetical less expensive biosimilar insulin that was approved by their provider. Approximately 66% of respondents reported that they would "definitely" or "likely" use a biosimilar insulin, while 17% reported that they were "unlikely" to use or would "definitely not use" such a product. Type 2 diabetes patients demonstrated slightly more willingness to use biosimilars than type 1 diabetes patients. Common patient concerns included whether biosimilars would be as effective as reference products (~650 respondents), whether side effect profiles would deviate from those of reference products (~220 respondents), and the design of the delivery device (~50 respondents). While cost savings associated with biosimilar insulins could increase patient uptake, especially among patients without health insurance (some recent estimates suggest that biosimilars will come at a substantial discount), patients may still need assurance that a cheaper price tag is not necessarily associated with substandard quality. Overall, the dQ&A survey indicates that the majority of patients are willing to consider biosimilar insulins, but manufacturers will need to work proactively to address and assuage patient concerns regarding efficacy, safety, drug administration, and other factors. © 2014 Diabetes Technology Society.

  5. Surgical patient selection and counseling.

    Science.gov (United States)

    Ziegelmann, Matt; Köhler, Tobias S; Bailey, George C; Miest, Tanner; Alom, Manaf; Trost, Landon

    2017-08-01

    The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures. The process of appropriate patient selection is determined by the integration of patient and surgeon factors, including psychological capacity to handle unsatisfactory results, baseline expectations, complexity of case, and surgeon volume and experience. Using this model, a high-risk scenario includes one in which a low-volume surgeon performs a complex case in a patient with limited psychological capacity and high expectations. In contrast, a high-volume surgeon performing a routine case in a male with low expectations and abundant psychiatric reserve is more likely to achieve a successful outcome. To further help identify patients who are at high risk for dissatisfaction, a previously published mnemonic is recommended: CURSED Patient (compulsive/obsessive, unrealistic, revision, surgeon shopping, entitled, denial, and psychiatric). Appropriate patient counseling includes setting appropriate expectations, reviewing the potential and anticipated risks of surgery, post-operative instruction to limit complications, and long-term follow-up. As thorough counseling is often a time-consuming endeavor, busy practices may elect to utilize various resources including educational materials, advanced practice providers, or group visits, among others. The consequences for poor patient selection and counseling may range from poor surgical outcomes and patient dissatisfaction to lawsuits, loss of

  6. Hepatocellular carcinoma in Danish patients

    DEFF Research Database (Denmark)

    Stefansdottir, Jenna; Christensen, Erik; Schiødt, Frank Vinholt

    2017-01-01

    OBJECTIVE: Hepatocellular carcinoma (HCC) is a common cause of cancer, and most HCC patients have underlying cirrhosis. Retrospectively, we aimed to characterize patients with newly diagnosed HCC at a Danish hospital and to investigate survival and identify predictive factors for survival. METHODS...

  7. Government influence on patient organizations

    NARCIS (Netherlands)

    van de Bovenkamp, H.M.; Trappenburg, M.J.

    2011-01-01

    Patient organizations increasingly play an important role in health care decision-making in Western countries. The Netherlands is one of the countries where this trend has gone furthest. In the literature some problems are identified, such as instrumental use of patient organizations by care

  8. Delirium hos kritisk syge patienter

    DEFF Research Database (Denmark)

    Strøm, Thomas; Pande-Rolfsen, Guri; Hagen, Christine

    2009-01-01

    Interest in and the quantity of publications on delirium in critically ill patients have grown increasingly over the last decade. Critically ill patients have traditionally been sedated to facilitate mechanical ventilation. This practice impeded the recognition of delirium in the critically ill p...

  9. Radiosensitivity in Fanconi's anemia patients

    International Nuclear Information System (INIS)

    Alter, Blanche P.

    2002-01-01

    The risks of radiation therapy in patients with Fanconi's anemia who have cancer are not clear. Possible toxicity was reported in six of 14 patients: 1/1 with vaginal cancer, 4/10 with head and neck or esophageal cancer, and 1/3 with oral cancer following bone marrow transplant

  10. Optimizing the strategic patient mix

    NARCIS (Netherlands)

    Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.

    In this paper we address the decision of choosing a patient mix for a hospital that leads to the most beneficial treatment case mix. We illustrate how capacity, case mix and patient mix decisions are interrelated and how understanding this complex relationship is crucial for achieving the maximum

  11. Patient identification in blood sampling.

    Science.gov (United States)

    Davidson, Anne; Bolton-Maggs, Paula

    The majority of adverse reports relating to blood transfusions result from human error, including misidentification of patients and incorrect labelling of samples. This article outlines best practice in blood sampling for transfusion (but is recommended for all pathology samples) and the role of patient empowerment in improving safety.

  12. ECG changes in epilepsy patients

    DEFF Research Database (Denmark)

    Tigaran, S; Rasmussen, V; Dam, M

    1997-01-01

    To investigate the frequency of ECG abnormalities suggestive of myocardial ischaemia in patients with severe drug resistant epilepsy and without any indication of previous cardiac disease, assuming that these changes may be of significance for the group of epileptic patients with sudden unexpected...

  13. Patient's breath controls comfort devices

    Science.gov (United States)

    Schrader, M.; Carpenter, B.; Nichols, C. D.

    1972-01-01

    Patient assist system for totally disabled persons was developed which permits a person, so paralyzed as to be unable to move, to activate by breathing, a call system to summon assistance, turn the page of a book, ajust his bed, or do any one of a number of other things. System consists of patient assist control and breath actuated switch.

  14. Metabolic alterations in dialysis patients

    NARCIS (Netherlands)

    Drechsler, Christiane

    2010-01-01

    Assessing metabolic risk in dialysis patients, three main aspects are important: a) the pathophysiologic effects of metabolic disturbances as known from the general population are unlikely to completely reverse once patients reach dialysis. b) Specific additional problems related to chronic kidney

  15. Behandling af den hypoterme patient

    DEFF Research Database (Denmark)

    Kjærgaard, Benedict; Rudolph, Søren Finnemann; Lucas, Alexander

    2008-01-01

    Treatment of the hypothermic patient depends more on the clinical condition than on the core temperature. Unconscious patients need thorough investigation, and they can often be rewarmed with warm water in the pleural cavities. Cardiac arrest requires cardio pulmonary rescue until rewarming can b...

  16. Implicit learning in psychotic patients

    NARCIS (Netherlands)

    Schmand, B.; Kop, W. J.; Kuipers, T.; Bosveld, J.

    1992-01-01

    Implicit verbal learning of psychotic patients (n = 59) and non-psychotic control patients (n = 20) was studied using stem completion and association tasks in lexical and semantic priming paradigms. Performance on these tasks was contrasted with explicit memory on Rey's verbal learning test.

  17. Empowering Patients: PD in Healthcare

    DEFF Research Database (Denmark)

    Kensing, Finn; Strand, Dixi Louise; Bansler, Jørgen P.

    2004-01-01

    In this paper, we discuss PD issues and concerns in the context of a national initiative the purpose of which is to provide IT support for the communication and collaboration within a heterogeneous network of patients/citizens and health care professionals. We present the notion of patient empowe...

  18. Endocrinopathies in thalassemia major patient

    Science.gov (United States)

    Lubis, D. A.; Yunir, E. M.

    2018-03-01

    Advanced in chelation therapy and regular blood transfusion have marked improvements in the life expectancy of patients with thalassemia major, however these patients still have to deal with several complications. We report a 19-year-old male, presented with multiple endocrine complication-related thalassemia; hypogonadism, short stature, osteoporosis with history of fracture, and subclinical hypothyroid.

  19. Brief hospitalizations of elderly patients

    DEFF Research Database (Denmark)

    Strømgaard, Sofie; Rasmussen, Søren Wistisen; Schmidt, Thomas Andersen

    2014-01-01

    BACKGROUND: Crowded departments are a common problem in Danish hospitals, especially in departments of internal medicine, where a large proportion of the patients are elderly. We therefore chose to investigate the number and character of hospitalizations of elderly patients with a duration of less...

  20. Rhinoplasty in Middle Eastern Patients.

    Science.gov (United States)

    Sajjadian, Ali

    2016-01-01

    Rhinoplasty in patients of Middle Eastern origin requires complete understanding of nasal morphology and an individualized approach to create a racially congruent and aesthetically pleasing outcome. In this article, common anatomic features and characteristics and detailed steps, surgical techniques, and operative maneuvers that can lead to predictable outcome in rhinoplasty of Middle Eastern patients are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Psychodynamics in medically ill patients.

    Science.gov (United States)

    Nash, Sara Siris; Kent, Laura K; Muskin, Philip R

    2009-01-01

    This article explores the role of psychodynamics as it applies to the understanding and treatment of medically ill patients in the consultation-liaison psychiatry setting. It provides historical background that spans the eras from Antiquity (Hippocrates and Galen) to nineteenth-century studies of hysteria (Charcot, Janet, and Freud) and into the twentieth century (Flanders Dunbar, Alexander, Engle, and the DSM). The article then discusses the effects of personality on medical illness, treatment, and patients' ability to cope by reviewing the works of Bibring, Kahana, and others. The important contribution of attachment theory is reviewed as it pertains the patient-physician relationship and the health behavior of physically ill patients. A discussion of conversion disorder is offered as an example of psychodynamics in action. This article highlights the important impact of countertransference, especially in terms of how it relates to patients who are extremely difficult and "hateful," and explores the dynamics surrounding the topic of physician-assisted suicide, as it pertains to the understanding of a patient's request to die. Some attention is also given to the challenges surrounding the unique experience of residents learning how to treat medically ill patients on the consultation-liaison service. Ultimately, this article concludes that the use and understanding of psychodynamics and psychodynamic theory allows consultation-liaison psychiatrists the opportunity to interpret the life narratives of medically ill patients in a meaningful way that contributes importantly to treatment.

  2. Venous thrombosis : a patient's view

    NARCIS (Netherlands)

    Korlaar, Inez van

    2006-01-01

    The studies described in this thesis had two main aims: 1) To study the quality of life of patients with venous thrombosis and to examine the role of illness perceptions in explaining the quality of life of these patients. 2) To assess the psychological consequences of genetic testing for

  3. Psychological aspects of cancer patients

    Directory of Open Access Journals (Sweden)

    Graça Cardoso

    2014-06-01

    Full Text Available Cancer is accompanied by important psychological distress experienced by both patient and family. From the moment of the diagnosis on, the patient has to develop a great number of mechanisms and tasks of adjustment to the illness and its circumstances. The high prevalence of anxiety and depressive disorders during the course of cancer increases in the end stage disea‐ se. Therefore, a global plan of intervention integrating somatic and psychological/ psychiatric care throughout all the phases of the illness is crucial in the treatment of these patients. Health professionals working on this field can also experience emotional reactions to their patients’ suffering. They should be aware of the emotional aspects involved and develop training to help them intervene adequately with the patient and the family. The articulation between oncologists, palliative care professionals, and mental health care teams can be of great help in providing good quality of care to cancer patients.

  4. Pulmonary complications in neurosurgical patients

    Directory of Open Access Journals (Sweden)

    Randeep Guleria

    2012-01-01

    Full Text Available Pulmonary complications are a major cause of morbidity and mortality in neurosurgical patients. The common pulmonary complications in neurosurgical patients include pneumonia, postoperative atelectasis, respiratory failure, pulmonary embolism, and neurogenic pulmonary edema. Postoperative lung expansion strategies have been shown to be useful in prevention of the postoperative complications in surgical patients. Low tidal volume ventilation should be used in patients who develop acute respiratory distress syndrome. An antibiotic use policy should be put in practice depending on the local patterns of antimicrobial resistance in the hospital. Thromboprophylactic strategies should be used in nonambulatory patients. Meticulous attention should be paid to infection control with a special emphasis on hand-washing practices. Prevention and timely management of these complications can help to decrease the morbidity and mortality associated with pulmonary complications.

  5. Developing patient safety in dentistry.

    Science.gov (United States)

    Pemberton, M N

    2014-10-01

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

  6. Semi-customizing patient surveys

    DEFF Research Database (Denmark)

    Riiskjær, Erik; Ammentorp, Jette; Nielsen, Jørn Flohr

    2011-01-01

    Objective. The study investigated the needs and consequences of semi-customizing patient satisfaction surveys to low organizational levels and explored whether patient satisfaction was correlated with local organizational conditions. Design. From 1999 to 2006, the County of Aarhus carried out 398....... Establishing a link between patient satisfaction and organizational variables broadens the quality development focus to include more than simply analysis of specific questions. Semi-customizing patient surveys are recommended....... surveys during four rounds in eight hospitals. To explain differences between the wards, data on the 40 wards with the best and the 40 wards with the worst evaluations (identified by patient surveys) were compared with the data from job satisfaction surveys and management information systems. Setting...

  7. Endodontics and the ageing patient.

    Science.gov (United States)

    Johnstone, M; Parashos, P

    2015-03-01

    Patients are living longer and the rate of edentulism is decreasing. Endodontic treatment is an essential part of maintaining the health and well-being of the elderly. Retention of natural teeth improves the quality of life and the overall health and longevity of ageing patients. Also, teeth that might be otherwise extracted may be strategically valuable to retain a prosthesis, and elderly patients are more likely to have medical complications that may prevent dental extractions from being safely performed. The technical goals of endodontic treatment in the elderly are the same as those for younger patients. However, the pulpo-dentinal complex undergoes calcific changes over time, which may pose challenges for the clinician. The purposes of this review are to discuss age changes in the pulp and the challenges posed by diagnosing, treatment planning and treating the elderly endodontic patient. © 2015 Australian Dental Association.

  8. Endodontics and the irradiated patient

    International Nuclear Information System (INIS)

    Cox, F.L.

    1976-01-01

    With increasingly larger numbers of irradiated patients in our population, it seems likely that all dentists will eventually be called upon to manage the difficult problems that these patients present. Of utmost concern should be the patient's home care program and the avoidance of osteroradionecrosis. Endodontics and periodontics are the primary areas for preventing or eliminating the infection that threatens osteoradionecrosis. Endodontic treatment must be accomplished with the utmost care and maximum regard for the fragility of the periapical tissues. Pulpally involved teeth should never be left open in an irradiated patient, and extreme care must be taken with the between-visits seal. If one is called upon for preradiation evaluation, routine removal of all molar as well as other compromised teeth should be considered. Attention should be directed to the literature for further advances in the management of irradiated patients

  9. Mirroring patients – or not

    DEFF Research Database (Denmark)

    Davidsen, Annette Sofie; Fosgerau, Christina Fogtmann

    2015-01-01

    on studies of imitative behaviour within linguistics and psychology, we argue that interactional mirroring is an important aspect of displaying implicit mentalization. We aimed to explore if, and in that case how, mirroring is displayed by general practitioners (GPs) and psychiatrists in consultations...... with patients with depression. We wanted to see how implicit mentalizing unfolds in physician–patient interactions. Consultations were videorecorded and analysed within the framework of conversation analysis. GPs and psychiatrists differed substantially in their propensity to mirror body movements and verbal...... and acoustic features of speech. GPs mirrored their patients more than psychiatrists in all modalities and were more flexible in their interactional behaviour. Psychiatrists seemed more static, regardless of the emotionality displayed by patients. Implicitly mirroring and attuning to patients could signify...

  10. Patients experience of source isolation

    DEFF Research Database (Denmark)

    Johansen, Kamilla; Pedersen, Didde; Kragbak, Nina

    2014-01-01

    , Nursing education in Århus, Hedeager 2, 8200 Aarhus N, Denmark. Background: Medical treatment and care of patients with infections may include source isolation of the patient, to avoid spreading of the infection. However, isolation is a potential physiological and psychological stress factor...... of the patients perspectives of being isolated to identify areas of potential interest for developing new caring strategies to minimize the negative side effects of isolation. Methods: Literature was systematically searched in CINAHL, Nursing Reference Center, Social Care Online, SveMed+, The Cochrane Library...... of Care: The patients felt abandoned and forgotten by the nurses, because of fewer visits and time limited communication. This led to emotions such as frustrations, insecurity and neglect. While isolated the patients felt it difficult to achieve contact and have an optimal relation with the nurses...

  11. Autoantibody signature differentiates Wilms tumor patients from neuroblastoma patients.

    Directory of Open Access Journals (Sweden)

    Jana Schmitt

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

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

    Science.gov (United States)

    Dellson, Pia; Nilbert, Mef; Carlsson, Christina

    2016-02-01

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

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

    Science.gov (United States)

    Niimi, Yukari; Ota, Katsumasa

    2013-01-01

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

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

    Science.gov (United States)

    Towle, Angela; Godolphin, William

    2013-01-01

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

  15. Blood transfusion: patient identification and empowerment.

    Science.gov (United States)

    Stout, Lynn; Joseph, Sundari

    Positive patient identification is pivotal to several steps of the transfusion process; it is integral to ensuring that the correct blood is given to the correct patient. If patient misidentification occurs, this has potentially fatal consequences for patients. Historically patient involvement in healthcare has focused on clinical decision making, where the patient, having been provided with medical information, is encouraged to become involved in the decisions related to their individualised treatment. This article explores the aspects of patient contribution to patient safety relating to positive patient identification in transfusion. When involving patients in their care, however, clinicians must recognise the diversity of patients and the capacity of the patient to be involved. It must not be assumed that all patients will be willing or indeed able to participate. Additionally, clinicians' attitudes to patient involvement in patient safety can determine whether cultural change is successful.

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

    Science.gov (United States)

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

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

  17. Cancer patients and mass media

    Directory of Open Access Journals (Sweden)

    Mirjana Rajer

    2015-06-01

    Full Text Available ABSTRACTBACKGROUNDNowadays cancer patients tend to be more involved in the medical decision process. Active participation improves health outcomes and patient satisfaction. To participate effectively patients require a huge amount of information, but time limits make it impossible to satisfy all information needs at clinics. We tried to find out which kind of media cancer patients use when searching for information and how often. Lastly, we try to find out how popular the Internet is in this regard.METODSIn this research we invited cancer patients, who had regular clinic examinations at the Oncology Institute between 21st and 25th May in 2012. We carried out a prospective research by anonymous questionnaires. We were investigating which media were used and how often. We analysed results with descriptive statistics, ANOVA, the χ²-Test and the t-test.RESULTS478 of 919 questionnaires distributed among cancer patients were returned. Mean age was 59.9 years. 61 % of responders were female, and the most common level of education was high school (33 %. Most common cancer type was breast cancer (33 %, followed by gastrointestinal and lung cancer. Patients search for information most often on television (81.4% responders, followed by specialized brochures (78%, internet (70.8% and newspapers (67.6%. Patients who do not use media for information searching are older than average (62.5 years vs. 59.9 years; p<0,000.CONCLUSIONSAccording to our results patients search for information most often on television, followed by brochures, internet and newspapers. Older patients less often search for information. This data might help doctors in everyday clinical practice.

  18. Patient satisfaction with medical care

    Directory of Open Access Journals (Sweden)

    M. A. Sadovoy

    2017-01-01

    Full Text Available Patients’ evaluation of medical care is becoming more and more important due to expanding patient-centered care. For this purpose a complex index of patient satisfaction with healthcare is used. This parameter reflects the correspondence of actual healthcare services to patient’s expectations that were formed under the influence of cultural, social, economic factors, and personal experience of each patient. Satisfaction is a subjective parameter, thus, a grade of satisfaction is barely connected with quality of healthcare services itself. Moreover, medical organizations should always take into account specific features of each patient, since they can have an influence on customer attitude to medical services.This article comprises the review of publications studying determinants of patient satisfaction. In the course of the study, we analyzed data received by research teams from different countries.According to the review, we made some conclusions. First, determinants of patient satisfaction with healthcare can be divided in two groups. The first group of factors includes patients’ characteristics such as age, gender, ethnical and cultural features. However, researches from different countries revealed that there is a difference in the importance of factors belonging to this group and their influence on satisfaction of certain patient cohorts. The second group includes factors that belong to the process of healthcare services delivery and its organization. Moreover, it was found that patient satisfaction level is changing in a waveform. Thus, medical organization should not only try to increase patient satisfaction level but also maintain it. AS a result, it necessary to monitor patient satisfaction with healthcare services. That is why there is a distinct need for the development of a new tool or adaptation of existing instrument of satisfaction measurement, which would be unitized for all medical organizations in the Russian Federation 

  19. The experiences of cancer patients.

    Science.gov (United States)

    Alifrangis, C; Koizia, L; Rozario, A; Rodney, S; Harrington, M; Somerville, C; Peplow, T; Waxman, J

    2011-12-01

    To assess the needs of cancer patients for information about their condition and to understand the psychological impact of their illness. The discussion of prognosis and treatment options in the palliative setting is an important and difficult part of oncology practice. To evaluate this, we examined the experiences of cancer patients of the physical and psychological impact of their disease on their life, and their opinions on the communication of end-of-life decisions and treatment options. A patient questionnaire was designed that encompassed communication regarding treatment and prognosis, quality-of-life attitudes subsequent to cancer diagnosis, end-of-life care and cancer drug funding. One hundred and twenty-five patients with a diagnosis of cancer were asked to participate and 96 questionnaires were completed and available for analysis. The questionnaire consisted of 63 questions and was completed in both an inpatient and outpatient setting. This survey brought to light a number of controversial issues in cancer service provision, highlighting the emotional and psychological changes brought about by a cancer diagnosis. Major concerns of our patients include fear of death and pain, changes in interpersonal relationships and financial constraints. Only 66% of the patients wanted to be given a prognosis by their clinicians and just 70% of the patients recalled being given a detailed prognosis. 11% of the patients were not prepared to undergo palliative treatment. In all, 7% were not prepared to accept treatment for 1 year and 2% for 5 years of life in exchange for the potential side effects of cytotoxic chemotherapy. 12% of the patients would not want to be in possession of the information that they were in the terminal phase of the illness with a short time to live and 16% would not want this discussed with their next of kin. This study informs medical professionals about the importance of tailoring information to the needs of the individual patient, and we

  20. Patient satisfaction: focusing on "excellent".

    Science.gov (United States)

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

    2009-01-01

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

  1. Creating the ideal patient experience

    Science.gov (United States)

    Purcărea, Th.V

    2016-01-01

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

  2. Neurological disorders in hypertensive patients

    Directory of Open Access Journals (Sweden)

    N. V. Vakhnina

    2015-01-01

    Full Text Available Hypertension is one of the most common vascular diseases. The brain as target organs in hypertension is damaged more often and earlier. Neurological complications due to hypertension are frequently hyperdiagnosed in Russian neurological practice. Thus, headache, dizziness, impaired recall of recent events, nocturnal sleep disorders, and many other complaints in a hypertensive patient are usually regarded as a manifestation of dyscirculatory encephalopathy. At the same time headaches (tension headache and migraine in hypertensive patients are predominantly primary; headache associated with dramatic marked elevations in blood pressure is encountered in only a small number of patients. The role of cerebrovascular diseases in the development of dizziness in hypertensive patients is also overestimated. The vast majority of cases, patients with this complaint are in fact identified to have benign paroxysmal postural vertigo, Mеniеre’s disease, vestibular neuronitis, or vestibular migraine. Psychogenic disorders or multisensory insufficiency are generally responsible for non-systemic vertigo in hypertensive patients. Chronic cerebral circulatory insufficiency may cause non-systemic vertigo as a subjective equivalent of postural instability.Cognitive impairments (CIs are the most common and earliest manifestation of cerebrovascular lesion in hypertension. In most cases, CIs in hypertension were vascular and associated with cerebrovascular lesion due to lacunar infarcts and leukoaraiosis. However, mixed CIs frequently occur when hypertensive patients are also found to have signs of a degenerative disease, most commonly in Alzheimer’s disease.

  3. Patient satisfaction in radiation oncology

    International Nuclear Information System (INIS)

    Zissiadis, Y.; Provis, A.; Dhaliwal, S.S.

    2003-01-01

    In this current economic climate where the costs of providing a good medical service are escalating, patients are demanding a higher level of service from the Radiation Oncology providers. This coupled with the rising level of patients' expectations make it absolutely paramount for Radiation Oncology providers to offer the best possible service to their patients. In order to do this, it is essential to assess the present level of patient satisfaction prior to deciding which aspects of the current service need to be changed. In this pilot study, we assess the level of patient satisfaction with aspects of the radiotherapy service and the level of patient anxiety both prior to and following radiotherapy at the Perth Radiation Oncology Centre. A questionnaire was created using a combination of the Information Satisfaction Questionnaire-1 (ISQ-1), the Very Short Questionnaire 9 (VSQ 9) and the State Trait Anxiety Index (STAI). One hundred new patients were studied, all of whom were to have radiotherapy with curative intent. The results of this study are reviewed in this presentation

  4. HPV Carcinomas in Immunocompromised Patients

    Directory of Open Access Journals (Sweden)

    Nicole M. Reusser

    2015-01-01

    Full Text Available Human papillomavirus (HPV infection is the most common sexually transmitted disease worldwide and can result in pre-malignancies or overt malignancies of the skin and mucosal surfaces. HPV-related illnesses are an important personal and public health problem causing physical, mental, sexual and financial detriments. Moreover, this set of malignancies severely affects the immunosuppressed population, particularly HIV-positive patients and organ-transplant recipients. There is growing incidence of HPV-associated anogenital malignancies as well as a decrease in the average age of affected patients, likely related to the rising number of high-risk individuals. Squamous cell carcinoma is the most common type of HPV-related malignancy. Current treatment options for HPV infection and subsequent disease manifestations include imiquimod, retinoids, intralesional bleomycin, and cidofovir; however, primary prevention with HPV vaccination remains the most effective strategy. This review will discuss anogenital lesions in immunocompromised patients, cutaneous warts at nongenital sites, the association of HPV with skin cancer in immunocompromised patients, warts and carcinomas in organ-transplant patients, HIV-positive patients with HPV infections, and the management of cutaneous disease in the immunocompromised patient.

  5. Celebrity Patients, VIPs, and Potentates.

    Science.gov (United States)

    Groves, James E.; Dunderdale, Barbara A.; Stern, Theodore A.

    2002-12-01

    BACKGROUND: During the second half of the 20th century, the literature on the doctor-patient relationship mainly dealt with the management of "difficult" (personality-disordered) patients. Similar problems, however, surround other types of "special" patients. METHOD: An overview and analysis of the literature were conducted. As a result, such patients can be subcategorized by their main presentations; each requires a specific management strategy. RESULTS: Three types of "special" patients stir up irrational feelings in their caregivers. Sick celebrities threaten to focus public scrutiny on the private world of medical caregivers. VIPs generate awe in caregivers, with loss of the objectivity essential to the practice of scientific medicine. Potentates unearth narcissism in the caregiver-patient relationship, which triggers a struggle between power and shame. Pride, privacy, and the staff's need to be in control are all threatened by introduction of the special patient into medicine's closed culture. CONCLUSION: The privacy that is owed to sick celebrities should be extended to protect overexposed staff. The awe and loss of medical objectivity that VIPs generate are counteracted by team leadership dedicated to avoiding any deviation from standard clinical procedure. Moreover, the collective ill will surrounding potentates can be neutralized by reassuring them that they are "special"-and by caregivers mending their own vulnerable self-esteem.

  6. Personality of the tinnitus patient.

    Science.gov (United States)

    House, P R

    1981-01-01

    Personality and coping mechanisms are related to patients' perceptions of their tinnitus. Although the occurrence of tinnitus is not unusual, its nature varies from infrequent, barely noticeable sound to an unrelenting, absorbing disturbance of critical significance. Tinnitus is a subjective complaint: the same level of tinnitus may be described by one patient as intolerable and by another as barely noticeable. Stress is intricately related to tinnitus: persons with severe tinnitus experience excessive stress. This has debilitating effects on their defences and coping can become very difficult. Patients may demonstrate a cluster of hysterical defences or a serious degree of depression. Many tinnitus patients focus on their problem, objectifying it and thus intensifying the disturbance. Most tinnitus patients can be helped by psychological intervention. A small percentage of tinnitus patients can be classified as disturbed, with borderline personalities. These patients are usually not suitable for therapy or biofeedback training. Tinnitus can be stress-related disorder. As a person is faced with conflict, physiological changes occur as a result of the "fight or flight" reaction. This state of stress can be responsible for the onset or exacerbation of a tinnitus episode. Treatment by management of stress can be successful, promoting relief through a shift of focus, repose from a state of tension, and support of constructive defences.

  7. [Treatment of patients with osteoarthritis].

    Science.gov (United States)

    Vargas Negrín, Francisco; Medina Abellán, María D; Hermosa Hernán, Juan Carlos; de Felipe Medina, Ricardo

    2014-01-01

    The therapeutic management of patients with osteoarthritis aims to decrease pain and inflammation, improve physical function, and to apply safe and effective treatments. A patient-centered approach implies the active participation of the patient in the design of the treatment plan and in timely and informed decision-making at all stages of the disease. The nucleus of treatment is patient education, physical activity and therapeutic exercise, together with weight control in overweight or obese patients. Self-care by the individual and by the family is fundamental in day-to-day patient management. The use of physical therapies, technical aids (walking sticks, etc.) and simple analgesics, opium alkaloids, and antiinflammatory drugs have demonstrated effectiveness in controlling pain, improving physical function and quality of life and their use is clearly indicated in the treatment of osteoarthritis. Conservative surgery and joint replacement is indicated when treatment goals are not achieved in specific patients. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  8. Emotional influences in patient safety.

    Science.gov (United States)

    Croskerry, Pat; Abbass, Allan; Wu, Albert W

    2010-12-01

    The way that health care providers feel, both within themselves and toward their patients, may influence their clinical performance and impact patient safety, yet this aspect of provider behavior has received relatively little attention. How providers feel, their emotional or affective state, may exert a significant, unintended influence on their patients, and may compromise safety. We examined a broad literature across multiple disciplines to review the interrelationships between emotion, decision making, and behavior, and to assess their potential impact on patient safety. There is abundant evidence that the emotional state of the health care provider may be influenced by factors including characteristics of the patient, ambient conditions in the health care setting, diurnal, circadian, infradian, and seasonal variables, as well as endogenous disorders of the individual provider. These influences may lead to affective biases in decision making, resulting in errors and adverse events. Clinical reasoning and judgment may be particularly susceptible to emotional influence, especially those processes that rely on intuitive judgments. There are many ways that the emotional state of the health care provider can influence patient care. To reduce emotional errors, the level of awareness of these factors should be raised. Emotional skills training should be incorporated into the education of health care professionals. Specifically, clinical teaching should promote more openness and discussion about the provider's feelings toward patients. Strategies should be developed to help providers identify and de-bias themselves against emotional influences that may impact care, particularly in the emotionally evocative patient. Psychiatric conditions within the provider, which may compromise patient safety, need to be promptly detected, diagnosed, and managed.

  9. [Desmoid tumors in three patients].

    Science.gov (United States)

    Mohos, E; Kovács, T; Brittig, F; Nagy, A

    2001-12-01

    Desmoids are rare tumors of the connective tissue. It develops about 1:1000 times more in patients with familial adenomatous polyposis (FAP, Gardner syndrome) compared to normal population. It has been shown in molecular genetic examinations, that different mutations of the APC gene are responsible for desmoid tumors in FAP. It means, that this disease is one of the extraintestinal manifestations of Gardner syndrome. This tumor has high recurrence rate and is growing rapidly, and as a result it is the second most common cause of death in FAP patients. That is why genetic examination for FAP patients is advised to decide if the patient has higher risk for desmoid formation. If the result of the genetic test is positive, it is advisable to try to slow the progression of polyposis with medical treatment, and so to delay the date of the colectomy because the surgical intervention--and connective tissue damage--can induce desmoid formation in these patients. At the same time it is reasonable to examine and regularly control patients with sporadic desmoid tumors searching for other manifestations of Gardner syndrome (colon, stomach and duodenum polyposis, tumor of papilla Vateri, retinopathy, etc.). Palliative surgery is not indicated in patients with inoperable intraabdominal desmoid tumors, because partial resections (R1, R2, debulking) result in further tumor progression. In these patients medical treatment (sulindac, tamoxifen), chemotherapy (doxorubicin, dacarbazin) and radiotherapy or combination of them can result tumor remission. We describe our three patients (an abdominal wall desmoid four years following Cesarean section; a desmoid tumor in the retroperitoneum and in the pelvis diagnosed three years after total colectomy; and a retroperitoneal and abdominal wall desmoid one year after total colectomy) and etiology, diagnosis and therapy of desmoid tumors are discussed.

  10. Patients with narcolepsy in Slovenia

    Directory of Open Access Journals (Sweden)

    Leja Dolenc Grošelj

    2014-12-01

    Full Text Available Abstract Background: To determine the number of patients with narcolepsy in Slovenia, describe their typical clinical features and the diagnostic criteria they met on polysomnography (PSG, the mean sleep latency test (MSLT and HLA typing.Methods: Retrospective study of all narcolepsy patients referred to the National Sleep Disorder Centre at the Institute of Clinical Neurophysiology, University Medical Centre Ljubljana in the period from May 1994 to September 2013.Results: There are currently only 38 patients with narcolepsy in Slovenia. The average time lapse from onset to diagnosis is 17 years. The time lapse is much longer for older patients. The prevalence of narcolepsy in Slovenia is 1.85 to 100,000 inhabitants. All patients had EDS, 89% cataplexy, 66% hallucinations and 37% sleep paralysis at the time of diagnosis. Characteristic changes on PSG and MSLT were present in 97% of all tested patients. HLA DQB1*0602 is present in 88% of all tested patients. The most common differential diagnoses found were OSAS and hypersomnia.Conclusion: With a prevalence of 1.85/100,000 narcolepsy in Slovenia, it is seriously underdiagnosed and not recognized by general practitioners and neurologists alike. Both should be more aware of the disease and think about the possibility of it in patients with excessive daytime sleepiness and unexplained attacks, with additional symptoms such as hallucinations and paralysis during sleep. Such patients should be sent to the Sleep Disorder Centre, where the diagnosis can be confirmed and treatment started as soon as possible, thereby reducing the patient’s pathological symptoms and improve their quality of life.  

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

    Science.gov (United States)

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

    2013-08-01

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

  12. Patient risk from interproximal radiography

    International Nuclear Information System (INIS)

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

    1984-01-01

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

  13. [Medical ethics and patient responsibility].

    Science.gov (United States)

    Gajda, Z

    1998-01-01

    When we say "medical ethics" we understand the responsibility of the physician for his medical education and his attitude to his patient. But Hippocrates is known to have said that the efficiency and good results of the treatment depends not only on the physician but on the patient and his engagement, his observance of the doctors' advice, his attitude to his own psyche and body, both in health as in illness. This is an ethical problem known to every practitioner, the problem of ethics of the patient, which ought to be more widely disseminated in society.

  14. [The magnetotherapy of hypertension patients].

    Science.gov (United States)

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

    1990-01-01

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

  15. Advocating for Patient Care Literacy.

    Science.gov (United States)

    Poirier, Therese I

    2018-02-01

    The value of the arts and humanities in becoming an "educated" pharmacist is reviewed in this commentary. The term "patient care literacy" is defined as becoming a more humane pharmacist. This implies not only using heads but HARTSS (humanities, arts and social sciences) for developing the necessary skills. A conceptual framework for curricular reform that focuses on using the arts and humanities is proposed for advancing patient care literacy. Methods for enhancing use of arts and humanities for developing pharmacy graduates is specifically proposed. The need for more empiric research to demonstrate the value of the arts and humanities in developing a patient care literate professional is highlighted.

  16. Patient dosimetry during chest radiography

    International Nuclear Information System (INIS)

    Ciraj-Bjelac, O.; Kosutic, D.; Markovic, S.

    2004-01-01

    Reasons for the variation in patient doses from chest radiography procedure were investigated by assessing entrance skin doses from kerma-area product measurements. Data were collected from seven x-ray tubes in five hospitals involving 259 adult patients. The third quartile value was 0.81 mGy compared to general reference level of 0.30 mGy. The applied tube potential was main contributor to patient dose variation. If department use at least 90 k Vp, the mean entrance surface dose would be reduced ut to factor six. Modification of departmental procedure is correct approach for dose reduction in diagnostic radiology. (author) [sr

  17. ANEMIA IN HEMODIALYSIS PATIENTS: DIABETIC VS NON DIABETIC PATIENTS

    Directory of Open Access Journals (Sweden)

    SH SHAHIDI

    2002-12-01

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

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

    Science.gov (United States)

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

    2018-06-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

    Henriksen, Ann-Helen; Ringsted, Charlotte

    2011-09-01

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

  1. Living with HIV: Patients Perspective

    Centers for Disease Control (CDC) Podcasts

    This podcast showcases three people who are living with HIV. The patients share their experiences of being diagnosed with HIV, of the treatments they are undergoing, and on taking responsibility for their health.

  2. Malnutrition in paediatric oncology patients

    African Journals Online (AJOL)

    Nutritional status of paediatric cancer patients at diagnosis ... Professor and Executive Head, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, .... can lead to decreased oral intake, weight loss.

  3. Rosuvastatin in diabetic hemodialysis patients

    DEFF Research Database (Denmark)

    Holdaas, Hallvard; Holme, Ingar; Schmieder, Roland E

    2011-01-01

    A randomized, placebo-controlled trial in diabetic patients receiving hemodialysis showed no effect of atorvastatin on a composite cardiovascular endpoint, but analysis of the component cardiac endpoints suggested that atorvastatin may significantly reduce risk. Because the AURORA (A Study...

  4. Osseous involvement in AIDS patients

    International Nuclear Information System (INIS)

    Marchiori, Edson; Pereira, Abercio Arantes

    1995-01-01

    The radiological findings of eight patients with the acquired immunodeficiency syndrome (AIDS) who developed bone lesions were analyzed in conjunction with twelve similar published cases. Our series included three patients with lymphoma, two with bacillary angiomatosis, two with tuberculosis and one with staphylococcal osteomyelitis. All the lesions were lithic regardless of the etiology. Both in our cases and in those previously published bone repair was only seen in cases of bacillary angiomatosis treated with erythromycin. No pathognomonic findings were observed. However, the association of skin and bone lesions in immuno deficient patients should always bring the consideration of bacillary angiomatosis in the differential diagnosis. This is particularly relevant since this a condition amenable to treatment once correctly identified. The radiological findings in the lymphoma and tuberculosis patients have not been described previously. (author). 9 refs., 7 figs., 3 tabs

  5. National Patient Care Database (NPCD)

    Data.gov (United States)

    Department of Veterans Affairs — The National Patient Care Database (NPCD), located at the Austin Information Technology Center, is part of the National Medical Information Systems (NMIS). The NPCD...

  6. Bone health in cancer patients

    DEFF Research Database (Denmark)

    Coleman, R; Body, J J; Aapro, M

    2014-01-01

    There are three distinct areas of cancer management that make bone health in cancer patients of increasing clinical importance. First, bone metastases are common in many solid tumours, notably those arising from the breast, prostate and lung, as well as multiple myeloma, and may cause major...... morbidity including fractures, severe pain, nerve compression and hypercalcaemia. Through optimum multidisciplinary management of patients with bone metastases, including the use of bone-targeted treatments such as potent bisphosphonates or denosumab, it has been possible to transform the course of advanced...... cancer for many patients resulting in a major reduction in skeletal complications, reduced bone pain and improved quality of life. Secondly, many of the treatments we use to treat cancer patients have effects on reproductive hormones, which are critical for the maintenance of normal bone remodelling...

  7. Patients Bill of Rights Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — Reducing Costs, Protecting Consumers - The Affordable Care Act on the One Year Anniversary of the Patients Bill of Rights For too long, too many hard working...

  8. Music for untying restrained patients.

    Science.gov (United States)

    Janelli, L M; Kanski, G

    1998-03-01

    The purpose of this descriptive pilot study was two-fold: (a) to test psychometrically an observational instrument designed to measure patient behaviors displayed while unrestrained and receiving a musical intervention; and (b) to determine the effect of a musical intervention on the behavioral reactions of physically restrained patients. The Restraint-Music Response Instrument (RMRI) is a 40-item observational checklist consisting of 22 positive and 18 negative responses developed by the researchers. Content validity was assessed by a panel of experts. The RMRI was tested for interrater reliability using three simulated and 10 actual patients. Results suggest that the RMRI is a valid and reliable measure of patients' responses to music but requires additional study with a control group not receiving the intervention.

  9. Preventing Infections in Cancer Patients

    Science.gov (United States)

    ... Protect: Know the Signs and Symptoms of Infection Neutropenia and Risk for Infection Health Care Providers Educational Materials Cancer and Flu How to Prevent Flu from Spreading Flu Symptoms Information for Families and Caregivers Flu Treatment for Cancer Patients and ...

  10. Implant rehabilitation in bruxism patient

    Science.gov (United States)

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

    2014-01-01

    A white female patient presented to the university clinic to obtain implant retained prostheses. She had an edentulous maxillary jaw and presented three teeth with poor prognosis (33, 34 and 43). The alveolar bone and the surrounding tissues were healthy. The patient did not report any relevant medical history contraindicating routine dental treatment or implant surgery, but self-reported a dental history of asymptomatic nocturnal bruxism. The treatment plan was set and two Branemark protocols supported by six implants in each arch were installed after a 6-month healing period. A soft occlusal splint was made due to the patient's history of bruxism, and the lack of its use by the patient resulted in an acrylic fracture. The prosthesis was repaired and the importance of using the occlusal splint was restated. In the 4-year follow-up no fractures were reported. PMID:24907215

  11. Engaging patients through your website.

    Science.gov (United States)

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

    2014-01-01

    Legislation requires the healthcare industry to directly engage patients through technology. This paper proposes a model that can be used to review hospital websites for features that engage patients in their healthcare. The model describes four levels of patient engagement in website design. The sample consisted of 130 hospital websites from hospitals listed on 2010 and 2011 Most Wired Hospitals. Hospital websites were analyzed for features that encouraged patient interaction with their healthcare according to the levels in the model. Of the four levels identified in the model, websites ranged from "informing" to "collaborative" in website design. There was great variation of features offered on hospital websites with few being engaging and interactive. © 2012 National Association for Healthcare Quality.

  12. Latex allergies - for hospital patients

    Science.gov (United States)

    ... ency/patientinstructions/000499.htm Latex allergies - for hospital patients To use the sharing features on this page, ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  13. Muscle dysfunction in cancer patients

    DEFF Research Database (Denmark)

    Christensen, Jesper Frank; Jones, L W; Andersen, J L

    2014-01-01

    dysfunction in cancer patients lies in the correlation to vital clinical end points such as cancer-specific and all-cause mortality, therapy complications and quality of life (QoL). Such associations strongly emphasize the need for effective therapeutic countermeasures to be developed and implemented...... implications of muscle dysfunction in cancer patients. The efficacy of exercise training to prevent and/or mitigate cancer-related muscle dysfunction is also discussed. DESIGN: We identified 194 studies examining muscular outcomes in cancer patients by searching PubMed and EMBASE databases. RESULTS: Muscle...... dysfunction is evident across all stages of the cancer trajectory. The causes of cancer-related muscle dysfunction are complex, but may involve a wide range of tumor-, therapy- and/or lifestyle-related factors, depending on the clinical setting of the individual patient. The main importance of muscle...

  14. Systems Thinking and Patient Safety

    National Research Council Canada - National Science Library

    Schyve, Paul M

    2005-01-01

    Patient safety is a prominent theme in health care delivery today. This should come as no surprise, given that "first, do no harm" has been the ethical watchword throughout the history of medicine, nursing, and pharmacy...

  15. Patient-specific surgical simulation.

    Science.gov (United States)

    Soler, Luc; Marescaux, Jacques

    2008-02-01

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

  16. [Patients, doctors and the internet].

    Science.gov (United States)

    Jeannot, Jean Gabriel; Bischoff, Thomas

    2015-05-13

    The majority of the Swiss population uses the internet to seek information about health. The objective is to be better informed, before or after the consultation. Doctors can advise their information-seeking patients about high quality websites, be it medical portals or websites dedicated to a specific pathology. Doctors should not see the internet as a threat but rather as an opportunity to strengthen the doctor-patient relationship.

  17. Smoking Cessation in COPD patients

    OpenAIRE

    Carlos A. Jimenez-Ruiz

    2016-01-01

    Tobacco smoking is the main cause of COPD. Smoking cessation is the only therapeutic measure that can cure COPD and prevent this disorder from its chronic progression. Smoking cessation in COPD patients is difficult because most of these patients have specific characteristics that prevent them to quit. Recently, an ERS Task Force has developed a Consensus Document that contains recommendations for helping COPD smokers to quit.

  18. Mechanical ventilation in neurosurgical patients

    Directory of Open Access Journals (Sweden)

    Keshav Goyal

    2013-01-01

    Full Text Available Mechanical ventilation significantly affects cerebral oxygenation and cerebral blood flow through changes in arterial carbon dioxide levels. Neurosurgical patients might require mechanical ventilation for correction and maintenance of changes in the pulmonary system that occur either due to neurosurgical pathology or following surgery during the acute phase. This review discusses the basics of mechanical ventilation relevant to the neurosurgeon in the day-to-day management of neurosurgical patient requiring artificial support of the respiration.

  19. SWALLOWING IN PATIENTS WITH LARYNGITIS

    Directory of Open Access Journals (Sweden)

    Isabela MODA

    Full Text Available ABSTRACT BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin. The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

  20. Assessing the patient's mammogram experience.

    Science.gov (United States)

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

    2004-01-01

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

  1. Patient exposure in paediatric radiology

    International Nuclear Information System (INIS)

    Iacob, O.; Diaconescu, C.; Isac, R.

    2002-01-01

    Because of their longer life expectancy, the risk of late manifestations of detrimental radiation effects is greater in children than in adults and, consequently, paediatric radiology gives ground for more concern regarding radiation protection than radiology of adults. The purpose of our study was to assess, in terms of effective dose, the magnitude of paediatric patient exposure during conventional X-ray examinations, selected for their high frequency or their relatively high doses delivered to patient

  2. Rehabilitative Games for Stroke Patients

    Directory of Open Access Journals (Sweden)

    A. Pyae

    2015-07-01

    Full Text Available Stroke is one of the major problems in medical and healthcare that can cause severe disability and death of patients especially for older population. Rehabilitation plays an important role in stroke therapy. However, most of the rehabilitative exercises are monotonous and tiring for the patients. For a particular time, they can easily get bored in doing these exercises. The role of patient’s motivation in rehabilitation is vital. Motivation and rehabilitative outcomes are strongly related. Digital games promise to help stroke patients to feel motivated and more engaged in rehabilitative training through motivational gameplay. Most of the commercial games available in the market are not well-designed for stroke patients and their motivational needs in rehabilitation. This study aims at understanding the motivational requirements of stroke patients in doing rehabilitative exercises and living in a post-stroke life. Based on the findings from the literature review, we report factors that can influence the stroke patients’ level of motivation such as social functioning, patient-therapist relationship, goal-setting, and music. These findings are insightful and useful for ideating and designing interactive motivation-driven games for stroke patients. The motivational factors of stroke patients in rehabilitation may help the game designers to design motivation-driven game contexts, contents, and gameplay. Moreover, these findings may also help healthcare professionals who concern stroke patient’s motivation in rehabilitative context. In this paper, we reported our Virtual Nursing Home (VNH concept and the games that we are currently developing and re-designing. Based on this literature review, we will present and test out the ideas how we can integrate these motivational factors in our future game design, development, and enhancement.

  3. SWALLOWING IN PATIENTS WITH LARYNGITIS.

    Science.gov (United States)

    Moda, Isabela; Ricz, Hilton Marcos Alves; Aguiar-Ricz, Lilian Neto; Dantas, Roberto Oliveira

    2018-01-01

    Dysphagia is described as a complaint in 32% of patients with laryngitis. The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

  4. Difficult physician-patient relationships.

    Science.gov (United States)

    Reifsteck, S W

    1998-01-01

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

  5. Protection of patients in dentistry

    International Nuclear Information System (INIS)

    Selato Selato, P.

    2013-04-01

    Current literature on dental radiology was reviewed in order to seek justification for radiological protection of patients in dental radiography, to explore the different factors affecting patient dose and to derive practical guidance on how to achieve radiological protection of patients in dentistry. Individual doses incurred in dental radiology are in general relatively low, however it is generally accepted that there is no safe level of radiation dose and that no matter how low the doses received are, there is a mathematical probability of an effect. Hence appropriate patient protection measures must be instituted to keep the exposures as low as reasonably achievable (ALARA). The literature review demonstrated that there is considerable scope for significant dose reductions in dental radiology using the techniques of optimisation of protection. The techniques of optimization of protection that can be used to ensure patient dose is as low as reasonably achievable whilst achieving clinically adequate image quality include the following: image receptor selection, image receptor holders, collimation, beam filtration, operating potential and exposure time, patient protective equipment, film exposure and processing, film storage, image viewing, quality assurance, diagnostic reference levels, technique charts and training and education.(au)

  6. Patients survey after concurrent chemoradiotherapy

    International Nuclear Information System (INIS)

    Shimane, Toshikazku; Egawa, Syunya; Mori, Tomoaki; Ono, Tomohiro; Monden, Tetsuya; Kobayashi, Sei; Sanbe, Takeyuki; Suzaki, Harumi

    2010-01-01

    Concurrent chemoradiotherapy for cancer of head and neck is becoming more popular as the treatment of choice. It is considered to maintain the quality of life (QOL) of patients better than operative treatments in terms of preserving the functions, organs, and figure, but recently we cannot necessarily say that it maintains the QOL of patients better than operative treatments because its complications after therapy disturb daily life. We report the results of a questionnaire survey about complications after therapy, problems during therapy, improvements, and satisfaction level directed at patients with cancer of the head and neck who received Concurrent chemoradiotherapy for the purpose of ascertaining if patients can actually maintain their QOL after therapy. As a result, the most controversial problem was mouth dryness, but the symptom improved as the follow-up duration got longer. As for the satisfaction level, 'very-satisfied' and 'almost-satisfied' were more than 90%, so we concluded that the QOL of patients is maintained after therapy, while there are still improvements to be made. We also concluded that we should continue to make improvement and try to improve the QOL of patients during and after therapy. (author)

  7. Radiographic evaluation of AIDS patients

    International Nuclear Information System (INIS)

    Le Blang, S.D.; Witheman, M.L.; Donovan Post, M.J.; Casillas, J.V.

    1995-01-01

    Morphological imaging, based on the use of various techniques including ultrasound, X-ray computed tomography (CT), and magnetic resonance imaging (MRI), plays an important role in the characterization, diagnosis and follow-up of patients with Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS). While the presence of thoracic infections, the most frequently observed illnesses in AIDS patients, can best be performed by using conventional chest films and CT, the assessment of cerebral involvement in AIDS patients - characterized by the presence of focal masses, demyelination, meningitis, and infarction - is best achieved using MRI. The work-up of patients with gastrointestinal symptoms should include the use of ultrasound for the evaluation of visceral involvement and lymphadenopathy, completed by CT to further characterize pathologic conditions in either the bowel or visceral organs. Ultrasound is the screening exam of choice in AIDS patients with suspected renal disease, but other methods may be necessary for the assessment of the complications due to pharmacological treatment. Musculoskeletal complications may require the combined use of all the above methods, since they may be caused by infections, tumors and rheumatologic illness. The use of the radiographic methods for the detection of the numerous forms of infections and malignancies in AIDS patients is described in detail for the various body districts

  8. Neurophysiological approach to tinnitus patients.

    Science.gov (United States)

    Jastreboff, P J; Gray, W C; Gold, S L

    1996-03-01

    The principal postulate of the neurophysiological model of tinnitus is that all levels of the auditory pathways and several nonauditory systems play essential roles in each case of tinnitus, stressing the dominance of nonauditory systems in determining the level of tinnitus annoyance. Thus it has been proposed to treat tinnitus by inducing and facilitating habituation to the tinnitus signal. The goal is to reach the stage at which, although patients may perceive tinnitus as unchanged when they focus on it, they are otherwise not aware of tinnitus. Furthermore, even when perceived, tinnitus does not evoke annoyance. Habituation is achieved by directive counseling combined with low-level, broad-band noise generated by wearable generators, and environmental sounds, according to a specific protocol. For habituation to occur, it is imperative to avoid masking tinnitus by these sounds. Since 1991, > 500 tinnitus patients have been seen in our center. About 40% exhibited hyperacusis to varying degrees. A survey of > 100 patients revealed > 80% of significant improvement in groups of patients treated with the full protocol involving counseling and the use of noise generators. Notably, in patients who received counseling only, the success rate was < 20%. The improvement in hyperacusis was observed in approximately 90% of treated patients.

  9. Comparisons between written and computerised patient histories

    NARCIS (Netherlands)

    Quaak, Martien; Westerman, R. Frans; van Bemmel, Jan H.

    1987-01-01

    Patient histories were obtained from 99 patients in three different ways: by a computerised patient interview (patient record), by the usual written interview (medical record), and by the transcribed record, which was a computerised version of the medical record. Patient complaints, diagnostic

  10. Information technology for patient empowerment in healthcare

    CERN Document Server

    Grando, Maria Adela; Bates, David

    2015-01-01

    The authors explore novel information-based mechanisms that are changing the way patients are involved in their own health care. The book covers models, frameworks and technologies to improve patient-to-provider communication, patient interaction with information technologies, patient education and involvement in health care decision processes, and patient access, understanding and control over their clinical data.

  11. [Enteral nutrition in burn patients].

    Science.gov (United States)

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

    1992-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  13. Radiation protection in BNCT patients

    International Nuclear Information System (INIS)

    Blaumann, Hernan R.; Scharnichia, E.; Levanon, I.; Fernandez, C.; Facchini, Guillermo; Longhino, J.; Calzetta, Osvaldo; Pereira, M.

    2008-01-01

    Full text: Boron Neutron Capture Therapy (BNCT) is a technique that selectively targets cancer cells while sparing normal tissues by virtue of the differential uptake of a 10 B carrier compound in tumor. The National Atomic Energy Commission (CNEA) and the Oncology Institute 'Angel H. Roffo' (IOAR) began a BNCT programme in 2003 for treating cutaneous skin melanomas in extremities. The neutron beam used is the hyperthermal one developed at the RA-6 Reactor of the Bariloche Atomic Centre (CAB). The prescribed dose is delivered in one fraction and therefore patient positioning and knowledge of the dose received by normal tissue are crucial. 10 irradiations have been done since 2003, all of them in legs and feet and the dose prescription was determined by the maximum tolerable skin dose. Due to the characteristics of this treatment the patient body might be exposed not only to the primary beam but also to the secondary photon beam produced by neutron capture at the target itself. Thus a patient radiation-monitoring plan was implemented in order to evaluate the gamma dose delivered to sensible organs of each patient. An acrylic water-filled whole body phantom was used for preliminary gamma dose and thermal neutron flux measurements at positions related to patient's body sensible organs considering tentative patient positions. The beam port shielding was, in this way, optimized. TLD-700 and Manganese foils were used for gamma and thermal neutron detection. The TLD-700 thermal neutron response was previously evaluated by using the in-phantom beam dosimetry characterization. In-vivo dosimetry with TLD is routinely implemented in order to evaluate gamma dose to sensible organs of each patient. These organs are chosen depending on its distance from the zone to be irradiated and its radio-sensibility. All TLDs have been positioned well outside the irradiation field. Maximum gamma dose received outside the radiation field in healthy tissues was well below tolerance dose for

  14. Survival of Sami cancer patients

    Directory of Open Access Journals (Sweden)

    Leena Soininen

    2012-07-01

    Full Text Available Objectives. The incidence of cancer among the indigenous Sami people of Northern Finland is lower than among the Finnish general population. The survival of Sami cancer patients is not known, and therefore it is the object of this study. Study design. The cohort consisted of 2,091 Sami and 4,161 non-Sami who lived on 31 December 1978 in the two Sami municipalities of Inari and Utsjoki, which are located in Northern Finland and are 300–500 km away from the nearest central hospital. The survival experience of Sami and non-Sami cancer patients diagnosed in this cohort during 1979–2009 was compared with that of the Finnish patients outside the cohort. Methods. The Sami and non-Sami cancer patients were matched to other Finnish cancer patients for gender, age and year of diagnosis and for the site of cancer. An additional matching was done for the stage at diagnosis. Cancer-specific survival analyses were made using the Kaplan–Meier method and Cox regression modelling. Results. There were 204 Sami and 391 non-Sami cancer cases in the cohort, 20,181 matched controls without matching with stage, and 7,874 stage-matched controls. In the cancer-specific analysis without stage variable, the hazard ratio for Sami was 1.05 (95% confidence interval 0.85–1.30 and for non-Sami 1.02 (0.86–1.20, indicating no difference between the survival of those groups and other patients in Finland. Likewise, when the same was done by also matching the stage, there was no difference in cancer survival. Conclusion. Long distances to medical care or Sami ethnicity have no influence on the cancer patient survival in Northern Finland.

  15. Otorhinolaryngological patient injuries in Finland.

    Science.gov (United States)

    Lehtivuori, Tuuli; Palonen, Reima; Mussalo-Rauhamaa, Helena; Holi, Tarja; Henriksson, Markus; Aaltonen, Leena-Maija

    2013-10-01

    Otorhinolaryngology (ORL) is considered a specialty associated with few serious patient injuries. Research data that support this belief are, however, scarce. We analyzed claims associated with ORL to determine the number of Finnish cases and the possible common denominators. Register study of ORL cases in the Patient Insurance Centre (PIC), the Regional State Administrative Agencies (RSAA), and the National Supervisory Authority for Welfare and Care (Valvira) during the years 2004 to 2008. These three agencies are the main actors in the field of patient injury in Finland. We analyzed compensated ORL patient injury cases from the PIC and cases associated with the ORL specialty for Valvira and RSAA from 2004 to 2008 and surveyed patient treatment files, statements from specialists, and compensation decisions. Injuries were usually associated with operations; three patients who experienced injuries during these procedures died. Common ORL operations such as tonsillectomy, septoplasty, and paranasal sinus surgery were most often associated with compensated injuries. Serious injuries were few, with a total of 110 out of 422 (26.1%) claims compensated by the PIC. Of the 110 compensated cases, 30 (27.3%) were related to tumor surgery. The most usual compensated case had iatrogenic nerve injury affecting the facial or trigeminal nerves. Of the compensated cases, 79 (71.8%) were treated by specialists, 15 (13.6%) by residents, and the rest by other medical professionals. Patient injuries in ORL are seldom severe and are strongly associated with surgery. A typical compensated injury was one that occurred in a central hospital during working hours. N/A. Copyright © 2013 The American Laryngological, Rhinological, and Otological Society, Inc.

  16. Visuomotor learning in cerebellar patients.

    Science.gov (United States)

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

    1996-11-01

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

  17. Clinical management of patients with hyperthyroidism

    International Nuclear Information System (INIS)

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

    1985-01-01

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

  18. Mental changes in patients with AIDS

    NARCIS (Netherlands)

    Derix, M. M.; de Gans, J.; Stam, J.; Portegies, P.

    1990-01-01

    Mental changes are common in patients with acquired immunodeficiency syndrome (AIDS). Neuropsychological data of 32 patients with AIDS and cognitive symptoms were reviewed. All patients were neurologically examined and ancillary investigations were performed. According to the neuropsychological data

  19. Masticatory performance in patients with myasthenia gravis

    NARCIS (Netherlands)

    Weijnen, FG; Kuks, JBM; van der Glas, HW; Oudenaarde, [No Value; Bosman, F

    Masticatory muscle electromyograms (EMGs) were recorded while patients with bulbar myasthenia gravis chewed artificial food and compared with those of patients with ocular myasthenia gravis, patients in clinical remission who had previously suffered from bulbar myasthenia gravis and healthy

  20. Development of acromegaly in patients with prolactinomas

    DEFF Research Database (Denmark)

    Andersen, Marianne; Hagen, Casper; Frystyk, Jan

    2003-01-01

    OBJECTIVES: Patients with prolactinomas and patients with acromegaly often have heterogenous adenomas. In this study we have focused on patients with prolactinomas who developed acromegaly and acromegalic patients with hyperprolactinaemia. Our hypothesis is that some patients with hyperprolactina......OBJECTIVES: Patients with prolactinomas and patients with acromegaly often have heterogenous adenomas. In this study we have focused on patients with prolactinomas who developed acromegaly and acromegalic patients with hyperprolactinaemia. Our hypothesis is that some patients...... with hyperprolactinaemia may develop clinical acromegaly. METHODS: We have included patients examined at department M, Odense University Hospital between 1996 and 2001. Seventy-eight patients with prolactinomas, 65 females and 13 males, with a median age (range) of 30 Years (14-74) and 47 Years (20-66), respectively, were...

  1. How Communication Disharmonies between Patients and Nurses Can Affect Patients

    DEFF Research Database (Denmark)

    Thygesen, Marianne Kirstine; Pedersen, Birthe D.

    2017-01-01

    verbatim and analyzed using a Ricoeur inspired technique, which started open-minded. Situations with harmony between patients’ experience of their health state and nurses’ signals in this regard were more peaceful and energizing for the patients than situations with disharmony, which gave limbo experiences...... and drained of energy. The Broaden and Build theory and the Sense of Coherence theory might support our findings. True presence of the nurse is important in order to meet the patient where she is and communicate from there. More evidence based suggestions for future clinical foci are given. Female cancer...

  2. [Patients' decision for aesthetic surgery].

    Science.gov (United States)

    Fansa, H; Haller, S

    2011-12-01

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

  3. Reconstruction of alveolar defects in patients with cleft lip and palate - 111 consecutive patients

    DEFF Research Database (Denmark)

    Andersen, Kristian

    2012-01-01

    Reconstruction of alveolar defects in patients with cleft lip and palate - 111 consecutive patients......Reconstruction of alveolar defects in patients with cleft lip and palate - 111 consecutive patients...

  4. 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....

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

    NARCIS (Netherlands)

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

    Essentials: It is unknown if hemophilia patients with atrial fibrillation need anticoagulation. Endogenous thrombin potentials (ETP) in hemophilia patients and patients on coumarins were compared. Severe hemophilia patients had comparable ETP to therapeutic international normalized ratio (INR). In

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  7. Orthognathic surgery in cleft patients.

    Science.gov (United States)

    Phillips, John H; Nish, Iain; Daskalogiannakis, John

    2012-03-01

    After studying this article, the participant should be able to: 1. Identify the skeletal changes in the cleft patient that necessitate surgery. 2. Describe the orthodontic principles that precede surgical treatment. 3. Demonstrate the surgical principles involved in cleft orthognathic surgery and how to avoid common pitfalls particular to cleft orthognathic surgery. 4. Anticipate when dentoalveolar distraction can help in the treatment of problems not easily treated with conventional orthognathic techniques. This CME article covers the basic multidisciplinary approach to the treatment of patients requiring a combined orthodontic orthognathic approach to their skeletally based malocclusion. The dentoskeletal abnormalities are described for these patients, as are the fundamental orthodontic principles in the presurgical treatment of these patients. The basic surgical principles are discussed in general, and the reader is provided with advice on avoiding common pitfalls. Specific attention is given to the more recent advances in dentoalveolar distraction in cases of large defects that would have been difficult to treat using conventional orthognathic surgery. Videos are provided to illustrate the general principles in treating the cleft orthognathic patient and to illustrate the treatment of large defects using dentoalveolar distraction.

  8. Invasive Aspergillosis in Hematological Patients.

    Science.gov (United States)

    Kimura, Shun-Ichi

    2016-01-01

    Invasive aspergillosis (IA) is still one of the leading causes of morbidity and mortality in hematological patients, although its outcome has been improving. Prolonged and profound neutropenia in patients receiving intensive chemotherapy for acute leukemia and stem cell transplantation is a major risk factor for IA. Allogeneic stem cell transplant recipients with graft-versus-host disease and corticosteroid use are also at high risk. Management in a protective environment with high efficiency particular air (HEPA) filter is generally recommended to prevent aspergillosis in patients with prolonged and profound neutropenia. Antifungal prophylaxis against Aspergillus species should be considered in patients with past history of aspergillosis or colonization of Aspergillus species, at facilities with high incidence of IA and those without a protective environment. Early diagnosis and prompt antifungal treatment is important to improve outcome. Imaging studies such as computed tomography and biomarkers such as galactomannan antigen and β-D-glucan are useful for early diagnosis. Empirical antifungal treatment based on persistent or recurrent fever during neutropenia despite broad-spectrum antibiotic therapy is generally recommended in high-risk patients. Alternatively, a preemptive treatment strategy has recently been proposed in the context of progress in the early diagnosis of IA based on the results of imaging studies and biomarkers. Voriconazole is recommended for initial therapy for IA. Liposomal amphotericin B is considered as alternative initial therapy. Combination antifungal therapy of echinocandin with voriconazole or liposomal amphotericin B could be a choice for refractory cases.

  9. Hope in Patients with Cancer

    Directory of Open Access Journals (Sweden)

    Selma Turan Kavradim

    2014-06-01

    Full Text Available Cancer, which is one of the major health problems leading to despair, uncertainty, pain and suffering, is perceived as a serious and chronic disease. Cancer negatively affects individuals' quality of life due to the physical, psychological, and socio-economic problems. Today, despite inspiring advances in diagnosis and treatment of cancer and increase in survival rates of patients, appearance of physical and psycho-social disorders during cancer course disrupts the adaptation mechanisms of patients and undermines expectations for the future. Most of the time in clinical practice, clinicians focus on physical assessments and treatment planning of cancer patients primarily, ignoring social, psychological, economic and cultural factors related with the disease. This approach definitely influences patients' hope levels and their effective dealing with the disease. The aim of this article is to guide medical staff and increase awareness about the concept of hope in patients with cancer. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 154-164

  10. Conditional Reasoning in Schizophrenic Patients.

    Science.gov (United States)

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

    2017-01-01

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

  11. Patient Safety and Healthcare Quality

    Directory of Open Access Journals (Sweden)

    Aikaterini Toska

    2012-01-01

    Full Text Available Introduction: Due to a variety of circumstances and world-wide research findings, patient safety andquality care during hospitalization have emerged as major issues. Patient safety deficits may burdenhealth systems as well as allocated resources. The international community has examined severalproposals covering general and systemic aspects in order to improve patient safety; several long-termprograms and strategies have also been implemented promoting the participation of health-relatedagents, and also government agencies and non-governmental organizations.Aim: Those factors that have negative correlations with patient safety and quality healthcare weredetermined; WHO and EU programs as well as the Greek health policy were also reviewed.Method: Local and international literature was reviewed, including EU and WHO official publications,by using the appropriate keywords.Conclusions: International cooperation on patient safety is necessary in order to improvehospitalization and healthcare quality standards. Such incentives depend heavily on establishing worldwideviable and effective health programs and planning. These improvements also require further stepson safe work procedures, environment safety, hazard management, infection control, safe use ofequipment and medication, and sufficient healthcare staff.

  12. Hemodialysis in the Poisoned Patient

    Directory of Open Access Journals (Sweden)

    Megan Boysen-Osborn

    2017-09-01

    Full Text Available Audience: This classic team based learning (cTBL didactic is aimed for emergency medicine residents and fourth year medical students entering emergency medicine. Introduction: Over one million visits per year to United States (US emergency departments (ED are related to poisonings.1 Extracorporeal treatment (ECTR, specifically hemodialysis (HD, is one potential method to enhance elimination of certain drugs and their toxic metabolites.2-12 While HD may be life-saving in certain poisonings, it may have no effect on others and it carries associated risks and costs. It is essential that emergency physicians know the indications for HD in the poisoned patient. This cTBL reviews many poisonings which may be managed by HD. Objectives: By the end of this cTBL, the learner will: 1 recognize laboratory abnormalities related to toxic alcohol ingestion; 2 calculate an anion gap and osmolal gap; 3 know the characteristics of drugs that are good candidates for HD; 4 discuss the management of patients with toxic alcohol ingestions; 5 discuss the management of patients with salicylate overdose; 6 know the indications for HD in patients with overdoses of antiepileptic drugs; 7 discuss the management of patients with lithium toxicity. Method: This didactic session is a cTBL (classic team based learning.

  13. CT examinations in older patients

    International Nuclear Information System (INIS)

    Sciuk, J.; Peters, P.E.

    1989-01-01

    A total of 2,878 unselected subsequent CT examinations carried out in 1984 were analyzed retrospectively. All studies were performed in a university hospital with a centralized department of diagnostic radiology. Most of the patients investigated were hospitalized; there were only 12% outpatients. Of the patients studied 12.6% were older than 65 years and 20.5% older than 60; 17.7% were emergency cases and patients between 16 and 25 years of age represented the largest fraction. In all other age groups the relative distribution between emergency cases and regular studies revealed no significant differences. There was no statistically significant difference between the older age group (patients older than 65 years) and the total population of this study in almost all items investigated, i.e., no differences in CT examination time and no differences in preparation time (time between two CT studies). The rate of abdominal CT examinations was 7% higher in the older age group, while the relative distribution of all other CT examinations was again comparable to the total population under study. Thus, the expected increase in patients in the older age group does not measurably prolong the CT examination time. This statement applies to a major referral center with a high percentage of inpatients. (orig.) [de

  14. [Nutrition therapy of cancer patients].

    Science.gov (United States)

    Lövey, József

    2017-09-20

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

  15. Researching patient-professional interactions.

    Science.gov (United States)

    Bury, Mike

    2004-01-01

    This paper explores the nature and future of social research on patient-professional interactions. It first sketches the historical background to such research and notes that in the UK and US this was characterised by a focus on the doctor-patient relationship. This research embodied a sceptical view of the power of the medical profession in sustaining and promoting social inequalities, and a critique of 'medical dominance' over other health care professionals and patients. The paper then goes on to outline changes occurring in the nature of professional practice that suggest a fundamental shift in the social relations of health care and the role of medicine. These include a putative loss of public confidence in the medical profession and the authority of science, an increased role of the media in informing patients, and a change in the state's relationship with health care professionals. Finally, the paper outlines some items for a future research agenda, including the need to understand better patient preferences about changes in health care delivery, including a willingness to engage in 'partnership', and the possibilities and barriers to change in professional practice.

  16. Dependency in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Rumei Yang

    2016-03-01

    Full Text Available By necessity, critically ill patients admitted to intensive care units (ICUs have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients.

  17. Patient education in Europe: united differences.

    OpenAIRE

    Visser, S.; Deccache, A.; Bensing, J.

    2001-01-01

    This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient education in the US is presented in this issue. Patient education is defined as all the educational activities directed to patients, including aspects of therapeutic education, health education an...

  18. Patient Care Planning: An Interdisciplinary Approach

    OpenAIRE

    Prophet, Colleen M.

    1989-01-01

    The INFORMM Patient Care Planning System provides interdepartmental communication and individualized patient care plans based upon current standards of care. This interdisciplinary system facilitates the identification of patient problems and nursing diagnoses as well as patient care orders. The selected nurses' and physicians' orders are integrated and organized by care plan categories in printouts. As a system by-product, Patient Care Planning automatically generates and calculates patient ...

  19. Cause of Mortality in Thermally Injured Patients

    Science.gov (United States)

    1993-01-01

    11 patients, Cladosporium species from nine patients, Penicillium species from seven patients, and Phycomycetes ( mucor species and rhizopus species...infecting organisms were filamentous fungi, Aspergillus species in 16 and Mucor species in two, and in four patients C(nlida species were the causative...surface. Twelve, or 75 %, of the 16 patients with Aspergillus wound infections died but, somewhat surprisingly, both of the patients with mucor species

  20. 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

  1. Patient safety: break the silence.

    Science.gov (United States)

    Johnson, Hope L; Kimsey, Diane

    2012-05-01

    A culture of patient safety requires commitment and full participation from all staff members. In 2008, results of a culture of patient safety survey conducted in the perioperative division of the Lehigh Valley Health Network in Pennsylvania revealed a lack of patient-centered focus, teamwork, and positive communication. As a result, perioperative leaders assembled a multidisciplinary team that designed a safety training program focusing on Crew Resource Management, TeamSTEPPS, and communication techniques. The team used video vignettes and an audience response system to engage learners and promote participation. Topics included using preprocedural briefings and postprocedural debriefings, conflict resolution, and assertiveness techniques. Postcourse evaluations showed that the majority of respondents believed they were better able to question the decisions or actions of someone with more authority. The facility has experienced a marked decrease in the number of incidents requiring a root cause analysis since the program was conducted. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  2. The diabetic patient in Ramadan.

    Science.gov (United States)

    Chamsi-Pasha, Hassan; Aljabri, Khalid S

    2014-04-01

    During the month of Ramadan, all healthy, adult Muslims are required to fast from dawn to sunset. Fasting during Ramadan involves abstaining from food, water, beverages, smoking, oral drugs, and sexual intercourse. Although the Quran exempts chronically ill from fasting, many Muslims with diabetes still fast during Ramadan. Patients with diabetes who fast during the month of Ramadan can have acute complications. The risk of complications in fasting individuals with diabetes increases with longer periods of fasting. All patients with diabetes who wish to fast during Ramadan should be prepared by undergoing a medical assessment and engaging in a structured education program to undertake the fast as safely as possible. Although some guidelines do exist, there is an overwhelming need for better designed clinical trials which could provide us with evidence-based information and guidance in the management of patients with diabetes fasting Ramadan.

  3. Identifying patient risks during hospitalization

    Directory of Open Access Journals (Sweden)

    Lucélia Ferreira Lima

    2008-12-01

    Full Text Available Objective: To identify the risks reported at a public institution andto know the main patient risks from the nursing staff point of view.Methods: A retrospective, descriptive and exploratory study. Thesurvey was developed at a hospital in the city of Taboão da Serra, SãoPaulo, Brazil. The study included all nurses working in care areas whoagreed to participate in the study. At the same time, sentinel eventsoccurring in the period from July 2006 to July 2007 were identified.Results: There were 440 sentinel events reported, and the main risksincluded patient falls, medication errors and pressure ulcers. Sixty-fivenurses were interviewed. They also reported patient falls, medicationerrors and pressure ulcers as the main risks. Conclusions: Riskassessment and implementation of effective preventive actions arenecessary to ensure patient’s safety. Involvement of a multidisciplinaryteam is one of the steps for a successful process.

  4. Cannabis Use in Psychiatrie Patients.

    Science.gov (United States)

    Chaudhury, S; Sudarsanan, S; Salujha, S K; Srivastava, K

    2005-02-01

    Cannabis abuse has been associated with psychiatric disorders. The pattern of cannabis use and incidence of cannabis dependence and cannabis psychosis among 471 consecutive patients admitted to a tertiary care psychiatric center was investigated. Cannabis use was reported by 67 (14.23%) patients of whom 42 (8.92%) were occasional users, 18 (3.82%) were classified as frequent users while 7 (1.49%) fulfilled criteria for cannabis dependence. 3 (0.64%) patients showed symptoms which were characteristic of cannabis psychosis. Among the 67 cannabis users, 56 (83.58%) had their first exposure to cannabis before entering service at 13-19 years of age. The remaining 14 (16.09%) began consuming cannabis 1-5 years after joining service. The reasons given for using cannabis were curiosity about its effects 32 (47.76%), peer pressure 17 (25.37%) or traditional use during festivals 18 (26.87%).

  5. Patient communication in hormone therapy.

    Science.gov (United States)

    Schnare, S M

    2001-01-01

    Common regimens of HRT therapy are reviewed, including common routes of hormone administration. Inconsistent patterns of HRT use are discussed, including the reasons women most often give for discontinuing hormone therapies. Specific issues related to misperceptions and fears regarding HRT are clarified, and specific, focused patient education formats are discussed to address women's common concerns about HRT. Obstacles to HRT use are elucidated, with suggestions for clinicians about how to communicate more effectively with women: clinicians must focus on emotional and physical aspects of HRT choices and tailor therapies to the individual patient. Discussing frankly the very serious concerns of women regarding the association between lobular breast cancer and endometrial cancer is important; discussing and preparing women for possible side effects helps patients cope better if and when side effects occur. Finally, offering a wide variety of HRT therapies provides women with a broader choice if an initial regimen is unsuccessful.

  6. Near patient cholesterol testing in patients with peripheral arterial disease.

    Science.gov (United States)

    Hobbs, S D; Jones, A; Wilmink, A B; Bradbury, A W

    2003-09-01

    To assess the bias, precision and utility of the Bioscanner 2000 for near patient testing of total cholesterol (NPTC) in patients with peripheral arterial disease (PAD). One hundred consecutive patients attending a hospital-based clinic with symptomatic PAD underwent non-fasting NPTC using finger prick blood sample and a laboratory total cholesterol (TC) using blood drawn from an antecubital fossa vein. The Bioscanner 2000 showed good precision with a coefficient of variation of 1.8-3.8%. NPTC was significantly lower than laboratory TC (mean (S.D.) 4.67 (1.1) vs. 5.12 (1.2) mmol/l), p Bioscanner 2000 compared to laboratory testing, which was demonstrated to be a systematic bias using a Bland-Altman plot. Almost half (46%) of the readings differed by > 0.5 mmol/l, 16% by > 1.0 mmol/l and 3% by > 2 mmol/l. This means that if the cut-off for statin treatment were taken as a TC of 5.0 or 3.5 mmol/l then, based on NPTC, alone 18 and 6% of patients, respectively, would not have received a statin. In the present study, NPTC significantly under-estimated TC when compared to laboratory testing. However, in the majority of cases, this would not have affected the decision to prescribe a statin and NPTC testing allows the immediate institution or titration of statin treatment.

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

    Science.gov (United States)

    Day, Dawn

    2014-01-01

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

  8. Patients' Satisfaction With Surgical Out Patient Services At The Delta ...

    African Journals Online (AJOL)

    TNHJOURNALPH

    upsurge of medical tourism, the need for ... The highest subscale score was 8.8107. (76.21%) in the area ... Patients' satisfaction is a critical health care outcome ..... major limiting factor to many persons seeking medical ... the cost of medical care is low when compared with that ... mentioned above even though this subscale.

  9. Patient related factors for optimal blood pressure control in patients ...

    African Journals Online (AJOL)

    EB

    2013-09-03

    Sep 3, 2013 ... e” 90 mm Hg.8. Interview questionnaires. The questionnaires during the interview were comprised of four categories. The first was in relation to formal .... high blood pressure in clinics and hospitals is a major cause. Our earlier study on a rural Australian population showed that 56.7% of the patients with.

  10. Cachexia among US cancer patients.

    Science.gov (United States)

    Arthur, Susan T; Van Doren, Bryce A; Roy, Debosree; Noone, Joshua M; Zacherle, Emily; Blanchette, Christopher M

    2016-09-01

    Cancer cachexia is a debilitating condition and results in poor prognosis. The purpose of this study was to assess hospitalization incidence, patient characteristics, and medical cost and burden of cancer cachexia in the US. This study used a cross-sectional analysis of the Nationwide Inpatient Sample (NIS) for 2009. Five cancers reported to have the highest cachexia incidence were assessed. The hospitalization incidence related to cachexia was estimated by cancer type, cost and length of stay were compared, and descriptive statistics were reported for each cancer type, as well as differences being compared between patients with and without cachexia. Risk of inpatient death was higher for patients with cachexia in lung cancer (OR = 1.32; CI = 1.20-1.46) and in all cancers combined (OR = 1.76; CI = 1.67-1.85). The presence of cachexia increased length of stay in lung (IRR = 1.05; CI = 1.03-1.08), Kaposi's sarcoma (IRR = 1.47; CI = 1.14-1.89) and all cancers combined (IRR = 1.09; CI = 1.08-1.10). Additionally, cachectic patients in the composite category had a longer hospitalization stay compared to non-cachectic patients (3-9 days for those with cachexia and 2-7 days for those without cachexia). The cost of inpatient stay was significantly higher in cachexic than non-cachexic lung cancer patients ($13,560 vs $13 190; p Cachexia increases hospitalization costs and length of stay in several cancer types. Identifying the medical burden associated with cancer cachexia will assist in developing an international consensus for recognition and coding by the medical community and ultimately an effective treatment plans for cancer cachexia.

  11. Insomnia in patients with COPD.

    Science.gov (United States)

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

    2012-03-01

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

  12. Infrared-Guided Patient Setup for Lung Cancer Patients

    International Nuclear Information System (INIS)

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

    2008-01-01

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

  13. Nutritional support of reptile patients.

    Science.gov (United States)

    De Voe, Ryan S

    2014-05-01

    Providing nutritional support to reptile patients is a challenging and often misunderstood task. Ill reptiles are frequently anorexic and can benefit greatly from appropriate nutrition delivered via a variety of assist-feeding techniques. Neonatal reptiles can also be very challenging patients because many fail to thrive without significant efforts to establish normal feeding behaviors. This article presents ideas supporting the benefit of timely nutritional support as well as specific recommendations for implementation of assist feeding. Also discussed are a few nutritional issues that affect captive reptile species. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Dysphagia in the Older Patient.

    Science.gov (United States)

    Nawaz, Samia; Tulunay-Ugur, Ozlem E

    2018-05-17

    Dysphagia in older adults is a challenging problem and necessitates a team approach. The key to effective management is recognition. Patients tend to dismiss their symptoms as normal aging; therefore, early diagnosis depends on the diligence of the primary care doctors. No diagnostic technique can replace the benefits of a thorough history, with a detailed understanding of nutritional status and aspiration risk. Although one of the main goals in management is to ensure safe swallowing, the impact of a nonoral diet on the quality of life of patients should not be underestimated. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Hypokalemia in acute medical patients

    DEFF Research Database (Denmark)

    Jensen, Helene Christine Kildegaard; Brabrand, Mikkel; Vinholt, Pernille Just

    2015-01-01

    . METHODS: We conducted a prospective cohort study involving all first time admissions (n=11988) to the Acute Medical Department at Odense University Hospital linking potassium level at admission with registry data on patient characteristics, laboratory data, redeemed prescriptions and time of death......: Hypokalemia occurred in 16.8% of first time admissions (n=2011). It was associated with an adjusted hazard ratio [HR] of 1.34 (95% confidence interval [CI], 0.98-1.85) for 7-day mortality and 1.56 (CI, 1.18-3.06) for 8-30 day mortality. Among patients with more severe hypokalemia (plasma [K(+)

  16. 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....

  17. Patient-Specific Computational Modeling

    CERN Document Server

    Peña, Estefanía

    2012-01-01

    This book addresses patient-specific modeling. It integrates computational modeling, experimental procedures, imagine clinical segmentation and mesh generation with the finite element method (FEM) to solve problems in computational biomedicine and bioengineering. Specific areas of interest include cardiovascular problems, ocular and muscular systems and soft tissue modeling. Patient-specific modeling has been the subject of serious research over the last seven years and interest in the area is continually growing and this area is expected to further develop in the near future.

  18. Sporotrichosis in Renal Transplant Patients

    Directory of Open Access Journals (Sweden)

    Paulo Gewehr

    2013-01-01

    Full Text Available The current report describes two renal transplant recipients who presented with sporotrichosis. In addition, the authors review the general aspects of sporotrichosis in renal transplant recipients reported in the literature. Sporotrichosis is a rare fungal infection in transplant patients and has been reported primarily in renal transplant recipients not treated with antifungal prophylaxis. Extracutaneous forms of sporotrichosis without skin manifestations and no previous history of traumatic injuries have been described in such patients and are difficult to diagnose. Renal transplant recipients with sporotrichosis described in the present report were successfully treated with antifungal therapy including amphotericin B deoxycholate, lipid amphotericin B formulations, fluconazole and itraconazole.

  19. Cerebellar atrophy in epileptic patients

    International Nuclear Information System (INIS)

    Taneva, N.

    1991-01-01

    52 patients with epileptic seizures of different form, frequency and duration who had received long term treatment with anticonvulsive drugs were examined on Siretom 2000, a brain scanner of II generation. 6 standard incisions were made in all patients in the area of cerebellum, side ventricules and high convexity. Additional scanning with an incision width of 5 mm was made when pathological changes were detected. There were found 3 cases of cerebellar atrophy, 3 - cerebral atrophy, 1 - combined atrophy and 4 - with other changes. It was difficult to establish any relation between the rerebellar atrophy and the type of anticonvulsant used because treatment had usually been complex. 1 fig., 1 tab., 4 refs

  20. Patient positioning and supporting arrangement

    International Nuclear Information System (INIS)

    Heavens, M.; James, R.C.; Slinn, D.S.

    1980-01-01

    This patent specification describes an E.M.I. claim relating to a patient positioning and support arrangement for a computerised axial tomography system, the arrangement comprising a curved platter upon which the patient can be disposed, a table having a curved groove to accommodate the platter, and means for driving the platter slidably along the groove; the platter being formed of a substantially rigid platform shaped to conform to the groove, and a shroud, secured to the platter and disposed between the platter and the surface of the groove, so as to permit the platter to slide smoothly. (U.K.)

  1. Laboratory errors and patient safety.

    Science.gov (United States)

    Miligy, Dawlat A

    2015-01-01

    Laboratory data are extensively used in medical practice; consequently, laboratory errors have a tremendous impact on patient safety. Therefore, programs designed to identify and reduce laboratory errors, as well as, setting specific strategies are required to minimize these errors and improve patient safety. The purpose of this paper is to identify part of the commonly encountered laboratory errors throughout our practice in laboratory work, their hazards on patient health care and some measures and recommendations to minimize or to eliminate these errors. Recording the encountered laboratory errors during May 2008 and their statistical evaluation (using simple percent distribution) have been done in the department of laboratory of one of the private hospitals in Egypt. Errors have been classified according to the laboratory phases and according to their implication on patient health. Data obtained out of 1,600 testing procedure revealed that the total number of encountered errors is 14 tests (0.87 percent of total testing procedures). Most of the encountered errors lay in the pre- and post-analytic phases of testing cycle (representing 35.7 and 50 percent, respectively, of total errors). While the number of test errors encountered in the analytic phase represented only 14.3 percent of total errors. About 85.7 percent of total errors were of non-significant implication on patients health being detected before test reports have been submitted to the patients. On the other hand, the number of test errors that have been already submitted to patients and reach the physician represented 14.3 percent of total errors. Only 7.1 percent of the errors could have an impact on patient diagnosis. The findings of this study were concomitant with those published from the USA and other countries. This proves that laboratory problems are universal and need general standardization and bench marking measures. Original being the first data published from Arabic countries that

  2. Suicide among forensic psychiatric patients.

    Science.gov (United States)

    Johnson, C; Smith, J; Crowe, C; Donovan, M

    1993-04-01

    This paper examines the problem of suicide among patients discharged from a Regional Secure Unit. The stereotype that emerges is a young man with anti-social personality traits, suffering from an affective psychosis, with a history of substance abuse and impulsive violence directed both towards himself and others, who is alienated from care staff and social supports because of his provocative and uncooperative behaviour. In contrast with the general population, forensic patients are more likely to commit suicide using a violent method and are more likely to have a suicide verdict recorded by the coroner. The implications of these findings for treatment and preventive interventions are discussed.

  3. Synergistic approach to patient dialysate.

    Science.gov (United States)

    Dragotoiu, A; Checheriţă, A I; Ciocâlteu, A; Rizeanu, S

    2015-01-01

    The stress a patient is subjected to during dialysis treatment can be reduced by using a synergetic approach by the medical team. The integration into therapy of the positive psychical resources such as: active positive coping mechanisms, individual or family mental resilience, improvement of the image and self-esteem, better tolerance to frustration can represent an important part in the improvement of the patient's quality of life, determination of a positive approach of the situations both for him and close friends and relatives.

  4. The patient as skilled practitioner

    DEFF Research Database (Denmark)

    Kilbourn, Kyle

    2012-01-01

    Healthcare is leaking away from the hospital and clinic into everyday life, disrupting work and play. It is no longer confined to a strictly medical sphere. Overwhelmed medical practitioners care for the expanding ranks of chronic dependents. One solution has to been to expand healthcare activities...... and create duties for patients. For the patient at home, it is not just about applying bandages to a wound. They now configure dialysis machines, inject insulin and stock medical supplies. Information technology produces data to be transformed into meaningful knowledge about one’s own body. However, with all...

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

    Science.gov (United States)

    Schneider, Henning

    2015-01-01

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

  6. Ventrikulaere takyarytmier hos patienter med kardiomyopati

    DEFF Research Database (Denmark)

    Henningsen, Kristoffer; Christensen, Alex Hørby; Svendsen, Jesper Hastrup

    2008-01-01

    by disease, gender, age, previous cardiac arrest and treatment with implantable cardioverter-defibrillator (ICD). RESULTS: 993 patients were screened and 128 patients with cardiomyopathy were identified, corresponding to 13% of the screened patients. 58 (45%) of the patients had dilated cardiomyopathy (DCM......), 57 (45%) patients had arrhythmogenic right ventricular cardiomyopathy (ARVC) and 13 (10%) had hypertrophic cardiomyopathy (HCM). The average age was 44 years for HCM, 41 years for ARVC and 58 years for DCM. The majority of the patients were male. ICD treatment was used in 95% of the patients...... with ARVC, 70% of the patients with HCM and 59% of the patients with DCM. Only 5 patients had previous cardiac arrest without reversible cause. CONCLUSION: The study shows that cardiomyopathies are relatively frequent causes of ventricular tachyarrhythmias in patients discharged from a specialised...

  7. [Ventricular tachyarrhythmias in patients with cardiomyopathy

    DEFF Research Database (Denmark)

    Henningsen, K.; Christensen, A.H.; Svendsen, Jesper Hastrup

    2008-01-01

    by disease, gender, age, previous cardiac arrest and treatment with implantable cardioverter-defibrillator (ICD). RESULTS: 993 patients were screened and 128 patients with cardiomyopathy were identified, corresponding to 13% of the screened patients. 58 (45%) of the patients had dilated cardiomyopathy (DCM......), 57 (45%) patients had arrhythmogenic right ventricular cardiomyopathy (ARVC) and 13 (10%) had hypertrophic cardiomyopathy (HCM). The average age was 44 years for HCM, 41 years for ARVC and 58 years for DCM. The majority of the patients were male. ICD treatment was used in 95% of the patients...... with ARVC, 70% of the patients with HCM and 59% of the patients with DCM. Only 5 patients had previous cardiac arrest without reversible cause. CONCLUSION: The study shows that cardiomyopathies are relatively frequent causes of ventricular tachyarrhythmias in patients discharged from a specialised...

  8. THYMOMA -A Review of Fourteen Patients

    International Nuclear Information System (INIS)

    Kim, S. K.; Lee, H. S.; Cho, K. H.; Suh, C. O.; Kim, G. E.

    1985-01-01

    Between Jan. 1977 and Dec. 1984, 14 patients diagnosed of thymoma has been analyzed retrospectively. 6 patients(6/14 patients 43%) had myasthenia gravis. 12 patients (12/14 patients 86%) had invasive thymoma. Complete resection was carried out in 6 patients (43%), 2 patients had partial resection (14%) and 6 patients had only biopsy (43%). Postoperative or radical radiotherapy was given to 8 patients, of whom 5 patients was still alive (4 yr. 2.8 yr. 1.6 yr. 1.4 yr. 1.3 yr) and 3 patients died (1 yr. 0.6 yr. 0.6 yr). External irradiation ranges 1,950-7,000 rads (mean 4,500, median 4,000 rads)

  9. THYMOMA -A Review of Fourteen Patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, S. K.; Lee, H. S.; Cho, K. H.; Suh, C. O.; Kim, G. E. [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1985-06-15

    Between Jan. 1977 and Dec. 1984, 14 patients diagnosed of thymoma has been analyzed retrospectively. 6 patients(6/14 patients 43%) had myasthenia gravis. 12 patients (12/14 patients 86%) had invasive thymoma. Complete resection was carried out in 6 patients (43%), 2 patients had partial resection (14%) and 6 patients had only biopsy (43%). Postoperative or radical radiotherapy was given to 8 patients, of whom 5 patients was still alive (4 yr. 2.8 yr. 1.6 yr. 1.4 yr. 1.3 yr) and 3 patients died (1 yr. 0.6 yr. 0.6 yr). External irradiation ranges 1,950-7,000 rads (mean 4,500, median 4,000 rads)

  10. Technical devices for hearing-impaired individuals: cochlear implants and brain stem implants - developments of the last decade.

    Science.gov (United States)

    Müller, Joachim

    2005-01-01

    Over the past two decades, the fascinating possibilities of cochlear implants for congenitally deaf or deafened children and adults developed tremendously and created a rapidly developing interdisciplinary research field.The main advancements of cochlear implantation in the past decade are marked by significant improvement of hearing and speech understanding in CI users. These improvements are attributed to the enhancement of speech coding strategies.The Implantation of more (and increasingly younger) children as well as the possibilities of the restoration of binaural hearing abilities with cochlear implants reflect the high standards reached by this development. Despite this progress, modern cochlear implants do not yet enable normal speech understanding, not even for the best patients. In particular speech understanding in noise remains problematic [1]. Until the mid 1990ies research concentrated on unilateral implantation. Remarkable and effective improvements have been made with bilateral implantation since 1996. Nowadays an increasing numbers of patients enjoy these benefits.

  11. [Management of patients with stomas].

    Science.gov (United States)

    Simon, Anne

    2016-01-01

    With the occurrence of an intestinal obstruction, many patients may need an intestinal stoma. This decision is often taken in an emergency context but may also be planned. The treatment will be multi-disciplinary involving the surgeon, anaesthetist, nurse, health care assistant, physiotherapist, dietician and stoma therapist. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  12. Hypertension in Patients with Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Vinicius Barbosa de; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade, E-mail: wolney@cardiol.br [Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense, Niterói, RJ (Brazil)

    2015-03-15

    There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality.

  13. Temporomandibular disorders in headache patients

    Science.gov (United States)

    Mello, Christiane-Espinola-Bandeira; Oliveira, José-Luiz-Góes; Jesus, Alan-Chester-Feitosa; Maia, Mila-Leite-de Moraes; de Santana, Jonielly-Costa-Vasconcelos; Andrade, Loren-Suyane-Oliveira; Siqueira Quintans, Jullyana-de Souza; Quintans-Junior, Lucindo-José; Conti, Paulo-César-Rodrigues

    2012-01-01

    Objective: To identify the frequency of signs and symptoms of temporomandibular disorder (TMD) and its seve-rity in individuals with headache. Study Design: 60 adults divided into three groups of 20 individuals: chronic daily headache (CDH), episodic headache (EH) and a control group without headache (WH). Headache diagnosis was performed according to the criteria of International Headache Society and the signs and symptoms of TMD were achieved by using a clinical exam and an anamnestic questionnaire. The severity of TMD was defined by the temporomandibular index (TMI). Results: The TMD signs and symptoms were always more frequent in individuals with headache, especially report of pain in TMJ area (CDH, n=16; EH, n=12; WH, n=6), pain to palpation on masseter (CDH, n=19; EH, n=16; WH, n=11) which are significantly more frequent in episodic and chronic daily headache. The mean values of temporomandibular and articular index (CDH patients) and muscular index (CDH and EH patients) were statistically higher than in patients of the control group, notably the articular (CDH=0.38; EH=0.25;WH=0.19) and muscular (CDH=0.46; EH=0.51; WH=0.26) indices. Conclusions: These findings allow us to speculate that masticatory and TMJ pain are more common in headache subjects. Besides, it seems that the TMD is more severe in headache patients. Key words:Temporomandibular dysfunction, headache disorders. PMID:22926473

  14. Patient doses in interventional cardiology

    International Nuclear Information System (INIS)

    Carrera, F.; Ojeda, C.; Ruiz-Cruces, R.; Francisco Diaz, J.; Sanchez, A.; Tort, I.

    2001-01-01

    Cardiovascular diseases are the first cause of death in Spain. The most usual procedures in interventional cardiology are coronariography and PTCA. The first is a diagnostic technique, and the second one is interventional. Our goal has been to study procedures made during the first six months in the Interventional Cardiology Unit of the Juan Ramon Jimenez Hospital (Huelva-Spain), taking into account radiation protection issues. We have studied 178 patients; 145 of them underwent coronariography, and 33 of the patients had PTCA too. Every case was analyzed taking into account technical and dosimetric parameters. We show parameters values gathered: Diagnostic techniques (valvular and non-valvular patients), and interventional techniques (coronariography and PTCA in different or in the same intervention). Higher doses were obtained with valvular patients, although the number of frames was similar. Attending to therapeutic procedures, the highest values were gotten with the 'double' interventions. Interventional procedures exceed in 60% doses gotten in diagnostic studies: this is because of the number of series and number of frames per series. Similar values obtained by other authors have been gotten. (author)

  15. Hypertension in Patients with Cancer

    International Nuclear Information System (INIS)

    Souza, Vinicius Barbosa de; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade

    2015-01-01

    There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality

  16. Mismanagement of a hypochondriacal patient

    Directory of Open Access Journals (Sweden)

    Reza Bidaki

    2015-01-01

    Full Text Available Hypochondriasis is a persistent preoccupation that despite appropriate medical evaluations and assurance of patient′s physical health, the patient insists on having a serious disease. The case which is discussed in this article is a 39-years-old woman that hospitalized for half of her life and no one can perceive her disorder according to her assertions. The mentioned case is a "difficult patient"with fear of oxygen shortage and being choked (Pnigophobia which leads to continuous tendency to wear oxygen device even during sleep. There is no benefit in exaggerating her condition for herself so there is no fictitious disorder considered. During the therapy she has been assured that she does not have a serious disease and she has learnt to decrease oxygen intake and breath with his mouth. The point that makes this study different from the others is that most of hypochondriacal patients have a fear of getting HIV, cancers, hepatitis and MS but our patient has phobia of pulmonary embolism.

  17. Patient dosimetry in diagnostic radiology

    Directory of Open Access Journals (Sweden)

    Ciraj-Bjelac Olivera F.

    2003-01-01

    Full Text Available The objective of this work is to assess patient organ doses, effective doses and entrance surface doses in conventional diagnostic radiology procedures for standard adult patient. The survey consists of measurements of doses delivered to 239 patients in nine types of X-ray examinations. Three types of data were collected: X-ray machine data, patient data, and output measurements. Entrance surface dose was assessed based on the survey data and subsequently, using conversion coefficients, the organ doses and effective doses were calculated. Values of the entrance surface dose and the effective dose were estimated to be 0.4 to 5.8 mGy and 0.03 to 3.00 mSv for different examinations. Derived doses were compared with recommended general diagnostic reference levels. The impact of examination parameters on dose values was discussed. Except for posterior-anterior chest examination, all estimated doses are lower than stated reference levels. Survey data are aimed at helping development of national quality control and radiation protection programmed for medical exposures.

  18. [Maintaining patients' autonomy at home].

    Science.gov (United States)

    Niang, Bénédicte; Coudre, Jean Pierre

    2015-01-01

    To maintain the flow of hospital discharges, the patient's return home with support from a home nursing service is important. If any difficulties are identified, there are various programmes or good practices which can be put into place. The future law on adapting society to ageing also comprises a scheme combining home assistance and nursing care.

  19. EEG Findings in Burnout Patients

    NARCIS (Netherlands)

    Luijtelaar, E.L.J.M. van; Verbraak, M.J.P.M.; Bunt, P.M. van den; Keijsers, G.P.J.; Arns, M.W.

    2010-01-01

    The concept of burnout remains enigmatic since it is only determined by behavioral characteristics. Moreover, the differential diagnosis with depression and chronic fatigue syndrome is difficult. EEG-related variables in 13 patients diagnosed with burnout syndrome were compared with 13 healthy

  20. Patient privacy and social media.

    Science.gov (United States)

    Hader, Amy L; Brown, Evan D

    2010-08-01

    Healthcare providers using social media must remain mindful of professional boundaries and patients' privacy rights. Facebook and other online postings must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), applicable facility policy, state law, and AANA's Code of Ethics.

  1. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H

    1999-01-01

    Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance....... The economic implications of alcohol abuse in surgical patients are tremendous. Interventional studies are required to reduce future increases in post-operative morbidity....

  2. Abdominal ultrasound in AIDS patients

    International Nuclear Information System (INIS)

    Escribano, J.; Gonzalez, J.; Alvarez, M.; Rivero, S.; Raya, J.L.; Ruza, M.

    1998-01-01

    To analyze the ultrasonography findings in abdomen in the AIDS patients in our hospital, as well as the indications for this exploration, assessing the role of abdominal ultrasound (AU). The ultrasonographic and clinical findings in 527 patients who underwent a total of 715 explorations between 1992 and 1996 were studied. Hepatomegaly and/or splenomegaly, usually homogeneous, were observed in nearly half of the studies (45%); one third of the patients with marked splenomegaly presented visceral leishmaniasis. Focal lesions in liver and/or spleen, corresponding to angiomas, abscesses, lymphomatous lesions and metastasis, were detected in 5.7% of the explorations. Thirty-five percent of the AU revealed the presence of lymphadenopathy; nodes measuring over 2.5 cm were usually related to potential treatable infection or neoplasm. Thickening of the gallbladder wall did not usually indicate the presence of acute cholecystitis unless Murphy''s sign was also detected. Bile duct dilation and wall thickening was related to opportunistic cholangitis, and the increase in the echogenicity of the renal parenchyma was linked to AIDS-related nephropathy. Despite the fact that many of findings with AU are nonspecific, we consider that this approach should be the principal diagnostic technique in AIDS patients with suspected abdominal pathology or fever of unknown origin. (Author) 43 refs,

  3. Patient evaluations of primary care.

    NARCIS (Netherlands)

    Schäfer, W.L.A.; Boerma, W.G.W.; Schellevis, F.G.; Groenewegen, P.P.

    2012-01-01

    Background: So far, studies about people’s appreciation of primary care services has shown that patient satisfaction seems to be lower in health care systems with regulated access to specialist services by gate keeping. Nevertheless, international comparative research about patients’ expectations

  4. BAYESIAN BICLUSTERING FOR PATIENT STRATIFICATION.

    Science.gov (United States)

    Khakabimamaghani, Sahand; Ester, Martin

    2016-01-01

    The move from Empirical Medicine towards Personalized Medicine has attracted attention to Stratified Medicine (SM). Some methods are provided in the literature for patient stratification, which is the central task of SM, however, there are still significant open issues. First, it is still unclear if integrating different datatypes will help in detecting disease subtypes more accurately, and, if not, which datatype(s) are most useful for this task. Second, it is not clear how we can compare different methods of patient stratification. Third, as most of the proposed stratification methods are deterministic, there is a need for investigating the potential benefits of applying probabilistic methods. To address these issues, we introduce a novel integrative Bayesian biclustering method, called B2PS, for patient stratification and propose methods for evaluating the results. Our experimental results demonstrate the superiority of B2PS over a popular state-of-the-art method and the benefits of Bayesian approaches. Our results agree with the intuition that transcriptomic data forms a better basis for patient stratification than genomic data.

  5. Psychological profile of laryngectomized patients

    Directory of Open Access Journals (Sweden)

    Bogdan Popescu

    2016-04-01

    Full Text Available Larynx cancer is one of the most susceptible form of cancer susceptible to induce alteration of the patient’s psychological profile due to the social role that the larynx has in communication. Oral communication is severely impaired even after voice rehabilitation of the laryngectomized patients, so that the social rehabilitation is somewhat not only a medical but also a social problem. The psychological profile of these patients is altered in a way that dealing with the disease is sometimes neglected and the interaction with the outside world in terms of oral communication is totally abandoned. The starting point for depression in these cases is the acknowledgement of the disease and is, in some cases, the entire medical environment. Facial scarring, the inability to verbally interact with other human, as well as the presence of the tracheostoma, are all deciding factors in the presence of a low self-esteem for these particular patients. Psychological counseling is a mandatory approach for laryngectomized patients, in order to improve their ability to cope with cancer and providing better recovery chances.

  6. When a Patient Commits Suicide.

    Science.gov (United States)

    Marshall, Karol A.

    1980-01-01

    Suicide is a tragic and upsetting event which sometimes occurs when a person is in some form of therapy. This paper advocates a process after a patient commits suicide which allows for a thorough and orderly working through of the event by involved treatment personnel. (Author)

  7. Skin cancers in elderly patients.

    Science.gov (United States)

    Malaguarnera, Giulia; Giordano, Maria; Cappellani, Alessandro; Berretta, Massimiliano; Malaguarnera, Michele; Perrotta, Rosario Emanuele

    2013-11-01

    Cancer in older people is a common problem worldwide. Among various types of cancer, skin cancers represent an important percentage. The principal risk factors are sun exposure, family history of skin cancer, fair skin color, but also the age plays an important role in the genesis of skin cancers. In older people there are a more prolonged exposure to carcinogenesis and a decreased functionality of reparation mechanisms of the cells so they acquire a selective advantage of growing and proliferating. At the same time age causes alteration in immune system by increasing NK-cells absolute number and decreasing both the endogenous and the lymphokine-induced lytic activities. The anti-tumor immune response is also mediated by the cytotoxic T- lymphocytes and in the elderly a strong reduction of T-cell function has been demonstrated. In elderly patients the diagnosis and the treatment of skin cancers can be different from younger counterpart. For example in older patients with melanoma is important to evaluate Breslow depth while higher mitotic rate has major value in younger patients. Moreover, the treatment should consider the performance status of patients and their compliance.

  8. Patienters vurdering af medicinpakningernes indlaegssedler

    DEFF Research Database (Denmark)

    Horwitz, Anna; Reuther, Lene; Andersen, Stig Ejdrup

    2009-01-01

    information leaflets, but relied on the doctor or the pharmacist. 62% of the interviewed had no problems reading or understanding the patient information leaflets. Among the 38% with reading problems, 57% had difficulties due to text-size, and 33% found the written language difficult to understand. Thirty...

  9. Cerebrovascular disease in pediatric patients

    Directory of Open Access Journals (Sweden)

    Rotta Newra Tellechea

    2002-01-01

    Full Text Available Although rare in childhood, stroke may have a serious impact when it happens in this stage of life. Also, it may be the first sign of a systemic disease. We report 12 cases of patients with stroke treated in the Neuropediatrics Unit of Hospital de Clínicas de Porto Alegre (HCPA from March 1997 to March 2000. All patients, from term infants to 12-year-old children hospitalized in the Pediatrics Unit of HCPA, had clinical suspicion of stroke, which was later confirmed by radiological studies. Patient follow up ranged from 1 to 6 years (mean = 3.4 years. Presenting symptoms were hemiparesis in 9 patients, seizures in 7, deviation of labial commissure in 3, and loss of consciousness in 1. The increase in the number of cases of childhood stroke identified and later confirmed by noninvasive methods had helped in the determination of different ethiologies of stroke: the most frequent being hematologic, cardiac and genetic diseases. However, our study included 6 newborns with stroke whose ethiology was not identified. Seven children with seizures received phenobarbital. Six term infants had neonatal seizures secondary to stroke and restricted to the first 72 hours of life.

  10. Patient Blood Management in Europe

    DEFF Research Database (Denmark)

    Bruun, M T; Pendry, K; Georgsen, J

    2016-01-01

    BACKGROUND AND OBJECTIVES: Patient Blood Management (PBM) in Europe is a working group of the European Blood Alliance with the initial objective to identify the starting position of the participating hospitals regarding PBM for benchmarking purposes, and to derive good practices in PBM from...

  11. Patient advocacy versus employer protection.

    Science.gov (United States)

    Deubner, David; Sturm, Richard E

    2002-01-01

    In a departure from the usual Occupational Medicine: State of the Art Reviews article, this piece comprises responses from two occupational physicians to the question of how balance is achieved between employer and patient interests in occupational medicine. The authors discuss the ethical dilemmas that may arise in such relationships, negotiation of confrontations, physician responsibilities, and conflict resolution.

  12. [Patient evaluation and outcome measures].

    Science.gov (United States)

    Nieto Pol, Enrique

    2014-01-01

    Both the initial evaluation and follow-up of patients with osteoarthritis require systematic evaluation of the indicators that provide information on the degree of involvement of the disease and allow its quantification. Reliable measures of disease progression help decision-making by clinicians and provide valid information on treatment response and the effectiveness of the distinct therapeutic interventions. The instruments recommended in research, as outcome measures in osteoarthritis, are pain evaluation, assessment of physical function, and self-reported global evaluation. In studies lasting more than 1 year, structural changes are evaluated through simple X-ray. Self-reported quality of life assessment and physician global assessment are also recommended as options. These indicators should be incorporated into routine clinical practice for adequate evaluation and correct follow-up of patients with osteoarthritis. The recommended pain evaluation method for use in clinical practice is the visual analog scale (VAS). The best instrument to evaluate physical function in patients with hip or knee osteoarthritis is the WOMAC scale (Western Ontario and McMaster Universities Osteoarthritis Index). For patient-reported global assessment in routine practice, the recommended scales are VAS or the SF-12 (12-item short-form health survey). Copyright © 2014 Elsevier España, S.L. All rights reserved.

  13. Asthma in patients with psoriasis

    DEFF Research Database (Denmark)

    Lønnberg, A S; Skov, L; Skytthe, A

    2015-01-01

    We read with interest the report by Fang and colleagues of the relationship between psoriasis and asthma in a large retrospective case-control study from Taiwan [1]. The study found a 1.38-fold increased risk of asthma among patients with psoriasis, and with an increasing risk according to higher...

  14. Lynch syndrome: the patients' perspective

    NARCIS (Netherlands)

    Seppen, Jurgen; Bruzzone, Linda

    2013-01-01

    People with Lynch syndrome have a high lifetime risk for the development of colorectal, endometrial and several other types of cancer. Lynch syndrome is caused by germline mutations in genes encoding DNA mismatch repair proteins. In this review, issues that concern Lynch patients are highlighted

  15. Implications for patient-centeredness

    African Journals Online (AJOL)

    Kate H

    health outcomes, research on enablers and dis-enablers of patient care is crucial ... participation and has given rise to the prevalence of concepts such as 'user .... interviews with doctors, which did not need translation because they were done ...

  16. Patient Radiation Protection in Radiotherapy

    International Nuclear Information System (INIS)

    Hegazy, M.

    2010-01-01

    The Role of Radiotherapy is treatment modalities for cancer which is generally assumed that 50 to 60% of cancer patients will benefit from radiotherapy. It constitutes a peaceful application of ionizing radiation and an essential part of cancer management. The two aims of radiation protection Prevention is of deterministic effect and Reduction of the probability of stochastic effects. The Shielding fundamentals is to limit radiation exposure of staff, patients, visitors and the public to acceptable levels it also optimize protection of patients, staff and the public. Diagnosis is important for target design and the dose required for cure or palliation while Simulator is often used twice in the radiotherapy process where Patient data acquisition - target localization, contours, outlines and Verification. The Prescription is the responsibility of individual clinicians, depending on the patient’s condition, equipment available, experience and training. An ultimate check of the actual treatment given can only be made by using in vivo dosimetry. Treatment records must be kept of all relevant aspects of the treatment – including Session and Summary Record information, Records all treatment parameters, Dose Calculations and Dose Measurements

  17. Patients with epilepsy and patients with psychogenic non-epileptic seizures

    DEFF Research Database (Denmark)

    Turner, Katherine; Piazzini, Ada; Chiesa, Valentina

    2011-01-01

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

  18. Pulmonary infections in immunocompromised patients

    International Nuclear Information System (INIS)

    Choneva, I.; Abadjieva, D.; Kirilov, R.

    2013-01-01

    Full text: Introduction: The lung is one of the most commonly affected organs in immunocompromised patients. Primary complication is pulmonary infection which is associated with high morbidity and mortality. Although radiography and CT, as main diagnostic tools are reliable and credible methods, often there is difficulty with the correct diagnose. The reasons for this are that immunocompromised patients are potentially susceptible to infection by various microorganisms and that the radiographic findings are rarely specific for detecting a particular pathogen. What you will learn : Our objective is to present general nosological classification of pulmonary infections in immunocompromised patients, and to evaluate and analyze new imaging methods and discuss their correlation with the clinical setting, which aims to facilitate the diagnosis and to take a decision for the treatment. The experience indicates that a clinical environment conducive the immunocompromised patients to infection with certain pathogens, thereby changing the frequency of their occurrence. The most commonly cited fungal infections, cytomegalovirus infections, Pneumocystis carinii pneumonia and Pulmonary tuberculosis (PTB) of which convincing is the Imaging diagnosis primarily in fungal infections, and Pneumocystis carinii pneumonia and less accurate - in bacterial and viral infections. Discussion: The term 'immunocompromised' describes a subject with an increased risk for life-threatening infection as a result of congenital or acquired abnormalities of the immune system. Over the past few decades, the number of immunocompromised patients has grown considerably, reflecting the increased use of immunosuppressive drugs, and the syndrome of acquired immunodeficiency. Given the high incidence of pulmonary infections in immunocompromised patients (lung is one of the most commonly affected organs, such as lung infection is about 75% of pulmonary complications), rapid and accurate diagnosis is important

  19. [Patients' rights--doctors' duties].

    Science.gov (United States)

    Jaeger, L; Bertram, E; Grate, S; Mischkowsky, T; Paul, D; Probst, J; Scala, E; Wbllenweber, H D

    2015-06-01

    On 26 February 2013 the new "Law on Patients' Rights" (hereinafter also the "Law") became effective. This Law strengthens patients' rights vis-à-vis the insurdnce company and also regulates patients' rights regarding their relation to the doctor. This has consequences for the laws on medical liability all doctors must consider. The doctor's performance is and remains a service and such service does not hold any guarantee of success. Nevertheless, this Law primarily reads as a "law on the duties of physicians". To duly take into account these duties and to avoid mistakes and misinterpretation of the Law, the Ethics Committee of the Consortium of Osteosynthesis Trauma Germany (AOTRAUMA-D) has drafted comments on the Law. Brief summaries of its effects are to be found at the end of the respective comment under the heading "Consequences for Practice". The text of the law was influenced particularly by case law, as continuously developed by the German Federal Court of Justice ("BGH"). The implementation of the Law on Patients' Rights was effected by the newly inserted sections 630a to 630h of the German Civil Code (the "BGB"), which are analysed below. The following comments are addressed to physicians only and do not deal with the specific requirements and particularities of the other medical professions such as physiotherapy, midwifery and others so on. Special attention should be paid to the comments on the newly inserted Duty to inform, which has to be fullfilled prior to any diagnostic or therapeutic procedure (sec. 630c para 2 sentence 1 BGB). Under certain conditions the doctor also has to inform the patient about the circumstances that lead to the presumed occurance of a therapeutic or diagnostic malpractice (sec. 630c para. 2 sentence 2 BGB), based on the manifestation of an undesired event or an undesired outcome. As before, the patient's valid consent to any procedure (sec. 630d BGB) is directly linked to the comprehensive and timely provision of information

  20. Dissociative symptomatology in cancer patients

    Science.gov (United States)

    Civilotti, Cristina; Castelli, Lorys; Binaschi, Luca; Cussino, Martina; Tesio, Valentina; Di Fini, Giulia; Veglia, Fabio; Torta, Riccardo

    2015-01-01

    Introduction: The utilization of the post-traumatic stress disorder (PTSD) diagnostic spectrum is currently being debated to categorize psychological adjustment in cancer patients. The aims of this study were to: (1) evaluate the presence of cancer-related traumatic dissociative symptomatology in a sample of cancer patients; (2) examine the correlation of cancer-related dissociation and sociodemographic and medical variables, anxiety, depression, and post-traumatic stress symptomatology; (3) investigate the predictors of cancer-related dissociation. Methods: Ninety-two mixed cancer patients (mean age: 58.94, ds = 10.13) recruited from two hospitals in northern Italy were administered a questionnaire on sociodemographic and medical characteristics, the Karnofsky Scale to measure the level of patient activity and medical care requirements, the Hospital Anxiety and Depression Scale (HADS) to evaluate the presence of anxiety and depression, the Impact of Event Scale Revised (IES-R) to assess the severity of intrusion, avoidance, and hypervigilance, and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) to quantify the traumatic dissociative symptomatology. Results: 31.5% of participants report a PDEQ score above the cutoff. The results indicated that dissociative symptomatology was positively correlated with HADS scores (HADS-Anxiety: r = 0.476, p dissociative symptomatology. The results converged on a three predictor model revealing that IES-R-Intrusion, IES-R-Avoidance, and IES-R-Hyperarousal accounted for 53.9% of the explained variance. Conclusion: These findings allow us to hypothesize a specific psychological reaction which may be ascribed to the traumatic spectrum within the context of cancer, emphasizing the close relationship between the origin of dissociative constituents which, according to the scientific literature, compose the traumatic experience. Our results have implications for understanding dissociative symptomatology in a cancer

  1. Oxidative Stress in Cystinosis Patients

    Directory of Open Access Journals (Sweden)

    Maria Helena Vaisbich

    2011-09-01

    Full Text Available Background/Aims: Nephropathic cystinosis (NC is a severe systemic disease and cysteamine improves its prognosis. Lysosomal cystine accumulation is the hallmark of cystinosis and is regarded as the primary defect due to mutations in the CTNS gene. However, there is great evidence that cystine accumulation itself is not responsible for all abnormalities observed in NC. Studies have demonstrated altered ATP metabolism, increased apoptosis, and cell oxidation. An increased number of autophagosomes and autophagic vacuoles have been observed in cystinotic fibroblasts and renal epithelial cells, suggesting that altered autophagy plays a role in NC, leading to increased production of reactive oxygen species. Therefore, cystinosis patients can be more susceptible to oxidative stress (OS and it can contribute to the progression of the renal disease. Our goal was to evaluate a marker of OS (serum TBARS in NC children, and to compare the results with those observed in healthy controls and correlated with renal function parameters. Methods: The study included patients aged under 18 years, with good adherence to the treatment and out of renal replacement therapy. The following parameters were evaluated: serum creatinine, BUN, creatinine clearance estimated by stature and serum TBARS levels. Results: We selected 20 patients aged 8.0 ±3.6 years and observed serum TBARS levels of 4.03 ±1.02 nmol/ml. Serum TBARS levels in the 43 healthy controls, aged 7.4 ±1.1 years, were 1.60 ±0.04 nmol/ml. There was a significant difference between the plasma TBARS levels among the 2 groups (p Conclusion: An increased level of serum TBARS in patients with NC was observed and this abnormality was not correlated with the renal function status degree. This is the first report that shows increased oxidative stress in serum of NC patients.

  2. Cortical Plasticity after Cochlear Implantation

    DEFF Research Database (Denmark)

    Petersen, Bjørn; Gjedde, Albert; Wallentin, Mikkel

    2013-01-01

    recently implanted adult implant recipients listened to running speech or speech-like noise in four sequential PET sessions at each milestone. CI listeners with postlingual hearing loss showed differential activation of left superior temporal gyrus during speech and speech-like stimuli, unlike CI listeners...... with prelingual hearing loss. Furthermore, Broca's area was activated as an effect of time, but only in CI listeners with postlingual hearing loss. The study demonstrates that adaptation to the cochlear implant is highly related to the history of hearing loss. Speech processing in patients whose hearing loss...... occurred after the acquisition of language involves brain areas associated with speech comprehension, which is not the case for patients whose hearing loss occurred before the acquisition of language. Finally, the findings confirm the key role of Broca's area in restoration of speech perception, but only...

  3. Patient-centered care in Parkinson's disease

    NARCIS (Netherlands)

    Eijk, M. van der

    2015-01-01

    Patient centeredness means providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions’.The concept assumes that both physicians and patients are experts; physicians in diagnostic and

  4. Needs and preferences of patients with cancer

    NARCIS (Netherlands)

    Wessels-Wynia, H.

    2010-01-01

    What do patients prefer in cancer care and does gender matter? Introduction: To provide patient-centred care for cancer patients it is important to have insight into the patients' specific preferences for health care. To gain such insight we have developed a questionnaire based on cancer patients’

  5. Patient education in Europe: united differences.

    NARCIS (Netherlands)

    Visser, S.; Deccache, A.; Bensing, J.

    2001-01-01

    This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient

  6. A Model for Nationwide Patient Tracking

    Science.gov (United States)

    2009-09-01

    SUBJECT TERMS Patient Tracking, Public Health, Emergency Medical Services, Patient Movement, Evacuation, Public Health Preparedness 16. PRICE CODE 17...Emergency Medical Services................................................................................................19 2. Ideal Patient Tracking... Medical Services ............................................................36 a. Patient Flow in Field-Based Casualty Care—Current Process

  7. Thallium-201 stress imaging in hypertensive patients

    International Nuclear Information System (INIS)

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

    1987-01-01

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

  8. Echocardiographic findings in patients with rheumatoid arthritis ...

    African Journals Online (AJOL)

    Pulmonary hypertension was found in 5.5% of patients. Conclusion: This study shows a high prevalence of cardiac abnormalities among RA patients despite these patients being on disease modifying medications and being diagnosed relatively earlier. Majority of the patients were in remission with duration of illness less ...

  9. Patient safety: Safety culture and patient safety ethics

    DEFF Research Database (Denmark)

    Madsen, Marlene Dyrløv

    2006-01-01

    ,demonstrating significant, consistent and sometimes large differences in terms of safety culture factors across the units participating in the survey. Paper 5 is the results of a study of the relation between safety culture, occupational health andpatient safety using a safety culture questionnaire survey......Patient safety - the prevention of medical error and adverse events - and the initiative of developing safety cultures to assure patients from harm have become one of the central concerns in quality improvement in healthcare both nationally andinternationally. This subject raises numerous...... challenging issues of systemic, organisational, cultural and ethical relevance, which this dissertation seeks to address through the application of different disciplinary approaches. The main focus of researchis safety culture; through empirical and theoretical studies to comprehend the phenomenon, address...

  10. Radiotherapy of patients with germ cell tumor

    International Nuclear Information System (INIS)

    Inomata, Taisuke; Maeda, Tomoho; Yoshida, Shoji; Ogawa, Yasuhiro; Hamada, Fumio; Imajo, Yoshinari; Gose, Kyuhei; Fujiwara, Kiyoshi.

    1986-01-01

    Twenty-one patients with germ cell tumor who received radiotherapy were discussed. There were eight patients with germinoma, two patients with malignant teratoma, three patients with pineocytoma (out of category of germ cell tumor today) and eight unverified patients. Irradiated dose was mostly from 50 Gy to 60 Gy and local irradiation was performed after whole brain irradiation in many cases. The effect of radiotherapy was not so good in patients with malignant teratoma. On the contrary, it was relatively good in patients with germinoma and five out of eight patients are alive with no symptoms of recurrence. Six out of eight unverified patients are also alive. Among them, several patients with germinoma are considered to be included. Germinoma occupies many cases of germ cell tumor and has a good response to radiotherapy. Against spinal cord metastasis and late recurrence, additional therapy, such as chemotherapy, seems to be useful to improve cure ratio. (author)

  11. Patient blood management -- the GP's guide.

    Science.gov (United States)

    Minck, Sandra; Robinson, Kathryn; Saxon, Ben; Spigiel, Tracey; Thomson, Amanda

    2013-05-01

    There is accumulating evidence of a strong association between blood transfusion and adverse patient outcomes. Patient blood management aims to achieve improved patient outcomes by avoiding unnecessary exposure to blood products through effective conservation and management of a patient's own blood. To introduce the general practitioner's role in patient blood management. There are a number of ways in which GPs can contribute to patient blood management, particularly in the care of patients scheduled for elective surgery. These include awareness, identification, investigation and management of patients with or at risk of anaemia; assessment of the adequacy of iron stores in patients undergoing planned procedures in which substantial blood loss is anticipated; awareness and assessment of medications and complementary medicines that might increase bleeding risk; and awareness of and ability to discuss with patients, the possible risks associated with blood transfusion and alternatives that may be available.

  12. [Melanoma in organ transplant patients].

    Science.gov (United States)

    Lévêque, L; Dalac, S; Dompmartin, A; Louvet, S; Euvrard, S; Catteau, B; Hazan, M; Schollhamer, M; Aubin, F; Dreno, B; Daguin, P; Chevrant-Breton, J; Frances, C; Bismuth, M J; Tanter, Y; Lambert, D

    2000-02-01

    The incidence of cutaneous melanoma has rapidly increased in the white population over the last decades. It has been estimated that the incidence doubles world-wide every 10 years. Different risk factors have been identified, including immunosuppression. The aim of our study-was to determine the relative risk of developing melanoma in the organ transplant population and the clinical and histological features of their melanomas. This retrospective study was conducted with the collaboration of 9 University Hospital Centers: Besançon, Brest, Caen, Dijon, Lille, Lyon, Nantes, Paris (Pitié-Salpétrière) and Rennes. A questionnaire was sent to the different departments of dermatology of these hospitals to obtain information on patients who had presented a melanoma after a transplantation between 1971 and 1997. During this period, there were 12,477 organ transplant recipients in the transplantation units of these 9 hospitals. Average follow-up for these patients was about 5 years and the average duration of immunosuppressive therapy was about 4.5 years. Among 12,477 organ transplant recipients, we found 17 cases of melanoma but no data could be obtain on one case: 14 occurred in renal transplant recipients and 3 in cardiac transplant recipients. Clinical and histological data were only available in 16 patients. The average time between transplantation and diagnosis of melanoma was 63 months, but it was 5 times shorter for 2 patients who had a past history of melanoma before transplantation. Two patients had a mucosal melanoma; for the cutaneous melanomas, 2 appeared on Dubreuilh melanosis, 2 were in situ melanomas, 7 were superficial spreading melanomas and 3 were nodular melanomas. The histological review of 11 cutaneous melanomas revealed a precursor nevus in 6 cases and a weak or no stroma reaction in 7/7 cases. Complete excision of the melanoma was performed in all patients except one with anorectal melanoma. Four patients died of visceral metastasis within a mean

  13. Atypisk femurfraktur hos en patient uden bisfosfonatbehandling

    DEFF Research Database (Denmark)

    Hansen, Henrik Michael; Jensen, Jens-Erik Beck; Hyldstrup, Lars

    2012-01-01

    The present case describes an atypical femur fracture in a patient, who had not previously been treated with bisphosphonate. The patient fulfilled the specific characteristics for an atypical fracture that have recently been suggested by an international expert group. For 15 years after her...... menopause the patient had been treated with oestrogen. Prospective studies to determine the frequency and pathogenesis of these fractures in patients treated with bisphosphonate and in bisphosphonate naïve patients are suggested....

  14. Advanced Patient Data Replication and Recovery

    Science.gov (United States)

    2010-10-01

    Patient Data Protection (APDAPT) Eisenhower Medical Center (EMC) is attempting to lower the risk of losing patient data, as well as the risk...includes radiological images. EMC has made a multi-million dollar investment in the digitization of patient data; the Electronic Medical Record (EMR...storage and retrieval of the patient chart or EMR. The EMR is comprised of patient vital signs, nurse notes, medications administered, doctors

  15. Artificial humidification for the mechanically ventilated patient.

    Science.gov (United States)

    Selvaraj, N

    Caring for patients who are mechanically ventilated poses many challenges for critical care nurses. It is important to humidify the patient's airways artificially to prevent complications such as ventilator-associated pneumonia. There is no gold standard to determine which type of humidification is best for patients who are artificially ventilated. This article provides an overview of commonly used artificial humidification for mechanically ventilated patients and discusses nurses' responsibilities in caring for patients receiving artificial humidification.

  16. Countering the stereotype of the unpopular patient.

    Science.gov (United States)

    Price, Bob

    2013-07-01

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

  17. Catabolic Processes in Cardiosurgical Patients

    Directory of Open Access Journals (Sweden)

    V. V. Lomivorotov

    2007-01-01

    Full Text Available Objective: to evaluate catabolic and anabolic processes in cardiosurgical patients during heart operations under extracorporeal circulation.Subjects and methods. Seventy-one patients with coronary heart disease (CHD and acquired cardiac defects (ACD, who had been operated on under extracorporeal circulation, were examined. The plasma levels of cortisol, adrenaline, insulin, growth hormone, and albumin were measured. For determination of daily nitrogen excretion, blood and diurnal urine were sampled at the following stages: 1 before surgery; 2 postoperative (PO day 1; 3 PO day 3; 4 PO day 7; 5 PO day 14; 6 PO day 21.Results. The preoperative daily nitrogen excretion in CHD patients was 10.4±1.0 g/day. By PO day 3, there was a significant increase in nitrogen excretion by 66%, up to 17.3±1.6 g/day (p<0.01. In ACD patients, the baseline daily urinary nitrogen excretion was 11.9±1.7 g/day. By PO day 3, there was a 1.4-fold increase in this index — up to 16.3±2.0 g/day. Daily nitrogen excretion significantly increased up to 17.1±1.2 g/day by the end of the first PO week (p<0.05, by exceeding the baseline values by 44%. Nitrogen excretion peaked by the end of PO days 14 (17.2±1.6 g/day (p<0.05. By hospital discharge, nitrogen excretion was 23% greater than its baseline preoperative level (p>0.05. In cardiosurgical patients, an increase in daily nitrogen excretion occurred with the elevated concentrations of the stress hormones cortisol and adrenaline.Conclusion. The magnitude of catabolic reactions after cardiosurgical interventions depends on the type of cardiac disease. In patients with CHD, the maximum catabolic reactions were recorded on PO day 3 whereas in those with ACD, they continued within three weeks postoperatively.  

  18. Radiation therapy for cancer patients

    International Nuclear Information System (INIS)

    Mileikowsky, C.

    1987-01-01

    This patent describes an apparatus for irradiating a patient comprising: a source of a radiation beam directed along a radiation axis; means mounting the source for pivotal movement about a first horizontal axis which intersects the source, is stationary with respect to the apparatus, and extends in a direction substantially normal to the radiation axis, whereby the beam is capable of an angular scan in a vertical plane; table means adapted to support a patient to be irradiated; and suspension means mounted the table means for arcuate movement to any positions angularly spaced about the first horizontal axis and for pivoting movement about a second horizontal axis displacement from and substantially parallel to the first horizontal axis. The suspension means maintain the second horizontal axis in substantially intersecting relation to the radiation axis in each of the positions while maintaining a fixed angular position of the table means with respect to the environment

  19. Cardiomyopathy in the pediatric patients

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2018-04-01

    Full Text Available Pediatric cardiomyopathies are a group of myocardial diseases with complex taxonomies. Cardiomyopathy can occur in children at any age, and it is a common cause of heart failure and heart transplantation in children. The incidence of pediatric cardiomyopathy is increasing with time. They may be associated with variable comorbidities, which are most often arrhythmia, heart failure, and sudden death. Medical imaging technologies, including echocardiography, cardiac magnetic resonance, and nuclear cardiology, are helpful in reaching a diagnosis of cardiomyopathy. Nevertheless, endomyocardial biopsy is the final diagnostic method of diagnosis. Patients warrant surgical operations, such as palliative operations, bridging operations, ventricular septal maneuvers, and heart transplantation, if pharmaceutical therapies are ineffective. Individual therapeutic regimens due to pediatric characteristics, genetic factors, and pathogenesis may improve the effects of treatment and patients' survival. Key Words: cardiomyopathy, classification, pediatrics

  20. Empowering Patients with Chronic Diseases

    DEFF Research Database (Denmark)

    Bestek, Mate; Meglič, Matic; Kurent, Blaž

    2012-01-01

    Background: Chronic diseases require most of the resources in todays healthcare systems. Healthcare systems, as such, are thus not sustainable in the long term. Solutions to this problem are needed and a lot of research is focused on finding new approaches to more sustainable healthcare systems...... himself to become empowered. The patient needs to see data about his health in order to start thinking about new decisions in life that can lead to change in his behaviour. Objective: We have approached the problem of empowering patients with chronic diseases from a biological, psychological, sociological....... We want to develop extensible technology to support even more new interventions for different chronic diseases. We want the technology to enable semantic interoperability with other systems. Methods: We have collaborated with doctors in order to model the care plans for different chronic diseases...