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Sample records for prenatal patients patients

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

    Science.gov (United States)

    Bergman, Alicia A; Connaughton, Stacey L

    2013-01-01

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

  2. Effectiveness of prenatal treatment for congenital toxoplasmosis: a meta-analysis of individual patients' data

    DEFF Research Database (Denmark)

    Thiébaut, Rodolphe; Leproust, Sandy; Chêne, Geneviève

    2007-01-01

    BACKGROUND: Despite three decades of prenatal screening for congenital toxoplasmosis in some European countries, uncertainty remains about the effectiveness of prenatal treatment. METHODS: We did a systematic review of cohort studies based on universal screening for congenital toxoplasmosis. We did...... a meta-analysis using individual patients' data to assess the effect of timing and type of prenatal treatment on mother-to-child transmission of infection and clinical manifestations before age 1 year. Analyses were adjusted for gestational age at maternal seroconversion and other covariates. FINDINGS......: We included 26 cohorts in the review. In 1438 treated mothers identified by prenatal screening, we found weak evidence that treatment started within 3 weeks of seroconversion reduced mother-to-child transmission compared with treatment started after 8 or more weeks (adjusted odds ratio [OR] 0.48, 95...

  3. When the topic is you: genetic counselor responses to prenatal patients' requests for self-disclosure.

    Science.gov (United States)

    Balcom, Jessica R; Veach, Patricia McCarthy; Bemmels, Heather; Redlinger-Grosse, Krista; LeRoy, Bonnie S

    2013-06-01

    A limited amount of research indicates patient requests play a major role in genetic counselors' self-disclosure decisions and that disclosure and non-disclosure responses to patient requests may differentially affect genetic counseling processes. Studies further suggest patient requests may be more common in prenatal settings, particularly when counselors are pregnant. Empirical evidence is limited however, concerning the nature of patient requests. This study explored genetic counselors' experiences of prenatal patients' requests for self-disclosure. Four major research questions were: (1) What types of questions do prenatal patients ask that invite self-disclosure?; (2) Do pregnant genetic counselors have unique experiences with prenatal patient disclosure requests?; (3) How do genetic counselors typically respond to disclosure requests?; and (4) What strategies are effective and ineffective in responding to disclosure requests? One hundred seventy-six genetic counselors completed an online survey and 40 also participated in telephone interviews. Inductive analysis of 21 interviews revealed patient questions vary, although questions about counselor demographics are most common, and patients are more likely to ask pregnant counselors questions about their personal pregnancy decisions. Participants reported greater discomfort with self-disclosure requests during pregnancy, yet also disclosing more frequently during pregnancy. Counselor responses included personal self-disclosure, professional self-disclosure, redirection, and declining to disclose. Factors perceived as influencing disclosure included: topic, patient motivations, timing of request, quality of counseling relationship, patient characteristics, and ethical/legal responsibilities. Disclosure practices changed over time for most counselors. Additional findings, practice implications, and research recommendations are discussed.

  4. Congenital cystic adenomatoid malformation: impact of prenatal diagnosis and changing strategies in the treatment of the asymptomatic patient.

    Science.gov (United States)

    Marshall, K W; Blane, C E; Teitelbaum, D H; van Leeuwen, K

    2000-12-01

    This study was designed to assess the effect of prenatal sonographic diagnosis on the treatment of congenital cystic adenomatoid malformation of the lung. The medical records of 27 patients with pathologically proven congenital cystic adenomatoid malformations were retrospectively reviewed. Patients were divided into four groups based on mode of presentation: with or without abnormal findings on prenatal sonography and with or without symptoms at birth. Age at diagnosis, age at surgical intervention, complications, and length of hospital stay were recorded for each group. Twenty-seven patients with 31 proven congenital cystic adenomatoid malformations were included. Eleven patients underwent prenatal sonography establishing the diagnosis (6 asymptomatic at birth, 5 symptomatic), and 16 did not have a prenatal diagnosis (10 asymptomatic at birth, 6 symptomatic). In the symptomatic populations, prenatal diagnosis had no impact on age at surgery, length of stay, or surgical complication rate (p = 0.78-0.83). In the asymptomatic population, prenatal diagnosis allowed early diagnosis (p < 0.001) and resection in the asymptomatic period. It was also associated with a shorter length of stay at the time of surgical resection (mean time, 4.2 days for patients with prenatal diagnosis versus 12.9 days for those without it;p < 0.001) and with a trend toward lower serious complication rate (3 patients without prenatal diagnosis versus 1 patient with it). Prenatal sonography provides the radiologist a means to identify congenital cystic adenomatoid malformations in a population of infants who are asymptomatic at birth. Surgical intervention in the asymptomatic infant is associated with a shorter length of stay, a trend toward fewer complications, and decreased medical cost compared with intervening after symptoms develop.

  5. Patients' Knowledge of Prenatal Screening for Trisomy 21.

    Science.gov (United States)

    Sheinis, Michal; Bensimon, Kira; Selk, Amanda

    2017-07-14

    This study's objective was to assess the knowledge of prenatal screening for Trisomy 21 in pregnant women in one institution in Canada. A cross-sectional survey measuring demographics, knowledge of screening, and health literacy, was administered to pregnant women. Of the 135 women who completed the survey, 74% had adequate knowledge of Trisomy 21 and associated screening procedures. Twenty-eight point one percent of women did not receive any counseling. Overall, 29.5% of women did not know that the screening test was optional and 10.2% of women underwent screening prior to having been counseled. Multigravidity (p < 0.05) and prior counseling (p < 0.001) were positively correlated with knowledge while first language other than English (p < 0.001) was negatively correlated with knowledge. Given these findings, an effort needs to be made on the part of health care providers to increase counseling rates to 100%, stressing the optional nature of the test to attain true informed consent.

  6. Prenatal latex sensitization in patients with spina bifida: a pilot study.

    Science.gov (United States)

    Boettcher, Michael; Goettler, Susanne; Eschenburg, Georg; Kracht, Thorben; Kunkel, Philip; Von der Wense, Axel; Reinshagen, Konrad

    2014-03-01

    Patients with spina bifida are particularly vulnerable to developing immunoglobulin E (IgE)-mediated latex sensitization. Even though many risk factors leading to latex allergy in these patients have been described, it is still unclear whether the increased prevalence of latex sensitization is disease associated or due to the procedures used to treat spina bifida. The aim of this study was to assess prenatal latex sensitization in patients with spina bifida by examining IgE levels in umbilical cord blood. Patients with spina bifida and matched healthy infants were recruited from the University Medical Center Hamburg-Eppendorf and Children's Hospital Altona. Latex-specific and total IgE were assessed in umbilical cord blood using ImmunoCAP testing to evaluate the degree of prenatal latex sensitization. Twenty-two subjects, 10 with spina bifida and 12 healthy individuals, were included. Subjects were selected after matching for sex, gestational age, weight, parental allergy profile, number of prenatal examinations, and utilization of latex tools during pregnancy (propensity score estimates, p = 0.36). In patients with spina bifida, latex-specific and total IgE levels were significantly higher than those in healthy individuals (p = 0.001). After normalization to total IgE, latex-specific IgE levels were higher, yet not significantly increased (p = 0.085). Perinatally, there is a significant augmentation of total and latex-specific IgE in patients with spina bifida. After correcting for total IgE, latex-specific IgE was increased, yet not significantly higher than in matched, healthy controls. This pilot study gives novel insights in the immunological reactions related to spina bifida. The increased latex-specific IgE levels could possibly be associated with the occurrence of a latex allergy in the future.

  7. Awareness among parents of β-thalassemia major patients, regarding prenatal diagnosis and premarital screening.

    Science.gov (United States)

    Ishaq, Fouzia; Abid, Hasnain; Kokab, Farkhanda; Akhtar, Adil; Mahmood, Shahid

    2012-04-01

    To assess the knowledge among parents of thalassemia major patients about prenatal diagnosis, premarital screening for carrier detection and impact of consanguineous marriage on disease transmission. Descriptive study. The Thalassemia Centre, Sir Ganga Ram Hospital, Lahore, from July to September 2009. One hundred and fifteen parents of β-thalassemia major patients were enrolled in this study. A questionnaire was developed and parents were interviewed to assess their knowledge about preventive measures against thalassemia major. Parents of patients with all other types of blood disorder were excluded from the study. There were 74 male (64.3%) and 41 female (35.7) patients with mean age of 9.5 ± 5.1 years. Eighty-eight patients (76.5%) were accompanied by mothers and the rest by their fathers. Seventy-four parents (32.1%) were illiterate; among the literates only 7 were highly educated (3%). Ninety-four couples (81.7%) had consanguineous marriage. Fiftytwo parents (44.6%) knew that thalassemia is an inherited disorder. Thirty-eight (33%) had heard about the test for detecting thalassemia carrier. Premarital screening and prenatal diagnosis was known to 97 (84.3%) and 88 (76.5%) parents respectively. Ninety-nine parents (86.1%) knew about the termination of pregnancy on positive prenatal test but only 69 considered it acceptable religiously (60%). Major source of information to the parents were doctors. Parental knowledge about thalassemia and its preventive measures was inadequate; this requires intervention in the form of public health education programs concentrating on high risk/targeted population.

  8. Providing prenatal care to pregnant women with overweight or obesity: Differences in provider communication and ratings of the patient-provider relationship by patient body weight.

    Science.gov (United States)

    Washington Cole, Katie O; Gudzune, Kimberly A; Bleich, Sara N; Cheskin, Lawrence J; Bennett, Wendy L; Cooper, Lisa A; Roter, Debra L

    2017-06-01

    To examine the association of women's body weight with provider communication during prenatal care. We coded audio recordings of prenatal visits between 22 providers and 117 of their patients using the Roter Interaction Analysis System. Multivariate, multilevel Poisson models were used to examine the relationship between patient pre-pregnancy body mass index and provider communication. Compared to women with normal weight, providers asked fewer lifestyle questions (IRR 0.66, 95% CI 0.44-0.99, p=0.04) and gave less lifestyle information (IRR 0.51, 95% CI 0.32-0.82, p=0.01) to women with overweight and obesity, respectively. Providers used fewer approval (IRR 0.68, 95% CI 0.51-0.91, p=0.01) and concern statements (IRR 0.68, 95% CI 0.53-0.86, p=0.002) when caring for women with overweight and fewer self-disclosure statements caring for women with obesity (IRR 0.40, 95% CI 0.19-0.84 p=0.02). Less lifestyle and rapport building communication for women with obesity may weaken patient-provider relationship during routine prenatal care. Interventions to increase use of patient-centered communication - especially for women with overweight and obesity - may improve prenatal care quality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Mutation analysis and prenatal diagnosis of EXT1 gene mutations in Chinese patients with multiple osteochondromas

    Institute of Scientific and Technical Information of China (English)

    ZHU Hai-yan; HU Ya-li; YANG Ying; WU Xing; ZHU Rui-fang; ZHU Xiang-yu; DUAN Hong-lei; ZHANG Ying; ZHOU Jin-yong

    2011-01-01

    Background Multiple osteochondromas (MO), an inherited autosomal dominant disorder, is characterized by the presence of multiple exostoses on the long bones. MO is caused by mutations in the EXT1 or EXT2 genes which encode glycosyltransferases implicated in heparin sulfate biosynthesis.Methods In this study, efforts were made to identify the underlying disease-causing mutations in patients from two MO families in China.Results Two novel EXT1 gene mutations were identified and no mutation was found in EXT2 gene. The mutation c.497T>A in exon 1 of the EXT1 gene was cosegregated with the disease phenotype in family 1 and formed a stop codon at amino acid site 166. The fetus of the proband was diagnosed negative. In family 2, the mutation c. 1430-1431delCC in exon 6 of the EXT1 gene would cause frameshift and introduce a premature stop codon after the reading frame being open for 42 amino acids. The fetus of this family inherited this mutation from the father.Conclusions Mutation analysis of two MO families in this study demonstrates its further application in MO genetic counseling and prenatal diagnosis.

  10. Increased co-expression of genes harboring the damaging de novo mutations in Chinese schizophrenic patients during prenatal development

    OpenAIRE

    Qiang Wang; Miaoxin Li; Zhenxing Yang; Xun Hu; Hei-Man Wu; Peiyan Ni; Hongyan Ren; Wei Deng; Mingli Li; Xiaohong Ma; Wanjun Guo; Liansheng Zhao; Yingcheng Wang; Bo Xiang; Wei Lei

    2015-01-01

    Schizophrenia is a heritable, heterogeneous common psychiatric disorder. In this study, we evaluated the hypothesis that de novo variants (DNVs) contribute to the pathogenesis of schizophrenia. We performed exome sequencing in Chinese patients (N = 45) with schizophrenia and their unaffected parents (N = 90). Forty genes were found to contain DNVs. These genes had enriched transcriptional co-expression profile in prenatal frontal cortex (Bonferroni corrected p 

  11. Patients

    African Journals Online (AJOL)

    Items 1 - 7 ... Results: The mean age for patient group is 65.6 years while for controls it is 30.3 years. ... result in large number of population in old ages ... Originally the American Urological Asso- .... age distribution and study results in this study.

  12. Increased co-expression of genes harboring the damaging de novo mutations in Chinese schizophrenic patients during prenatal development.

    Science.gov (United States)

    Wang, Qiang; Li, Miaoxin; Yang, Zhenxing; Hu, Xun; Wu, Hei-Man; Ni, Peiyan; Ren, Hongyan; Deng, Wei; Li, Mingli; Ma, Xiaohong; Guo, Wanjun; Zhao, Liansheng; Wang, Yingcheng; Xiang, Bo; Lei, Wei; Sham, Pak C; Li, Tao

    2015-12-15

    Schizophrenia is a heritable, heterogeneous common psychiatric disorder. In this study, we evaluated the hypothesis that de novo variants (DNVs) contribute to the pathogenesis of schizophrenia. We performed exome sequencing in Chinese patients (N = 45) with schizophrenia and their unaffected parents (N = 90). Forty genes were found to contain DNVs. These genes had enriched transcriptional co-expression profile in prenatal frontal cortex (Bonferroni corrected p genes (LRP1, MACF1, DICER1 and ABCA2) harboring the damaging de novo mutations are strongly prioritized as susceptibility genes by multiple evidences. Our findings in Chinese schizophrenic patients indicate the pathogenic role of DNVs, supporting the hypothesis that schizophrenia is a neurodevelopmental disease.

  13. IMPAIRED PRENATAL AND POSTNATAL-GROWTH IN DUTCH PATIENTS WITH PHENYLKETONURIA

    NARCIS (Netherlands)

    VERKERK, PH; VANSPRONSEN, FJ; SMIT, GPA; SENGERS, RCA

    1994-01-01

    Objective - To assess whether physical growth is affected in early treated Dutch patients with phenylketonuria (PKU). Methods - The birth weights of all 137 early detected patients with PKU born in the period from 1974 to 1988 in the Netherlands were compared with reference values. Height, head circ

  14. The Legal Past, Present and Future of Prenatal Genetic Testing: Professional Liability and Other Legal Challenges Affecting Patient Access to Services

    Directory of Open Access Journals (Sweden)

    Deborah Pergament

    2014-12-01

    Full Text Available This chapter is an overview of the current status of the law in the United States regarding prenatal genetic testing with an emphasis on issues related to professional liability and other challenges affecting patient access to prenatal genetic testing. The chapter discusses the roles that federal regulations, promulgated by the Centers for Medicare and Medicaid Services (CMS, the Food and Drug Administration (FDA and the Federal Trade Commission (FTC, play in the regulation of prenatal genetic tests. The chapter discusses tort litigation based on allegations of malpractice in the provision of prenatal genetic testing and how courts have analyzed issues related to causation, damages and mitigation of damages. The chapter provides reference information regarding how individual states address causes of action under the tort theories of wrongful birth and wrongful life. The chapter concludes with a discussion of future legal issues that may affect clinical prenatal genetic testing services arising from the continued expansion of prenatal genetic testing, legal restrictions on access to abortion and the potential development of embryonic treatments.

  15. The Legal Past, Present and Future of Prenatal Genetic Testing: Professional Liability and Other Legal Challenges Affecting Patient Access to Services.

    Science.gov (United States)

    Pergament, Deborah; Ilijic, Katie

    2014-12-15

    This chapter is an overview of the current status of the law in the United States regarding prenatal genetic testing with an emphasis on issues related to professional liability and other challenges affecting patient access to prenatal genetic testing. The chapter discusses the roles that federal regulations, promulgated by the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC), play in the regulation of prenatal genetic tests. The chapter discusses tort litigation based on allegations of malpractice in the provision of prenatal genetic testing and how courts have analyzed issues related to causation, damages and mitigation of damages. The chapter provides reference information regarding how individual states address causes of action under the tort theories of wrongful birth and wrongful life. The chapter concludes with a discussion of future legal issues that may affect clinical prenatal genetic testing services arising from the continued expansion of prenatal genetic testing, legal restrictions on access to abortion and the potential development of embryonic treatments.

  16. Using Patient-Centered Care After a Prenatal Diagnosis of Trisomy 18 or Trisomy 13: A Review.

    Science.gov (United States)

    Haug, Shelly; Goldstein, Mitchell; Cummins, Denise; Fayard, Elba; Merritt, T Allen

    2017-04-01

    Patient-centered care (PCC) has been advocated by the Institute of Medicine to improve health care in the United States. Four concepts of PCC align with clinical ethics principles and are associated with enhanced patient/parent satisfaction. These concepts are dignity and respect, information sharing, participation, and collaboration. The objective of this article is to use the PCC approach as a framework for an extensive literature review evaluating the current status of counseling regarding prenatal diagnosis of trisomy 18 (T18) or trisomy 13 (T13) and to advocate PCC in the care of these infants. Extensive availability of prenatal screening and diagnostic testing has led to increased detection of chromosomal anomalies early in pregnancy. After diagnosis of T18 or T13, counseling and care have traditionally been based on assumptions that these aneuploidies are lethal or associated with poor quality of life, a view that is now being challenged. Recent evidence suggests that there is variability in outcomes that may be improved by postnatal interventions, and that quality-of-life assumptions are subjective. Parental advocacy for their infant's best interest mimics this variability as requests for resuscitation, neonatal intensive care, and surgical intervention are becoming more frequent. With new knowledge and increased parental advocacy, physicians face ethical decisions in formulating recommendations including interruption vs continuation of pregnancy, interventions to prolong life, and choices to offer medical or surgical procedures. We advocate a PCC approach, which has the potential to reduce harm when inadequate care and counseling strategies create conflicting values and uncertain outcomes between parents and caregivers in the treatment of infants with T18 and T13.

  17. Impact of the increased adoption of prenatal cfDNA screening on non-profit patient advocacy organizations in the United States.

    Science.gov (United States)

    Meredith, Stephanie; Kaposy, Christopher; Miller, Victoria J; Allyse, Megan; Chandrasekharan, Subhashini; Michie, Marsha

    2016-08-01

    The 'Stakeholder Perspectives on Noninvasive Prenatal Genetic Screening' Symposium was held in conjunction with the 2015 annual meeting of the International Society for Prenatal Diagnosis. During the day-long meeting, a panel of patient advocacy group (PAG) representatives discussed concerns and challenges raised by prenatal cell-free DNA (cfDNA) screening, which has resulted in larger demands upon PAGs from concerned patients receiving prenatal cfDNA screening results. Prominent concerns included confusion about the accuracy of cfDNA screening and a lack of patient education resources about genetic conditions included in cfDNA screens. Some of the challenges faced by PAGs included funding limitations, lack of consistently implemented standards of care and oversight, diverse perspectives among PAGs and questions about neutrality, and lack of access to training and genetic counselors. PAG representatives also put forward suggestions for addressing these challenges, including improving educational and PAG funding and increasing collaboration between PAGs and the medical community. © 2016 John Wiley & Sons, Ltd.

  18. Prenatal Radiation exposures at diagnostic procedures: methods to identify exposed pregnant patients

    Energy Technology Data Exchange (ETDEWEB)

    Pettersson, H.; Sandborg, M.; Nilsson, J.; Olsson, S.; Hellman, S. [Dept of Radiation Physics, Faculty of Health Sciences, Linkoeping University, Linkoeping(Sweden); Helmrot, E. [Radiology Dept, County Hospital Ryhov, Joenkoeping (Sweden); Persliden, J. [Dept of Medical Physics, Oerebro Univ Hospital, Oerebro (Sweden); Cederlund, T. [Swedish Radiation Protection Authority, Stockholm (Sweden)

    2003-06-01

    Knowledge about frequency and doses to embryo/foetus from diagnostic radiology is of great importance both in the sense of estimating the radiation risks but also for optimizing the diagnostic procedures and making decisions regarding alternative procedures. In addition, the pregnant patient has a right to know the magnitude and type of radiation risks expected as a result of foetus exposure. From a risk perspective epidemiological data has shown that the embryo/foetus together with children experience higher radiation sensitivity in terms of induced leukemia and cancer compared to an adult population. Recent estimates give cancer excess lifetime mortality risks for whole body exposures of children and foetus (0-15 y age) of 0.06% up to 0.14% per 10 mSv. In addition to the risk of cancer induction effects of cell killing, e.g. CNS abnormalities, cataracts, malformations, growth retardation, may occur. However, these effects are believed to have a threshold, about 100-200 mGy, and such foetus doses are rarely reached in diagnostic radiology procedures. There are 2 principal situations where foetus exposures may occur in diagnostic radiology; The pregnancy of the patient is known at the time of examination, but due to the medical indications the examination can not be postponed or put forward in time, and there are no suitable alternative non-radiological procedures. The pregnancy of the patient is not known at the time of examination, either due to the fact that the patient is unaware of her pregnancy or the medical personnel failed to obtain this information. The former situation may occur during the first few weeks from conception, whereas the latter situation may cover a greater gestation period. The frequency of foetus exposure is not well documented. In Sweden, there are well-established routines to track down pregnant patients before examinations are being performed. However, there are no general obligations or routines to document the cases either (i) when

  19. It's More Than a Blood Test: Patients' Perspectives on Noninvasive Prenatal Testing.

    Science.gov (United States)

    Farrell, Ruth M; Mercer, Mary Beth; Agatisa, Patricia K; Smith, Marissa B; Philipson, Elliot

    2014-06-19

    Noninvasive prenatal testing (NIPT) offers pregnant women a new risk assessment tool for fetal aneuploidy that is superior to conventional screening tests. We conducted focus groups with women who were currently pregnant or had recently delivered in the past year to characterize their perspectives about NIPT and to explore factors they would consider during decision making about its use. Women identified accuracy, early timing, testing ease, and determination of fetal sex as advantages of NIPT over other screens, and the noninvasive method of NIPT as an advantage over diagnostic tests. False positive and false negative results, anxiety, cost and insurance coverage were seen as disadvantages of NIPT. Women who do not want fetal aneuploidy information most likely will not undergo NIPT, despite its advantages over other screening tests. However, given its advantages, the decision to have NIPT is straightforward for women who want genetic information about the fetus. Women emphasized the need to make autonomous, private, and informed choices about NIPT, as they would with any prenatal genetic testing option. These perspectives may guide clinicians to conduct effective and clinically relevant counseling with pregnant women who consider utilizing this new genetic technology.

  20. Preferences for Prenatal Tests for Cystic Fibrosis: A Discrete Choice Experiment to Compare the Views of Adult Patients, Carriers of Cystic Fibrosis and Health Professionals

    Directory of Open Access Journals (Sweden)

    Melissa Hill

    2014-02-01

    Full Text Available As new technologies enable the development of non-invasive prenatal diagnosis (NIPD for cystic fibrosis (CF, research examining stakeholder views is essential for the preparation of implementation strategies. Here, we compare the views of potential service users with those of health professionals who provide counselling for prenatal tests. A questionnaire incorporating a discrete choice experiment examined preferences for key attributes of NIPD and explored views on NIPD for CF. Adult patients (n = 92 and carriers of CF (n = 50 were recruited from one children’s and one adult NHS specialist CF centre. Health professionals (n = 70 were recruited via an e-mail invitation to relevant professional bodies. The key attribute affecting service user testing preferences was no miscarriage risk, while for health professionals, accuracy and early testing were important. The uptake of NIPD by service users was predicted to be high and includes couples that would currently decline invasive testing. Many service users (47% and health professionals (55.2% thought the availability of NIPD for CF would increase the pressure to undergo prenatal testing. Most service users (68.5% thought NIPD for CF should be offered to all pregnant women, whereas more health professionals (68.2% thought NIPD should be reserved for known carrier couples. The implications for clinical practice are discussed.

  1. Positive predictive value and completeness of prenatally assigned International Classification of Disease-10 kidney anomaly diagnoses in the Danish National Patient Registry

    Directory of Open Access Journals (Sweden)

    Rasmussen M

    2016-01-01

    Full Text Available Maria Rasmussen,1 Morten Smærup Olsen,2 Lone Sunde,1,3 Lars Pedersen,2 Olav Bjørn Petersen4 1Department of Clinical Genetics, Aarhus University Hospital, Skejby, 2Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, 3Department of Biomedicine, Aarhus University, Aarhus, 4Department of Gynecology and Obstetrics, Aarhus University Hospital, Skejby, Denmark Objective: Restricting studies of severe congenital malformations to live-born children may introduce substantial bias. In this study, we estimated the attendance to the second-trimester fetal malformation screening program. We also estimated the positive predictive value (PPV of prenatally assigned International Classification of Disease-10 diagnoses recorded in the Danish National Patient Registry (DNPR and the completeness of case registration. We used kidney anomalies as an example. Methods: We identified the proportion of all Danish live-born children from January 1, 2007 to December 31, 2012, who were scanned during the second trimester using the DNPR and the Civil Registration System. Details of all fetuses with specific kidney anomaly diagnoses according to the DNPR were retrieved. The PPV was estimated using the nationwide Astraia database of pregnancy medical charts or traditional medical charts, as gold standard. The completeness was assessed using the total number of cases estimated by the capture–recapture method. Results: Of 372,263 live born infants, 97.3% were scanned during the second trimester. We identified 172 fetuses in the DNPR. Of these, 149 had kidney anomalies according to Astraia or medical chart review, corresponding to a PPV of 87% (95% CI: 81%–91%. The estimated completeness was 43% (95% CI: 38%–49% for the DNPR and 75% (95% CI: 70%–79% for Astraia. Conclusion: Almost all live-born children were scanned during the second trimester in Denmark. However, low completeness may hamper the use of the DNPR for studies of prenatally detected

  2. Reproductive genetic counselling in non-mosaic 47,XXY patients: implications for preimplantation or prenatal diagnosis: Case report and review.

    Science.gov (United States)

    Tachdjian, Gérard; Frydman, Nelly; Morichon-Delvallez, Nicole; Dû, Anne Le; Fanchin, Renato; Vekemans, Michel; Frydman, René

    2003-02-01

    With an incidence of approximately 1 in 500 male newborns, the 47,XXY genotype is one the most common sex chromosome anomalies. It is also the most frequent genetic cause of human infertility. Some non-mosaic 47,XXY patients have sperm production which allows infertility treatment to be offered by ICSI. Therefore, the risk of transmitting a chromosome anomaly to the next generation is an important problem in reproductive genetic counselling of these patients. Here, we report on a twin pregnancy where two karyotypically normal neonates 46,XX and 46,XY were born after the use of ICSI in assisted reproduction of a patient with a non-mosaic 47,XXY syndrome. To date, only 38 evolving pregnancies including the present cases, have been reported after ICSI using sperm from non-mosaic 47,XXY patients. Although these data are scarce, they suggest that the risk of chromosome anomaly in the offspring of these patients is low; hence, their reproductive genetic counselling can be reassuring, and management of the pregnancy can proceed with caution.

  3. MANAGEMENT OF ENDOCRINE DISEASE: Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: update on the management of adult patients and prenatal treatment.

    Science.gov (United States)

    Bachelot, Anne; Grouthier, Virginie; Courtillot, Carine; Dulon, Jérôme; Touraine, Philippe

    2017-04-01

    Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is characterized by cortisol and in some cases aldosterone deficiency associated with androgen excess. Goals of treatment are to replace deficient hormones and control androgen excess, while avoiding the adverse effects of exogenous glucocorticoid. Over the last 5 years, cohorts of adults with CAH due to 21-hydroxylase deficiency from Europe and the United States have been described, allowing us to have a better knowledge of long-term complications of the disease and its treatment. Patients with CAH have increased mortality, morbidity and risk for infertility and metabolic disorders. These comorbidities are due in part to the drawbacks of the currently available glucocorticoid therapy. Consequently, novel therapies are being developed and studied in an attempt to improve patient outcomes. New management strategies in the care of pregnancies at risk for congenital adrenal hyperplasia using fetal sex determination and dexamethasone have also been described, but remain a subject of debate. We focused the present overview on the data published in the last 5 years, concentrating on studies dealing with cardiovascular risk, fertility, treatment and prenatal management in adults with classic CAH to provide the reader with an updated review on this rapidly evolving field of knowledge. © 2017 European Society of Endocrinology.

  4. Diagnósticos de Enfermagem identificados em gestantes durante o pré-natal Diagnósticos de Enfermería identificados en embarazos durante el prenatal Nursing Diagnoses identified in pregnant patients under prenatal care

    Directory of Open Access Journals (Sweden)

    Sandra Valéria Martins Pereira

    2005-12-01

    -risk pregnant patients. Eleven pregnant women received prenatal care in a safe maternity in the state of Goiás. The data were classified under the NANDA (North American Nursing Diagnosis Association taxonomy II and analyzed according to the referrals in obstetrics. Twenty-five different Nursing Diagnoses were identified. All pregnant women presented: insufficient knowledge (different levels and subjects, disturbed sleep pattern, activity intolerance, self-care deficit (bathing and hygiene, stress urinary incontinence, and some risk diagnoses. Identifying NANDA's Nursing Diagnoses allows the identification of the risk level, early detection of complications, and individualization in nursing assistance.

  5. Can 3-dimensional power Doppler indices improve the prenatal diagnosis of a potentially morbidly adherent placenta in patients with placenta previa?

    Science.gov (United States)

    Haidar, Ziad A; Papanna, Ramesha; Sibai, Baha M; Tatevian, Nina; Viteri, Oscar A; Vowels, Patricia C; Blackwell, Sean C; Moise, Kenneth J

    2017-08-01

    Traditionally, 2-dimensional ultrasound parameters have been used for the diagnosis of a suspected morbidly adherent placenta previa. More objective techniques have not been well studied yet. The objective of the study was to determine the ability of prenatal 3-dimensional power Doppler analysis of flow and vascular indices to predict the morbidly adherent placenta objectively. A prospective cohort study was performed in women between 28 and 32 gestational weeks with known placenta previa. Patients underwent a two-dimensional gray-scale ultrasound that determined management decisions. 3-Dimensional power Doppler volumes were obtained during the same examination and vascular, flow, and vascular flow indices were calculated after manual tracing of the viewed placenta in the sweep; data were blinded to obstetricians. Morbidly adherent placenta was confirmed by histology. Severe morbidly adherent placenta was defined as increta/percreta on histology, blood loss >2000 mL, and >2 units of PRBC transfused. Sensitivities, specificities, predictive values, and likelihood ratios were calculated. Student t and χ(2) tests, logistic regression, receiver-operating characteristic curves, and intra- and interrater agreements using Kappa statistics were performed. The following results were found: (1) 50 women were studied: 23 had morbidly adherent placenta, of which 12 (52.2%) were severe morbidly adherent placenta; (2) 2-dimensional parameters diagnosed morbidly adherent placenta with a sensitivity of 82.6% (95% confidence interval, 60.4-94.2), a specificity of 88.9% (95% confidence interval, 69.7-97.1), a positive predictive value of 86.3% (95% confidence interval, 64.0-96.4), a negative predictive value of 85.7% (95% confidence interval, 66.4-95.3), a positive likelihood ratio of 7.4 (95% confidence interval, 2.5-21.9), and a negative likelihood ratio of 0.2 (95% confidence interval, 0.08-0.48); (3) mean values of the vascular index (32.8 ± 7.4) and the vascular flow index

  6. Motivations for undertaking DNA sequencing-based non-invasive prenatal testing for fetal aneuploidy: a qualitative study with early adopter patients in Hong Kong.

    Directory of Open Access Journals (Sweden)

    Huso Yi

    Full Text Available BACKGROUND: A newly introduced cell-free fetal DNA sequencing based non-invasive prenatal testing (DNA-NIPT detects Down syndrome with sensitivity of 99% at early gestational stage without risk of miscarriage. Attention has been given to its public health implications; little is known from consumer perspectives. This qualitative study aimed to explore women's motivations for using, and perceptions of, DNA-NIPT in Hong Kong. METHODS AND FINDINGS: In-depth interviews were conducted with 45 women who had undertaken DNA-NIPT recruited by purposive sampling based on socio-demographic and clinical characteristics. The sample included 31 women identified as high-risk from serum and ultrasound based Down syndrome screening (SU-DSS. Thematic narrative analysis examined informed-decision making of the test and identified the benefits and needs. Women outlined a number of reasons for accessing DNA-NIPT: reducing the uncertainty associated with risk probability-based results from SU-DSS, undertaking DNA-NIPT as a comprehensive measure to counteract risk from childbearing especially at advanced age, perceived predictive accuracy and absence of risk of harm to fetus. Accounts of women deemed high-risk or not high-risk are distinctive in a number of respects. High-risk women accessed DNA-NIPT to get a clearer idea of their risk. This group perceived SU-DSS as an unnecessary and confusing procedure because of its varying, protocol-dependent detection rates. Those women not deemed high-risk, in contrast, undertook DNA-NIPT for psychological assurance and to reduce anxiety even after receiving the negative result from SU-DSS. CONCLUSIONS: DNA-NIPT was regarded positively by women who chose this method of screening over the routine, less expensive testing options. Given its perceived utility, health providers need to consider whether DNA-NIPT should be offered as part of universal routine care to women at high-risk for fetal aneuploidy. If this is the case, then

  7. Comparison of pre-procedural anxiety and depression scores for patients undergoing chorion villus sampling and amniocentesis: An alternative perspective on prenatal invasive techniques.

    Science.gov (United States)

    Sanhal, Cem Yasar; Mendilcioglu, Inanc; Ozekinci, Murat; Simsek, Mehmet; Bozkurt, Selen

    2015-01-01

    To compare the pre-procedural anxiety and depression levels of patients undergoing chorion villus sampling (CVS) and amniocentesis (AC). Patients referred to our department for fetal karyotype analysis with a positive first or second trimester screening test for aneuploidy between January 2013 to June 2015 were included. CVS and AC procedures were performed in patients with gestation periods of between 11-14 and 16-20 weeks, respectively. Anxiety was evaluated using the Spielberger State-Trait Anxiety Inventory (STAI), and depression was assessed using the Beck Depression Inventory II (BDI-II). A total of 1,400 patients were included. Compared to first trimester controls, patients undergoing CVS had significantly higher STAI-state and BDI-II results. Likewise, patients undergoing AC had higher STAI-state and BDI-II scores than controls in the second trimester. In terms of STAI-trait results, no difference was found between the groups. Our results also showed that, compared to AC group, patients undergoing CVS had similar STAI-state, STAI-trait and but higher BDI-II scores. We conclude that evaluating the stress and depression levels of these patients should be one of the routine procedures in pregnancy follow-up.

  8. Patient - patient interaction

    DEFF Research Database (Denmark)

    Birkelund, Regner; Søndergaard Larsen, Lene

    2013-01-01

    Aim:  The aim of this study is to provide an understanding of the significance of hospitalized patients’ interpersonal interaction with fellow patients in an infectious disease ward in a large Danish hospital. Method:  A qualitative approach was selected using participant observation and semi...... subcategories representing significance of patients’ interaction with fellow patients. Results:  The qualitative analysis resulted in two main categories: (i) Caring for fellow patients and (ii) Sharing illness information with fellow patients. Each of the main categories was elucidated through several...... subcategories. Our findings clearly showed that interpersonal interaction with fellow patients was of utmost importance when it came to care and support and when they needed information about their illness. Typically, the interpersonal interaction was experienced as giving and referred to in positive terms...

  9. Patient Empowerment

    Science.gov (United States)

    ... ONS Journals Research Medical Advisors Young Investigator Award Patient Empowerment What’s Empowerment? Patients and families have rights, ... organizations for your type of cancer. Contact Your Patient Organization The Kidney Cancer Association (KCA) serves kidney ...

  10. Patient Rights

    Science.gov (United States)

    As a patient, you have certain rights. Some are guaranteed by federal law, such as the right to get a copy ... them private. Many states have additional laws protecting patients, and healthcare facilities often have a patient bill ...

  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 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....

  13. Awareness among Parents of β-Thalassemia Major Patients Regarding Prenatal Diagnosis and Premarital Screening in Day Care Centre of Transfusion Medicine Department.

    Science.gov (United States)

    Rudra, S; Chakrabarty, P; Hossain, M A; Ripon, M J; Rudra, M; Mirza, T T

    2016-01-01

    Thalassemia is one of the most common genetic diseases in the world. It is a major health problem, brings much morbidity, early mortality and a great deal of misery for a family both financially and emotionally. The patients suffering from beta thalassemia major do not survive for more than 5 years without blood transfusion. Blood transfusion is usually administered every two to five weeks to maintain the pre-transfusion hemoglobin level of 9-10 gm/dL. This study carried out in the department of Transfusion Medicine of Mymensingh Medical College Hospital from January 2014 to June 2014. A total of 200 parents were interviewed. There was a slight preponderance of females which accounted for 57.5% of the parents. Ninety seven (45.5%) had an income less than Rs. 5000 per month. Nearly 50% were illiterate with only 24.5% with a higher education. Consanguinity was positive in 72.5% of the parents with extended family history of thalassemia positive in 40.8%. Only 29.5% were immunized against Hepatitis B. Around 27.5% did not know whether they should be immunized. Fifty five percent of parents knew children should receive Dysferol. Twelve percent were aware of consanguinity to be a risk factor for thalassaemia with only 5% having undergone antenatal diagnosis. Parental knowledge about thalassemia and its preventive measures is inadequate; this requires intervention in the form of public health education programs concentrating on high risk/targeted population.

  14. 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 ...... knowledge and better understanding about patients' lives would give nurses and other professionals more scope to identify and oblige patient needs and preferences during hospitalisation and in planning nursing care....

  15. [Communication skills for prenatal counselling].

    Science.gov (United States)

    Bitzer, J; Tschudin, S; Holzgreve, W; Tercanli, S

    2007-04-18

    Prenatal counselling is characterized by specific characteristics: A):The communication is about the values of the pregnant woman and her relationship with the child to be. B) The communication deals with patient's images and emotions. C) It is a communication about risks, numbers and statistics. D) Physician and patient deal with important ethical issues. In this specific setting of prenatal diagnosis and care physicians should therefore learn to apply basic principles of patient-centred communication with elements of non directive counselling, patient education and shared decision making. These elements are integrated into a process which comprises the following "steps": 1. Clarification of the patient's objectives and the obstetrician's mandate. 2. The providing of individualized information and education about prenatal tests and investigations. 3. Shared decision making regarding tests and investigations 4. Eventually Breaking (bad, ambivalent) news. 5. Caring for patients with an affected child.

  16. Congenital dacryocystocele: prenatal MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Yazici, Zeynep [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Uludag University, Department of Radiology, Faculty of Medicine, Bursa (Turkey); Kline-Fath, Beth M.; Rubio, Eva I.; Calvo-Garcia, Maria A.; Linam, Leann E. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Yazici, Bulent [Uludag University, Department of Ophthalmology, Faculty of Medicine, Bursa (Turkey)

    2010-12-15

    Congenital dacryocystocele can be diagnosed prenatally by imaging. Prenatal MRI is increasingly utilized for fetal diagnosis. To present the radiological and clinical features of seven fetuses with congenital dacryocystocele diagnosed with prenatal MRI. The institutional database of 1,028 consecutive prenatal MR examinations performed during a period of 4 years was reviewed retrospectively. The cases of congenital dacryocystocele were identified by reading the report of each MRI study. The incidence of dacryocystocele diagnosed with prenatal MRI was 0.7% (n=7/1,028). The dacryocystocele was bilateral in three fetuses. Mean gestational age at the time of diagnosis was 31 weeks. The indication for prenatal MRI was the presence or the suspicion of central nervous system abnormality in six fetuses and diaphragmatic hernia in one. Dacryocystocele was associated with an intranasal cyst in six of ten eyes. Prenatal sonography revealed dacryocystocele in only two of seven fetuses. Of eight eyes with postnatal follow-up, four did not have any lacrimal symptoms. Prenatal MRI can delineate congenital dacryocystocele more clearly and in a more detailed fashion than ultrasonography. Presence of dacryocystocele was symptomatic in only 50% of our patients, supporting that prenatal diagnosis of dacryocystocele might follow a benign course. (orig.)

  17. Patient empowerment

    DEFF Research Database (Denmark)

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

    2017-01-01

    assessing empowerment from the user perspective. The aim of this review was to identify questionnaires and subscales measuring empowerment and manifestations of empowerment among cancer patients. MATERIALS AND METHODS: We conducted a systematic search of the PubMed, PsycINFO and CINAHL databases......BACKGROUND: There is an increased attention to and demand for patient empowerment in cancer treatment and follow-up programs. 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....... 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...

  18. 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.

  19. 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.

  20. Patient life

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    2004-01-01

    , treatment, and staff members will be attended to. A specific focus on contrasting experiences is made in order to enhance a better understanding of patients' interactions. Methods: I explore patients' social interactions in their day-to-day lives in two adult surgical units at a University Hospital......-interviews. The material will consist of field-notes, interviews, and audio-video recordings of interactions between patients. The material will be analysed with inspiration from Mattingly's ideas of narrative, drawing on the work of Ricoeur's term of emplotment developed through considering the narrative structures...... of fiction and history. Especially her way of bringing the term emplotment directly into the area of social action, I find inspiring. Conclusions:The study is ongoing. Yet it is not clear in what perspectives the findings will be interpreted, but age, body, gender, time and space might be relevant. More...

  1. Patient safety

    African Journals Online (AJOL)

    406 CME Nov/Dec 2012 Vol. 30 No. 11 ... The message remains the same: around 10% of all patients ... error rates in healthcare in South Africa, no real data exist. ... so as technology progresses. The medical .... top priority and they will include it in planning and .... Reason J. Managing the risks of organisational accidents.

  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. Relationship between prenatal care and maternal complications in women with preeclampsia: Implications for continuity and discontinuity of prenatal care

    OpenAIRE

    Ching-Ming Liu; Shuenn-Dyh Chang; Po-Jen Cheng

    2012-01-01

    Objective: Prenatal care is associated with better pregnancy outcome and may be a patient safety issue. However, no studies have investigated the types and quality of prenatal care provided in northern Taiwan. This retrospective study assessed whether the hospital-based continuous prenatal care model at tertiary hospitals reduced the risk of perinatal morbidity and maternal complications in pre-eclampsia patients. Materials and Methods: Of 385 pre-eclampsia patients recruited from among 23...

  4. [Patient advice].

    Science.gov (United States)

    Lucio-Villegas Menéndez, M Eulalia; González, Laura López; Gutiérrez Pérez, M Isabel; Lluch, Natalia Aresté; Morató Agustí, M Luisa; Cachafeiro, Santiago Pérez

    2014-05-01

    In wound care, knowing what to do is as important as knowing what not to do. The first step is to evaluate the severity of the lesion and to know whether it is necessary to attend a health center or not. If the wound is simple, the recommended course of action is cleansing with serum or water after washing one's hands, followed by wound disinfection with the most appropriate antiseptic. Antiseptics not should be used for wound cleansing (physiological serum or tap water should be used) or for wound healing with granulation tissue. Equally, antiseptics should not be used in the ear or near the eyes; if there is accidental application, the eye should be washed in abundant water. Povidone iodine should not be used in pregnant women, nor should iodine preparations be used in neonates, in patients with thyroid alterations or in those allergic to iodine. Currently, merbromine/mercurochrome is not used because of its mercury content. Before an antiseptic is applied, all inorganic residues (foreign bodies) and dead tissue should be removed; detritus, slough, purulent exudate, scabs… This will aid healing and the action of antiseptics, since they become inactive in the presence of organic material. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  5. 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....

  6. Combining approach with multiplex PCR and MLPA to detect deletion and duplication in DMD patients,carriers, and prenatal diagnosis%应用多重PCR和MLPA技术检测DMD患者和携带者的基因突变及产前诊断

    Institute of Scientific and Technical Information of China (English)

    李红; 丁洁; 王玮; 陈瑛; 陆伟; 邵红; 吴柏林

    2009-01-01

    Objective Applying multiplex PCR and multiplex ligation-dependent probe amplification (MLPA) in a clinical setting to detect deletions and duplications in the Duchenne/Becker muscular dystrophy (DMD/BMD) gene not only for patients, but also for identification of possible carriers and prenatal diagnosis. Methods Multiplex PCR was used first in patients clinically diagnosed with DMD/BMD to examine 26 exons for a large deletion in the two hot regions of the dystrophin gene. For patients without a deletion detected in the aforementioned regions, MLPA was used to further examine all 79 exons to determine whether a deletion in the remaining non-hot regions or any duplication was present. A similar approach was applied to suspected carriers. In requested prenatal diagnosis cases, specific PCR was used to detect deletions, while MLPA was applied to detect duplications. Results Multiplex PCR was used to examine 26 exons within the two hot regions in the Dystrophin gene for 22 patients with DMD;13 (13/22) had multi-exon deletions. For the 9 patients without deletions in the 26 exons, MLPA was used to examine 79 exons. 3 patients had duplications, 1 patient had a single deletion in exon 18, and no deletions or duplications could be detected in the remaining 5 patients. Of the 16 carriers, 2 out of the 3 that had family history had deletions, while the other 13 carriers were mothers of affected children who were sporadic patients without family history. Of them, 8 mothers were carriers for either deletions or duplications. For prenatal diagnosis, 9 fetuses were examined (one case was twins). Of them, 2 fetuses had familial deletions or duplications detected. These results were verified after induced abortion. In 7 fetuses, no deletions or duplications were detected and all developed into children. Conclusion Multiplex PCR can detect 92.86% of deletions and is useful for prenatal diagnosis of deletions because it is simple, reliable and inexpensive. It can be the first choice

  7. 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

  8. 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.

  9. Prenatal psychosocial risk assessment using event history calendars with Black women.

    Science.gov (United States)

    Munro, Michelle L; Dahlem, Chin Hwa Y; Lori, Jody R; Martyn, Kristy K

    2012-01-01

    To explore the clinical acceptability and perceptions of use of a prenatal event history calendar (EHC) for prenatal psychosocial risk assessment in Black pregnant women. A qualitative descriptive study focused on interviews and prenatal EHCs completed by Black pregnant women. Inner city hospital prenatal care clinic in Southeastern Michigan. Thirty 18-35 year old pregnant Black women receiving prenatal care at the participating clinic. Women completed the prenatal EHCs and their perceptions of its use were obtained through face to face interviews. The constant comparative method of analysis (Glaser, 1978, 1992) revealed themes from participants' descriptions about use of a prenatal EHC for prenatal psychosocial risk assessment. Three main themes emerged describing how the prenatal EHC enhanced communication. The prenatal EHC provided "an opening" for disclosure, "an understanding with you," and a way for providers to "know you, your life, and future plans." The participants' completed prenatal EHCs included information regarding their pre-pregnancies, trimester histories, and future plans. These completed prenatal EHCs showed patterns of change in life events and behaviors that included worries, stressors, and risk behaviors. The participants perceived the prenatal EHC as an easy to use tool that should be used to improve communication with health care providers. The prenatal EHC allows the patient and provider to "start on the same page" and provides an additional avenue for discussion of sensitive psychosocial issues with Black pregnant women. As a clinical tool, the prenatal EHC facilitated patient-provider communication for pregnant women often marked by health disparities. The prenatal EHC is a clinically acceptable tool to assess for psychosocial risk factors of Black women in a prenatal clinical setting. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  10. Pharmacist-Patient Interaction and Patient Expectations

    Science.gov (United States)

    DeSimone, Edward M.; And Others

    1977-01-01

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

  11. Patient Treatment Tracking Chart

    Science.gov (United States)

    ... ZIP code here Hepatitis C Treatment Tracking Chart Patient Treatment Tracking Chart Patient Treatment Tracking Chart Sample Chart This chart is ... this website Submit Share this page Related Resource Patient Treatment Tutorial return to top CONNECT Veterans Crisis ...

  12. 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...

  13. [Patient education in France].

    Science.gov (United States)

    Bertrand, Dominique

    2011-10-01

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

  14. Human prenatal diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Filkins, K.; Russo, R.J.

    1985-01-01

    The multiauthor text is written as a ''guide to rationalize and clarify certain aspects of diagnosis, general counseling and intervention'' for ''health professionals who provide care to pregnant women.'' The text is not aimed at the ultrasonographer but rather at the physicians who are clinically responsible for patient management. Chapters of relevance to radiologists include an overview of prenatal screening and counseling, diagnosis of neural tube defects, ultrasonographic (US) scanning of fetal disorders in the first and second trimesters of pregnancy, US scanning in the third trimester, multiple gestation and selective termination, fetal echo and Doppler studies, and fetal therapy. Also included are overviews of virtually all currently utilized prenatal diagnostic techniques including amniocentesis, fetal blood sampling, fetoscopy, recombinant DNA detection of hemoglobinopathies, chorionic villus sampling, embryoscopy, legal issues, and diagnosis of Mendelian disorders by DNA analysis.

  15. [The clinical and molecular genetic characteristics of phenylketonuria patients in the Republic of Crimea].

    Science.gov (United States)

    Afanas'eva, N A; Bychkova, A M; Livshits, L A; Bariliak, I R

    1998-01-01

    The clinical and genetical characteristics of patients with phenylketonuria in the Crimean population is done in the present work. The comparison of clinical peculiarities of 28 patients, revealed by means of neonatal screening and that of 24 patients, the treatment of which was started late is presented. The prenatal diagnostics of 4 families with high phenylketonuria risk is conducted.

  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. Relationship between prenatal care and maternal complications in women with preeclampsia: implications for continuity and discontinuity of prenatal care.

    Science.gov (United States)

    Liu, Ching-Ming; Chang, Shuenn-Dyh; Cheng, Po-Jen

    2012-12-01

    Prenatal care is associated with better pregnancy outcome and may be a patient safety issue. However, no studies have investigated the types and quality of prenatal care provided in northern Taiwan. This retrospective study assessed whether the hospital-based continuous prenatal care model at tertiary hospitals reduced the risk of perinatal morbidity and maternal complications in pre-eclampsia patients. Of 385 pre-eclampsia patients recruited from among 23,665 deliveries, 198 were classified as patients with little or no prenatal care who received traditional, individualized, and physician-based discontinuous prenatal care (community-based model), and 187 were classified as control patients who received tertiary hospital-based continuous prenatal care. The effects on perinatal outcome were significantly different between the two groups. The cases in the hospital-based care group were less likely to be associated with preterm delivery, low birth weight, very low birth weight, and intrauterine growth restriction. After adjustment of confounding factors, the factors associated with pregnant women who received little or no prenatal care by individualized physician groups were diastolic blood pressure ≥ 105 mmHg, serum aspartate transaminase level ≥ 150 IU/L, and low-birth-weight deliveries. This study also demonstrated the dose-response effect of inadequate, intermediate, adequate, and intensive prenatal care status on fetal birth weight and gestational periods (weeks to delivery). The types of prenatal care may be associated with different pregnancy outcomes and neonatal morbidity. Factors associated with inadequate prenatal care may be predictors of pregnancy outcome in pregnant women with pre-eclampsia. Copyright © 2012. Published by Elsevier B.V.

  18. PRENATAL EXPOSURE TO PHENYTOIN, FACIAL DEVELOPMENT, AND A POSSIBLE ROLE FOR VITAMIN-K

    NARCIS (Netherlands)

    HOWE, AM; LIPSON, AH; SHEFFIELD, LJ; HAAN, EA; HALLIDAY, JL; JENSON, F; DAVID, DJ; WEBSTER, WS

    1995-01-01

    Ten patients with maxillonasal hypoplasia (Binder ''syndrome''), who were prenatally exposed to phenytoin (usually in combination with other anticonvulsants), were identified retrospectively. In addition to their facial anomalies, 6 of the patients were radiographed neonatally and showed punctate ca

  19. PRENATAL EXPOSURE TO PHENYTOIN, FACIAL DEVELOPMENT, AND A POSSIBLE ROLE FOR VITAMIN-K

    NARCIS (Netherlands)

    HOWE, AM; LIPSON, AH; SHEFFIELD, LJ; HAAN, EA; HALLIDAY, JL; JENSON, F; DAVID, DJ; WEBSTER, WS

    1995-01-01

    Ten patients with maxillonasal hypoplasia (Binder ''syndrome''), who were prenatally exposed to phenytoin (usually in combination with other anticonvulsants), were identified retrospectively. In addition to their facial anomalies, 6 of the patients were radiographed neonatally and showed punctate

  20. 三维斑点追踪成像技术评价妊娠高血压综合征患者产前和产后左心室收缩功能的价值%Value of Three-Dimensional Speckle Tracking Imaging in Assessment of Prenatal and Postnatal Left ventricular Systolic Function in Patients with Pregnancy-Induced Hypertension

    Institute of Scientific and Technical Information of China (English)

    应康; 胡震; 王继伟; 郭良云

    2016-01-01

    ABSTRACT:Objective To investigate the clinical value of three-dimensional speckle tracking im-aging(3D-STI)in assessment of prenatal and postnatal left ventricular systolic function in pa-tients with pregnancy-induced hypertension(PIHS).Methods The left ventricular global peak longitudinal strain(LVGLS),left ventricular global peak radial strain(LVGRS),left ventricular global peak circumferential strain(LVGCS)and left ventricular global peak area strain(LVGAS) were measured by 3D-STI in 32 antepartum PIHS patients(antepartum PIHS group),30 3-month postpartum PIHS patients(postpartum PIHS group),and 40 healthy pregnant women(normal control group).Results Compared with normal control group,the LVGLS decreased in antepar-tum PIHS group(P 0.05).Com-pared with antepartum PIHS group,the LVGLS increased in postpartum PIHS group(P 0.05).Conclusion The 3D-STI technique can sensitively reflect the changes in prenatal and postnatal left ventricular systolic function in PIHS patients through as-sessing the global response of left ventricle.Therefore,3D-STI technique provides a reference for early diagnosis and treatment of PIHS.%目的:探讨三维斑点追踪成像(3-dimensional speckle tracking imaging,3D-STI)技术评价妊娠高血压综合征(pregnancy-induced hypertension syndrome,PIHS)患者产前和产后左心室收缩功能的临床价值。方法采用3D-STI 测量32例待产的 PIHS 孕妇(PIHS 产前组)、30例产后3个月复查的 PIHS 产妇(PIHS 产后组)及40例待产的正常孕妇(正常对照组)的左心室整体纵向收缩期峰值应变(left ventricle global longitudinal strain,LVGLS)、左心室整体径向收缩期峰值应变(left ventricle global radial strain,LVGRS)、左心室整体圆周收缩期峰值应变(left ventricle global circumferential strain,LVGCS)、左心室整体面积收缩期峰值应变(left ventricular global area peak systolic strain,LVGAS)值,并进行比较。结果

  1. 'Patient satisfaction' in hospitalized cancer patients.

    Science.gov (United States)

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

    2002-01-01

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

  2. Patient hand hygiene practices in surgical patients.

    Science.gov (United States)

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

    2013-06-01

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

  3. 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.

  4. Invasive prenatal diagnostic procedures: a developing countries' perspective

    Directory of Open Access Journals (Sweden)

    Namrata Kashyap

    2016-01-01

    Conclusions: With appropriate prenatal invasive test were able to prevent birth of affected fetus which is of huge importance considering the patients who give birth to abnormal babies only to see them suffering and frequently dying also. Prenatal invasive test were able to prevent this psychological, mental as well as physical trauma in these patients. [Int J Reprod Contracept Obstet Gynecol 2016; 5(1.000: 41-47

  5. Prediction of preterm birth in nulliparous patients.

    Science.gov (United States)

    Guinn, D A; Wigton, T R; Owen, J; Socol, M L; Frederiksen, M C

    1994-10-01

    Our goal was to determine whether the mammary stimulation test combined with a risk scoring system and cervical examination at 26 to 28 weeks' gestation could effectively identify private nulliparous patients at risk for spontaneous preterm birth. The mammary stimulation test was performed by 267 nulliparous patients with singleton gestations at 26 to 28 weeks. Risk scores were determined by the method of Creasy et al. and cervical examinations were performed at the first prenatal visit and at 26 to 28 weeks. Summary predictive values were calculated for each test, and a stepwise discriminate analysis was performed. Spontaneous preterm birth occurred at preterm birth: positive result of mammary stimulation test, risk score > or = 10, soft cervix at 26 to 28 weeks, bacteriuria, and current smoking. The best discriminate model included positive result of mammary stimulation test, soft cervix, bacteriuria, current smoking, and prior spontaneous abortion(s). This model identified 19 patients as being at risk for spontaneous preterm birth with sensitivity of 35%, specificity of 96%, and positive predictive value of 47%. Combining the mammary stimulation test with a cervical examination at 26 to 28 weeks' gestation and routinely obtained prenatal data correctly identified 35% of spontaneous preterm births in nulliparous patients with a positive predictive value of 47%. Prospective validation of this model is warranted.

  6. Displacing the Patient

    DEFF Research Database (Denmark)

    Pors, Anja Svejgaard

    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...... 2005) the analysis examines how the hospital’s patient communication is not just about disease treatment, but rather about information treatment of the patient in order to attain a high level of patient satisfaction. The goal of patient satisfaction addresses care-oriented understandings of the patient...

  7. Patient-centred Prevention among PAD Patients

    DEFF Research Database (Denmark)

    Pii, Kathrine Hoffmann

    2014-01-01

    -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...... that the patient-centred approach does not ensure patient autonomy, but continues to be organized according to biomedical regimes and thereby carry on a paternalistic approach. In this paper, I present findings from a PhD project, which investigates how the ideal of patient-centredness is practiced in the case...... as a relational property/entity, which implies that professionals intervene in the development of patients’ autonomy by expanding their capacity to make and actualize choices. The dilemma regarding the concern to ensure patient autonomy and still wanting patients to make the “right” choices is not one...

  8. Mucormycosis in trauma patients.

    Science.gov (United States)

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

    1992-01-01

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

  9. Prenatal diagnosis of hemimegalencephaly.

    Science.gov (United States)

    Lang, Shih-Shan; Goldberg, Ethan; Zarnow, Deborah; Johnson, Mark P; Storm, Phillip B; Heuer, Gregory G

    2014-01-01

    In recent literature, there have been case reports of prenatal diagnosis of hemimegalencephaly, an extremely rare entity characterized by enlargement of all or portions of 1 cerebral hemisphere and intractable seizures. A unique case is presented of hemimegalencephaly of a fetus diagnosed in utero. A 27-year-old woman presented at 32 weeks' gestation for fetal magnetic resonance imaging after an abnormal fetal ultrasound. Fetal magnetic resonance imaging showed hemimegalencephaly of the left cerebral hemisphere with abnormal gyration. The patient was born via cesarean section at 39 weeks' gestation. He had continuous infantile spasms and partial-onset seizures starting on day 1 of life, and electroencephalography showed burst suppression. The patient's seizures were initially managed with antiepileptics, prednisolone, and a ketogenic diet; however, he was hospitalized multiple times because of status epilepticus. At 6 months of age, he underwent a successful anatomic left hemispherectomy. In utero diagnosis of complex developmental brain anomalies allows a multidisciplinary approach to provide optimal prenatal patient treatment and parental counseling. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. The participatory patient

    DEFF Research Database (Denmark)

    Andersen, Tariq Osman

    2010-01-01

    This paper introduces the concept of the “participatory patient” as a vehicle to promote attention to patients¿ dual enactment of participation on participatory design (PD) projects in healthcare. By an empirical case-story from an ongoing PD project in healthcare, I illustrate the relationship...... between a patient¿s work on the project as a co-designer and his work of being a patient using a prototype. I conclude by arguing for the importance of being aware of the ways in which patients inscribe patient work and non-work and thinking of what kind of working or non-working patients it implies....

  11. Displacing the patient

    DEFF Research Database (Denmark)

    Pors, Anja Svejgaard

    2012-01-01

    This analysis is based on an empirical study of a Danish hospital‟s communication programme entitled: 'The Perspective of the Patient'. The paper explores how strategic documents of the programme organize the communication work through situated displacements of the patient. Based on methodological...... elements from situational analysis (Clarke 2005) the analysis examines how the hospital‟s patient communication is not only about disease treatment, but rather about information treatment of the patient in order to attain a high level of patient satisfaction. The goal of patient satisfaction addresses both...

  12. 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...... with assessment and development of the patient safety culture is in early days in Denmark. It depends upon valid, reliable and effective methods. The patient safety culture represents a wide range of social phenomena permeating the way of life in a health care. In essence, the safety culture is an aggregation...

  13. National Patient Safety Foundation

    Science.gov (United States)

    ... Donate Help Contact Home Creating a world where patients and those who care for them are free ... News Member Testimonials Lifetime Members Stand Up for Patient Safety Welcome Stand Up Members Stand Up e- ...

  14. 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...... in hospitals today. Purpose The purpose was to explore how informal relationships between patients affect their hospital experiences in the hospital. The assumption is that, on the one hand, the impacts on patients' suffering affect the way they act and experience encounters with fellow patients for good....... Methods The study is designed within a phenomenological-hermeneutical philosophic frame of reference and is based on ethnographic fieldwork among hospitalised patients in a Danish university hospital. Data for the study were collected through participant observations over a period of 18 months. Nine males...

  15. 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.

  16. A good patient?

    DEFF Research Database (Denmark)

    Campbell, Catherine; Scott, Kerry; Skovdal, Morten

    2015-01-01

    Background: While patient-provider interactions are commonly understood as mutually constructed relationships,the role of patient behaviour, participation in interactions, and characteristics, particularly ideals surrounding notionsof ‘good’ and ‘bad’ patients, are under-examined. This article ex...

  17. 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 was to...

  18. HYPERTENSION IN PSYCHIATRIC PATIENTS

    OpenAIRE

    Chaturvedi, Santosh K.; Michael, Albert

    1986-01-01

    SUMMARY Known cases of hypertension and those fulfilling WHO criteria for diagnosis of hypertension were identified in psychiatric patients and compared with non - hypertensive psychiatric patients. Hypertension was detected in 141 (9.98%) cases, and was significantly more associated with elder age, married status, urban background and neurotic illness. The implications are in early detection and effective management of hypertension in psychiatric patients.

  19. 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...

  20. Patient Delay in Colorectal Cancer Patients

    DEFF Research Database (Denmark)

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

    2013-01-01

    , at patienter med kolorektal¬kræft, som har oplevet blødning fra endetarmen, har længere forsinkelser i forløbet (39 dage) end patienter, som ikke har haft dette symptom (15 dage). Tidligere studier har tolket det som et tegn på, at patienter med rektal blødning regner med, at blødningen skyldes godartede...... lidelser. Dette studie finder som noget nyt, at mange patienter med rektal blødning har tænkt mere over kræft i perioden op til første lægebesøg end patienter uden dette symptom. En forkert tolkning af symptomet er altså ikke den eneste forklaring på forsinkelserne i forløbet for denne patientgruppe....... Fundene i studiet åbner for den mulighed, at forsinkelserne hos nogle patienter kan skyldes bekymring for, hvad lægen vil finde, og at de derfor tøver med at konsultere lægen. Denne tøven kan hænge sammen med følelses¬mæssige barrierer, fx at patienten er flov over symptomerne eller frygter forestående...

  1. Patient blood management equals patient safety.

    Science.gov (United States)

    Zacharowski, Kai; Spahn, Donat R

    2016-06-01

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

  2. 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.

  3. Patient-centered Care.

    Science.gov (United States)

    Reynolds, April

    2009-01-01

    Patient-centered care focuses on the patient and the individual's particular health care needs. The goal of patient-centered health care is to empower patients to become active participants in their care. This requires that physicians, radiologic technologists and other health care providers develop good communication skills and address patient needs effectively. Patient-centered care also requires that the health care provider become a patient advocate and strive to provide care that not only is effective but also safe. For radiologic technologists, patient-centered care encompasses principles such as the as low as reasonably achievable (ALARA) concept and contrast media safety. Patient-centered care is associated with a higher rate of patient satisfaction, adherence to suggested lifestyle changes and prescribed treatment, better outcomes and more cost-effective care. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your area of interest. For access to other quizzes, go to www.asrt.org/store. According to one theory, most patients judge the quality of their healthcare much like they rate an airplane flight. They assume that the airplane is technically viable and is being piloted by competent people. Criteria for judging a particular airline are personal and include aspects like comfort, friendly service and on-time schedules. Similarly, patients judge the standard of their healthcare on nontechnical aspects, such as a healthcare practitioner's communication and "soft skills." Most are unable to evaluate a practitioner's level of technical skill or training, so the qualities they can assess become of the utmost importance in satisfying patients and providing patient-centered care.(1).

  4. Prenatal diagnosis of 45,X/46,XX

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, L.Y.F. [New York Univ. School of Medicine, New York, NY (United States)

    1996-03-01

    I read with great interest the paper on {open_quotes}Prenatal Diagnosis of 45,X/46,XX mosaicism and 45,X: Implications for Postnatal Outcome{close_quotes} by Koeberl et al. They reported their experience with 12 prenatally diagnosed cases of 45,X/46,XX mosaicism and made a clinical comparison between those 12 cases and their own 41 postnatally diagnosed cases of 45,X/46,XX mosaicism. As expected, they found an overall milder phenotypic manifestation in the prenatal cases than in the postnatal ones. These authors report a lack of previous prognostic information on this type of prenatally diagnosis of mosaicism and offer their findings to fill this need. However, considerable information on this topic has been published. There have been >200 prenatally diagnosed cases of 45,X/46,XX. According to my data on 189 cases with a prenatal diagnosis of 45,X/46,XX mosaicism (Hsu 1992), there are 114 cases with available information on phenotypic outcome. Of these, 12 (10.5%) were reported to have some features of Turner syndrome, 4 had other anomalies probably not related to Turner syndrome, and 2 resulted in stillbirth. The overall rate for an abnormal phenotype in this category was thus 16/114 (14.03%). However, we must realize that, even in patients with a nonmosaic 45,X complement, the major features of Turner syndrome, such as short stature and sexual infantilism, are manifested only later in childhood or in adolescence. 3 refs.

  5. Patient-centered professionalism

    Directory of Open Access Journals (Sweden)

    Rapport F

    2012-03-01

    Full Text Available Hayley A Hutchings, Frances RapportCollege of Medicine, Swansea University, Swansea, Wales, United KingdomIntroduction: Although the concept of patient-centered professionalism has been defined in the literature and adopted to some extent by key health care regulatory bodies, there has been little research that has identified what the concept means to professionals and patients.Aim: The purpose of this paper is to identify the key concepts of patient-centered professionalism as identified in the literature and to discuss these within the context of existing research across a variety of health care settings.Findings: Key documents have been identified from within nursing, medicine, and pharmacy, which outline what is expected of professionals within these professional groups according to their working practices. Although not defined as patient-centered professionalism, the principles outlined in these documents mirror the definitions of patient-centered professional care defined by Irvine and the Picker Institute and are remarkably similar across the three professions. While patients are identified as being at the heart of health care and professional working practice, research within the fields of community nursing and community pharmacy suggests that patient and professional views diverge as regards what is important, according to different group agendas. In addition, the delivery of patient-centered professional care is often difficult to achieve, due to numerous challenges to the provision of patient-centric care.Conclusion: According to the literature, patient-centered professionalism means putting the patient at the heart of care delivery and working in partnership with the patient to ensure patients are well informed and their care choices are respected. However, limited research has examined what the concept means to patients and health care professionals working with patients and how this fits with literature definitions. Further work is

  6. 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

  7. Follow-up studies in prenatal medicine

    NARCIS (Netherlands)

    Nagel, Hélène Theodora Catharina

    2007-01-01

    With the availability of prenatal diagnostics in the last century, the fetus became a patient. Obstetricians looked togheter with neonatologist and pediatric surgeons, who in the past needed to treat sick neonates, for an earlier moment of treatment. An example of such a shift towards an earlier mom

  8. Follow-up studies in prenatal medicine

    NARCIS (Netherlands)

    Nagel, Hélène Theodora Catharina

    2007-01-01

    With the availability of prenatal diagnostics in the last century, the fetus became a patient. Obstetricians looked togheter with neonatologist and pediatric surgeons, who in the past needed to treat sick neonates, for an earlier moment of treatment. An example of such a shift towards an earlier mom

  9. Prehospital transported patients

    DEFF Research Database (Denmark)

    Bech, Camilla Louise Nørgaard; Brabrand, M.; Lassen, Annmarie Touborg

    2015-01-01

    Introduction The survival of patients transported by ambulance to the emergency department (ED) depends on clinical conditions, patient-related factors and organisational prehospital set up. Data and information concerning patients in the prehospital system could form a valuable resource for asse......Introduction The survival of patients transported by ambulance to the emergency department (ED) depends on clinical conditions, patient-related factors and organisational prehospital set up. Data and information concerning patients in the prehospital system could form a valuable resource......-time ambulance transport to the ED at Odense University Hospital in the period 1 April 2012 to 30 September 2013. Ambulance personnel recorded vital signs and other clinical findings on a structured form on paper during the ambulance transport. Each contact was linked to information from population...

  10. 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...

  11. 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...

  12. Patient-doctor communication.

    Science.gov (United States)

    Teutsch, Carol

    2003-09-01

    Communication is an important component of patient care. Traditionally, communication in medical school curricula was incorporated informally as part of rounds and faculty feedback, but without a specific or intense focus on skills of communicating per se. The reliability and consistency of this teaching method left gaps, which are currently getting increased attention from medical schools and accreditation organizations. There is also increased interest in researching patient-doctor communication and recognizing the need to teach and measure this specific clinical skill. In 1999, the Accreditation of Council for Graduate Medical Education implemented a requirement for accreditation for residency programs that focuses on "interpersonal and communications skills that result in effective information exchange and teaming with patients, their families, and other health professionals." The National Board of Medical Examiners, Federation of State Medical Boards. and the Educational Commission for Foreign Medical Graduates have proposed an examination between the. third and fourth year of medical school that "requires students to demonstrate they can gather information from patients, perform a physical examination, and communicate their findings to patients and colleagues" using standardized patients. One's efficiency and effectiveness in communication can be improved through training, but it is unlikely that any future advances will negate the need and value of compassionate and empathetic two-way communication between clinician and patient. The published literature also expresses belief in the essential role of communication. "It has long been recognized that difficulties in the effective delivery of health care can arise from problems in communication between patient and provider rather than from any failing in the technical aspects of medical care. Improvements in provider-patient communication can have beneficial effects on health outcomes". A systematic review of

  13. Displacing the patient

    DEFF Research Database (Denmark)

    Pors, Anja Svejgaard

    2014-01-01

    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 with pat...... conditions. Care and market appear to be intertwined in political patient figures through which the hospital is trying to manage the patient as well as to transform itself from within.......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...... with patients. However, in the existing studies of strategic communication in the hospital sector, the patient’s role in the organizational work has yet to be explored. This paper draws on a major case study of a communication programme entitled 'The Perspective of the Patient', conducted at a public hospital...

  14. Prenatal parenting.

    Science.gov (United States)

    Glover, Vivette; Capron, Lauren

    2017-06-01

    Parenting begins before birth. This includes prenatal maternal and paternal bonding with the baby, and biological effects on fetal development. Recent research has confirmed how prenatal maternal stress can alter the development of the fetus and the child, and that this can persist until early adulthood. Children are affected in different ways depending, in part, on their own genetic makeup. The fetus may also have a direct effect on prenatal maternal mood and later parenting behaviour via the placenta. The father is important prenatally too. An abusive partner can increase the mother's prenatal stress and alter fetal development, but he can also be an important source of emotional support. New research suggests the potential benefits of prenatal interventions, including viewing of prenatal scans and cognitive behavioural therapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Den moderne patient

    DEFF Research Database (Denmark)

    Lassen, Trine

    2012-01-01

    Kapitlet indkredser, hvordan vi som sundhedsprofessionelle kan forklare den moderne patient. I særdeleshed lægges vægt på definerende faktorer i skabelsen af den patient vi møder i sundhedsvæsnet i dag. Kapitlet giver forskellige teoretiske bud på, hvordan man som sundhedsprofessionel kan anskue...... den moderne, nutidige patienter samt en kortere beskrivelse af, hvordan patienten tidligere er blev anskuet....

  16. [Therapeutic patient education revisited].

    Science.gov (United States)

    Ruiz, Juan

    2014-06-04

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

  17. [Impressibility of schizophrenic patients].

    Science.gov (United States)

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

    1978-01-01

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

  18. Anesthesia for geriatric patients.

    Science.gov (United States)

    Deiner, S; Silverstein, J H

    2011-02-01

    The number of elderly surgical patients will be increasing in Italy. Slowly, anesthesiologists are developing the expertise to care for these patients. The information available to apply to these cases is now the topic of a number of anesthesia textbooks dedicated to the elderly. In this article, we review some of the more recent findings and provide some tips to help guide the care of elderly patients. It is hoped that practitioners will use this information to improve the care of these patients and conduct additional research to further improve care in the future.

  19. Lactacidosis in the neonate is minimized by prenatal detection of congenital heart disease

    NARCIS (Netherlands)

    Verheijen, PM; Lisowski, LA; Stoutenbeek, P; Hitchcock, JF; Bennink, GBWE; Meijboom, EJ

    2002-01-01

    Objectives To investigate the impact of prenatal detection of congenital heart disease on preventing severe preoperative lactacidosis. Design Patients operated upon for congenital heart disease during the first 31 days of life (n=209) were studied retrospectively, 21 were diagnosed prenatally and 18

  20. Physician liability and non-invasive prenatal testing.

    Science.gov (United States)

    Toews, Maeghan; Caulfield, Timothy

    2014-10-01

    Although non-invasive prenatal testing (NIPT) marks a notable development in the field of prenatal genetic testing, there are some physician liability considerations raised by this technology. As NIPT is still emerging as the standard of care and is just starting to receive provincial funding, the question arises of whether physicians are obligated to disclose the availability of NIPT to eligible patients as part of the physician-patient discussion about prenatal screening and diagnosis. If NIPT is discussed with patients, it is important to disclose the limitations of this technology with respect to its accuracy and the number of disorders that it can detect when compared with invasive diagnostic options. A failure to sufficiently disclose these limitations could leave patients with false assurances about the health of their fetuses and could raise informed consent and liability issues, particularly if a child is born with a disability as a result.

  1. Prenatal diagnosis of Carpenter syndrome: looking beyond craniosynostosis and polysyndactyly.

    Science.gov (United States)

    Victorine, Anna S; Weida, Jennifer; Hines, Karrie A; Robinson, Barrett; Torres-Martinez, Wilfredo; Weaver, David D

    2014-03-01

    Carpenter syndrome is an autosomal recessive disorder comprising craniosynostosis, polysyndactyly, and brachydactyly. It occurs in approximately 1 birth per million. We present a patient with Carpenter syndrome (confirmed by molecular diagnosis) who has several unique and previously unreported manifestations including a large ovarian cyst and heterotaxy with malrotation of stomach, intestine, and liver. These findings were first noted by prenatal ultrasound and may assist in prenatally diagnosing additional cases of Carpenter syndrome.

  2. [Prenatal diagnosis by ultrasonography. A randomized study of 3000 patients].

    Science.gov (United States)

    García Roig, F; Hicks Gomez, J J

    1991-11-01

    From January through December, 1990 at Hospital de Ginecoobstetricia Tlatelolco, 3,000 pregnant women were subjected to ultrasonography at random using a real time, B mode apparatus with a 3.5 MHz lineal transducer. Fetal malformation were diagnosed, some of which would have passed undetected in the labor room with consequent delay of treatment and false raise of perinatal morbidity and mortality rates.

  3. 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.

  4. Patient life in hospital

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    basic tool for emplotting the encounters between patients with the message that we are in an awaiting position and obliged to stay here for a while is a specific set of behaviours that patients perform. The emplotment of waiting is communicated as a frame within which minor plots appear. These plots...

  5. 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...

  6. Effective communication with patients.

    Science.gov (United States)

    Klein, Evelyn R

    2005-09-01

    This brief article aims at heightening awareness about communication with various patients, including strategies to assist in improving communicative effectiveness. It assists us as health care professionals to go back to basics and reflect on how we communicate. Several researchers have provided insight into ways that communication may be enhanced. Walter, Bundy, and Donan (2005) suggested personally greeting the patient, introducing oneself, engaging in talk about clinical concerns, and then discussing next steps toward healthcare solutions. Schillinger (2003) implored that health related jargon be avoided and that all messages be clear and simple. Illustrations in the form of black-white line drawn pictures also tend to assist in patient comprehension. Lawton and Carroll (2005) suggested that effective communication requires assessing what the patient knows about their illness. Seidel's model (2004) stated that healthcare providers listen to the patient's story and elicit information through questioning with sufficient time allotted to provide answers. He also discussed the importance of providing a short summary of what the patient conveyed and giving additional information so they learn more about what is happening to them and can become an active participant in making decisions. It is important that patients understand what we as healthcare professionals say to them. Wisner (1999) further conveyed that it is not words alone that communicate. Body language, facial expressions, and tone of voice often provide additional clues influencing communicative effectiveness. Without a doubt, communication, directly impacts service delivery and quality of care in healthcare today. Listen to your patients, they have much to say.

  7. 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...

  8. 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...

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

    Science.gov (United States)

    Ribeiro, Carolina Sobrinho; Mourão, Joana Irene de Barros

    2015-01-01

    Anesthesia is still a major concern for patients, although the anesthetic complications have decreased significantly. Additionally, the role assigned to the anesthesiologist remains inaccurate. The aim of this study was to evaluate the concerns with anesthesia and assess the patient's knowledge about the anesthesiologist's duties. Prospective study conducted over three months with patients in the preoperative anesthetic visit in a university hospital. Demographic information about the level of education and prior anesthesia was obtained. The knowledge of patients regarding the anesthesiologists' education was evaluated. Patients' concerns and anesthesiologist and surgeon responsibilities were classified with a 5-point scale. The analysis was performed with SPSS 21, and pAnestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. Anesthesiologist: the patient's perception.

    Science.gov (United States)

    Ribeiro, Carolina Sobrinho; Mourão, Joana Irene de Barros

    2015-01-01

    Anesthesia is still a major concern for patients, although the anesthetic complications have decreased significantly. Additionally, the role assigned to the anesthesiologist remains inaccurate. The aim of this study was to evaluate the concerns with anesthesia and assess the patient's knowledge about the anesthesiologist's duties. Prospective study conducted over three months with patients in the preoperative anesthetic visit in a university hospital. Demographic information about the level of education and prior anesthesia was obtained. The knowledge of patients regarding the anesthesiologists' education was evaluated. Patients' concerns and anesthesiologist and surgeon responsibilities were classified with a 5-point scale. The analysis was performed with SPSS 21, and pAnestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  11. A good patient?

    DEFF Research Database (Denmark)

    Campbell, Catherine; Scott, Kerry; Skovdal, Morten;

    2015-01-01

    Background: While patient-provider interactions are commonly understood as mutually constructed relationships,the role of patient behaviour, participation in interactions, and characteristics, particularly ideals surrounding notionsof ‘good’ and ‘bad’ patients, are under-examined. This article...... examines social representations of ‘a good patient’and how these representations affect patient-healthcare provider relationships and antiretroviral treatment (ART) forpeople living with HIV. Methods: Using thematic network analysis, we examined interview and focus group transcripts involving 25healthcare...... staff, 48 ART users, and 31 carers of HIV positive children, as well as field notes from over 100 h ofethnographic observation at health centres in rural Zimbabwe. Results: Characteristics of a good patient include obedience, patience, politeness, listening, enthusiasm fortreatment, intelligence...

  12. The right patient.

    Science.gov (United States)

    Howrigon, Ron

    2012-01-01

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

  13. [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.

  14. Prenatal diagnosis of cloacal malformation.

    Science.gov (United States)

    Peiro, Jose L; Scorletti, Federico; Sbragia, Lourenco

    2016-04-01

    Persistent cloaca malformation is the most severe type of anorectal and urogenital malformation. Decisions concerning the surgical treatment for this condition are taken during the first hours of life and may determine the quality of life of these patients. Thus, prenatal diagnosis becomes important for a prompt and efficient management of the fetus and newborn, and accurate counseling of the parents regarding its consequences and the future of the baby. Careful evaluation by ultrasonography, and further in-depth analysis with MRI, allow prenatal detection of characteristic findings, which can lead to diagnose or at least suspect this condition. We reviewed our experience and the literature in order to highlight the most important clues that can guide the physician in the differential diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Nutrition of burned patients.

    Science.gov (United States)

    Gudaviciene, Daiva; Rimdeika, Rytis; Adamonis, Kestutis

    2004-01-01

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

  16. Anesthesiologist: the patient's perception

    Directory of Open Access Journals (Sweden)

    Carolina Sobrinho Ribeiro

    2015-12-01

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

  17. 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.

  18. The patient with ataxia.

    Science.gov (United States)

    Maggs, F G

    2014-01-01

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

  19. Prenatal care: associations with prenatal depressive symptoms and social support in low-income urban women.

    Science.gov (United States)

    Sidebottom, Abbey C; Hellerstedt, Wendy L; Harrison, Patricia A; Jones-Webb, Rhonda J

    2017-06-03

    We examined associations of depressive symptoms and social support with late and inadequate prenatal care in a low-income urban population. The sample was prenatal care patients at five community health centers. Measures of depressive symptoms, social support, and covariates were collected at prenatal care entry. Prenatal care entry and adequacy came from birth certificates. We examined outcomes of late prenatal care and less than adequate care in multivariable models. Among 2341 study participants, 16% had elevated depressive symptoms, 70% had moderate/poor social support, 21% had no/low partner support, 37% had late prenatal care, and 29% had less than adequate prenatal care. Women with both no/low partner support and elevated depressive symptoms were at highest risk of late care (AOR 1.85, CI 1.31, 2.60, p care (AOR 0.74, CI 0.54, 1.10, p = 0.051). Women with moderate/high depressive symptoms were less likely to experience less than adequate care compared to women with low symptoms (AOR 0.73, CI 0.56, 0.96, p = 0.022). Social support and partner support were negatively associated with indices of prenatal care use. Partner support was identified as protective for women with depressive symptoms with regard to late care. Study findings support public health initiatives focused on promoting models of care that address preconception and reproductive life planning. Practice-based implications include possible screening for social support and depression in preconception contexts.

  20. Acknowledging the back patient

    DEFF Research Database (Denmark)

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

    #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......, 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...... to gain a better idea of the most ideal treatment process, it is important to first investigate what it feels like to be a back patient and what patients consider important when dealing with the healthcare system. It is the aim of this qualitative literature review based on thematic synthesis to shed more...

  1. Nurse-patient collaboration

    DEFF Research Database (Denmark)

    Sørensen, Dorthe; Frederiksen, Kirsten; Groefte, Thorbjoern

    2013-01-01

    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......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...

  2. Nigerian obstetric patients

    African Journals Online (AJOL)

    combination of Mallampati and Thyro-mental distance had values of ... difficult tracheal intubation is not precisely known but failed ... predictive values in a sample of Nigeria Obstetric Patients. ... the mentum to the thyroid notch was measured.

  3. The patient's perspective

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Backer, Vibeke; Søes-Petersen, Ulrik

    2006-01-01

    Adherence with controller therapy poses a major challenge to the effective management of persistent asthma. The aim of this study was to explore the patient-related aspects of adherence among adult asthmatics....

  4. 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.,...

  5. Patient survey (HCAHPS) - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of the state averages for the HCAHPS survey responses. HCAHPS is a national, standardized survey of hospital patients about their experiences during a recent...

  6. IMPROVING PATIENT SAFETY:

    DEFF Research Database (Denmark)

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

    2013-01-01

    Every year millions of patients worldwide suffer injury or death due to unsafe care, thus improving patient safety is both a national and international priority. A developmental project involving University College Zealand and clinical partners in the region focused upon the improvement of patient...... safety by optimizing the theory-practice connection with respect to the development of students’ competencies and the reporting of clinical errors. Population: 2nd year nursing students at University College Zealand (N: 56). Informed consent and full anonymity. Aims: - To increase patient safety...... errors. An interesting finding though is that despite the legal requirements concerning the mandatory reporting of all clinical errors, 37% of the students participating in this study report that they perhaps would be reluctant to report an eventual clinical error. Further initiatives are thus necessary...

  7. Nurse–patient collaboration

    DEFF Research Database (Denmark)

    Sørensen, Dorthe; Frederiksen, Kirsten; Grøfte, Thorbjørn;

    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...

  8. Patient Advocate Foundation

    Science.gov (United States)

    ... Resources CoPay Resources Healthcare Reform Prevention View Resource Click here to submit a resource Subscribe Copyright © 2012 Patient Advocate Foundation Headquarters: 421 Butler Farm Road, Hampton, VA 23666 Phone: (800) 532-5274 - ...

  9. 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...

  10. 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 ...

  11. 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.

  12. 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

  13. 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....

  14. Inappropriate requests from patients

    African Journals Online (AJOL)

    injury. Some of these patients were vege- tative or severely neurologically damaged. Others were children — anencephalic infants, for example, or infants with anox- ic brain injury. On some ... represented an odd twist on the older debates ...

  15. 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...

  16. 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...

  17. Patient satisfaction constructs.

    Science.gov (United States)

    Rahman, Muhammad Sabbir; Osmangani, Aahad M

    2015-01-01

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

  18. 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...

  19. 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...

  20. Leadership for patient care.

    Science.gov (United States)

    Nackel, J G; Shelley, S R

    1991-01-01

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

  1. UAVs and Patient Movement

    Science.gov (United States)

    2016-04-01

    to mitigate hemorrhage, to optimize airway management , and to reduce the time interval between the point of injury and surgical intervention.72...depth look at the evolution of patient movement and the utilization of advanced technologies from to ultimately decrease the time to care. Future...with its employment for Class VII resupply (i.e., blood) and easily evolves toward full scale patient movement using advanced remote tele-monitoring

  2. The patient's perspective

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Backer, Vibeke; Søes-Petersen, Ulrik

    2006-01-01

    Adherence with controller therapy poses a major challenge to the effective management of persistent asthma. The aim of this study was to explore the patient-related aspects of adherence among adult asthmatics.......Adherence with controller therapy poses a major challenge to the effective management of persistent asthma. The aim of this study was to explore the patient-related aspects of adherence among adult asthmatics....

  3. Medical Services: Patient Administration

    Science.gov (United States)

    2007-11-02

    Family planning services a. Family planning services (for example, counseling, prescription of oral contraceptive pills , and prescription of other methods...of contraception ) may be furnished to eligible persons requesting such care at Army MTFs. They will be provided to the extent that professional...table 2–2, table 2–3 Comfort items for patients, 4–3 Commercial transportation or travel, 2–6, 9–9 Consent by nonmilitary patient, 2–12 Contraception , 2

  4. Keeping the patient happy.

    Science.gov (United States)

    Bomar, F

    1992-01-01

    Customer service is the catch word for the 90s and hospitals are constantly looking for ways to make their customer--the patient--happier. In a section of the country where fried chicken, grits and gravy are home-cooking staples, an unlikely marriage between Southern hospitals and a European food preparation process may be the key to many hospitals' ability to cater to the patient by offering gourmet meals on a regular basis.

  5. The effect of patient qualifications and number of patient accompanist on patient's satisfaction

    OpenAIRE

    Korkmaz, Tanzer; Balaban, Burcin; Onder, Husnu; Saricil, Fusun

    2016-01-01

    Objectives Patient satisfaction surveys are important information sources for the evaluation of the quality and continuity of medical care. In this study, it is aimed to investigate the impact of patient's qualifications and the number of patient accompanists on the patient satisfaction and to find out whether there is a relationship between the number of patient accompanist and discharge status of patient. Methods All patients over 18 years old who have applied to emergency department within...

  6. Tuberculosis in HIV Patient

    Directory of Open Access Journals (Sweden)

    Bidhan Nidhi Paudel

    2013-09-01

    Full Text Available Introduction: Strict monitoring of anti tuberculosis therapy (ATT and antiretroviral therapy (ART is crucial for proper management of TB/HIV co-infected patients. Methods: Between December 2006 and December 2008 a prospective observational study was conducted among 135 TB/HIV co-infected patients visiting antiretroviral therapy in Seti Zonal Hospital, Dhangadi. The diagnosed TB patients were subjected to ATT through directly observed treatment short-course (DOTS and its response was evaluated as per WHO guidelines. Results: Among 135 studied subjects, 71.9% were males and over 88 % of the patients were in the age group 21 to 50. Of the Total TB cases 68.1% presented pulmonary TB (PTB and 37.20% of the Extra-pulmonary Tuberculosis (EPTB cases were lymph node TB. 75.5% of them had completed ATT, 8.2% transfer out and 12.6% were default. Conclusions: Majority of the patients presented PTB, and lymph node TB was found to be the most common EPTB. Comparatively, high efficacy of ATT was found in HIV patients visiting this resource poor setting. Key words: antiretroviral therapy; anti TB therapy; Dhangadi; lymph node T; treatment response.

  7. [Nutrition and cancer patients].

    Science.gov (United States)

    Katsuramaki, T; Hirata, K; Isobe, M

    1998-03-01

    Nutritional therapy for cancer patients includes various objectives such as improvement of cachexia, elucidation of the mechanism of malnutrition, development of therapy for anorexia, nutrition support during chemotherapy or radiotherapy, and inhibition of tumor growth under controlled caloric intake. This review describes recent remarkable developments in nutritional therapy for cancer patients. Cytokines such as interleukin (IL)-1, IL-6, and tumor necrosis factor which induce proteolysis and lipolysis are involved in the cause of malnutrition and cachexia in cancer patients. IL-1 also plays a significant role in the development of cancer anorexia via direct action in the brain. For anorexia therapy, progestogens have been shown to improve appetite and food intake in cancer patients. Moreover, glutamine supplementation improves the host protein metabolism without enhancement of tumor growth during chemotherapy. Among the effects of caloric intake on anticancer therapy, AO-90, a methionine-free intravenous amino acid solution, has been shown to increase the antitumor effect of 5-fluorouracil in clinical studies. From these observations, recent progress in nutritional therapy for cancer patients has been remarkable. Further study of nutritional therapy is required in order to maintain or improve the quality of life of cancer patients in the future.

  8. Evaluation of Patient Satisfaction

    Directory of Open Access Journals (Sweden)

    Ioana GĂDĂLEAN

    2011-12-01

    Full Text Available Introduction: Patient satisfaction is an element of psychological health which influence the results of the medical care and their impact. Patient experience can be quantified from their questioning or direct observation. Objectives: The purpose of this paper is to analyze and evaluate the satisfaction of nursing activities closely related to the patients admitted in ICU ward Institute of Oncology Prof. Dr. Ion Chiricuţă Cluj-Napoca. Materials and Methods: This paper describes a prospective study conducted on a sample of 106 patients hospitalized in the intensive care unit of the Institute of Oncology Prof. Dr. Ion Chiricuţă Cluj-Napoca in June 2011 - August 2011. The results were obtained using descriptive and analytical statistical technique of SPSS software. To detect relationships / associations between qualitative variables the Chi-Square test was used (statistically significant association if p ≤ 0.05. Patients received an anonymous questionnaire applied at 24 hours after discharge from the IT department so that the responses would be most sincerely. Results: Patients selected only two degrees of satisfaction, 53.8% very satisfied, respectively 46.2% satisfied. Dissatisfaction factors that may affect satisfaction were communication, accommodation facilities, factors arising from the lack of personal, pain and lack of sleep. Conclusions: Satisfaction “score” is influenced by education level and diagnosis. Resumption of the questionnaire is required periodically to assess the results of our section. It is also necessary to continue to compare results with other departments in the country.

  9. 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.

  10. Callosal agenesis followed postnatally after prenatal diagnosis.

    Science.gov (United States)

    Imataka, George; Nakagawa, Eiji; Kuwashima, Shigeko; Watanabe, Hiroshi; Yamanouchi, Hideo; Arisaka, Osamu

    2006-09-01

    Callosal agenesis is a congenital brain anomaly caused by embryonal hypogenesis of the corpus callosum. Concerning the neurological prognosis, epilepsy and motor disturbance are noted in some cases, while many cases are asymptomatic and the prognosis is good. We report a fetus tentatively diagnosed with hydrocephaly on prenatal echo-encephalography, which was performed without adequate explanation to and understanding of the parents. The parents had not expected an abnormality before the screening, and were subsequently not psychologically prepared for the discovery of the congenital brain anomaly on imaging. Moreover, they received no guidance on how to deal with any possible abnormalities. The pregnant mother was referred to our hospital. Prenatal MRI was performed after informed consent was obtained, and the fetus was diagnosed with callosal agenesis. The patient was followed for 5 years, and neurological development was normal. However, the parents have remained anxious while raising the child. Thus, the prenatal diagnosis of callosal agenesis in this case caused unnecessary mental burden to the parents. Here, we report the course of the case, and discuss the way prenatal ultrasonography should be used as a prenatal screening method, and the importance of counseling before the test.

  11. Prenatal Diagnosis

    Directory of Open Access Journals (Sweden)

    Ozge Ozalp Yuregir

    2012-02-01

    Full Text Available Prenatal diagnosis is the process of determining the health or disease status of the fetus or embryo before birth. The purpose is early detection of diseases and early intervention when required. Prenatal genetic tests comprise of cytogenetic (chromosome assessment and molecular (DNA mutation analysis tests. Prenatal testing enables the early diagnosis of many diseases in risky pregnancies. Furthermore, in the event of a disease, diagnosing prenatally will facilitate the planning of necessary precautions and treatments, both before and after birth. Upon prenatal diagnosis of some diseases, termination of the pregnancy could be possible according to the family's wishes and within the legal frameworks. [Archives Medical Review Journal 2012; 21(1.000: 80-94

  12. [Urosepsis in Geriatric Patients].

    Science.gov (United States)

    Heppner, H J; Yapan, F; Wiedemann, A

    2016-02-01

    Due to the demographic shift, increasing numbers of geriatric patients are admitted to acute care hospitals of all levels of care. This means that special challenges must be met in the medical care and management of these patients.Immunosenescence and multimorbidity make elderly patients vulnerable to infectious diseases. Urinary tract infections range from "simple" cystitis to pyelonephritis and urosepsis and, at 25%, are the second most common form of infection in geriatric patients. It is often difficult to make a diagnosis because typical symptoms do not always occur. Urosepsis, a hyperactive and uncontrolled immune response of the organism due to exogenous damage, is based on bacterial infection of the urogenital tract. Urinary retention, immunosuppressive medication, malignancy, diabetes mellitus and renal or prostatic processes promote the risk for urosepsis. Complicated urosepsis additionally comprises a structural or functional abnormality, including ureteral obstruction. Risk factors for urosepsis are urinary incontinence, an indwelling urinary catheter, hydronephrosis or ureteral calculi. Patients suffering from diabetes mellitus are also at a higher risk for urosepsis. When diagnosing elderly patients, one has to consider that the classic symptoms can be masked by multimorbidity, or septic encephalopathy and acute confusion (delirium) may be the only symptoms. Body temperature is lower in elderly patients and does not necessarily rise to 38°C or more in the acute phase. In patients older than 75 years who are suspicious for sepsis, temperatures as low as 37.4°C should be rated as fever. Treatment of urosepsis basically includes clearing the focus, antimicrobial treatment, stabilisation of circulation and replacement of failed organ functions. Initial empiric antibiotic treatment, depending on local resistance, should be done with acylaminopenicilline and beta-lactamase inhibitors (e. g. piperacillin/combactam or tazobactam or group 3 cephalosporins

  13. Pain in patients with cancer

    NARCIS (Netherlands)

    Vissers, K.C.P.; Besse, K.; Wagemans, M.; Zuurmond, W.; Giezeman, M.J.; Lataster, A.; Mekhail, N.; Burton, A.W.; Kleef, M. van; Huygen, F.

    2011-01-01

    Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate

  14. Preventing Infections in Cancer Patients

    Science.gov (United States)

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

  15. Den digitale patient

    DEFF Research Database (Denmark)

    Dahl, Mads Ronald; birkler, jacob

    Den digitale patient tager afsæt i en ny verden: Patienten er blevet digitaliseret! Men hvem og hvad er den digitale patient, og hvornår og hvordan bliver den enkelte borger til en digital patient? Bogen indkredser patientens nye digitale identitet, som kan skabe grobund for en fælles forståelse og...... tværfagligt samarbejde mellem forskellige faggrupper. Bogens målgruppe er alle, som arbejder professionelt med sundhed og sundhedsvæsenet i Danmark. Det gælder på grunduddannelsesniveau, i forhold til efter- og videreuddannelse samt i klinisk praksis og blandt praktikere. Den digitale patient er skrevet ud...... fra et patientperspektiv, og ideen er at synliggørelse de mange udfordringer og konsekvenser, sundhedsinformatikken er svanger med. Bogen beskriver ikke blot den digitale patients fremtid, men fokuserer især på en række forhold og forbehold, der bør medtænkes, når nye elektroniske kommunikationsveje...

  16. The "Permanent" Patient Problem.

    Science.gov (United States)

    Bruce, Courtenay R; Majumder, Mary A

    2014-01-01

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

  17. Participating in patient education

    DEFF Research Database (Denmark)

    Kristiansen, Tine Mechlenborg; Antoft, Rasmus

    2015-01-01

    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...... 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....... Related to both status passages we analyse how the central properties of status passage are at play and how they are shaped by the social interactions among the different agents: participants, lay experts and health professionals. We discuss how the theory of status passage might further enrich empirical...

  18. 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...... medical treatment on the basis of their belief in Divine intervention. On the other hand, faith in miracles forms an important part of a well-integrated religiosity by inspiring hope and so helping patients to find meaning and initiative in situations in which they might otherwise be tempted to give up....... Against the backdrop of such considerations, the chapter provides recommendations for health professionals and relatives as how to handle patient belief in miracles in practice....

  19. [Toxoplasmosis in immunocompromised patients].

    Science.gov (United States)

    Machala, L; Kodym, P; Malý, M; Geleneky, M; Beran, O; Jilich, D

    2015-06-01

    In humans, toxoplasmosis mostly occurs as a latent infection, but in immunocompromised individuals, the agent may reactivate and cause severe to life-threatening disease. HIV positive individuals and transplant recipients, in particular hematopoietic stem cell transplant and heart transplant recipients, are at highest risk. The disease most often affects the central nervous system but can involve any organ. Because of the alteration of the immune response in these patients, the serodiagnosis is not reliable and direct detection of the causative agent is needed--namely by microscopy and DNA PCR. If inadequately treated or left untreated, toxoplasmosis generally has a fatal prognosis in immunocompromised patients and therefore, the treatment must be started as early and energetically as possible. The gold standard both in the treatment of reactivation and secondary prophylaxis is the pyrimethamine-sulfadiazine combination while co-trimoxazole can be used in the primary prophylaxis for high-risk patients.

  20. IMPROVING PATIENT SAFETY:

    DEFF Research Database (Denmark)

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

    2013-01-01

    , 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......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...... it possible for the students to train and test their knowledge and understanding independent of time and place. Data accumulated from the e-learning program will be used to further develop digital learning initiatives....

  1. 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.

  2. The elderly patients' dignity

    DEFF Research Database (Denmark)

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

    2007-01-01

    This study shows how care providers in hospital practice perceive the elderly patient's dignity as a core value in health promoting care towards the elderly. Fifteen focus group interviews were conducted with care providers who told about their nursing practice experience. The interviews were...... analysed using a phenomenological hermeneutical approach. The results disclose that when caring for the elderly patient's health potential, care providers saw dignity as the core value of health. Dignity was found to capture three themes: autonomy, identity, and worthiness. These themes reflect...... 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...

  3. 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 applicationʹs impact on the patientʹs 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.

  4. 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...... medical treatment on the basis of their belief in Divine intervention. On the other hand, faith in miracles forms an important part of a well-integrated religiosity by inspiring hope and so helping patients to find meaning and initiative in situations in which they might otherwise be tempted to give up....... Against the backdrop of such considerations, the chapter provides recommendations for health professionals and relatives as how to handle patient belief in miracles in practice....

  5. Participating in patient education

    DEFF Research Database (Denmark)

    Kristiansen, Tine Mechlenborg; Antoft, Rasmus

    2015-01-01

    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...... promoting initiative. It is set up to regularize and help people manage the status passage from being a normal person to becoming a person living with chronic illness and to support them in accepting and learning to live with this identity transition. The theory of status passage and the concept of turning...... 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...

  6. Limitations of Aneuploidy and Anomaly Detection in the Obese Patient

    Directory of Open Access Journals (Sweden)

    Paula Zozzaro-Smith

    2014-07-01

    Full Text Available Obesity is a worldwide epidemic and can have a profound effect on pregnancy risks. Obese patients tend to be older and are at increased risk for structural fetal anomalies and aneuploidy, making screening options critically important for these women. Failure rates for first-trimester nuchal translucency (NT screening increase with obesity, while the ability to detect soft-markers declines, limiting ultrasound-based screening options. Obesity also decreases the chances of completing the anatomy survey and increases the residual risk of undetected anomalies. Additionally, non-invasive prenatal testing (NIPT is less likely to provide an informative result in obese patients. Understanding the limitations and diagnostic accuracy of aneuploidy and anomaly screening in obese patients can help guide clinicians in counseling patients on the screening options.

  7. [Anesthesia for ambulatory patients].

    Science.gov (United States)

    Landauer, B

    1975-11-13

    The specific problems of outpatient anesthesia are discussed with respect to the patient's condition, the anesthesist's qualification and pharmacological properties of anesthetics used. Methohexitone seems to be the best choice for induction. Problems may arise from the use of Propanidid, Ketamin and Diazepam. Nitrousoxide and Enflurane are a suitable completion. Endotracheal intubation, if needed, is facilitated by Suxamethonium, which is rapidly eliminated. Practical aspects of timing, premedication, induction, maintenance and ending of anesthesia are pointed out. After 1-2 hours the patient can be allowed to leave the hospital accompanied by a responsible person. Driving a car is not recommended before 24 hours have elapsed since anesthesia.

  8. [Patients and the Web].

    Science.gov (United States)

    Cluzeau, T; Mounier, N

    2010-10-01

    In recent years, Internet has become an indispensable tool for all types of information. Its importance has increased in medicine and particularly in human malignancies. The data issued by the Internet are many and varied sources ranging from official websites to patient's blogs. HIV infection is an infection highly publicized in recent years, we take the case of Hodgkin's disease associated with HIV to compare data from the Internet and scientific articles. The information from the Internet is mostly good but not updated and erroneous data are regularly found. This confirms that the consultation by a specialist doctor referral should remain the main source of information for the patient.

  9. Practical Patient Safety

    CERN Document Server

    Reynard, John; Stevenson, Peter

    2009-01-01

    Following recent high profile cases of surgical error in the UK and USA, patient safety has become a key issue in healthcare, now placed at heart of junior doctor's training. Errors made by doctors are very similar to those made in other high risk organisations, such as aviation, nuclear and petrochemical industries. Practical Patient Safety aims to demonstrate how core principles of safety from these industries can be applied in surgical and medical practice, in particular throughtraining for health care professionals and healthcare managers.Whilst theoretical aspects of risk management form

  10. Do patients initiate therapy?

    DEFF Research Database (Denmark)

    Thengilsdóttir, G; Pottegård, Anton; Linnet, K

    2015-01-01

    their prescription dispensed within a year from issuing (primary non-adherent) was assessed, as well as the time from issue until dispensing. Associations between demographic factors and primary non-adherence were estimated using logistic regression. RESULTS: The overall primary non-adherence was 6.3% and 8...... when a prescription is issued until it is dispensed. METHODS: Data on patients receiving a new prescription for a statin or an antidepressant from the Primary Health Care database were linked with dispensing histories from The Icelandic Prescription Database. The proportion of patients who did not have...

  11. Sarcopenia in Cancer Patients.

    Science.gov (United States)

    Chindapasirt, Jarin

    2015-01-01

    Sarcopenia, characterized by a decline of skeletal muscle plus low muscle strength and/or physical performance, has emerged to be an important prognostic factor for advanced cancer patients. It is associated with poor performance status, toxicity from chemotherapy, and shorter time of tumor control. There is limited data about sarcopenia in cancer patients and associated factors. Moreover, the knowledge about the changes of muscle mass during chemotherapy and its impact to response and toxicity to chemotherapy is still lacking. This review aimed to provide understanding about sarcopenia and to emphasize its importance to cancer treatment.

  12. Control Prenatal

    National Research Council Canada - National Science Library

    P. Susana Aguilera, DRA; M.D. Peter Soothill, MR

    2014-01-01

    Los principales objetivos del control prenatal son identificar aquellos pacientes de mayor riesgo, con el fin de realizar intervenciones en forma oportuna que permitan prevenir dichos riesgos y así...

  13. Patient Participation: Current Knowledge and Applicability to Patient Safety

    OpenAIRE

    Longtin, Yves; Sax, Hugo; Leape, Lucian L; Sheridan, Susan E.; Donaldson, Liam; Pittet, Didier

    2010-01-01

    Patient participation is increasingly recognized as a key component in the redesign of health care processes and is advocated as a means to improve patient safety. The concept has been successfully applied to various areas of patient care, such as decision making and the management of chronic diseases. We review the origins of patient participation, discuss the published evidence on its efficacy, and summarize the factors influencing its implementation. Patient-related factors, such as accept...

  14. Comparable low-level mosaicism in affected and non affected tissue of a complex CDH patient

    NARCIS (Netherlands)

    D.C.M. Veenma (Danielle); L.W.J.E. Beurkens (Leonardus); H. Douben (Hannie); H.J.F.M.M. Eussen (Bert); P. Noomen (Petra); L.C. Govaerts (Lutgarde); E.W.M. Grijseels (Els); M. Leguin (Maarten); R.R. de Krijger (Ronald); D. Tibboel (Dick); J.E.M.M. de Klein (Annelies); A.R.M. van Opstal (Diane)

    2010-01-01

    textabstractIn this paper we present the detailed clinical and cytogenetic analysis of a prenatally detected complex Congenital Diaphragmatic Hernia (CDH) patient with a mosaic unbalanced translocation (5;12). High-resolution whole genome SNP array confirmed a low-level mosaicism (20%) in uncultured

  15. 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...

  16. Fra Person til Patient

    DEFF Research Database (Denmark)

    Worsøe, Line Brink; Tordsson, Emma Mathilde

    2008-01-01

    I efteråret 2007 gennemførte forfatterne af denne artikel en undersøgelse af fertilitetspatienters kommunikation på nettet. Undersøgelsen var en del af kandidatspecialet i Sprogpsykologi "Fra Person til Patient - en narrativ undersøgelse af fertilitetspatienters kommunikation". Sigtet med special...

  17. [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.

  18. Patient Telmonitoring at Home

    Science.gov (United States)

    2007-11-02

    dealing with cardiovascular variables . This is the case, as we have already pointed out, of diabetic patients during periods of dialysis. Another...1999. [2] J.P. Silva Cunha, M. Baptista, A. Ribeiro and A. Sousa Pereira. “Telecardio: especificação técnica e funcional do demonstrador de

  19. 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...

  20. Patient management in dermoscopy

    Directory of Open Access Journals (Sweden)

    Işıl Kılınç Karaarslan

    2014-03-01

    Full Text Available Considering the work load in daily practice, it’s necessary to establish a cost-effective approach in the dermoscopic evaluation for early diagnose of melanoma, which is the primary goal of dermoscopy. In this article, the basic characteristics of “patient management strategy in dermoscopy”, which are necessary for such an approach, are discussed.

  1. Patient's Bill of Rights

    Science.gov (United States)

    ... in medical writing. Along with the American Cancer Society, other sources of information and support include: US Department of Health and Human Services Website: www.healthcare.gov/how-does-the-health-care-law-protect-me This site explains patient rights with ...

  2. 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...

  3. The first report of Japanese patients with asparagine synthetase deficiency.

    Science.gov (United States)

    Yamamoto, Takahiro; Endo, Wakaba; Ohnishi, Hidenori; Kubota, Kazuo; Kawamoto, Norio; Inui, Takehiko; Imamura, Atsushi; Takanashi, Jun-Ichi; Shiina, Masaaki; Saitsu, Hirotomo; Ogata, Kazuhiro; Matsumoto, Naomichi; Haginoya, Kazuhiro; Fukao, Toshiyuki

    2017-03-01

    Asparagine synthetase (ASNS) deficiency was recently discovered as a metabolic disorder of non-essential amino acids, and presents as severe progressive microcephaly, intellectual disorder, dyskinetic quadriplegia, and intractable seizures. Two Japanese children with progressive microcephaly born to unrelated patients were analyzed by whole exome sequencing and novel ASNS mutations were identified. The effects of the ASNS mutations were analyzed by structural evaluation and in silico predictions. We describe the first known Japanese patients with ASNS deficiency. Their clinical manifestations were very similar to reported cases of ASNS deficiency. Progressive microcephaly was noted during the prenatal period in patient 1 but only after birth in patient 2. Both patients had novel ASNS mutations: patient 1 had p.L145S transmitted from his mother and p.L247W which was absent from his mother, while patient 2 carried p.V489D and p.W541Cfs*5, which were transmitted from his mother and father, respectively. Three of the four mutations were predicted to affect protein folding, and in silico analyses suggested that they would be pathogenic. We report the first two Japanese patients with ASNS deficiency. Disease severity appears to vary among patients, as is the case for other non-essential amino acid metabolic disorders. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  4. 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....

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

    Science.gov (United States)

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

    1996-01-01

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

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

    Science.gov (United States)

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

    2016-07-01

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

  7. Trauma patients: I can't get no (patient) satisfaction?

    Science.gov (United States)

    Bentley-Kumar, Karalyn; Jackson, Theresa; Holland, Danny; LeBlanc, Brian; Agrawal, Vaidehi; Truitt, Michael S

    2016-12-01

    The Centers for Medicare and Medicaid Services (CMS) provides financial incentives to hospitals based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey. This data is made publicly available on their website to be utilized by patients and insurers. Hospitals are profoundly interested in identifying patient populations that negatively contribute to overall patient satisfaction scores. Hospitals consider trauma patients "high risk" from a HCAHPS perspective, but there is no data to inform this opinion. The purpose of this study is to evaluate trauma patient satisfaction scores and their impact on overall patient satisfaction. Three different analyses were performed. Group 1 was composed of ALL patients admitted to our hospital over a 7-month period who were administered a validated patient satisfaction survey by a 3rd party and compared patient satisfaction of trauma vs. non-trauma patients (ALL). Group 2 compared admitted patients with a specific ICD-9 procedure code to non-trauma patients who underwent a procedure with the same ICD-9 code (ICD). Group 3 examines patient satisfaction between three Level I Trauma Centers within our geographic area (TC). Patient satisfaction data of trauma vs non-trauma patients (ALL), those with a specific ICD-9 procedure code (ICD), and the 3 Level I Trauma Centers in our area (TC) were analyzed with the appropriate statistical test. In the ALL group, no difference in satisfaction was noted in 18/21 questions for trauma patients when compared to non-trauma patients at our hospital. In the ICD group, 57 ICD-9 procedure codes were analyzed. Of these, only patients who required spinal fusion secondary to trauma reported lower overall patient satisfaction. No meaningful difference was found in HCAHPS associated satisfaction between the Level I Trauma Centers in our area (TC). In contrast to commonly held opinion, trauma patients do not negatively contribute to overall patient

  8. "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 observations...... and semistructured interviews and analyzed according to the guidelines for meaning condensation by Giorgi. The imaging staff found that care is expressed in an administrative, an instrumental, and a compassionate sense. The imaging staff perceived care in a way that clearly differs from the traditional perception...... of care understood as the close relations between people. In their self-understanding, the staff found that care not only comprised the relational aspect but also that it was already delivered during the preparatory phases before the actual meeting with the patient and up until the image...

  9. Handover of patients

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...... 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....... 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...

  10. Visualising patient flow.

    Science.gov (United States)

    Jensen, Andrew; Boyle, Justin; Khanna, Sankalp

    2012-01-01

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

  11. [Postoperative patient. Treatment plan].

    Science.gov (United States)

    López Medina, I M; Sánchez Criado, V

    2001-03-01

    In order to prevent problems and complications which patients who have undergone surgery tend to suffer, it is fundamental to utilize a generic standardized treatment plan due to the preventive dimension which nursing care may then acquire. So that this treatment plan provide greater effectiveness, it should include standardized nursing interventions such as those listed in the Classification of Nursing Interventions since by this method, a common terminology is built up among professionals which provides continuity to treatment and facilitates the selection of adequate interventions for each situation. This report establishes the most frequent nursing diagnoses among post-surgical patients and adapts these to the nursing treatments in the Classification of Nursing Interventions.

  12. "Patient care in radiology"

    DEFF Research Database (Denmark)

    Bro Brask, Kirsten; Birkelund, Regner

    2014-01-01

    and semistructured interviews and analyzed according to the guidelines for meaning condensation by Giorgi. The imaging staff found that care is expressed in an administrative, an instrumental, and a compassionate sense. The imaging staff perceived care in a way that clearly differs from the traditional perception...... of care understood as the close relations between people. In their self-understanding, the staff found that care not only comprised the relational aspect but also that it was already delivered during the preparatory phases before the actual meeting with the patient and up until the image...... was electronically forwarded. And, care expressed in between was perceived as care in the traditional sense and termed as “patient care in radiology.”...

  13. Communicating with Latino patients.

    Science.gov (United States)

    de Pheils, Pilar Bernal; Saul, Naledi Marie

    2009-09-01

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

  14. 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.

  15. Mucormycosis in immunochallenged patients.

    Science.gov (United States)

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

    2008-07-01

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

  16. 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

  17. Thromboprophylaxis with dalteparin in medical patients: which patients benefit?

    Science.gov (United States)

    Cohen, Alexander T; Turpie, Alexander G G; Leizorovicz, Alain; Olsson, Carl-Gustav; Vaitkus, Paul T; Goldhaber, Samuel Z

    2007-05-01

    It is unclear whether thromboprophylaxis produces a consistent risk reduction in different subgroups of medical patients at risk from venous thromboembolism. We performed a retrospective, post hoc analysis of 3706 patients enrolled in the PREVENT study. Patients were at least 40 years old with an acute medical condition requiring hospitalization for at least 4 days and had no more than 3 days of immobilization prior to enrolment. Patients received either subcutaneous dalteparin (5000 IU) or placebo once daily. The primary end point was the composite of symptomatic deep vein thrombosis (DVT), pulmonary embolism, asymptomatic proximal DVT, or sudden death. Primary diagnosis subgroups were acute congestive heart failure, acute respiratory failure, infectious disease, rheumatological disorders, or inflammatory bowel disease. All patients, except those with congestive heart or respiratory failure, had at least one additional risk factor for venous thromboembolism. A risk reduction was shown in patients receiving dalteparin versus placebo. The relative risk (RR) was 0.73 in patients with congestive heart failure, 0.72 for respiratory failure, 0.46 for infectious disease, and 0.97 for rheumatological disorders. The RR was 0.52 in patients aged > or = 75 years, 0.64 in obese patients, 0.34 for patients with varicose veins, and 0.71 in patients with chronic heart failure. No subgroup had a significantly different response from any other. Importantly, multivariate analysis showed that all patient groups benefited from thromboprophylaxis with dalteparin. Our findings, therefore, support the broad application of thromboprophylaxis in acutely ill hospitalized medical patients.

  18. Pain in burn patients.

    Science.gov (United States)

    Latarjet, J; Choinère, M

    1995-08-01

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

  19. Humidification for intubated patients

    Directory of Open Access Journals (Sweden)

    Fotoula Babatsikou

    2008-10-01

    Full Text Available Artificial airways bypass the physiological mechanism of humidification and filtration of the inspired air, increasing, therefore, the possibilities of copious secretions production. Copious secretions increase the danger for atelektasis and respiratory infections. Moreover, clots can be shaped in the interior of the endotracheal tube or thracheostomy, resulting in increased work of breathing (WOB and reduced odds of successful extubation. It is also possible to lead progressively to complete obstruction of the endotracheal tube.Thus, the choice of a suitable humidification device during mechanical ventilation is of distinguished importance. There are various types of humidifiers. However, hydroscopic Heat and Moisture Exchangers (HMEs with filter and Heated Humidifiers (HHs, which provide humidity in form of water vapors, are currently used. When they are used correctly, and not in the cases where they are contraindicated, HMEs’ do not have complications and they decrease the cost of hospitalization as well as the staff workload. HMEs are better choice for short duration of intubation (<96 hours and during transports. HHs are preferred for patients with persisting hypercapnia, chronic respiratory failure and difficulty in ventilator weaning. HHs should be used for patients with prolonged duration of mechanical ventilation or patients that HMEs are contraindicated for. Neither HMEs nor HHs have been accused for increased incidences of ventilator associated pneumonia (VAP.

  20. Dacryocystocele on prenatal ultrasonography: diagnosis and postnatal outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwa; Lee, Yu Jin; Song, Mi Jin; Han, Byoung Hee; Lee, Young Ho; Lee, Kyung Sang [Dept. of Radiology, Cheil General Hospital and Women' s Healthcare Center, Catholic Kwandong University College of Medicine, Seoul (Korea, Republic of)

    2015-01-15

    To report the incidence of dacryocystoceles detected by prenatal ultrasonography (US) and their postnatal outcomes and to determine the factors associated with the postnatal persistence of dacryocystoceles at birth. We retrospectively reviewed the prenatal US database at our institution for the period between January 2012 and December 2013. The medical records of women who had fetuses diagnosed with dacryocystocel larger than 5 mm were reviewed for maternal age, gestational age (GA) at detection, size and side of the dacryocystoceles, delivery, and postnatal information, such as GA at delivery, delivery mode, and gender of the neonate. A total of 49 singletons were diagnosed with a dacryocystocele on prenatal US, yielding an overall incidence of 0.43%. The incidence of dacryocystoceles was the highest at the GA of 27 weeks and decreased toward term. Of the 49 fetuses including three of undeter mined gender, 25 (54%) were female. The mean GA at first detection was 31.2 weeks. The dacryocystocele was unilateral in 29 cases, with a mean maximum diameter of 7 mm. Spontaneous resolution at birth was documented in 35 out of 46 neonates (76%), including six with prenatal resolution. Multivariate analysis demonstrated that GA at delivery was a significant predictor of the postnatal persistence of dacryocystoceles (P=0.045). The overall incidence of prenatal dacryocystoceles was 0.43%; the incidence was higher in the early third trimester and decreased thereafter. Prenatal dacryocystoceles resolved in 76% of the patients at birth, and the GA at delivery was a significant predictor of postnatal persistence.

  1. Patient health questionnaire. Using a patient-focused assessment tool.

    OpenAIRE

    Mitchell, J. D.

    1996-01-01

    A patient health questionnaire was developed for use in family practice to help identify lifestyle risk factors, assess health care needs, and better understand patients. This article discusses the questionnaire's development and practical application.

  2. Communication with patients and colleagues

    DEFF Research Database (Denmark)

    Nørgaard, Birgitte

    2011-01-01

    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......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...

  3. Prenatal office practices regarding infant feeding choices.

    Science.gov (United States)

    Dusdieker, Lois B; Dungy, Claibourne I; Losch, Mary E

    2006-11-01

    The objective of this study was to determine the obstetric care providers' roles in breast-feeding promotion during prenatal care. A questionnaire addressing breast-feeding issues was sent to family practitioners (FP), obstetric-gynecologists (OB/GYN), and nurse midwives (NM) in Iowa, USA. All NM, 97% of FP, and 85% of OB/GYN reported asking infant feeding preference-usually only at the first prenatal visit. NM (73%) were most likely to provide extensive breast-feeding counseling. OB/GYN (68%) and FP physicians (90%) reported doing their own breast-feeding counseling. Breast examinations targeting future breast-feeding problems were done in 82% to 84% of patients. NM practices shared more information supportive of breast-feeding. Nearly all providers offered prenatal classes, but only 41% of FP offered breast-feeding classes. Free formula samples were available in 73% of FP, 54% of OB/GYN, and 36% NM offices. Pamphlets on formula feeding and also breast-feeding were readily available. Overall NM (64%) reported being strong breast-feeding advocates compared to only 13% of FP and 7% of OB/GYN. In conclusion, little promotion of breast-feeding occurs in most prenatal practice settings.

  4. 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

  5. Physician-Patient Communication and Patient Compliance: A Theoretical Orientation.

    Science.gov (United States)

    Clampitt, Phillip G.; Williams, M. Lee

    This paper synthesizes much of the literature concerning physician/patient communication as it relates to patient compliance. Using the theoretical perspective that deals with belief, attitude, intention, and behavior (a perspective generated by Martin Fishbein and Icek Ajzen), a new theoretical orientation for predicting patient compliance is…

  6. Patient delay in patients with ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, Christel Ga; Laut, Kristina G; Jensen, Lisette O

    2016-01-01

    BACKGROUND AND AIMS: To improve treatment success of ST-elevation myocardial infarction, a minimal delay from symptom onset to reperfusion therapy is crucial. The patient's response to initial symptoms (patient delay) substantially affects the delay. We investigated time patterns of patient delay...

  7. Advantages of the Quadruple Screen over noninvasive prenatal testing.

    Science.gov (United States)

    Keller, Nathan A; Rijshinghani, Asha

    2016-03-01

    Noninvasive prenatal testing (NIPT) is becoming increasingly popular with some offering it as a primary screen option in all patients in place of serum screening. Serum screening offers insight into placental function, which NIPT does not. Abnormal levels of analytes in the serum screen have been associated with pregnancy complications.

  8. [Morquio A disease: clinical and molecular study of Tunisian patients].

    Science.gov (United States)

    Khedhiri, Souhir; Chkioua, Latifa; Ferchichi, Salima; Miled, Abdelhedi; Laradi, Sandrine

    2011-01-01

    Type IVA mucopolysaccharidosis or Morquio A disease is a lysosomal storage disease, autosomal recessive, caused by deficiency of the N-acetylgalactosamine-6-sulfate sulfatase or GALNS. The severe phenotype is characterized by a severe skeletal dysplasia without any mental retardation. The aim of this study was to propose a strategy of molecular and prenatal diagnosis of this pathology. A molecular study was carried out on 7 patients MPS IVA issued from 5 unrelated families recruited from different Tunisian regions. All the patients were offspring of consanguineous marriages. The clinical and biologic study confirmed the diagnosis of MPS IVA within the 7 studied patients. Three GALNS mutations were identified by molecular analysis: IVS1+1G>A, G66R and A85T. The unions between Tunisian relatives are important and increase the Morquio A incidence in Tunisia. The identification of GALNS mutations in the Tunisian population permits better understanding of the Morquio A phenotype, a reliable genetic counselling and a molecular prenatal diagnosis to Tunisian at-risk relatives.

  9. Vancomycin dosing in neutropenic patients

    NARCIS (Netherlands)

    M.B. Haeseker (Michiel); S. Croes (Ser); C. Neef (Cees); C.A. Bruggeman (Cathrien); L. Stolk (Lisette); A. Verbon (Annelies)

    2014-01-01

    textabstractBackground: To compare vancomycin pharmacokinetic parameters in patients with and without neutropenia.Methods: Patients ≥18 years admitted on general wards were included. Routinely vancomycin trough and peak plasma concentrations were measured with a fluorescence polarization immunoassay

  10. Bathing a patient in bed

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000427.htm Bathing a patient in bed To use the sharing features on this page, please enable JavaScript. Some patients cannot safely leave their beds to bathe. For ...

  11. 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 ...

  12. Semi-customizing patient surveys

    DEFF Research Database (Denmark)

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

    2011-01-01

    . Eight public hospitals in a Danish county. Participants. 32 809 inpatients and 1842 nurses on 84 wards. Main Outcome Measure. Optimal organizational level for measuring patient satisfaction and correlations between overall patient satisfaction and organizational context. Results. In all, 71...

  13. PATIENTS — THE CLINICAL IMPLICATIONS

    African Journals Online (AJOL)

    bin (HbA,¢) levels of diabetes mellitus patients as an index of glycaetnlc control. ... diabetic patients, attending a Diabetic Clinic at the Komfo Anokye Teaching ..... complications like nephropathy and retinopathy. ... technology and knowledge.

  14. Podcasting: contemporary patient education.

    Science.gov (United States)

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

    2008-04-01

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

  15. Polypharmacy in Osteoporosis Patients

    Directory of Open Access Journals (Sweden)

    Yavuz Ali Karahan

    2015-04-01

    Full Text Available Objective: In this study, it was aimed to determine the rates of multiple drug use in the patients with osteoporosis as well as the use of drugs affecting bone metabolism and balance. Materials and Methods: We included outpatients from Physical Medicine and Rehabilitation Policlinics diagnosed with primary or secondary osteoporosis between January 2014 and May 2014. Written consent of the participants was obtained. Data of the first 1000 patients who agreed to participate in the study were evaluated. Data regarding age, history, drugs currently being used and newly initiated were recorded. The drugs that affect bone metabolism were determined. The drugs that heva side effects including dizziness, somnolence, distractibility, decrease in the visual acuity, orthostatic hypotension and ototoxicity and were recorded because these can cause a balance disorder. Results: In this study, 64% of the participants were on five or more drugs. The most commonly used drugs were analgesics (65.4%, antihypertensives (52.6%, and drugs for digestive system (37.3%. We found that 65.5% of the participants were using drugs that may have side effects on bone metabolism and 93.7% were using drugs that may have side effects on balance. Conclusion: Multi-drug use and drug interactions should be considered during the treatment of osteoporosis and the drugs used should be recorded. Drugs that affect bone metabolism should only be used over the short term. Also, patients should be informed about side effects that might affect visuality, somatosensorial system and vestibular system and their daily activities should be regulated. (Turkish Journal of Osteoporosis 2015;21: 5-9

  16. Leptospirosis in elderly patients.

    Science.gov (United States)

    Gancheva, Galya Ivanova

    2013-01-01

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

  17. Leptospirosis in elderly patients

    Directory of Open Access Journals (Sweden)

    Galya Ivanova Gancheva

    2013-10-01

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

  18. 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...

  19. Sepsis in frail patient

    Directory of Open Access Journals (Sweden)

    Andrea Beltrame

    2016-12-01

    Full Text Available Frailty is defined as a clinical syndrome in which three or more of the following criteria are present: unintentional weight loss, self-reported exhaustion, weakness (grip strength, slow walking speed and low physical activity. Sepsis is defined as an inflammatory response to infection, with severe sepsis and septic shock being the most severe forms. The incidence of severe sepsis increases with older age and several studies have shown that there are many risk factors that predispose the elderly to a higher incidence of sepsis. Pre-existing co-morbidities such as cancer, diabetes, obesity, human immunodeficiency virus, and renal or pulmonary disease can cause sepsis, but other factors including poor lifestyle habits (i.e., smoking, drug or alcohol abuse, malnutrition, and endocrine deficiencies, which are frequent in the elderly, may also predispose to severe infections. Other risk factors for sepsis include recurrent hospitalization, especially in the Intensive Care Unit, and nursing home residence, where interventions such as urinary catheterization or multiple drug use are quite frequent and many studies reported that people above 65 years of age are three times more likely to be admitted to hospital than those aged 16-64 years, and have a higher risk of prolonged hospital stays, institutionalization and death. Clinical evaluation of the frail patient with sepsis poses some challenges. The immune response becomes progressively less efficient with increasing age thereby causing an altered response to infection and it is important to know that the clinical evaluation of the so-called fragile patient with severe infection should take into account the sometimes unusual signs and symptoms that, if identified, can lead to early diagnosis. Laboratory diagnostics can also be of great help in this setting. The treatment of sepsis in the fragile patient can be empirical or based on microbiological culture. Moreover, frail patient population presents

  20. Rehabilitation of cancer patients.

    Directory of Open Access Journals (Sweden)

    Pandey M

    2001-01-01

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

  1. Labeling of Patient Specimens

    Science.gov (United States)

    2011-01-26

    noted during the event that the actu.al number of near miss incidmts reported monthly was low due to laboratory personnel performing rounds each...specimens never leaves label and if moved it is labeled), All orders in system and all near misses and errors reported to patient safety Purchase/Install...Meeting 14 Aug 09, 1400 in lab break room thru out Develop TICK sheet to track near misses .JDI Ms. Clark Clinics will provide toPS 1st working day of

  2. Patient Safety Center Organization

    Science.gov (United States)

    2006-06-01

    Dr. Karen Horvath R3 Inguinal & Ventral Hernia Repair 2/22/06 4 hours/course (36 hours/year) Surgery R 9 Dr. Karen Horvath R4 Lap Entero...separate rooms for skills and computer-based simulators, group work areas and conferencing, and a dedicated Human Patient Anesthesia simulator (METI...2/15/06, 3/1/06, 3/15/06 (12 classes per year) 4 hours/class (288hours/year) Anesthesia R 6 students/month = 72 students

  3. Patient caries risk assessment

    DEFF Research Database (Denmark)

    Twetman, Svante; Fontana, Margherita

    2009-01-01

    Risk assessment is an essential component in the decision-making process for the correct prevention and management of dental caries. Multiple risk factors and indicators have been proposed as targets in the assessment of risk of future disease, varying sometimes based on the age group at which...... for prediction purposes, as measured until now in the literature, is at best questionable in schoolchildren, adolescents and adults. That is not to say these additional factors should not be assessed to help understand the strength of their associations with the disease experience in a particular patient......, and aid in the development of an individualized and targeted preventive and management plan....

  4. Prenatal Care.

    Science.gov (United States)

    Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Office for Maternal and Child Health Services.

    This booklet is the first in a series of publications designed to provide parents with useful information about childrearing. Contents are organized into three parts. Part I focuses on the pregnancy, prenatal care, development of the baby, pregnant lifestyles, nutrition, common discomforts, and problems of pregnancy. Part II provides information…

  5. The patient-friendly practice.

    Science.gov (United States)

    Dooley, Sharon Kay

    2006-01-01

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

  6. Gestational, perinatal and family findings of patients with Patau syndrome

    Directory of Open Access Journals (Sweden)

    Rafael Fabiano M. Rosa

    2013-12-01

    Full Text Available OBJECTIVE: To describe gestational, perinatal and family findings of patients with Patau syndrome (PS. METHODS: The study enrolled patients with PS consecutively evaluated during 38 years in a Clinical Genetics Service of a pediatric referral hospital in Southern Brazil. The clinical data and the results of cytogenetic analysis were collected from the medical records. For statistical analysis, the two-tailed Fisher's exact test and the chi-square test with Yates' correction were used, being significant p<0.05. RESULTS: The sample was composed of 27 patients, 63% were male, with a median age of nine days at the first evaluation. Full trisomy of chromosome 13 was the main cytogenetic finding (74%. Only six patients were submitted to obstetric ultrasound and none had prenatal diagnosis of PS. The patients' demographic characteristics, compared to born alive infants in the same Brazilian state showed a higher frequency of: mothers with 35 years old or more (37.5%; multiparous mothers (92.6%; vaginal delivery (77%; preterm birth (34.6%; birth weight <2500g (33.3%, and Apgar scores <7 in the 1st (75% and in the 5th minute (42.9%. About half of them (53% died during the first month of life. CONCLUSIONS: The understanding of the PS patients' gestational, perinatal and family findings has important implications, especially on the decision about the actions to be taken in relation to the management of these patients.

  7. Gestational, perinatal and family findings of patients with Patau syndrome.

    Science.gov (United States)

    Rosa, Rafael Fabiano M; Sarmento, Melina Vaz; Polli, Janaina Borges; Groff, Daniela de Paoli; Petry, Patrícia; Mattos, Vinícius Freitas de; Rosa, Rosana Cardoso M; Trevisan, Patrícia; Zen, Paulo Ricardo G

    2013-12-01

    To describe gestational, perinatal and family findings of patients with Patau syndrome (PS). The study enrolled patients with PS consecutively evaluated during 38 years in a Clinical Genetics Service of a pediatric referral hospital in Southern Brazil. The clinical data and the results of cytogenetic analysis were collected from the medical records. For statistical analysis, the two-tailed Fisher's exact test and the chi-square test with Yates' correction were used, being significant p<0.05. The sample was composed of 27 patients, 63% were male, with a median age of nine days at the first evaluation. Full trisomy of chromosome 13 was the main cytogenetic finding (74%). Only six patients were submitted to obstetric ultrasound and none had prenatal diagnosis of PS. The patients' demographic characteristics, compared to born alive infants in the same Brazilian state showed a higher frequency of: mothers with 35 years old or more (37.5%); multiparous mothers (92.6%); vaginal delivery (77%); preterm birth (34.6%); birth weight <2500g (33.3%), and Apgar scores <7 in the 1st (75%) and in the 5th minute (42.9%). About half of them (53%) died during the first month of life. The understanding of the PS patients' gestational, perinatal and family findings has important implications, especially on the decision about the actions to be taken in relation to the management of these patients.

  8. [Organizing patient education in cardiology].

    Science.gov (United States)

    Fischer, Eric; Thieffry, Eliane

    2014-02-01

    A central element of the care management of patients with heart failure, therapeutic patient education mobilises caregivers into forming a multi-disciplinary team. In this article, a hospital team shares the different stages in the construction and implementation of a programme for use with hospitalised patients and in consultations. To do this, the nurses undertook training to acquire new educational skills.

  9. Dental problems in epileptic patients.

    Science.gov (United States)

    Zioło, Anna; Mielnik-Błaszczak, Maria

    2004-01-01

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

  10. Communication with patients and colleagues

    DEFF Research Database (Denmark)

    Nørgaard, Birgitte

    2011-01-01

    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 healt...

  11. Dyspepsia in chronic psychiatric patients

    NARCIS (Netherlands)

    Mookhoek, E.J.; Meijs, V.M.M.; Loonen, A.J.M.; Leufkens, H.G.M.

    2005-01-01

    Introduction: We report on dyspeptic complaints among patients hospitalized in the long-stay ward of a general psychiatric hospital. Methods: A representative sample of the patients was interviewed using a structured questionnaire. Results: Eighty percent of the patients reported one or more symptom

  12. Sleep in obese patients

    Directory of Open Access Journals (Sweden)

    Natalya Victorova Strueva

    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.

  13. Diseases of Elderly Patient

    Directory of Open Access Journals (Sweden)

    Eulália Maria Martins da SILVA

    2007-03-01

    Full Text Available Introduction: With the population aging, the number of chronic and degenerative illnesses, own of the old age, it will appear more frequently. Objective: The objective of this study was to do a literature revision in order to approach the illnesses that more they attack the patients of the third age (from the chronic diseases even the degenerative chronic diseases. Para that, a description will be accomplished as the concept and the signs and symptoms of the illnesses observed more frequently in the senior patients that will be depression, stress, loss of the memory, aterosclerose, osteoporosis, arthritis reumatóide and disorder temporomandibular, arterial hypertension, vascular diseases, heart diseases, obesity, diabetes mellitus, urinary incontinence, hearing and visual disturbances, disease of Parkinson and still the disease of Alzheimer. Conclusion: Based on the literature revision, we ended that, not only the professionals of the health, as well as all those that work with the seniors in general, they should have the concern of treating him with larger attention, patience and perseverance, to the point of to minimize the limitations that each one presents.

  14. The Patient Who Falls

    Science.gov (United States)

    Tinetti, Mary E.; Kumar, Chandrika

    2013-01-01

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

  15. 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.

  16. Depression in geriatric patients.

    Science.gov (United States)

    Abbas Asghar-Ali, A; Braun, U K

    2009-02-01

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

  17. Prenatal Ultrasound Diagnosis of Congenital Talipes Equinovarus in Bogota (Colombia) Between 2003 and 2012.

    Science.gov (United States)

    Rosselli, Pablo; Nossa, Sergio; Huérfano, Elina; Betancur, Germán; Guzmán, Yuli; Castellanos, Cristal; Morcuende, Jose

    2015-01-01

    Congenital Talipes Equinovarus (CTEV) or clubfoot is one of the most common congenital abnormalities(1,2). Early diagnosis by means of ultrasonography allows an opportune intervention and improves the deformity's correction prognosis. To describe patients diagnosed with CTEV by means of prenatal sonographies between 2003 and 2012 in Bogotá (Colombia) at both the Institute de Ortopedia Infantil Roosevelt (IOIR) and one of the authors' private office. A descriptive, retrospective study on the focus population was made. The equality of the data of the quantitative variables in distance measure was analysed by the Kolmogorov-Smirnov test. For the variables "prenatal diagnoses" and "days from the start of the treatment" the Mann-Whitney U test was used. Finally, an analysis was made by means of the SPSS Statistics software package, version 18.0. 178 patients met the selection criteria. 34.3% of the patients had a prenatal diagnosis by ultrasonography (n=61). Regarding the number of prenatal ultrasounds performed, there were statistically significant differences between the patients with a CTEV prenatal diagnoses and those whose diagnoses came after birth, being higher in the first group (p<0.001). The number of days before the treatment started once the pre or postnatal diagnosis was done was also a subject of study. Significant differences were found in the treatment start between patients with a prenatal diagnosis (mean of 9.9 days) and those diagnosed after birth (mean of 30 days) (p<0.001). prenatal diagnosis by foetal ultrasonography contributes to an early detection of musculoskeletal abnormalities such as CTEV and promotes an early intervention of the patient.

  18. Pulmonary metastasectomy in pediatric patients.

    Science.gov (United States)

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

    2016-02-02

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

  19. 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...... patients, and consequently the disorder was underdiagnosed. Delirium in the critically ill patients is associated with increased morbidity and mortality. Less sedation, guided by protocols with daily wake up trials, and validated delirium scoring systems, have improved the opportunities to diagnose...... and monitor delirium in the critically ill patients. Udgivelsesdato: 2009-Oct-19...

  20. 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...... patients, and consequently the disorder was underdiagnosed. Delirium in the critically ill patients is associated with increased morbidity and mortality. Less sedation, guided by protocols with daily wake up trials, and validated delirium scoring systems, have improved the opportunities to diagnose...... and monitor delirium in the critically ill patients. Udgivelsesdato: 2009-Oct-19...

  1. Effective communication with the patient

    Directory of Open Access Journals (Sweden)

    R. Booker

    2005-12-01

    Full Text Available The chronic and slowly progressive nature of chronic obstructive pulmonary disease (COPD can create difficulties in effective communication between healthcare provider and patient. Such barriers, which include the personal beliefs of both caregiver and patient, need to be understood and addressed if the aims of the consultation are to be met. Patients with COPD may feel guilty, depressed and angry about their condition. Many patients with COPD are elderly and/or from lower socio-economic groups, both of which pose challenges to the caregiver, as does the stigma the disease carries, which stems from its strong link with smoking. Humanity, respect and people orientation are vital to good communication with COPD patients. Physicians and nurses should try to avoid patient misunderstanding and uncertainty, involve the patient in decision-making and achieve a shared understanding (concordance, as well as encourage the patient to accept responsibility for the actions agreed. This should improve management decisions made by healthcare professionals and ensure a more satisfied patient. Greater patient satisfaction may improve concordance and so bring about better patient outcomes.

  2. Obstructive Uropathy in Sudanese Patients

    Directory of Open Access Journals (Sweden)

    El Imam M

    2006-01-01

    Full Text Available In this paper we describe the causes, patterns of presentation, and management of obstructive uropathy in Sudanese patients in a retrospective multi-center audit. All patients who presented with obstructive uropathy during 2005 were included in this study. All of the patients were subjected to serial investigations including imaging and tests of renal function. Diversion, stenting, and/or definitive surgery were performed in order to relieve the obstruction. Five hundred twenty patients were diagnosed with obstructive uropathy during this period; 345 (66% patients presented with chronic obstruction and 175 (34% with acute obstruction. Of the study patients, 210 (40% presented with significant renal impairment; 50 (23% of them required emergent dialysis. The patterns of clinical presentation of the obstructed patients included pain at the site of obstruction in 48%, lower urinary tract symptoms in 42%, urine retention in 36.5%, mass effect in 22%, and anuria in 4%. Patients in the pediatric age group constituted 4% of the total. The common causative factors of obstruction included congenital urethral valves, pelvi-ureteral junction obstruction, urolithiasis, and iatrogenic trauma, especially in the obstetric practice. Renal function was completely recovered with early management in 100% of patients with acute obstruction and was stabilized in 90% of patients with chronic obstruction. Four patients were diagnosed with end-stage renal failure; two of them were transplanted. The mortality rate in this study was less than 0.3%.

  3. Patienters vurdering af medicinpakningernes indlaegssedler

    DEFF Research Database (Denmark)

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

    2009-01-01

    effects had made them stop taking their medicine. Future studies should bring into focus the reason for medication adherence, how written information can be made easier to read, comprehensive and correct without contributing to anxiety and non-adherence. Udgivelsesdato: 2009-Feb......INTRODUCTION: The objective was to investigate patients' perception of patient information leaflets, including their readability, comprehensibility and their impact on adherence. MATERIAL AND METHODS: A 14-item questionnaire was prepared and answered by unselected patients in a general practice...... in Copenhagen. RESULTS: A total of 111 patients were included. Eighty-eight patients (79%) always or often read the patient information leaflets. Among these, 77% attached importance to adverse effects. A mere 13% attached importance to all leaflet information. In all, 21% never or rarely read patient...

  4. Design of a 'smart' patient record system for mammography patients.

    Science.gov (United States)

    Frigas, Antonis; Spyrou, George; Antaraki, Argyro; Patiraki, Elisabeth; Koufopoulos, Konstantinos; Mantas, John; Ligomenides, Panos

    2009-01-01

    One of the most common cancer types among women is breast cancer. Regular mammographic examinations increase the possibility for early diagnosis and treatment and significantly improve the chance of survival for patients with breast cancer. Keeping an informed and complete patient record is of great importance as the doctor needs this information for every patient examination. The proposed implementation is a patient record system that includes 'smart' algorithms in order to automatically use data from the patient's record to calculate well established epidemiological breast cancer models. A computer-aided diagnosis system is also used in order to analyze each mammogram and obtain a certain risk percentage concerning whether the patient has to undergo biopsy or not. The aforementioned system has been implemented to support a large set of patient data (1,178 patients) which included detailed personal patient data, medical history and examination details per date and is used in the daily clinical practice of a breast cancer diagnostic center facilitating patient record retrieval, storage and supporting the doctor's decisions.

  5. Ultrasound prenatal diagnosis of congenital primary aphakia: case report

    Science.gov (United States)

    Di Meglio, Filippo; Vascone, Carmine; Di Meglio, Letizia; Turco, Luigi Carlo Lo; Vitale, Salvatore Giovanni; Cignini, Pietro; Valenti, Gaetano; Gulino, Ferdinando Antonio; Rapisarda, Agnese Maria Chiara; Cianci, Stefano

    2015-01-01

    Introduction the ultrasound prenatal diagnosis of aphakia is a difficult diagnosis and often requires a genetic study of the karyotype. Case report we present a rare case of prenatal bilateral aphakia, confirmed after bird. The patient was observed by ultrasound during the 23rd week of pregnancy. Through transabdominal ultrasound the lens could not be visualized bilaterally. The remaining anathomy, explorable by ultrasound, was still regular. When aphakia is suspected, genetic counseling is essential. Conclusion a differential diagnosis between aphakia and anophtalmia is necessary. A TORCH complex evaluation can be useful. Amniocentesis is always required. PMID:26918094

  6. Critically ill obstetric patients

    Directory of Open Access Journals (Sweden)

    Kirti Rajesh Bendre

    2015-04-01

    Methods: This is a retrospective study carried out in a medical college with tertiary hospital facility in Mumbai. The ICU admissions for a period of 5 years from October 2005 to October 2010 were reviewed. Results: Over 5 years, 48 out of 10800 obstetric patients were admitted in ICU (0.4%. Most common reasons for admissions were obstetric hemorrhage and preeclampsia. The most common intervention done was transfusion of blood and blood products. Conclusions: We need better information about high risk obstetrics in order to improve maternal care. The study identifies the risk factors for maternal mortality and severe maternal morbidity, most significant being obstetric hemorrhage. Lack of antenatal care and delay in referral to intensive care unit adversely affect the maternal outcome. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 370-372

  7. [Management of splenectomized patients].

    Science.gov (United States)

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

    2003-09-06

    PARTIAL SPLENECTOMY: Partial resection is possible in certain indications for splenectomy. Partial splenectomy is the best way to prevent postsplenectomy infections, even though vaccination and antibiotic prophylaxis must be prescribed. This association is also necessary when the patient undergoes an autograft to reimplant splenic tissue or develops splenosis, i.e. fortuitous autotransplantation of splenic parenchyma. GUIDELINES FOR PLANNED SPLENECTOMY: Prophylactic vaccination should be performed 15 days, or 6 weeks, before surgery. Antibiotic prophylaxis includes a preoperative injection of cefazolin followed by intravenous amoxicillin, then Oracilline (Penicilline V) with resumption of oral intake. SURGICAL ASPECTS: Indications for laparoscopic surgery have broadened, laparotomy being reserved for the most difficult cases. Special care is recommended concerning complications, particularly respiratory disorders (pleural effusion, atelectasia) and acute pancreatitis.

  8. Thrombolysis in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Santiago Herrero; Jose Antonio Lapuerta-Irigoyen

    2007-01-01

    The elderly population consists of those over age 75 years and appears to represent the fastest-growing segment of the population.Intravenous thrombolytic therapy (TT) is the most common strategy for the treament of acute myocardial infarction (AMI) in many parts of the world. However, TT carries a higher risk of intra-cranial hemorrhage (ICH) in the elderly patients. Primary percutaneous transluminal coronary angioplasty and stenting (PCI) represents an important alternative in these elderly individuals with contraindications to TT. In developing countries, or in areas without availability of primary PCI, TT remains the only therapeutic modality. Dedicated randomized trials are needed to provide a comprehensive understanding of AMI management in the elderly group.

  9. The Berlin Patient

    Institute of Scientific and Technical Information of China (English)

    Maya; Reid

    2011-01-01

    LAST December,the science journal Blood published a paper claiming a cure for HIV had been found.While the announcement breathes new life into the AIDS research community,it’s not without caveats. The paper’s authors’ evidence came in the form of a 44-year-old man referred to as "The Berlin Patient." An American living in Germany,the man,whose real name is Timothy Ray Brown, was diagnosed with HIV around age 30.He spent a decade following a traditional drug regimen for the disease with success; he was healthy and had a high T-cell count.Then,in 2006, Brown was diagnosed with acute leukemia.His doctor,Gero H(u|¨)tter,decided to use the cancer as an opportunity to also rid Brown of his HIV.

  10. EUS in pediatric patients.

    Science.gov (United States)

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

    2009-11-01

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

  11. Mutation analysis of 28 gaucher disease patients: The Australasian experience

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, B.D.; Nelson, P.V.; Robertson, E.F.; Morris, C.P. [Women`s and Children`s Hospital, North Adelaide, South Australia (Australia)

    1994-01-15

    Gaucher disease is the most common lysomal storage disease. It is an autosomal recessive disorder that results from a deficiency of {beta}-glucocerrebrosidase. Three clinical phenotypes have been described: non-neuronopathic, acute neuronopathic, and subacuteneuronopathic. Genomic DNA from 28 Australasian patients of diverse ethnic origin with Gaucher disease was screened for 3 common mutations (1226G, 1448C and 84GG) using the amplification refractory mutation system (ARMS), and one uncommon mutation (1504T) by restriction enzyme digestion. Thirty-eight of the 56 independent alleles in these patients were characterized, with 1448C present in 42% and 1226G in 28% of the alleles. The 1226G mutation was associated only with the nonneuronopathic phenotype and 7 of the 15 patients who carried the 1448C mutation developed neuronopathic disease. Three infants who died in the neonatal period following a rapidly progressive neurodegenerative course carried no identifiable mutations. The 84GG mutation was carried by 2 Jewish patients and 1504T was present in one patient. It is now possible to rapidly identify the common Gaucher mutations using ARMS and restriction enzyme digestion, and our findings confirm the heterogeneity of mutations in Gaucher disease. It is also possible to predict in part the phenotypic outcome when screening patients for these mutations. The authors consider mutation analysis to be of most use in prenatal diagnosis and for carrier detection within affected families. 27 refs., 2 figs., 2 tabs.

  12. Informed consent - Providing information about prenatal examinations

    DEFF Research Database (Denmark)

    Dahl, Katja; Kesmodel, Ulrik; Hvidman, Lone

    Prenatal care has gradually moved away from paternalism, to a state where patient autonomy and information is vital. It is known from other health care settings that the way information is presented affects understanding.The objective is to summarize current knowledge on aspects of informing...... pregnant women about prenatal examinations. Women's knowledge, decisional conflict, satisfaction and anxiety will be explored as compared with different ways and different groups of health professionals providing information. To what extent information empowers informed decision making will be explored......, individual sessions and by way of written materials. None of the interventions leads to a raise in anxiety scores or influence up-take rates. Satisfaction with information provided is found unrelated to level of knowledge, but associated with having expectations for information met. Information does not seem...

  13. Venous thromboembolism in cancer patients

    Directory of Open Access Journals (Sweden)

    Mehmet Fuat Eren

    2013-09-01

    Full Text Available Venous thromboembolism (VTE is a major complication of cancer and represents an important cause of morbidity and mortality. The incidence of VTE is 0.6-7.8% in patients with cancer more than double the incidence of VTE in patients without cancer. The risk of VTE which includes deep venous thrombosis (DVT and pulmonary embolism (PE is increased two to seven fold in patients with cancer. VTE risk is especially high among certain groups such as hospitalized patients with cancer and those receiving active antineoplastic therapy. Also cancer patients, who undergoing major surgery, are increased risk of VTE. Trauma, long-haul travel, increased age, obesity, previous VTE and genetic component are also predisposing factors for VTE. Patients with cancer who develop VTE should be managed multidisciplinary treatment guidelines. The primary goal of thromboprophylaxis in patients with cancer is to prevent VTE. The large majority of cancer patients should be treated with therapeutic doses of unfractioned heparin (UFH or low molecular weight heparin (LMWH. Prophylaxis should include cancer patients who underwent major surgery for cancer and patients with a history of VTE.

  14. [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.

  15. Hallux ulceration in diabetic patients.

    Science.gov (United States)

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

    2010-01-01

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

  16. Improving emergency department patient flow.

    Science.gov (United States)

    Jarvis, Paul Richard Edwin

    2016-06-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

  17. 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.

  18. 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.

  19. Burn Patient Expectations from Nurses

    Directory of Open Access Journals (Sweden)

    Sibel Yilmaz sahin

    2014-02-01

    Full Text Available AIM: Burn is a kind of painful trauma that requires a long period of treatment and also changes patients body image. For this reason, nursing care of burn patients is very important. In this study in order to provide qualified care to the burned patients, patient and #8217;s expectations from nurses were aimed to be established. METHODS: Patients and #8217; expectations were evaluated on 101 patients with burn in Ministry of Health Ankara Numune Education and Research Hospital Burn Service and Gulhane Military Medical Academy Education and Research Hospital Burn Center. A questionnaire which was developed by the researchers was used for collecting data. The questions on the questionnaire were classified into four groups to evaluate the patients and #8217; expectations about communication, information, care and discharge. Data was evaluated by using SPSS 12 package software. RESULTS: In this study, 48.5% of patients were at 18-28 age group, 79.2% were male and 51.5% of patients were employed. Almost all of patients expect nurses to give them confidence (98% and to give them information about latest developments with the disease. Patients prior expectation from nurses about care was to do their treatments regularly (100% and to take the necessary precautions in order to prevent infection (100%. 97% of patient expect nurses to give them information about the drugs, materials and equipment that they are going to use while discharge. CONCLUSION: As a result we found that burn patient expectations from nurses about communication, information, care and discharge were high. [TAF Prev Med Bull 2014; 13(1.000: 37-46

  20. Febrile neutropaenia in cancer patients.

    Science.gov (United States)

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

    2010-03-01

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

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

    DEFF Research Database (Denmark)

    Thygesen, Marianne Kirstine; D. Pedersen, Birthe

    2017-01-01

    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......Patient-provider interaction is important for cancer patients’ wellbeing and further coping and it might be beneficial to further investigate this in the fast track trajectories. Cancer patients experience themselves as liminal and we aimed to investigate how patients experience healthcare...

  2. Respiratory failure in elderly patients.

    Science.gov (United States)

    Sevransky, Jonathan E; Haponik, Edward F

    2003-02-01

    Elderly individuals comprise an increasing proportion of the population and represent a progressively expanding number of patients admitted to the ICU. Because of underlying pulmonary disease, loss of muscle mass, and other comorbid conditions, older persons are at increased risk of developing respiratory failure. Recognition of this vulnerability and the adoption of proactive measures to prevent decompensation requiring intrusive support are major priorities together with clear delineation of patients' wishes regarding the extent of support desired should clinical deterioration occur. Further, the development of coordinated approaches to identify patients at risk for respiratory failure and strategies to prevent the need for intubation, such as the use of NIV in appropriate patients, are crucial. As soon as endotracheal intubation and mechanical ventilation are implemented strategies that facilitate the liberation of elderly patients from the ventilator are especially important. The emphasis on a team approach, which characterizes geriatric medicine, is essential in coordinating the skills of multiple health care professionals in this setting. Respiratory failure can neither be effectively diagnosed nor managed in isolation. Integration with all other aspects of care is essential. Patient vulnerability to nosocomial complications and the "cascade effect" of these problems such as the effects of medications and invasive supportive procedures all impact on respiratory care of elderly patients. For example, prolonged mechanical ventilation may be required long after resolution of the underlying cause of respiratory failure because of unrecognized and untreated delirium or residual effects of small doses of sedative and/or analgesic agents or other medications in elderly patients with altered drug metabolism. The deleterious impact of the foreign and sometimes threatening ICU environment and/or sleep deprivation on the patient's course are too often overlooked because

  3. Anemia in peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Laušević Mirjana

    2006-01-01

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

  4. A Porsche for patient accrual.

    Science.gov (United States)

    Steinberg, David

    2005-01-01

    A $1,000 lottery ticket for a Porsche Boxster automobile was offered to the investigator who accrued the most patients to a Southwest Oncology Group prostate cancer protocol. This was done with the admirable intention of increasing patient accrual and improving the outlook for men with high risk prostate cancer. However, the offer of this prize also makes the statement that it is permissible to reward a doctor with an expensive automobile for putting patients on an oncology research protocol. Awarding an expensive prize for patient accrual risks eroding public confidence by creating the perception that clinical investigators, swayed by the allure of an expensive automobile, were motivated by material self-interest rather than the welfare of their patients and the advancement of medical science. I suspect that if the practice of expensive rewards for patient accrual became widespread the cumulative damage would ultimately outweigh the benefits.

  5. 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...

  6. Web Applications for Patient Communication.

    Science.gov (United States)

    Lewis, Kristopher; Reicher, Murray A

    2016-12-01

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

  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. Prenatal transplantation of mesenchymal stem cells to treat osteogenesis imperfecta.

    Directory of Open Access Journals (Sweden)

    Jerry KY Chan

    2014-10-01

    Full Text Available Osteogenesis Imperfecta (OI can be a severe disorder that can be diagnosed before birth. Transplantation of mesenchymal stem cells (MSC has the potential to improve the bone structure, growth and fracture healing. In this review we give an introduction to OI and MSC, and the basis for prenatal and postnatal transplantation in OI. We also summarize the two patients with OI who has received prenatal and postnatal transplantation of MSC.The findings suggest that prenatal transplantation of allogeneic MSC in OI is safe. The cell therapy is of likely clinical benefit with improved linear growth, mobility and reduced fracture incidence. Unfortunately, the effect is transient. For this reason postnatal booster infusions using same-donor MSC have been performed with clinical benefit, and without any adverse events.So far there is limited experience in this specific field and proper studies are required to accurately conclude on clinical benefits of MSC transplantation to treat OI.

  9. Update on prenatal care.

    Science.gov (United States)

    Zolotor, Adam J; Carlough, Martha C

    2014-02-01

    Many elements of routine prenatal care are based on tradition and lack a firm evidence base; however, some elements are supported by more rigorous studies. Correct dating of the pregnancy is critical to prevent unnecessary inductions and to allow for accurate treatment of preterm labor. Physicians should recommend folic acid supplementation to all women as early as possible, preferably before conception, to reduce the risk of neural tube defects. Administration of Rho(D) immune globulin markedly decreases the risk of alloimmunization in an RhD-negative woman carrying an RhD-positive fetus. Screening and treatment for iron deficiency anemia can reduce the risks of preterm labor, intrauterine growth retardation, and perinatal depression. Testing for aneuploidy and neural tube defects should be offered to all pregnant women with a discussion of the risks and benefits. Specific genetic testing should be based on the family histories of the patient and her partner. Physicians should recommend that pregnant women receive a vaccination for influenza, be screened for asymptomatic bacteriuria, and be tested for sexually transmitted infections. Testing for group B streptococcus should be performed between 35 and 37 weeks' gestation. If test results are positive or the patient has a history of group B streptococcus bacteriuria during pregnancy, intrapartum antibiotic prophylaxis should be administered to reduce the risk of infection in the infant. Intramuscular or vaginal progesterone should be considered in women with a history of spontaneous preterm labor, preterm premature rupture of membranes, or shortened cervical length (less than 2.5 cm). Screening for diabetes should be offered using a universal or a risk-based approach. Women at risk of preeclampsia should be offered low-dose aspirin prophylaxis, as well as calcium supplementation if dietary calcium intake is low. Induction of labor may be considered between 41 and 42 weeks' gestation.

  10. Causes and outcome of prenatally diagnosed hydronephrosis

    Directory of Open Access Journals (Sweden)

    Ahmadzadeh Ali

    2009-01-01

    Full Text Available Hydronephrosis is the most common abnormal finding in the urinary tract on prenatal screening with ultrasonography (U/S. Hydronephrosis may be obstructive or non-obstructive; obstructive lesions are more harmful to the developing kidneys. The aim of the study was to evaluate the causes of renal pelvic dilatation and the outcome of postnatal treatment in infants with hydronephrosis diagnosed prenatally with U/S. We prospectively studied 67 (60 males newborns with hydronephrosis diagnosed prenatally and confirmed postnatally with U/S from Sept. 2005 to Oct. 2007. The patients were allocated to three groups based on the mea-surement of the anteroposterior renal pelvic diameter (APRPD in transverse plane: mild (6-9.9 mm, moderate (10-14.9 mm and severe (> 15 mm hydronephrosis. Voiding cystourethrography (VCUG was obtained in all of the patients to rule out vesicoureteral reflux (VUR. In cases with negative VUR, Diethylenetriamine-pentaacetic acid (DTPA scan with diuretic renography was performed to detect ureteropelvic joint obstruction (UPJO. Twenty two cases (32.8% had mild, 20 (29.9% had moderate, and 25 (37.3% had severe hydronephrosis. The causes of hydroneph-rosis were VUR (40.2%, UPJO (32.8%, posterior urethral valves (PUVs (13.4 %, and transient hydronephrosis (13.4 %. The lesion was obstructive in 37 (55.2% infants. Totally, 33 (49.2% patients with hydronephrosis (9 mild, 9 moderate, and 15 severe subsequently developed com-plications such as UTI and renal insufficiency, or required surgery. Associated abnormalities were observed in 15 (22.4% patients. We conclude that every newborn with any degree of hydro-nephrosis should be assessed postnatally for specific diagnosis and treatment.

  11. Conversations with chronic schizophrenic patients.

    Science.gov (United States)

    Morgan, R

    1979-02-01

    An account is given of some of the topics discussed during a small informal weekly open group meeting of chronic schizophrenic patients, based on occasional notes compiled over eleven years. The main feature of the patients' condition as displayed was poverty--clinical, social, behavioural, material and financial--and certain features suggested an organic aetiology. Reasons are given for considering that the patients' condition was predominantly caused by schizophrenia rather than by institutionalism.

  12. Genital reconstruction in exstrophy patients

    OpenAIRE

    2012-01-01

    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 app...

  13. Thromboprophylaxis in immobilized medical patients.

    Science.gov (United States)

    Vaitkus, Paul T

    2004-03-30

    Venous thromboembolism accounts for a large number of preventable deaths. The majority of these events occur in medical patients, but medical thromboprophylaxis remains underutilised in this population. The purpose of this review is to examine the results of recent clinical trials of low molecular weight heparins in the prevention of venous thromboembolic disease in medical patients. The available data make a compelling case in favor of widespread use of low molecular weight heparin in medical patients.

  14. Phaeohyphomycosis in Transplant Patients

    Directory of Open Access Journals (Sweden)

    Sanjay G. Revankar

    2015-12-01

    Full Text Available Phaeohyphomycosis is caused by a large, heterogenous group of darkly pigmented fungi. The presence of melanin in their cell walls is characteristic, and is likely an important virulence factor. These infections are being increasingly seen in a variety of clinical syndromes in both immunocompromised and normal individuals. Transplant patients are especially at risk due their prolonged immunosuppression. There are no specific diagnostic tests for these fungi, though the Fontana-Masson stain is relatively specific in tissue. They are generally seen in a worldwide distribution, though a few species are only found in specific geographic regions. Management of these infections is not standardized due to lack of clinical trials, though recommendations are available based on clinical experience from case reports and series and animal models. Superficial infections may be treated without systemic therapy. Central nervous system infections are unique in that they often affect otherwise normal individuals, and are difficult to treat. Disseminated infections carry a high mortality despite aggressive therapy, usually with multiple antifungal drugs. Considerable work is needed to determine optimal diagnostic and treatment strategies for these infections.

  15. Efficacy of MCAD screening in SIDS patients in Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    Phillips, J.A. III; Vnencak-Jones, C.L. [Vanderbilt Univ. School of Medicine, Nashville, TN (United States); Ulm, J.E. [TN Dept. of Health, Nashville, TN (United States)] [and others

    1994-09-01

    Medium chain acyl-CoA deficiency (MCAD) is an autosomal recessive disorder of fatty acid oxidation. While several mutations have been identified in the MCAD gene, an A to G point mutation affecting codon 329 (K329E) represents >90% of those reported. Unfortunately, the reported carrier frequency of this mutation varies greatly between populations which reduces the efficiency of neonatal screening. Mounting evidence suggests a correlation between MCAD deficiency and sudden infant death syndrome (SIDS). To determine the utility of MCAD screening in SIDS patients, we screened for the K329E mutation in DNA extracted from paraffin blocks retrieved from 75 consecutive SIDS patients. Two of 75 (2.7%) had DNA findings consistent with MCAD. One patient (A) was homozygous for K329E while a second patient (B) was heterozygous for K329E. Although the second abnormal MCAD allele has not yet been identified in this patient, in a clinical setting of SIDS, this patient may well represent a compound heterozygote. Subsequent to the analysis, the family of A was contacted and a newborn sib was found to be homozygous for K329E. Carnitine supplementation and frequent feedings were started and the child is doing well. Evaluation of family B is planned. Our finding of 2/75 SIDS patients with DNA findings suggestive of MCAD demonstrates the efficacy of MCAD screening in this population in contrast to that of newborn screening in TN where the estimated K329E carrier frequency is 1/249 and the calculated incidence of MCAD disease is approximately 1/248,000. Our study (1) confirms the finding of MCAD in 2 to 3% of consecutive SIDS patients, (2) utility of DNA testing in presymtomatic sibs of SIDS patients attributable to MCAD and (3) provides accurate recurrent risks and enables prenatal testing for SIDS families where the diagnosis of MCAD has been established.

  16. Psychotherapy patient transfer: secondhand rose.

    Science.gov (United States)

    Sederer, L

    1975-10-01

    The author uses the analogy of the marketplace to examine the dynamics of the transfer of psychotherapy patients in university clinic settings. The outgoing therapist is the seller, the prospective therapist the buyer, and the patient the commodity--the secondhand Rose. Marketing techniques that are used in this buyers' market allow no active patient participation and are therefore antithetical to the tenets of psychotherapy. The author suggests early clarification of therapeutic goals, assignment of therapists on the basis of patient choice, and explanation of time frames and limits as means for ameliorating the problems he describes.

  17. 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.

  18. Fungal laryngitis in immunocompetent patients.

    Science.gov (United States)

    Ravikumar, A; Prasanna Kumar, S; Somu, L; Sudhir, B

    2014-01-01

    The diagnosis of fungal laryngitis is often overlooked in immunocompetent patients because it is commonly considered a disease of the immunocompromised. Further confusion is caused by clinical and histological similarity to more common conditions like Leukoplakia. Demonstration of hyperkeratosis particularly if associated with intraepithelial neutrophils on biopsy should trigger a search for fungus using specialized stains. These patients usually present with hoarseness of voice. Pain is present inconsistently along with dysphagia and odynophagia. We present three cases of fungal laryngitis in immunocompetent patients out of which one underwent microlaryngeal surgery with excision biopsy. All these patients responded well with oral antifungal therapy.

  19. Psychological distress and patient satisfaction.

    Science.gov (United States)

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

    1982-04-01

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

  20. Patient Transport via Commercial Airlines

    Science.gov (United States)

    Macnab, Andrew John

    1992-01-01

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

  1. Nutrition in the hospitalized patient.

    Science.gov (United States)

    Kirkland, Lisa L; Kashiwagi, Deanne T; Brantley, Susan; Scheurer, Danielle; Varkey, Prathibha

    2013-01-01

    Almost 50% of patients are malnourished on admission; many others develop malnutrition during admission. Malnutrition contributes to hospital morbidity, mortality, costs, and readmissions. The Joint Commission requires malnutrition risk screening on admission. If screening identifies malnutrition risk, a nutrition assessment is required to create a nutrition care plan. The plan should be initiated early in the hospital course, as even patients with normal nutrition become malnourished quickly when acutely ill. While the Harris-Benedict equation is the most commonly used method to estimate calories, its accuracy may not be optimal in all patients. Calculating the caloric needs of acutely ill obese patients is particularly problematic. In general, a patient's caloric intake should be slightly less than calculated needs to avoid the metabolic risks of overfeeding. However, most patients do not receive their goal calories or receive parenteral nutrition due to erroneous practices of awaiting return of bowel sounds or holding feeding for gastric residual volumes. Patients with inadequate intake over time may develop potentially fatal refeeding syndrome. The hospitalist must be able to recognize the risk factors for malnutrition, patients at risk of refeeding syndrome, and the optimal route for nutrition support. Finally, education of patients and their caregivers about nutrition support must begin before discharge, and include coordination of care with outpatient facilities. As with all other aspects of discharge, it is the hospitalist's role to assure smooth transition of the nutrition care plan to an outpatient setting.

  2. 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....

  3. Orthodontic treatment in oncological patients.

    Science.gov (United States)

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

    2015-01-01

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

  4. Mandibulotomy in the irradiated patient

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-04-01

    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.

  5. Erectile dysfunction in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Imen Gorsane

    2016-01-01

    Full Text Available Erectile dysfunction (ED is a common problem seen among patients on hemodialysis (HD, but it is still a taboo subject in our country. The attention given to this sexual problem remained low, and the prevalence of ED among these patients has not been well characterized. We carried out this study in order to determine the prevalence and severity of ED in HD patients. We conducted a descriptive cross-sectional study in our HD unit in March 2013. ED was evaluated using the International Index Erection Function. Thirty patients with a mean age of 49.1 years were eligible for this study. The main causes of chronic kidney disease were hypertension (62.5% and diabetes (41.6%. The prevalence of ED was 80%, including 33.3% severe ED. Plasma levels of gonadotropins: luteinizing hormone (LH, follicule-stimulating hormone were in the standards except for one patient who had an elevated level of LH. Prolactin was elevated in four cases. ED was present in 8.4% of patients before the discovery of renal failure and in 91.6% of patients at the beginning of dialysis. For 19 patients (79.1%, the ED had increased during the dialysis sessions. A significant number of our HD patients presented with ED of varying degrees. Nephrologists should pay attention to the problem of ED in order to improve the quality of their life.

  6. Hospitalized Older Adults’ Patient Satisfaction

    Directory of Open Access Journals (Sweden)

    Neale R. Chumbler

    2016-04-01

    Full Text Available This article examines the extent to which older adult patients’ perceptions of inpatient dimensions of care experiences are associated with their overall satisfaction. A secondary objective is to determine if these specific care experiences differed between elderly female and male patients. Patient satisfaction data from 6,021 older patients (65 years of age and older were collected by using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS Survey through telephone interviews of older patients who were recently discharged. Multiple linear regression analyses with older patients’ HCAHPS dimensions (Communication With Nurses, Communication With Doctors, Responsiveness of Hospital Staff, Communication About Medicines, Cleanliness of the Hospital Environment, and Quietness of Hospital Environment and gender were conducted while controlling for self-rated health status, age, race, and education. Multiple linear regression analysis showed that all of the HCAHPS dimensions were significantly associated with overall satisfaction. Older female patients reported substantially more positive global evaluations than their male counterparts. However, for older male patients, Communication With Doctors was more influential in their ratings of overall satisfaction than for older female patients. For older female patients, Communication With Nurses was more influential in their ratings of overall satisfaction than for older male patients.

  7. Observation af kritisk syge patienter

    DEFF Research Database (Denmark)

    Fuhrmann, Lone; Hesselfeldt, Rasmus; Lippert, Anne

    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...... vital signs measured by study personnel. A total of 77% of patients had vital signs documented in their records on the day of the observation. The previous day, vital signs were documented in 70% of records and on the day after in 66%. The documentation of vital signs was significantly higher when staff...

  8. Patient bill of rights 2001.

    Science.gov (United States)

    Benjamin, G C

    2001-01-01

    Breaking gridlock on managed care reform, a bipartisan coalition in Congress introduced the newest version of a patient bill of rights. Unlike last year's ill-fated Norwood-Dingell bill, the Bipartisan Patient Protection Act of 2001 has strong bipartisan support; concern remains, however, on the provisions that allow patients to sue their managed care plan. The debate now focuses on the type of liability reform that Congress and the White House can agree on. If they are able to agree, a patient bill of rights may soon become law.

  9. Thyroid Disease in the Older Patient

    Science.gov (United States)

    ... a brother, sister or child of the patient. HYPERTHYROIDISM IN THE OLDER PATIENT As in all hyperthyroid ... and family. TREATMENT OF THE OLDER PATIENT WITH HYPERTHYROIDISM As with younger patients, treatment of hyperthyroidism in ...

  10. Controlling Hypertension in Diabetic Patients | Familoni | Nigerian ...

    African Journals Online (AJOL)

    Controlling Hypertension in Diabetic Patients. ... risk factor for both macrovascular and microvascular complications in patients with diabetes. ... about 22.4% of patients with type 1 and 58.9% of patients with type 2 diabetes mellitus in Nigeria.

  11. Comparative effectiveness of a prenatal medical food to prenatal vitamins on hemoglobin levels and adverse outcomes: a retrospective analysis.

    Science.gov (United States)

    Bentley, Susan; Hermes, Amy; Phillips, Diane; Daoud, Yahya A; Hanna, Sylvia

    2011-02-01

    The role of folate in pregnancy is well established, with most prenatal vitamins (PNVs) on the market containing at least 800 μg of folic acid. Folic acid must be converted in the body to L-methylfolate, the natural and biologically active form of folate. The role of vitamin B(12) in pregnancy is less characterized, and most PNV formulations contain only 0 to 12 μg. The present study was undertaken to evaluate whether taking a prenatal medical food containing L-methylfolate and much higher doses of vitamin B(12) results in higher hemoglobin levels and thus, a lower incidence of anemia during pregnancy. The objective of this exploratory study was to evaluate the effects of the prenatal medical food versus standard PNVs on hemoglobin levels and adverse outcomes throughout pregnancy. For this retrospective analysis, we reviewed the charts of female patients taking either a prenatal medical food or standard PNV during pregnancy. Hemoglobin levels measured at initiation of prenatal care, end of second trimester, and delivery were recorded. Patients who had received additional iron supplementation, beyond that contained in the prenatal medical food or PNV they were taking and before anemia screening at the end of the second trimester, were excluded from the study. Fisher exact test, χ(2) test, student t test, and ANOVA were used to evaluate differences between the treatment groups. Data were analyzed from 112 charts: 58 patients (51.8%) were taking the prenatal medical food; 54 patients (48.2%) were taking standard PNVs. Mean (SD) age at first prenatal visit was 27 (4.6) years in the medical food group and 28.8 (3.5) years in the PNV group (P = 0.024). Mean (SD) body mass indices were 29.1 (6.5) and 31.7 (8.9) in the medical food and PNV groups, respectively (P = NS). In the medical food group, 35 women (60.3%) were white/Caucasian, 17 (29.3%) were African American, and 6 (10.4%) were of other races. In the PNV group, 24 women (44.4%) were white/Caucasian, 25 (46

  12. Patient safety risks and patients treated by multiple specialties.

    NARCIS (Netherlands)

    Baines, R.; Bruijne, M. de; Langelaan, M.; Wagner, C.

    2013-01-01

    Objectives: To determine if the number of medical specialties treating a patient is associated with the risk of experiencing harm during hospital admission. Methods: We performed structured retrospective patient record review study by trained nurses and physicians. We included 20 hospitals in the N

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

    NARCIS (Netherlands)

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

    2016-01-01

    Background and purpose: Proton therapy is an emerging technique in radiotherapy which results in less dose to the normal tissues with similar target dose than photon therapy, the current standard. Patient-level simulation models support better decision making on which patients would benefit most. Ma

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

    Science.gov (United States)

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

    2009-01-01

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

  15. 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

  16. Identifying Patients at Risk and Patients in Need

    DEFF Research Database (Denmark)

    Schmidt, Thomas

    2015-01-01

    En væsentlig andel af patienter oplever forværring under indlæggelse på Fælles Akutmodtagelsen (FAM). At identificere disse forværringer før de bliver alvorlige er vanskeligt for klinikere eftersom de behandler meget forskellige patienter under et stort pres for at bevare overblik og årvågenhed. ...

  17. 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...... involvement with PRO, I want to point to the need for further empirical exploration of how patients and professionals engage with PRO in specific daily practices and to stimulate a general discussion of all too simple normativities of the so-called ‘participatory turn’ in healthcare. I draw onempirical...

  18. Patient safety: Safety culture and patient safety ethics

    DEFF Research Database (Denmark)

    Madsen, Marlene Dyrløv

    2006-01-01

    and interviews with staff and management in four hospital departments. The appendix contains the Patient Safety Culture Questionnaire tool that I have developed, tested and revised for use in theDanish hospital setting based on the research projects on safety culture described in papers 3, 4 and 5. Paper 6......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...... the problems, and suggest possible solutions for improving patient safety through the promotion of safety culture and ethics. I seek to illuminate theissues of patient safety from several perspectives; the organizational healthcare system, in particular the healthcare workers perspectives and experiences...

  19. Factors Influencing the Use of Prenatal Care: A Systematic Review

    Directory of Open Access Journals (Sweden)

    2016-01-01

    Full Text Available Background & aim: Prenatal care is a key strategy for achieving public health goals, primary healthcare objectives, and the Millennium Development Goals. The aim of this study was to investigate the factors influencing the use of prenatal care services in order to design suitable interventions and promote the use of these services. Methods:In this systematic quantitative literature review, studies published in years 2010-2014 were evaluated. For this purpose, two international electronic databases, i.e., Scopus and PubMed, were explored to find English-language articles by using relevant keywords; moreover, the reference lists of the articles were hand-searched. We reviewed all cross-sectional and prospective studies, which focused on factors associated with the use of prenatal care services within the specified period of time. Results: In total, 17 relevant articles were included in our review. The results showed that late initiation and inadequate use of prenatal care services are independently associated with multiple variables, including demographic characteristics, socioeconomic factors, predisposing cultural and religious factors, social support, factors related to healthcare providers, women’s awareness and attitude, unintended pregnancy, high-risk medical or obstetric history, and health behaviors. Conclusion: Based on the literature review, proper use of prenatal care cannot be achieved merely by establishing healthcare centers. Utilization of maternal health services may be achieved and improved via developing socioeconomic factors and addressing patients' basic needs including education and financial independence.

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

    Science.gov (United States)

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

    2008-05-01

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

  1. 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

  2. Patient Satisfaction After Scoliosis Surgery

    Directory of Open Access Journals (Sweden)

    V. Tari

    2008-02-01

    Full Text Available Background:Patient satisfaction with the cosmetic result of spinal fusion surgery was studied in 40 cases of adolescent idiopathic scoliosis.Neutral or dissatisfied patients were compared with satisfied patients in several physical and psychological characteristics. The aim of the study was to determine whether adolescents generally report satisfaction with the postoperative appearance of their back after the correction of severe curves and whether preoperative medical and/or psychological factors could distinguish between patients who report satisfaction with the cosmetic surgical result from those who report neutrality or dissatisfaction. Previous reports emphasize the need for medical outcome research that evaluates both patient satisfaction and technical success. Patient satisfaction with spinal surgery has largely been evaluated in retrospective studies and most consistently is related to postoperative cosmesis and degree of curve correction. Methods: 40 adolescents with idiopathic scoliosis without any comorbidity who were 10 years of age or older were studied preoperatively by physical and psychological measurements. Results: Of patients undergoing surgical correction of severe curves, 50% reported satisfaction with the cosmetic result. Neutral or dissatisfied patients were more likely to have a King II or King IV curve types and less correction than satisfied patients. Preoperative psychological difficulties (P< 0.05 and unmet expectations regarding postoperative cosmesis (P<0.05 were more common among neutral or dissatisfied patients. Conclusion: Most adolescents with idiopathic scoliosis expressed satisfaction with the cosmetic surgical result. Preoperative physical characteristics, psychological difficulties, and unrealistic expectations regarding postoperative cosmesis are associated with patient neutrality or dissatisfaction.

  3. Telegenetics use in presymptomatic genetic counselling: patient evaluations on satisfaction and quality of care.

    Science.gov (United States)

    Otten, Ellen; Birnie, Erwin; Ranchor, Adelita V; van Langen, Irene M

    2016-04-01

    In recent years, online counselling has been introduced in clinical genetics to increase patients' access to care and to reduce time and cost for both patients and professionals. Most telegenetics reports so far evaluated online oncogenetic counselling at remote health centres in regions with large travelling distances, generally showing positive patient outcomes. We think online counselling--including the use of supportive tools that are also available during in-person counseling--of presymptomatic patients in their homes can also be feasible and valuable for patients in relatively small regions. We performed a single-centre pilot study of online genetic counselling for 57 patients who were presymptomatic cardiogenetic (n=17), presymptomatic oncogenetic (n=34) and prenatal (3 couples). One-third of presymptomatic patients we approached consented to online counselling. Patient evaluations of practical aspects, satisfaction and psychological outcomes were assessed and compared with a matched control group. Patients managed to fulfil the preparations, were significantly more satisfied with their counsellor and counselling session than controls and were satisfied with the online counselling more than they expected to be beforehand. Psychological outcomes (decreased anxiety and increased control) did not differ with control patients. Technical problems occurred in almost half of online sessions. Nonetheless, online counselling in patients' homes proved to be feasible and was appreciated by a substantial part of presymptomatic patients at our genetics centre in the Netherlands. Based on these outcomes, we conclude online counselling can be a valuable addition to existing counselling options in regular patient care.

  4. Using a prenatal electronic medical record to improve documentation within an inner-city healthcare network.

    Science.gov (United States)

    Ghartey, Jeny; Lee, Colleen; Weinberger, Elisheva; Nathan, Lisa M; Merkatz, Irwin R; Bernstein, Peter S

    2014-06-01

    To study the impact of a prenatal electronic medical record (EMR) on the adequacy of documentation. The authors reviewed paper prenatal records (historical control arm and contemporaneous control arm), and prenatal EMRs (study arm). A prenatal quality index (PQI) was developed to assess adequacy of documentation; the prenatal record was assigned a score (range, -1 to 2 for each element, maximum score = 30). A PQI raw score and PQI ratio-that controlled for which elements of care were indicated for a patient-were calculated and compared between the study arm versus historical control arm and then the study arm versus contemporaneous control arm. The median PQI raw score was significantly lower in the study arm compared with historical control arm; however, the PQI ratios were similar between these groups. The PQI raw score was similar in both the study arm and contemporaneous control arm; however the PQI ratio was significantly higher in the study arm when compared with the contemporaneous control arm. Implementation of this prenatal EMR did not have a significant impact on completeness of documentation when compared with a standardized paper prenatal record. Adequacy of documentation seems to be related to the type of practice. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. Patient error: a preliminary taxonomy.

    NARCIS (Netherlands)

    Buetow, S.; Kiata, L.; Liew, T.; Kenealy, T.; Dovey, S.; Elwyn, G.

    2009-01-01

    PURPOSE: Current research on errors in health care focuses almost exclusively on system and clinician error. It tends to exclude how patients may create errors that influence their health. We aimed to identify the types of errors that patients can contribute and help manage, especially in primary ca

  6. 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 thrombop

  7. Communicating effectively with deaf patients.

    Science.gov (United States)

    McAleer, Monica

    This article explores the communication needs of deaf patients who use British Sign Language as their first or preferred language. It would appear that these needs are not being met, particularly in acute hospital settings. Practical advice is provided for nurses to improve the quality of care that deaf patients receive.

  8. Asthma control: Patient and environment

    NARCIS (Netherlands)

    Rijssenbeek-Nouwens, L.H.M.

    2015-01-01

    Control of asthma, the goal of asthma treatment, seems hard to obtain. However, it is largely unknown why control of asthma remains difficult in many patients in spite of available powerful medication. In this thesis we studied non-pharmacological factors influencing asthma control: patient related

  9. Patient Disclosure of Medical Misdeeds

    Science.gov (United States)

    Bergen, Clara; Stivers, Tanya

    2013-01-01

    Modern patients walk a tightrope between respecting medical authority and acting as knowledgeable advocates regarding health issues, with the agency and responsibilities that come with this. This article uses conversation analysis to explore this balance in relation to patient disclosures of medical misdeeds in video-recorded primary care medical…

  10. Corneal Protection for Burn Patients

    Science.gov (United States)

    2013-10-01

    Houston, TX Purpose:Patients with severe facial burns often suffer indirect damage to their eyes. Burn wound contracture of the periocular skin...periocular muscles , are injured and the protective blink reflex is lost. With loss of the blink reflex the patient quickly develops exposure keratitis

  11. 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...

  12. 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.

  13. Industrial Robots for Patient Support

    Science.gov (United States)

    Sommer, Andres

    Flexibility, precision, and capability to support the clinical workflow make robots the ideal choice for ion beam therapy (IBT) facilities for use in patient positioning. To fulfill the clinical needs in IBT, an industrial robot patient positioner needs to be carefully designed regarding applications and safety issues as well as precision and handling.

  14. Nursing professional facing patient privacy

    Directory of Open Access Journals (Sweden)

    Fidel López Espuela

    2010-05-01

    Full Text Available Privacy of patients admitted to the hospital is played down in favour of other needs considered more basic by the healthcare system and more related to the disease than to patients themselves. Situations and factors where privacy is damaged are frequent, but it is known that when these are avoided by professionals’ attitude, through strategies and different mechanisms, it becomes one of the most satisfactory elements to patients.Objectives: To identify and analyze situations and factors which affect privacy in hospital environment as well as the adaptation capacity of patients to them.Methodology: Phenomenological, qualitative research. By means of discussion groups with professionals, the following questions where answered: ‘What do professionals understand by privacy? Which situations and factors jeopardize it during the hospital stay? How do they think patients get adapted?Results: The concept of privacy is complex, personal and non-transferable. Situations in which it is jeopardized were divided in 5 main areas. Numerous behaviors regarding adaptation of patients to these were collected.Discussion: Although there is little nursery research referring to privacy and its defense in the professional-patient relationship field, concern about this aspect always shown by nursery staff stands out.As a conclussion, we observe the need to complement this research with the perception patients have about these same questions, establishing the importance they give to privacy.

  15. 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...

  16. 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...... or betagonist use. CONCLUSIONS: In a mixed population of hospitalized medical patients, hypokalemia is common and plasma [K(+)

  17. Monitoring of stable glaucoma patients

    NARCIS (Netherlands)

    K.M. Holtzer-Goor (Kim); N.S. Klazinga (Niek); M.A. Koopmanschap (Marc); H.G. Lemij (Hans); T. Plochg; E. van Sprundel (Esther)

    2010-01-01

    textabstractA high workload for ophthalmologists and long waiting lists for patients challenge the organization of ophthalmic care. Tasks that require less specialized skills, like the monitoring of stable (well controlled) glaucoma patients could be substituted from ophthalmologists to other profes

  18. 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 d

  19. Perioperative nutrition in cancer patients.

    Science.gov (United States)

    Daly, J M; Redmond, H P; Gallagher, H

    1992-01-01

    Cancer patients have the highest incidence of protein-calorie malnutrition seen in hospitalized patients, with significant malnutrition occurring in more than 30% of cancer patients undergoing major upper gastrointestinal procedures. Clinically significant malnutrition occurs as a result of diminished nutrient intake, increased nutrient losses, and tumor-induced derangements in host metabolism. In the absence of adequate exogenous nutrients, the body utilizes endogenous substrates to satisfy the ongoing requirements of both host and tumor for energy and protein. In those patients with malignant obstruction of the gastrointestinal tract, the tumor itself may induce diminished nutrient intake. Present day treatment modalities including gastrointestinal resection, chemotherapy, and radiotherapy compound these metabolic derangements, further increasing the risk of postoperative morbidity and death. The presence of malnutrition in cancer patients has prognostic importance. In a review of more than 3000 cancer patients, DeWys and colleagues identified significantly improved survival in those patients without weight loss compared with those had lost 6% of their body weight (Am J Med 69:491-497, 1980). Other investigators have noted increased postoperative morbidity and mortality associated with malnutrition. Early hypotheses suggested that reversal of weight loss would improve survival. The development and refinements of enteral and parenteral nutrition have provided the opportunity for studying the relationship between nutritional supplementation and postoperative prognosis. Nutrition support is therefore often instituted to improve nutritional status and thereby reduce the risks of postoperative complications. This article addresses the beneficial role of preoperative nutrition therapy in cancer patients.

  20. Preventing pitfalls in patient surveys.

    Science.gov (United States)

    Steiber, S R

    1989-05-01

    Properly conceived, customer satisfaction surveys can yield the quantitative data needed to gauge patient satisfaction. But, as the author notes, these surveys can be "a veritable mine field of surprises for the uninitiated." This article, the last in a three-part series on measuring patient satisfaction, describes potential pitfalls and discusses the merits of in-person, mail and telephone surveys.

  1. 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

  2. Gadobutrol in Renally Impaired Patients

    Science.gov (United States)

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

    2017-01-01

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

  3. 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

  4. Preoperative anxiety in neurosurgical patients.

    Science.gov (United States)

    Perks, Anna; Chakravarti, Sucharita; Manninen, Pirjo

    2009-04-01

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

  5. 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...

  6. Dentinal candidiasis in cancer patients.

    Science.gov (United States)

    Damm, D D; Neville, B W; Geissler, R H; White, D K; Drummond, J F; Ferretti, G A

    1988-01-01

    Two examples of an unusual presentation of oropharyngeal candidiasis in cancer patients are offered. The light and scanning electron microscopic appearances of candidiasis involving the dentin of teeth are described. The potential significance of recognition of this form of candidiasis in cancer patients is discussed.

  7. Observation af kritisk syge patienter

    DEFF Research Database (Denmark)

    Fuhrmann, Lone; Hesselfeldt, Rasmus; Lippert, Anne

    2009-01-01

    The aim of this study was to estimate to which extent patients with abnormal vital signs on general wards had their vital signs monitored and documented and to establish if staff concern for patients influenced the level of monitoring and was predictive of increased mortality....

  8. Thromboembolic Complications in Fontan Patients

    DEFF Research Database (Denmark)

    Idorn, L; Jensen, A S; Juul, K

    2013-01-01

    patients and plasma was analyzed in 76 patients for biomarkers reflecting endothelial-, glycocalyx-, platelet-, and fibrinolysis function (histone-complexed DNA fragments, Protein C, soluble CD40 ligand, soluble thrombomodulin, syndecan-1, tissue-type plasminogen activator). The results were compared...

  9. The Danish National Patient Register

    DEFF Research Database (Denmark)

    Lynge, Elsebeth; Sandegaard, Jakob Lynge; Rebolj, Matejka

    2011-01-01

    The Danish National Patient Register (NPR) was established in 1977, and it is considered to be the finest of its kind internationally.......The Danish National Patient Register (NPR) was established in 1977, and it is considered to be the finest of its kind internationally....

  10. 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.

  11. Colonoscopic polypectomy in anticoagulated patients

    Institute of Scientific and Technical Information of China (English)

    Shai Friedland; Daniel Sedehi; Roy Soetikno

    2009-01-01

    AIM: To review our experience performing polypectomy in anticoagulated patients without interruption of anticoagulation.METHODS: Retrospective chart review at the Veterans Affairs Palo Alto Health Care System. Two hundred and twenty five polypectomies were performed in 123 patients. Patients followed a standardized protocol that included stopping warfarin for 36 h to avoid supratherapeutic anticoagulation from the bowel preparation. Patients with lesions larger than 1 cm were generally rescheduled for polypectomy off warfarin. Endoscopic clips were routinely applied prophylactically.RESULTS: One patient (0.8%, 95% CI: 0.1%-4.5%)developed major post-polypectomy bleeding that required transfusion. Two others (1.6%, 95% CI:0.5%-5.7%) had self-limited hematochezia at home and did not seek medical attention. The average polyp size was 5.1 ± 2.2 mm.

  12. 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...

  13. 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.

  14. Patients' attitudes towards animal testing

    DEFF Research Database (Denmark)

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

    2014-01-01

    A strong argument for the practice of animal testing in medical research is the potential benefit to patients in getting improved pain relief, minimising morbidity and mortality. However, patients’ opinions on the ethics of animal testing are seldom sought, despite their role as principal...... 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 the Swedish Rheumatism Association (n=1195) and to all scientific experts serving on Ethical Review Boards in Sweden (n=364), with response rates of 65 per cent and 60 per cent, respectively. Results show that patients hold a positive stance towards animal testing, but with many caveats, and the level...

  15. Oocyte cryopreservation in oncological patients.

    Science.gov (United States)

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

    2004-04-05

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

  16. 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.

  17. 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.

  18. 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.

  19. Patient discomfort following periapical surgery.

    Science.gov (United States)

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

    2008-02-01

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

  20. Hormone therapy for transgender patients

    Science.gov (United States)

    2016-01-01

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

  1. Patients experience of source isolation

    DEFF Research Database (Denmark)

    Johansen, Kamilla; Pedersen, Didde; Kragbak, Nina

    2013-01-01

    Patients´ experience of source isolation - a literature review Title: Patients experience of source isolation – a literature review Authors: Nina Kragbak*, Didde Pedersen*, Kamilla Johansen* and Peter E. Jensen** *students, **lecturer, bachelor in science and Ph.D., at VIA University College......, 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...

  2. Endodontics and the irradiated patient

    Energy Technology Data Exchange (ETDEWEB)

    Cox, F.L.

    1976-11-01

    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.

  3. Protect the Patient from Whom?

    DEFF Research Database (Denmark)

    Pii, Kathrine Hoffmann; Villadsen, Kaspar

    2013-01-01

    This article presents findings from an empirical study among patients and professionals involved in a preventive health program at a Danish hospital. It shows how patients enrolled in the program interact with health professionals in ways that challenge assumptions common to governmentality studies...... of discipline and biopolitics in preventive practices, this study eschews an interpretation that views the powers of the professional health system as invasive and one-directional. Perhaps surprisingly, the study demonstrates how patients in various ways defy a ‘patient-centered’ and empowering approach...... and demand to be treated medically and disciplined in a more traditional sense. The blurring of the public/private boundary, then, cannot be straightforwardly described as a result of a professional health system that, more or less subtly, reaches into the private lives of patients. A more complex picture...

  4. [Longitudinal effects of structured patient education programs for vasculitis patients].

    Science.gov (United States)

    Herlyn, K; Gross, W L; Reinhold-Keller, E

    2008-05-01

    According to the literature it is known that structured standardized patient education represents an effective additional treatment in patients with chronic diseases. Positive effects in the reduction of disease activity and depression have been shown for rheumatoid arthritis, systemic lupus erythematodes, and diabetes mellitus. An interdisciplinary approach for providing information was developed for patients with primary systemic vasculitides (PSV) in the vasculitis center in Bad Bramstedt. The contents of the seminars were revised and condensed into five modules. To evaluate the new form of the program a documentation system was designed. Patients were trained in closed groups (n=10-15) and completed the questionnaires at baseline, 4 weeks, 6 and 12 months following participation. A total of 102 patients in 10 closed groups showed a statistically significant increase in their knowledge in the three aspects of medicine, therapy and side effects, nutrition and physiotherapy. Health-related quality of life in all dimensions increased considerably. Both self-efficacy and the patient-assessed health status improved. The standardized structured education program for vasculitis patients provides an additional treatment in the interdisciplinary care of vasculitis.

  5. Patients' feelings about hand washing, MRSA status and patient information.

    Science.gov (United States)

    Duncan, Christopher Paul; Dealey, Carol

    The purpose of this study was to explore patient opinion about asking healthcare professionals to wash their hands before a clinical procedure and to explore if methicillin-resistant Staphylococcus aureus (MRSA) status and access to patient information about infection control would influence the patients' anxiety about asking. A descriptive survey was undertaken using a semi-structured questionnaire. The questionnaire was distributed to a randomized convenience sample of 185 inpatients across all departments of an acute NHS Trust hospital (response rate 58.9%). Spearman's rank order and Kendall Tau-b tests were used to analyse specific correlations. Respondents were more confident than anxious about being involved in a campaign that empowered patients to ask staff to wash their hands. Patients were more anxious to ask if their previous admission episodes were fewer, if their knowledge of MRSA was high and if there was less information about infection control available. Patients who had contracted MRSA in the past were less anxious, as they had a better understanding of the disease. In addition, more patients felt less anxious about asking staff to wash their hands if staff wore a badge saying 'It's OK to ask'.

  6. 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.

  7. Integration of microarray technology into prenatal diagnosis: counselling issues generated during the NICHD clinical trial.

    Science.gov (United States)

    Wapner, Ronald J; Driscoll, Deborah A; Simpson, Joe Leigh

    2012-04-01

    Cytogenetic microarray analysis (CMA) in prenatal testing detects chromosome abnormalities and new genetic syndromes that would be missed by conventional cytogenetics and has the potential to significantly enhance prenatal genetic evaluation. A large Eunice Kennedy Shriver National Institute Of Child Health and Human Development (NICHD)-sponsored multicentered trial to assess the role of CMA as a primary prenatal diagnostic tool has been completed, and results will soon be available. Integration of this technology into clinical care will require thoughtful changes in patient counseling. Here, we examine four cases, all ascertained in the NICHD prenatal microarray study, to illustrate the challenges and subtleties of genetic counseling required with prenatal CMA testing. Although the specifics of each case are distinct, the underlying genetic principles of uncertainty, variable expressivity, and lack of precise genotype-phenotype correlation are well known and already part of prenatal counseling. Counselor and practitioner education will need to include both the science of interpreting array findings as well as development of improved approaches to uncertainty. A team approach to interpretation will need to be developed, as will standardized guidelines by professional organizations and laboratories. Of equal import is additional research into patient attitudes and desires, and a better understanding of the full phenotypic spectrum of copy number variants discovered in utero.

  8. Noninvasive prenatal testing for fetal aneuploidy: clinical assessment and a plea for restraint.

    Science.gov (United States)

    Norton, Mary E; Rose, Nancy C; Benn, Peter

    2013-04-01

    The recent introduction of clinical tests to detect fetal aneuploidy by analysis of cell-free DNA in maternal plasma represents a tremendous advance in prenatal diagnosis and the culmination of many years of effort by researchers in the field. The development of noninvasive prenatal testing for clinical application by commercial industry has allowed much faster introduction into clinical care, yet also presents some challenges regarding education of patients and health care providers struggling to keep up with developments in this rapidly evolving area. It is important that health care providers recognize that the test is not diagnostic; rather, it represents a highly sensitive and specific screening test that should be expected to result in some false-positive and false-negative diagnoses. Although currently being integrated in some settings as a primary screening test for women at high risk of fetal aneuploidy, from a population perspective, a better option for noninvasive prenatal testing may be as a second-tier test for those patients who screen positive by conventional aneuploidy screening. How noninvasive prenatal testing will ultimately fit with the current prenatal testing algorithms remains to be determined. True cost-utility analyses will be needed to determine the actual clinical efficacy of this approach in the general prenatal population.

  9. Maternal Perspectives of Prenatal Sonogram in a North-Eastern Population in Nigeria

    Directory of Open Access Journals (Sweden)

    Ugwu AC

    2009-01-01

    Full Text Available Limited information exists on maternal perspectives of prenatal sonogram in north-eastern Nigeria. This study was aimed at documenting the views and expectations of pregnant women concerning prenatal sonogram as well as their level of awareness of its purpose, limitations and safety in a predominantly Moslem society. A survey was carried out on a convenience sample of 150 patients referred from ante-natal clinics for prenatal sonogram, by administering semi-structured questionnaires. The results show that 61.3% of the women had prenatal sonogram, with little or no information about the purpose, capabilities and limitations of the procedure. 24.7% had neither formal western nor Islamic educational background that may have influenced their perceptions. Most of the women (81.3% were sponsored by either government or their husbands, 72.7% perceived sonogram to be affordable and 63.4% viewed sonographic results as reliable. The perceived main reasons for having a prenatal sonogram were to determine the expected date of delivery and foetal well-being, and to obtain reassurance of maternal health. Sex determination and number of foetuses were the least considered reasons. The study indicates that providing pregnant women with adequate information and sensitising them to the purpose and limitations of sonograms is necessary to guarantee its rational utilisation. Improving patient care, enhancing the skill of sonographers and providing more facilities would improve the services and patients’ perspectives of prenatal sonography.

  10. Association of Duodenal Atresia, Malrotation, and Atrial Septal Defect in a Down-Syndrome Patient

    Directory of Open Access Journals (Sweden)

    R Angotti

    2016-04-01

    Full Text Available Duodenal atresia is the frequent cause of neonatal intestinal obstruction. The association between duodenal atresia, intestinal malrotation, cardiac anomalies and Down syndrome is infrequently reported. We present a prenatally suspected case of duodenal atresia which was associated with malrotation and atrial septal defect in a patient of Down syndrome. Duodenotomy and resection of web was performed in addition to Ladd’s procedure. Postoperative course remained uneventful.

  11. Pulmonary embolism in cancer patients

    Directory of Open Access Journals (Sweden)

    S P Sawant

    2012-01-01

    Full Text Available Aims and Objectives: Pulmonary embolism (PE is rare in the Indian population and is under-reported in patients with malignancy. We studied the clinical profile and outcome of patients with PE and cancer in the Indian population. Materials and Methods: Data of cancer patients with PE, admitted in a tertiary cancer centre, was analyzed. The prevalence of PE was calculated as the number of patients with PE per 10,000 hospital admissions. The demographic data, details of cancer, co-morbidities, details of PE, and treatment given for PE and their outcomes were recorded and analyzed. Results: There were 56,425 hospital admissions in the study period. The prevalence of PE was 6.4 per 10,000 hospital admissions .Thirty-six cancer patients were diagnosed to have PE. In females, gynecological malignancies (36.84% and in males gastrointestinal, head and neck cancers, and hematological malignancies were the most common sites (17.7% each. PE was associated with DVT in 41.7%. Dyspnea was the most common presenting symptom. Five patients (13.88% were asymptomatic and were incidentally detected to have PE . The most common echocardiographic finding was right ventricular dysfunction (55.55%. Mortality among the treated patients was 22% (7 / 31 and in untreated patients it was 80% (4 / 5. The factors that had an impact on a three-month survival were, the presence of massive PE (P = 0.019 and the presence of RV dysfunction at presentation (P = 0.005. Conclusion: The prevalence of PE and mortality due to PE is high in cancer patients. Risk stratification for venous thromboembolism (VTE should be done in all cancer patients and thromboprophylaxis should be optimally used.

  12. 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 

  13. Patient Admission Preferences and Perceptions

    Science.gov (United States)

    Wu, Clayton; Melnikow, Joy; Dinh, Tu; Holmes, James F.; Gaona, Samuel D.; Bottyan, Thomas; Paterniti, Debora; Nishijima, Daniel K.

    2015-01-01

    Introduction Understanding patient perceptions and preferences of hospital care is important to improve patients’ hospitalization experiences and satisfaction. The objective of this study was to investigate patient preferences and perceptions of hospital care, specifically differences between intensive care unit (ICU) and hospital floor admissions. Methods This was a cross-sectional survey of emergency department (ED) patients who were presented with a hypothetical scenario of a patient with mild traumatic brain injury (TBI). We surveyed their preferences and perceptions of hospital care related to this scenario. A closed-ended questionnaire provided quantitative data on patient preferences and perceptions of hospital care and an open-ended questionnaire evaluated factors that may not have been captured with the closed-ended questionnaire. Results Out of 302 study patients, the ability for family and friends to visit (83%), nurse availability (80%), and physician availability (79%) were the factors most commonly rated “very important,” while the cost of hospitalization (62%) and length of hospitalization (59%) were the factors least commonly rated “very important.” When asked to choose between the ICU and the floor if they were the patient in the scenario, 33 patients (10.9%) choose the ICU, 133 chose the floor (44.0%), and 136 (45.0%) had no preference. Conclusion Based on a hypothetical scenario of mild TBI, the majority of patients preferred admission to the floor or had no preference compared to admission to the ICU. Humanistic factors such as the availability of doctors and nurses and the ability to interact with family appear to have a greater priority than systematic factors of hospitalization, such as length and cost of hospitalization or length of time in the ED waiting for an in-patient bed. PMID:26587095

  14. Non-invasive Prenatal Testing: Technologies, Clinical Assays and Implementation Strategies for Women's Healthcare Practitioners.

    Science.gov (United States)

    Swanson, Amy; Sehnert, Amy J; Bhatt, Sucheta

    2013-06-01

    The field of prenatal genetic testing has exploded with new non-invasive technologies and test options in the past several years. It is challenging for women's healthcare providers to keep up with the multitude of publications and provide patients with the most accurate and up-to-date information possible regarding prenatal testing. In this article, we examine the sequencing technologies that provide the framework for non-invasive prenatal testing (NIPT) and review the major North American NIPT clinical validation studies published in 2011 and 2012. This paper also compares and contrasts the commercially available non-invasive prenatal tests in the United States, discusses clinical implementation recommendations from professional societies and highlights considerations for genetic counseling.

  15. Prenatal Diagnosis of 17p13.1p13.3 Duplication

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    Kirsi Kiiski

    2012-01-01

    Full Text Available We present here the first prenatal diagnosis of 17p13.1p13.3 duplication. 17p13.3 duplication has recently been defined as a new distinctive syndrome with several diagnosed patients. In the current case prenatal chromosome analysis (G-banding performed on cultured amniocytes revealed additional material in chromosome 19p. This was further defined as a chromosome 17p13.1p13.3 duplication by FISH and genomic microarray analysis (GMA. In addition Prenatal BACs-on-Beads (PN_BoBs assay was performed, which detected the duplication clearly. This enables rapid prenatal diagnosis of the duplication for this family in the future.

  16. Evaluation of prenatal corticosteroid use in spontaneous preterm labor in the Brazilian Multicenter Study on Preterm Birth (EMIP).

    Science.gov (United States)

    Dias, Tabata Z; Passini, Renato; Tedesco, Ricardo P; Lajos, Giuliane J; Rehder, Patricia M; Nomura, Marcelo L; Costa, Maria L; Oliveira, Paulo F; Sousa, Maria H; Cecatti, Jose G

    2017-11-01

    To evaluate prenatal corticosteroid use in women experiencing spontaneous preterm labor and preterm delivery. The present cross-sectional multicenter study analyzed interview data from patients attending 20 hospitals in Brazil owing to preterm delivery between April 1, 2011 and July 30, 2012. Patients were stratified based on preterm delivery occurring before 34 weeks or at 34-36(+6)  weeks of pregnancy, and the frequency of prenatal corticosteroid use at admission was compared. Prenatal corticosteroid use, sociodemographic data, obstetric characteristics, and neonatal outcomes were examined. There were 1455 preterm deliveries included in the present study; 527 (36.2%) occurred before 34 weeks of pregnancy and prenatal corticosteroids were used in 285 (54.1%) of these pregnancies. Among neonates delivered at 32-33(+6)  weeks, prenatal corticosteroid use was associated with lower pneumonia (P=0.026) and mortality (P=0.029) rates. Among neonates delivered at 34-36(+6)  weeks, prenatal corticosteroid use was associated with longer neonatal hospital admission (PPreterm labor and late preterm delivery were associated with worse neonatal outcomes following prenatal corticosteroids. This could reflect a sub-optimal interval between administration and delivery. © 2017 International Federation of Gynecology and Obstetrics.

  17. Patient-Centered Care Transition for Patients Admitted through the ED: Improving Patient and Employee Experience

    Directory of Open Access Journals (Sweden)

    Andrea Algauer BSN, RN

    2015-05-01

    Full Text Available With increasing wait times in emergency departments (ED across America, there is a need to streamline the inpatient admission process in order to decrease wait times and more important, to increase patient and employee satisfaction. One inpatient unit at New York-Presbyterian Weill Cornell Medical Center initiated a program to help expedite the inpatient admission process from the ED. The goal of the ED Bridge program is to ease the patient's transition from the ED to an inpatient unit by visiting the patient in the ED and introducing and setting expectations for the inpatient environment (i.e. telemetry alarms, roommates, hourly comfort rounds. Along with improving the patient experience, this program intends to improve the collaboration between ED nurses and inpatient nurses. With the continued support of our nurse management, hospital administrators and most important, our staff, this concept is aimed to increase patient satisfaction scores and subsequently employee satisfaction.

  18. 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.

  19. Dermatophytosis in special patient populations

    Institute of Scientific and Technical Information of China (English)

    Salama A Ouf; Tarek A Moussa; Alshimaa M Abd-Elmegeed; Samar R Eltahlawy

    2016-01-01

    Objective:To study the occurrence and prevalence of dermatomycosis in special patient populations suffering from diabetes, cancer and heart diseases. Methods: A total of 640 patients suffering from diabetes, 280 patients suffering from cancer and 210 patients suffering from heart diseases from Cairo City were evaluated for dermatophytosis at the dermatology clinics of four different hospitals from January 2005 to December 2006. Results: The presence of diabetes looks a risk factor for tinea pedis and tinea corporis. Tinea cruris and tinea unguium were not common among diabetics, while tinea capitis and tinea versicolor were completely missed. Tinea capitis followed by tinea pedis are the most common among cancer patients. Thirty cases were recorded for tinea among 210 patients with heart diseases of which tinea capitis and tinea versicolor were recorded once while the other clinical types of tinea were estimated in 6-8 patients for each type. Conclusions: The present investigation shows that diabetes remains to be a risk factor for dermatophytosis and cancer comes next due to the use of radioactive irradiation.

  20. 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.

  1. [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.

  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. PMID:27928442

  3. 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.

  4. Control Prenatal

    Directory of Open Access Journals (Sweden)

    P. Susana Aguilera, DRA.

    2014-11-01

    Full Text Available Los principales objetivos del control prenatal son identificar aquellos pacientes de mayor riesgo, con el fin de realizar intervenciones en forma oportuna que permitan prevenir dichos riesgos y así lograr un buen resultado perinatal. Esto se realiza a través de la historia médica y reproductiva de la mujer, el examen físico, la realización de algunos exámenes de laboratorio y exámenes de ultrasonido. Además es importante promover estilos de vida saludables, la suplementación de ácido fólico, una consejería nutricional y educación al respecto.

  5. Patients with narcolepsy in Slovenia

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    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.  

  6. Regional anesthesia for the trauma patient: improving patient outcomes

    OpenAIRE

    Gadsden J; Warlick A

    2015-01-01

    Jeff Gadsden, Alicia Warlick Department of Anesthesiology, Duke University, Durham, NC, USA Abstract: Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional...

  7. 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.

  8. Respiratory Emergencies in Geriatric Patients.

    Science.gov (United States)

    Tyler, Katren; Stevenson, Dane

    2016-02-01

    Acute dyspnea in older patients is a common presentation to the emergency department. Acute dyspnea in older adults is often the consequence of multiple overlapping disorders, such as pneumonia precipitating acute heart failure. Emergency physicians must be comfortable managing patients with acute dyspnea of uncertain cause and varying goals of care. In addition to the important role noninvasive ventilation (NIV) plays in full resuscitation, NIV can be useful as a method of providing supportive or nearly fully supportive care while more information is gathered from the patients and their loved ones.

  9. Healthcare IT and Patient Empowerment

    DEFF Research Database (Denmark)

    Danholt, Peter; Bødker, Keld; Hertzum, Morten

    2004-01-01

    This short paper outlines a recently initiated research project that concerns healthcare information systems and patient empowerment. Drawing on various theoretical backgrounds, Participatory Design (PD), Computer Supported Cooperative Work (CSCW), Computer Mediated Communication (CMC), and Science...... of type II diabetes at the clinic is characterized by team treatment, a diabetes school, standard treatment plans, and an electronic patient record system. By studying work at the clinic as well as the patients’ ‘work’ with their disease, we aim to come to grips with the complexity of treating type II...

  10. Improving oral hygiene for patients.

    Science.gov (United States)

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

    2015-01-13

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

  11. Diarrhea in the immunocompromised patient.

    Science.gov (United States)

    Krones, Elisabeth; Högenauer, Christoph

    2012-09-01

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

  12. With patient satisfaction under increasing scrutiny, consider patient callbacks.

    Science.gov (United States)

    2011-07-01

    Under the final rules for Medicare's value-based purchasing program, one-third of the funding that is set aside to reward quality will be based on how patients rate their hospital experience. However, some EDs are already working to maximize patient satisfaction by implementing programs or policies whereby patients who have been discharged are routinely called to make sure their recovery is going well, as well as to intervene if there is an opportunity for service recovery. There are benefits to having ED clinicians make the follow-up calls themselves, but some health care organizations are also reaping benefits by having non-clinicians collect feedback on individual clinicians as well as specific facilities. In addition to potentially boosting quality and customer service, experts say callbacks are useful in curbing malpractice litigation. To avoid pushback among staff, consider beginning a program of patient callbacks by asking clinicians to call back just two patients per shift worked, and to share their experiences with colleagues. For maximum value, experts recommend that patient callbacks be made within one to four days of discharge.

  13. 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.

  14. 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…

  15. 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…

  16. 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

  17. Fragile-X mental retardation: molecular diagnosis in Argentine patients.

    Science.gov (United States)

    Florencia, Giliberto; Irene, Szijan; Veronica, Ferreiro

    2006-11-30

    Fragile-X-syndrome (FXS) is the most common type of inherited cognitive impairment. The underlying molecular alteration consists of a CGG-repeat amplification within the FMR-1 gene. The phenotype is only apparent once a threshold in the number of repeats has been exceeded (full mutation). The aim of this study was to characterize the FMR-1 CGG-repeat status in Argentine patients exhibiting mental retardation. A total of 330 blood samples from patients were analyzed by PCR and Southern blot analysis. Initially, DNA from 78 affected individuals were studied by PCR. Since this method is unable to detect high molecular weight alleles, however, we undertook a second approach using the Southern blotting technique to analyze the CGG repeat number and methylation status. Southern blot analysis showed an altered pattern in 14 out of 240 (6%) unrelated patients, with half of them presenting a mosaic pattern. Eight out of 17 families (47%) showed a (suggest deleting highlight). The characteristic FXS pattern was identified in 8/17 families (47%), and in 4 of these families 25% of the individuals presented with a mosaic model. The expansion from pre-mutation to full mutation was shown to occur both at the pre and post zygotic levels. The detection of FXS mutations has allowed us to offer more informed genetic counseling, prenatal diagnosis and reliable patient follow-up.

  18. Prenatal control of Hb Bart's disease in mainland China: can we do better?

    Science.gov (United States)

    He, Ping; Yang, Yu; Li, Ru; Li, Dong-Zhi

    2014-01-01

    The aim of the present study was to report a 3-year experience on the prenatal control of Hb Bart's (γ4) disease in Mainland China. All pregnancies with fetal Hb Bart's disease were included from January 2011 to December 2013. The main clinical characteristics of the affected pregnancies were reviewed, including maternal reproductive history, prenatal care in the current pregnancy, the gestation of pregnancy at the time of booking, the gestation at the time of prenatal diagnosis (PND), and the complications associated with the pregnancy. A total of 246 cases of fetal Hb Bart's disease were identified during the study period; among these, 177 (72.0%) were diagnosed in early gestation (≤24 weeks), and 69 (28.0%) in late gestation. Most (87.0%) of the patients presenting in late pregnancy had late or no prenatal care. Twenty (29.0%) had major obstetrical complications in patients presenting in late pregnancy, and five (5.0%) in patients presenting in relatively early pregnancy. The delay in PND deprived couples of opportunities to make informed decisions early in pregnancy. Efforts for designing and targeting strategies to improve the timeliness of prenatal care are urgently needed.

  19. Developing patient-centered teams: The role of sharing stories about patients and patient care.

    Science.gov (United States)

    Bennett, Ariana H; Hassinger, Jane A; Martin, Lisa A; Harris, Lisa H; Gold, Marji

    2015-09-01

    Research indicates that health care teams are good for staff, patients, and organizations. The characteristics that make teams effective include shared objectives, mutual respect, clarity of roles, communication, trust, and collaboration. We were interested in examining how teams develop these positive characteristics. This paper explores the role of sharing stories about patients in developing patient-centered teams. Data for this paper came from 1 primary care clinic as part of a larger Providers Share Workshop study conducted by the University of Michigan. Each workshop included 5 facilitated group sessions in which staff met to talk about their work. This paper analyzes qualitative data from the workshops. Through an iterative process, research team members identified major themes, developed a coding scheme, and coded transcripts for qualitative data analysis. One of the most powerful ways group members connected was through sharing stories about their patients. Sharing clinical cases and stories helped participants bond around their shared mission of patient-centered care, build supportive relationships, enhance compassion for patients, communicate and resolve conflict, better understand workflows and job roles, develop trust, and increase morale. These attributes highlighted by participants correspond to those documented in the literature as important elements of teambuilding and key indicators of team effectiveness. The sharing of stories about patients seems to be a promising tool for positive team development in a primary care clinical setting and should be investigated further. (c) 2015 APA, all rights reserved).

  20. 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

  1. Muscle dysfunction in cancer patients

    DEFF Research Database (Denmark)

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

    2014-01-01

    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...... 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...

  2. Vaccines for Patients with COPD.

    Science.gov (United States)

    Moreno, Dolores; Barroso, Judith; Garcia, Alexis

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic obstruction of lung airflow limitation. This disease is currently the fourth higher cause of death in the world, and it is predicted to be the third by the year 2020. Patients with COPD are frequently exposed to Human Rhinovirus, Respiratory Syncytial and Influenza Virus, as well as to Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. These infectious agents are responsible for exacerbations increasing morbidity and mortality in COPD patients. Prevention of infectious exacerbations by vaccination would improve quality of life and patient survival. A literature search: "vaccination of COPD patients" was performed using Medline, the Cochrane Library and other Non-Indexed Citations for this review. This article presents a brief overview of the different studies found, on the new patents, and the future strategies on the field.

  3. Fluconazole Pharmacokinetics in Burn Patients

    Science.gov (United States)

    Boucher, Bradley A.; King, Stephen R.; Wandschneider, Heidi L.; Hickerson, William L.; Hanes, Scott D.; Herring, Vanessa L.; Canada, Todd W.; Hess, Mary M.

    1998-01-01

    The pharmacokinetics of fluconazole in nine adult patients with severe (30 to 95% total body surface area) burns were studied. There was no significant difference in half-life (t1/2), clearance (CL), or volume of distribution (V) over time in five patients on days 3 and 8 of the study (P > 0.05). Combined parameter estimates (means ± standard deviations) for all nine patients for the two study periods were as follows: t1/2, 24.4 ± 5.8 h; CL, 0.36 ± 0.09 ml/min/kg; and V, 0.72 ± 0.12 liters/kg. These estimates of t1/2 and CL in burn patients were approximately 13% shorter and 30% more rapid, respectively, than the most extreme estimates reported for other populations. PMID:9559811

  4. CCCT - Patient Advocate Steering Committee

    Science.gov (United States)

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

  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. 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.

  7. Writing of Patient Case History

    Institute of Scientific and Technical Information of China (English)

    Tian Junying

    2016-01-01

    This paper introduces the language features, structure and contents of case history. Good patient case history contributes to correct diagnosis and formulation of a treatment plan, therefore, it is important for physicians to learn how to write case history.

  8. [Perioperative Management of PD Patients].

    Science.gov (United States)

    Reichmann, H

    2016-07-01

    Both patients and caregivers but also treating physicians are concerned about complications along with surgical interventions. A major problem is abrupt cessation of anti-Parkinson medication, which leads to manifold disturbances, sometimes even to an akinetic crisis. There are several means to guarantee continuous dopaminergic stimulation even in patients that are not allowed to take medication orally before they undergo surgery. Amongst others rectally applied levodopa, amantadine infusions, and especially the use of a rotigotine patch are good means to overcome oral intake. Perioperative management is important due to the fact that in Germany alone each year more than 10 000 PD patients undergo surgery. Main reasons for this are fractures, but also elective interventions. Further emergency situations that cause treatment as an inpatient are psychosis, motoric disability, but also pneumonia and cardiovascular disturbances. In contrast PD patients suffer less often from cancer. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Pineal calcification among black patients.

    Science.gov (United States)

    Fan, K J

    1983-08-01

    A postmortem histopathological study was done in 233 pineal glands of black patients. Among them, 70 percent showed microscopic evidence of calcification in the pineal parenchyma. The frequency of calcification increased with age. However, the severity of calcification reached the peak in the 60 to 69 year old age group and then gradually declined. As compared to males, females had slightly higher frequency and reached the peak of severity in younger age groups. When pineal calcification was compared among patients with various malignancies, a higher frequency and more severe calcification were observed in patients with carcinoma of the prostate and the pancreas. A lower frequency and less severe calcification were observed in patients with carcinoma of the breast and the cervix. The results of this study emphasize the important role of sex hormone in genesis of pineal calcification.

  10. A comparison of patient satisfaction

    African Journals Online (AJOL)

    2014-09-11

    Sep 11, 2014 ... antenatal care: A comparison of patient satisfaction. Author: ... Methods: A quantitative comparative descriptive design with a Likert-scale measure was used. ..... Qualitative exploratory studies can permit one to ascertain.

  11. The patient with daily headaches.

    Science.gov (United States)

    Maizels, Morris

    2004-12-15

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

  12. Anaesthesia for a "Scalped" Patient.

    Science.gov (United States)

    Rizvi, M M; Singh, Raj Bahadur; Sarkar, Arindam; Choubey, Sanjay

    2015-06-01

    Trichilemmal carcinoma of scalp is a rare malignant tumour of scalp. A 52-year-old female presented with an extensive ulcerative lesion of the scalp. As the location of the tumour was in the occipital region and there was loss of bony skull in the region, this case became challenging. This patient was managed in the left lateral which was a difficult situation for even the experienced Anaesthesiologist. Intravenous access was acquired, central venous catheter (CVC) was placed in the right internal jugular vein under ultrasonography (USG) guidance and intubation was carried out in the lateral position. After the procedure, patient was again returned to the left lateral position. The trachea was extubated in the lateral position once the patient was awake, after thorough reversal of neuromuscular blockade. Patient had an uneventful postoperative period. This case report highlights the management of an unusual case of Trichilemmal carcinoma of the scalp.

  13. Framework for Patient Flow Improvement

    Directory of Open Access Journals (Sweden)

    S.V. Medina-León

    2014-07-01

    Full Text Available There has been much research where the flow of patients was improved, but most of this study is case-specific and only a few papers offer guidelines for patient flow analysis and improvement. In this study a general framework for the analysis and improvement of patient flow is presented, based on a literature review and on experience from a case study in a hospital in Mexico dealing with identifying improvement opportunities that reduced waiting times in the obstetrics/gynecology area of the emergency department. The framework involves an initial analysis using basic tools followed by the selection of a strategy based on system complexity; financial investment required and team participation. The alternative strategies considered were use of advanced analysis tools; use of kaizen events; or direct recommendations. The aim of the framework is to serve as guideline in patient flow improvement projects by helping select the most appropriate improvement path, resulting in project success.

  14. 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...

  15. Noma in an immunocompromised patient.

    Science.gov (United States)

    Silva, Igor Henrique Morais; Faria, Andreza Barkokebas S de; Fonseca, Deborah Daniela Diniz; Aguiar, Carlos Menezes; Carvalho, Alessandra Tavares; Gueiros, Luiz Alcino; Leao, Jair Carneiro

    2013-01-01

    Noma (also known as cancrum oris) is classified by the World Health Organization as a necrotizing ulcerative stomatitis, an invasive acute infection which affects the orofacial tissues. Patients who are subject to such risk factors as severe malnutrition or alteration of the immune system are predominantly affected. This article presents a case of noma in a 62-year-old immunocompromised patient with pain and tooth mobility in the mandibular region, ulceration, bleeding, gingival inflammatory secretion, and oral malodor. The signs and symptoms were controlled only after the intravenous administration of 500 mg tid of imipenem/cilastatin sodium and 2 g qd of vancomycin. After infection control was maintained, the patient was directed to surgery for removal of bone sequestration and curettage of the maxillary sinus. The patient was prescribed 1 g qd of oral clindamycin for 3 months postsurgery.

  16. Psychotherapists' dreams about their patients.

    Science.gov (United States)

    Kron, Tamar; Avny, Nadav

    2003-06-01

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

  17. 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.

  18. Implant rehabilitation in bruxism patient

    OpenAIRE

    Goiato, Marcelo Coelho; Sonego, Mariana Vilela; dos Santos, Daniela Micheline [UNESP; 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 protocol...

  19. Enteral nutrition in critical patients

    OpenAIRE

    Botello Jaimes, Jhon Jairo; Medico Cuidado Intensivo Clínica San Marcel / Jefe de Urgencias y Unidad de Cuidado Especial Clínica San Marcel / Docente Medicina Interna y Cuidado Intensivo Universidad de Manizales / Docente Internado de Urgencias y de PROFUNDIZACION Urgencias, Cuidado Intermedio e Intensivo Universidad de Caldas / Docente del programa de enfermería Universidad Católica de Manizales / Instructor Internacional / Director Fundación Versalles / Candidato a Magíster en Educación Docencia. Envío co rrespondencia:. Avenida Alberto Mendoza No 93-25 - Clínica San Marcel.; González Rincón, Alejandra; Enfermería Universidad Católica de Manizales. Miembro directivo Fundación Versalles. Miembro Correspondiente Asociación Colombiana de Trauma y Miembro Activo de la Sociedad Panamericana de Trauma. Envío correspondencia: alejita_gonzalez12@ hotmail.com . Calle 50 No 24-14 – Fundación Versalles.

    2010-01-01

    Nutritional support in critically ill patients is of vital importance for its impact on morbidity, hospital stay and preservation of tissue mass among others. It must ensure nutritional support to all critically ill patients enterally ideally by reduced bacterial translocationand stimulation of the function of the intestinal villi. In recent years we have studied immunonutrients as glutamine, arginine, fatty acids and nucleotides with promising effects (Immune response, Intestinal barrier or ...

  20. [Childhood of the schizophrenic patient].

    Science.gov (United States)

    Da Fonseca, D

    2009-01-01

    We are able to identify the different risk factors involved in the development of the disorder from a study of the childhood of a schizophrenic patient. More specifically, we will define the perinatal risk factors: season and place of birth, viral exposure during pregnancy and obstetric complications. Developmental factors will also be discussed. Socialisation, language, psychomotor and cognitive development disorders are all developmental difficulties seen during the childhood of the schizophrenic patient. Finally we will finish by discussing a few psychosocial risk factors.

  1. Cultural competence and simulated patients.

    Science.gov (United States)

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

    2016-10-01

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

  2. Pulmonary metastasectomy in pediatric patients

    OpenAIRE

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

    2016-01-01

    Background This study aims to evaluate the outcomes of pulmonary metastasectomy resections in pediatric patients. Methods We retrospectively reviewed the medical records of 43 children who were operated on in the Pediatric Surgery Clinic between January 1988 and 2014. Forty-three children (26 boys; 17 girls; mean age 10???4.24?years, range 6?months?18?years) who underwent pulmonary metastasectomy resection were included in the study. The patients were evaluated based on age, gender, history o...

  3. Hypogonadism in thalassemia major patients

    Directory of Open Access Journals (Sweden)

    Sasima Srisukh

    2016-09-01

    Full Text Available Despite recent advances in iron chelation therapy, excess iron deposition in pituitary gonadotropic cells remains one of the major problems in thalassemic patients. Hypogonadism, mostly hypogonadotropic hypogonadism, is usually detected during puberty. Early diagnosis and treatment are crucial for normal pubertal development and to reduce the complications of hypogonadism. The risks and benefits of hormonal replacement therapy, especially regarding the thromboembolic event, remain a challenge for providers caring for thalassemic patients.

  4. [Orthodontic treatment in periodontal patients].

    Science.gov (United States)

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

    2011-07-01

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

  5. 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.

  6. Platelet matching for alloimmunized patients

    Institute of Scientific and Technical Information of China (English)

    S H.Hsu

    2010-01-01

    @@ Platelets play an essential role in blood coagulation,hemostasis and maintenance of vascular integrity.Platelets are utilized primarily to prevent or treat bleeding in thrombocytopenic patients and patients with impaired platelet production in the bone marrow and/or with dysfunctional platelets.In current practice,platelet transfusion begins with randomly selected platelet products:either pooled platelets prepared from whole blood derived platelets; or single donor platelets prepared by apheresis procedures.

  7. Patient-empowerment interactive technologies.

    Science.gov (United States)

    Bruggers, Carol S; Altizer, Roger A; Kessler, Robert R; Caldwell, Craig B; Coppersmith, Kurt; Warner, Laura; Davies, Brandon; Paterson, Wade; Wilcken, Jordan; D'Ambrosio, Troy A; German, Massiell L; Hanson, Glen R; Gershan, Lynn A; Korenberg, Julie R; Bulaj, Grzegorz

    2012-09-19

    Video games capture the rapt attention of an individual player's mind and body, providing new opportunities for personalized health care. An example of therapeutic interactive technologies is an incentive-based video game that translates physical exercise into mental empowerment via motivational metaphoric visualization in order to help patients psychologically overcome cancer. Such nonpharmacological interventions may enhance patients' resilience toward various chronic disorders via neuronal mechanisms that activate positive emotions and the reward system.

  8. Patient Simulators Train Emergency Caregivers

    Science.gov (United States)

    2014-01-01

    Johnson Space Center teamed up with Sarasota, Florida-based METI (now CAE Healthcare) through the STTR program to ruggedize the company’s patient simulators for training astronauts in microgravity environments. The design modifications were implemented in future patient simulators that are now used to train first responders in the US military as well as fire departments and other agencies that work in disaster zones.

  9. Talking with eye injury patients

    Directory of Open Access Journals (Sweden)

    Helen Roberts

    2016-01-01

    Full Text Available Patients with an eye injury are usually in pain and very frightened. They need a gentle, reassuring approach. Your first task is to assess the general state of your patient. If they are alert and orientated and their general health is good, you can continue to examine them in the eye department. If their immediate general health is at risk, you will have to address this first.

  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. [GASTRIC CANCER IN YOUNG PATIENTS

    Science.gov (United States)

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

    2000-01-01

    OBJECTIVE: In order to determine a the clinicopatological features in young patients with gastric cancer and compare them with aged patients.PATIENTS AND METHODS: For this study, we selected the clinical charts from the total of patients with histological proved diagnosis of gastric adenocarcinoma admitted at the INEN between 1980 and 1996 whose age was less than 31 year (Young group, n =92). As a comparison group (Average Group) we chose of the same universe, a random sample of 184 patients between 50 to 70 years of age. Epidemiological, clinical and histological features, operability and resecability, TNM stage, type of surgery and follow-up of both groups were analyzed.RESULTS: In the Young Group in compared with Average Group, females were more frequent (73.9% vs. 50.5% p0.001). The mean survival time in the Young Group was 74.9 months and in the Average Group was 36.03 months (p=0.26), there were no significant differences in the survival between resecability and sex (p=0.10 and p=0.41).CONCLUSION: The females and undifferentiated carcinoma was the most frequent features in the young patients with gastric cancer. The survival in this group is better than the average group but this was a no significant difference because the diagnosis was made in late stages.

  12. [Delusion in the critical patient].

    Science.gov (United States)

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

    2008-02-01

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

  13. Social anxiety in orthognathic patients.

    Science.gov (United States)

    Ryan, F S; Moles, D R; Shute, J T; Clarke, A; Cunningham, S J

    2016-01-01

    There is evidence that patients seeking orthognathic treatment may be motivated by social anxiety disorder (SAD). The aim of this study was to investigate SAD in orthognathic patients using the Brief Fear of Negative Evaluation Scale (BFNES) and to compare these findings with those of the general population. This was a cross-sectional, questionnaire study conducted in two parts. Firstly, a national survey was conducted to yield data for the BFNES from a large, random sample of the UK general population. Secondly, orthognathic patients completed the BFNES. The BFNES scores are reported in two formats: the original 12-item scale (O-BFNES) and a shorter eight-item version (S-BFNES). With regards to the national survey, 1196 individuals participated. The mean O-BFNES score was 29.72 (standard deviation (SD) 9.39) and S-BFNES score was 15.59 (SD 7.67). With regards to the orthognathic sample, 61 patients participated. The mean O-BFNES score was 39.56 (SD 10.35) and the mean S-BFNES score was 24.21 (SD 8.41). Orthognathic patients had significantly higher scores than the general UK population (Porthognathic patients experience significantly higher levels of social anxiety than the general population.

  14. Caring for visually impaired patients.

    Science.gov (United States)

    Orrico, Kathleen B

    2013-01-01

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

  15. Stroke Care in Young Patients

    Directory of Open Access Journals (Sweden)

    L. Tancredi

    2013-01-01

    Full Text Available The aims of this study were (i to evaluate the clinical features of a consecutive series of young patients with ischemic stroke and (ii to assess the changes in the clinical management of these patients over the study period. All consecutive cases of young adults aged 16 to 44 years, with ischemic stroke, that were admitted between 2000 and 2005 in 10 Italian hospitals were included. We retrospectively identified 324 patients. One or more vascular risk factors were present in 71.5% of the patients. With respect to the diagnostic process, an increase in the frequency of cerebral noninvasive angiographic studies and a decrease in the use of digital subtraction angiography were observed ( and , resp.. Undetermined causes decreased over 5-year period of study (. The diagnosis of cardioembolism increased. Thrombolysis was performed for 7.7% of the patients. PFO closure (8% was the most frequently employed surgical procedure. In conclusion, the clinical care that is given to young patients with ischemic stroke changed over the study period. In particular, we detected an evolution in the diagnostic process and a reduction in the number of undetermined cases.

  16. Hepatitis C in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

    Despite reduction of hepatitis C prevalence afterrecognition of the virus and testing of blood products,hemodialysis (HD) patients still comprise a high riskgroup. The natural history of hepatitis C virus (HCV)infection in dialysis is not fully understood whilethe clinical outcome differs from that of the generalpopulation. HD patients show a milder liver diseasewith lower aminotransferase and viral levels depicted bymilder histological features on liver biopsy. Furthermore,the "silent" clinical course is consistent with a slowerdisease progression and a lower frequency of cirrhosisand hepatocellular carcinoma. Potential explanations forthe "beneficial" impact of uremia and hemodialysis onchronic HCV infection are impaired immunosurveillanceleading to a less aggressive host response to the virusand intradialytic release of "hepatoprotective" cytokinessuch as interferon (IFN)-α and hepatocyte growthfactor. However, chronic hepatitis C is associated witha higher liver disease related cardiovascular and allcausemortality of HD patients. Therapy is indicated inselected patients groups including younger patients withlow comorbidity burden and especially renal transplantcandidates, preferably after performance of a liverbiopsy. According to current recommendations, choice oftreatment is IFN or pegylated interferon with a reportedsustained viral response at 30%-40% and a withdrawalrate ranging from 17% to 30%. New data regardingcombination therapy with low doses of ribavirin whichprovide higher standard variable rates and good safetyresults, offer another therapeutic option. The newprotease inhibitors may be the future for HCV infectedHD patients, though data are still lacking.

  17. [Cystic adenomatoid malformation of the lung. Importance of prenatal diagnosis].

    Science.gov (United States)

    Cabeza, Beatriz; Oñoro, Gonzalo; Cantarín Extremera, Verónica; Sanz Santiago, Verónica; Sequeiros, Adolfo

    2011-04-01

    Cystic adenomatoid malformation of the lung is a rare malformation of the lung airway which often performed diagnosed in the prenatal period by ultrasound. Ultrasound monitoring should be performed during pregnancy to assess lung development. We report the case of a 4-year-old patient with prenatal diagnosis of cystic adenomatoid malformation of the lung, not confirmed by chest radiograph at birth. The patient underwent surgery at 4 years of age after diagnosis was made for presenting recurrent pneumonia. A normal chest radiograph at birth does not exclude this malformation and a computerized tomography at 4 weeks of birth must be done to confirm or rule out this anomaly. Once the diagnosis is made, surgical treatment should be prompted to avoid complications.

  18. Regional anesthesia for the trauma patient: improving patient outcomes.

    Science.gov (United States)

    Gadsden, Jeff; Warlick, Alicia

    2015-01-01

    Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile.

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

    Science.gov (United States)

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

    2012-02-01

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

  20. [Nutritional support in stroke patients].

    Science.gov (United States)

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

    2014-01-01

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

  1. [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

  2. NUTRITIONAL ASSESSMENT OF CAPD PATIENTS

    Directory of Open Access Journals (Sweden)

    Hong Ren

    2012-06-01

    Full Text Available Appearance and progressive development of malnutrition significantly influence the efficacy and treatment outcome in chronic renal failure (CRF patients receiving continuous ambulatory peritoneal dialysis (CAPD therapy. The aim of the present investigation was estimation of incidence and risk factors of the malnutrition development in CRF patients treated with CAPD. Nutritional status was studied in 244 PD patients (97 women, 146 men; age 59.58±16.55 years being under CAPD during 1-104 (median 30 months. Anthropometric (body mass index, dermato-fatty fold over 3-headed muscle, Subjective Global Assessment SGA, normalized protein catabolic rate nPCR and biochemical indices (hemoglobin Hb, serum albumin SALB, serum pre-albumin Spre-ALB, serum cholesterol SChol were used for nutritional status estimation. The overall mean body mass index was 28.18±47.11. The mean level of hemoglobin was 101.30±23.81 g/L, Scr was 857.28±336.17 umol/L, KT/V was 2.25±0.73. The overall mean SALB was 30.67±5.58 g/L, 74.2% patients on low SALB (SALB <35 g/L. The mean level of Spre-ALB was 331.63±91.43 mg/L, 35.66% patients on low Spre-ALB (Spre-ALB <300 mg/L. The mean level of PCR was 0.93±0.24 g/kg.d, 59.01% patients on low level PCR (PCR <1 g/kg.d. The mean dermato-fatty fold over 3-headed muscle was 13.42 mm. 25% patients had a SGA score of 1-4(malnutrition range. The prevalence of malnutrition was 18.03%. The main cause (44.6% of death is infection in our study, and the majority of these patients were complicated with different level of malnutrition. In conclusion, the results indicate that malnutrition is quite common and plays an important role in mortality in CAPD patients independent of dialysis efficacy and prevention or treatment of malnutrition by suitable means is necessary to improve clinical outcomes in CAPD patients.

  3. Responding to Prenatal Disclosure of Past Sexual Abuse

    OpenAIRE

    2014-01-01

    The American College of Obstetricians and Gynecologists recommends that physicians elicit a sexual abuse and rape trauma history for every patient. Yet in practice, physicians may still struggle to understand how best to obtain this history and what clinical obligations arise when a physician inquires and a woman discloses a remote history of childhood or adult sexual trauma during the course of her prenatal care. This commentary offers a practical strategy for responding to sexual trauma dis...

  4. Prenatal Diagnoses with Cordocentesis: Evaluation of 172 Cases

    OpenAIRE

    Mahmut Erdemoğlu; Ahmet Kale; Nurten Akdeniz

    2007-01-01

    The aim of this study was to evaluate the results of 172 cordosentesis cases for chromosomal analysis in high risk pregnant patients which were performed in our clinic during 2001 and 2004. Cordosentesis procedure were performed mainly for, fetal anomaly, positive triplescreening test. Fetal chromosomal anomaly ratio was 7.5%. Trisomi 21,18,13 were found in fetal anomaly group. The invasive procedure success rate was %98.8. Cordosentes is a safe and easily performed prenatal diagnosis and t...

  5. Prenatal Diagnosis and Genetic Counseling for Mosaic Trisomy 13

    Directory of Open Access Journals (Sweden)

    Chih-Ping Chen

    2010-03-01

    Full Text Available Counseling parents of a fetus with trisomy 13 mosaicism remains difficult because of the phenotypic variability associated with the condition; some patients exhibit the typical phenotype of complete trisomy 13 with neonatal death, while others have few dysmorphic features and prolonged survival. This article provides a comprehensive review of the prenatal diagnosis and genetic counseling for mosaic trisomy 13, including confined placental mosaicism 13, mosaic trisomy 13 diagnosed at amniocentesis, and phylloid hypomelanosis in association with mosaic trisomy 13.

  6. Communication during gynecological out-patient encounters.

    NARCIS (Netherlands)

    Dulmen, A.M. van

    1999-01-01

    The intimate nature of women's health problems presented during gynecological encounters places great demands on gynecologists' communicative behavior. The present study examined what patients expect from their gynecologist, how gynecologists and patients actually communicate during out-patient

  7. 'PROSTHETIC MANAGEMENT OF AN IEPILEPTIC PATIENT

    African Journals Online (AJOL)

    This case report illustrates the problems of tooth loss in an epileptic patient. The patient presented with .... Fig. lb fully dentate lower arch with no clinically obvious gingival ... For this patient who is partially edentulous: the ideal treatment option.

  8. Masticatory performance in patients with myasthenia gravis

    NARCIS (Netherlands)

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

    2002-01-01

    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 individu

  9. 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...

  10. 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...

  11. Mycoses in the transplanted patient.

    Science.gov (United States)

    Dictar, M O; Maiolo, E; Alexander, B; Jacob, N; Verón, M T

    2000-01-01

    The incidence of invasive fungal infection (IFI) has increased considerably over the past 20 years, and transplant recipients are at especially high risk for fungal infections owing to their overall immunosuppressed condition. Organ transplantation procedures were incorporated as a therapeutic option for many patients who lacked the normal functions of organs such as the heart, liver, kidney, lung, pancreas and small bowel. The prevalence of IFI in solid organ transplant (SOTR) patients ranges from 5 to 50% in kidney and liver transplants, respectively. In bone marrow transplant (BMT) patients, IFI are major causes of morbidity and mortality due to the protracted neutropenic period and graft-versus-host disease. Candida spp. and Aspergillus spp. account for >80% of fungal episodes in both SOTR and BMT. The development of new immunosuppressive agents, new prophylaxis strategies (as pre-emptive therapy) and the improvement in surgical techniques led to increase survival of transplant recipients. In this session, a clear and concise update of the recent advances in the laboratory diagnosis of candidiasis and aspergillosis in this kind of patients was presented. However, we still need to establish more rapid, sensitive and specific methods for IFI diagnosis. Representatives of the 'Subcomision de Infecciones en el Paciente Neutropenico y Transplantado (SIPNYT)' de la Sociedad Argentina de Infectologia (SADI), presented the results of an unusual multicenter study both retrospective and descriptive studies of IFI in SOTR and BMT patients in Argentina. In addition, a study of IFI in 1,861 SOTR patients from four centers and the analysis of IFI in 2,066 BMT patients from all 12 BMT centers from Argentina was presented. From these studies it can be concluded that 'all transplant recipients are not the same' and that they should be stratified according to their different risk degrees in order to determine the best prophylaxis and treatment strategies.

  12. Autoantibodies in Patients with Fasciolosis

    Directory of Open Access Journals (Sweden)

    M Korkmaz

    2009-07-01

    Full Text Available "nBackground: Antiself humoral immune responses have been detected not only in classical autoimmune dis­eases, but autoantibodies have also been found in sera of patients suffering from chronic parasitic dis­eases. We aimed to investigate the role of fasciolosis as a trigger factor of autoimmune reactivity by searching some anti­bodies related to hepatobiliary systems, in patients with fasciolosis. "nMethods: Thirty-two patients (17 males, 15 females with fasciolosis were included in this case-control study. Anti-nuclear antibodies (ANA Screen (antigen mixture of dsDNA, histones, nRNP/Sm, Sm, SS-A, SS-B, Scl-70, Jo-1, ribosomal P-proteins, centromere ELISA and single-antigen ELISAs for detection of some antibodies (dsDNA, Anti-M2, Anti- liver-kidney microsomes type 1 (LKM-1 and Myeloperoxidase (MPO were carried out. "nResults: ANA-screen, M-2, LKM-1, MPO and anti-dsDNA positivity were detected with ELISA in 7, 7, 4, 2 and 2 of 32 patients with fasciolosis, consecutively. No statistically significant difference was de­tected for any of the autoantibodies' frequency between patients with fasciolosis and control group. How­ever, autoantibody positivity rate was significantly higher in patients with fasciolosis (50 % than control group (12.5 %. Absorbance values of all autoantibodies in patients with fasciolosis were statistically sig­nificant higher than controls. "nConclusion: These results lent support to the role of fasciolosis as a trigger factor of autoimmune reactiv­ity by the breakdown of tolerance. In spite of the extensive knowledge that has accumulated, the specific relationship be­tween fasciolosis and autoimmunity is still obscure.

  13. Anxiety disorders in dialysis patients

    Directory of Open Access Journals (Sweden)

    Novaković Milan

    2007-01-01

    Full Text Available 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 the control group included 405 patients with other diagnoses causing renal insufficiency (N18. The study was designed as a comparative cross sectional study, and patients were tested using questionnaires assessing anxiety, depression and general mental health status. Statistical analysis was done using standard descriptive and analytical methods. Results. Socio-demographic data showed highly significant differences between BEN and N18 in relation to place of residence (urban/rural (c2 = 23.970 p<0.01; in the incidence of renal comorbidity (c2 = 23.970 p<0.01; familial renal comorbidity (c2 = 23.970 p<0.01; and migrations (c2 = 4.874 p<0.01. Beck Anxiety Inventory Scores were highly significantly different between the two groups p<0.001, in regard to the incidence and variables. Hamilton Depression Rating Scale demonstrated a group significance p<0.001, and variables pointed to somatization, general anxiety and depression. This was confirmed by mini-mental state examination pointing to generalmental weakness. Conclusion. Anxiety appeared in all tested dialysis patients. It may be independent, somatized as part of another mental disorder or reinforced by a cognitive damage. Structured anxiety and depression result in pre-suicidal risk. .

  14. Treating statin-intolerant patients

    Directory of Open Access Journals (Sweden)

    Pigna G

    2011-04-01

    Full Text Available Marcello Arca, Giovanni PignaAtherosclerosis Unit, Department of Internal Medicine and Allied Medical Specialities, Sapienza University of Rome, Rome, ItalyAbstract: Statins are effective in reducing cardiovascular events and are safe for almost all patients. Nevertheless, intolerance to statins is frequently faced in clinical practice. This is mostly due to muscular symptoms (myalgia with or without increase of plasma creatinine kinase and/or elevation of hepatic aminotransferases, which overall constitutes approximately two-thirds of reported adverse events during statin therapy. These side effects raise concerns in patients as well as in doctors and are likely to reduce patients' adherence and, as a consequence, the cardiovascular benefit. Therefore, it is mandatory that clinicians improve their knowledge on the clinical aspects of muscular and hepatic side effects of statin therapy as well as their ability to manage patients with statin intolerance. Besides briefly examining the clinical aspects and the mechanisms that are proposed to be responsible for the most common statin-associated side effects, the main purpose of this article is to review the available approaches to manage statin-intolerant patients. The first step is to determine whether the adverse events are indeed related to statin therapy. If so, lowering the dosage or changing statin, alternate dosing options, or the use of nonstatin compounds may be practical strategies. The cholesterol-lowering potency as well as the usefulness of these different approaches in treating statin-intolerant patients will be examined based on currently available data. However, the cardiovascular benefit of these strategies has not been well established, so their use has to be guided by a careful clinical assessment of each patient.Keywords: statin therapy, atorvastatin, rosuvastatin, aminotransferase levels, myopathy

  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......-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. RESULTS: Two major themes emerged: emotional responses and cognitive...

  16. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety...

    Science.gov (United States)

    2011-11-17

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety Foundation AGENCY: Agency for Healthcare Research and... relinquishment from Emergency Medicine Patient Safety Foundation of its status as a Patient Safety...

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

    DEFF Research Database (Denmark)

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

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

  18. 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...

  19. The patient health questionnaire-9: validation among patients with glaucoma.

    Directory of Open Access Journals (Sweden)

    Vijaya K Gothwal

    Full Text Available BACKGROUND: Depression and anxiety are two common normal responses to a chronic disease such as glaucoma. This study analysed the measurement properties of the depression screening instrument - Patient Health Questionnaire-9 (PHQ-9 using Rasch analysis to determine if it can be used as a measure. METHODS: In this hospital-based cross-sectional study, the PHQ-9 was administered to primary glaucoma adults attending a glaucoma clinic of a tertiary eye care centre, South India. All patients underwent a comprehensive clinical evaluation. Patient demographics and sub-type of glaucoma were abstracted from the medical record. Rasch analysis was used to investigate the following properties of the PHQ-9: behaviour of the response categories, measurement precision (assessed using person separation reliability, PSR; minimum recommended value 0.80, unidimensionality (assessed using item fit [0.7-1.3] and principal components analysis of residuals, and targeting. RESULTS: 198 patients (mean age ± standard deviation  = 59.83±12.34 years; 67% male were included. The native PHQ-9 did not fit the Rasch model. The response categories showed disordered thresholds which became ordered after category reorganization. Measurement precision was below acceptable limits (0.62 and targeting was sub-optimal (-1.27 logits. Four items misfit that were deleted iteratively following which a set of five items fit the Rasch model. However measurement precision failed to improve and targeting worsened further (-1.62 logits. CONCLUSIONS: The PHQ-9, in its present form, provides suboptimal assessment of depression in patients with glaucoma in India. Therefore, there is a need to develop a new depression instrument for our glaucoma population. A superior strategy would be to use the item bank for depression but this will also need to be validated in glaucoma patients before deciding its utility.

  20. Later Prenatal Checkups

    Science.gov (United States)

    ... report card Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Last reviewed: May, 2011 Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

  1. Prenatal Care Checkup

    Science.gov (United States)

    ... report card Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

  2. Prenatal ultrasound - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100197.htm Prenatal ultrasound - series—Procedure, part 1 To use the sharing ... Editorial team. Related MedlinePlus Health Topics Prenatal Testing Ultrasound A.D.A.M., Inc. is accredited by ...

  3. The role of moral imagination in patients' decision-making.

    Science.gov (United States)

    Rommetveit, Kjetil; Scully, Jackie Leach; Porz, Rouven

    2013-04-01

    This article reviews recent developments within a number of academic disciplines pointing toward an increasing importance of imagination for understanding morality and cognition. Using elements from hermeneutics and metaphor theory, it works toward a framework for a more context-sensitive understanding of human agency, especially focusing on moral deliberation and change. The analytic framework is used to analyze the story of a patient making tough decisions in the context of prenatal diagnosis. We show how a relatively stable outlook on the world, here called the "baseline of choice," is challenged by unexpected events and how imaginative processes enter into the active creation of a new moral order. The ensuing interpretation is then placed within a broader philosophical landscape. John Dewey's notion of "dramatic rehearsal" is put forward as one particularly promising way of understanding moral imagination, deliberation, and decision-making.

  4. Lymphoscintigraphy evaluation of paracoccidioidomycosis patients

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    Griva, B.L. E-mail: bgriva@fmb.unesp.br

    2005-07-01

    Lymph node involvement is very frequent in paracoccidioidomycosis (PBM) mainly in its juvenile form. PBM also affects the lymphatic system of patients with the chronic form as it was confirmed by bipedal lymphangiography and autopsy. Lymphoscintigraphy has been used to evaluate lymphedema and cancer. The purpose of this investigation was to study the lymphoscintigraphic variables in a critical manner, to functionally evaluate the lymphatic system of patients with different forms of PBM, and to evaluate the influence of the antifungal treatment on the lymphoscintigraphic variables by lymphoscintigraphy of the extremities. Forty-six patients with PBM were studied. Twenty-one had the juvenile and 25 the chronic form. Patients with the juvenile form were divided again into three subgroups according to age. Eleven healthy volunteers were evaluated as controls. All of them were injected with 37 MBq of dextran 500-99mTc into the first interdigital space of each foot, and blood was obtained for serum albumin determination. Twenty-nine patients were evaluated after the beginning of the antifungal treatment. The time elapsed between both exams was smaller in patients with the juvenile form than in those with the chronic form. Semi-quantitative variables, such as the intensity of visualization of the radiotracer and the pattern of the time-activity curve with regions of interest over ilioinguinal lymph nodes and legs, were studied. Quantitative variables were also evaluated including the velocity of visualization of the lymph nodes, lymph flow ratio, and lymph node radiotracer uptake. The error propagation was calculated to assess the lymph flow ratio accuracy. Correlation between variables and serum albumin was done. The intensity and velocity of visualization of the radiotracer, the lymph flow ratio, and the pattern of the time-activity curve were useful variables to the evaluation of patients with the juvenile and the chronic form of PBM. The lymph flow ratio calculated by

  5. [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

  6. IMMUNOTHERAPY EFFICIENCY IN RHINOSINUSITIS PATIENTS

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    I. V. Stagnieva

    2015-01-01

    Full Text Available Latent rhinosinusitis proceeds without facial pain symptoms. Immune deficiency plays a leading role in pathogenesis of the disease latency. Substance P seems to be a universal mediator of painful irritation and inflammation. The objective of our study was to determine effectiveness of therapies in patients with latent rhinosinusitis, in terms of substance P levels.We treated 148 patients with rhinosinusitis, being free of local pains. All the patients underwent clinical and laboratory examination, including immune profile assessment, measurements of serum cytokines IL-1β, IL-4, IL-6, IL-8, IL-10, TNFα, IFNγ, and substance P. To correct a secondary immunodeficiency, the standard treatment of rhinosinusitis in a subgroup of the patients was accomplished by immunomodulatory drugs from the first day of therapy. The latter drugs were avoided for the rest of study group. Efficacy of treatment was evaluated by clinical signs and laboratory parameters on day 7 of the medication. Pre-treatment levels of substance P were determined in all the patients with latent clinical course and lack of pain symptoms. Low substance P levels (< 100 pg /ml were considered as indications for immunomodulatory therapy, due to immune deficiency confirmed by the cytokine imbalance. Choice of a specific drug was dependent on immunopathogenesis, i.e., for catarrhal rhinosinusitis and deficiency of cellular immunity, we administered IFN-ES-lipint; in cases of purulent rhinosinusitis, Likopid was applied. The patients treated with immunomodulatory drugs showed improvement of immune indexes by the 7th day of treatment, along with return of substance P levels to control values typical to healthy persons. Among patients with low substance P levels and immune deficiency (without immunomodulatory treatment, the immune parameters and substance P levels did not exhibit any sufficient changes over time.Low contents of substance P (SP ≤ 100 pg /ml in blood serum in pain

  7. Dependency in Critically Ill Patients

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    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.

  8. [Multifocal tuberculosis in immunocompetent patients].

    Science.gov (United States)

    Rezgui, Amel; Fredj, Fatma Ben; Mzabi, Anis; Karmani, Monia; Laouani, Chadia

    2016-01-01

    Multifocal tuberculosis is defined as the presence of lesions affecting at least two extrapulmonary sites, with or without pulmonary involvement. This retrospective study of 10 cases aims to investigate the clinical and evolutionary characteristics of multifocal tuberculosis. It included 41 cases with tuberculosis collected between 1999 and 2013. Ten patients had multifocal tuberculosis (24%): 9 women and 1 man, the average age was 50 years (30-68 years). Our patients were correctly BCG vaccinated. The evaluation of immunodepression was negative in all patients. 7 cases had lymph node tuberculosis, 3 cases digestive tuberculosis, 2 cases pericardial tuberculosis, 2 cases osteoarticular tuberculosis, 1 case brain tuberculosis, 2 cases urinary tuberculosis, 4 cases urogenital tuberculosis, 1 case adrenal tuberculosis, 1 case cutaneous and 1 case muscle tuberculosis. All patients received anti-tuberculosis treatment for a mean duration of 10 months, with good evolution. Multifocal tuberculosis is difficult to diagnose. It can affect immunocompetent patients but often has good prognosis. Anti-tuberculosis therapy must be initiated as soon as possible to avoid sequelae.

  9. Hemodynamic changes in depressive patients

    Institute of Scientific and Technical Information of China (English)

    MA Ying; LI Hui-chun; ZHENG Lei-lei; YU Hua-liang

    2006-01-01

    Objective: This study is aimed at exploring the relationship between hemodynamic changes and depressive and anxious symptom in depression patients. Methods: The cardiac function indices including the left stroke index (LSI), ejection fraction (EF), heart rate (HR), diastolic pressure mean (DPM), systolic pressure mean (SPM), left ventricle end-diastolic volume (LVDV), effective circulating volume (ECV), resistance total mean (RTM) and blood flow smooth degree (BFSD) were determined in 65 patients with major depressive disorders and 31 healthy normal controls. The clinical symptoms were assessed with Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA). Results: In patients with depression without anxiety,LSI, EF, LVDV, DPM, SPM, ECV, BFSD were significantly lower than those in controls, while RTM was higher than that in controls. Patients with comorbidity of depression and anxiety showed decreased LVDV, ECV, BFSD, and increased HR in comparison with the controls. The anxiety/somatization factor score positively correlated with LSI, EF, LVDV, but negatively correlated with RTM. There was negative correlation between retardation factor score and DPM, SPM, LVDV. Conclusion: The study indicated that there are noticeable changes in left ventricle preload and afterload, blood pressure, peripheral resistance, and microcirculation in depressive patients, and that the accompanying anxiety makes the changes more complicated.

  10. in Patients with Mustard Lung

    Directory of Open Access Journals (Sweden)

    ShahrzadM Lari

    2013-05-01

    Full Text Available   Introduction: Chronic Obstructive Pulmonary Disease (COPD secondary to sulfur mustard exposure, known as mustard lung, is an important late pulmonary complication. The BODE (Body mass index, Obstruction, Dyspnea, and Exercise index has been established as a valuable tool for determining the adverse consequences of COPD. The aim of this study was to evaluate the role of the BODE index in patients with mustard lung.   Materials and Methods: Eighty-two consecutively stable patients with mustard lung with all levels of severity were entered this study. The following parameters were recorded in all patients: standard spirometry, pulse oximetry, health-related quality of life, the BODE index. Additionally, the severity of COPD was determined by GOLD (Global initiative for chronic Obstructive Lung Disease staging. The correlation of the BODE index with pulmonary parameters was determined. Results: The mean age of the patients was 47.30±7.08 SD years. The mean BODE index was 3.16±2.25 SD. There was a statistically significant inverse correlation between the BODE index and oxygen saturation (r=-0.30, p=0.007. Also a statistically significant correlation was found between the BODE index and quality of life (r=0.80, p=0.001. The BODE index was not correlated with age of the patients and duration of disease. Conclusions: The results of this study showed that the BODE index is correlated with important clinical parameters and can be used in clinical practice

  11. Audiological Manifestations in Vitiligo Patients

    Directory of Open Access Journals (Sweden)

    Parvane Mahdi

    2012-01-01

    Full Text Available Introduction: The hallmark of vitiligo is the disappearance of melanocytes from the skin due to an as yet unidentified mechanism. The presence of melanocytes in the auditory apparatus suggests that this system could possibly be affected by vitiligo, which targets the melanocytes of the whole body and not just the skin.The purpose of this study was to assess the incidence of auditory alterations in patients with vitiligo Materials and Methods: A total of 21 patients diagnosed with vitiligo were enrolled in this study. A group of 20 healthy subjects served as a control group. Pure tone audiometry (PTA and measurements of auditory brain stem responses (ABR were carried out in all participants. Results: High frequency sensory neural hearing loss was detected in 8 patients (38.09%. Analysis of ABR revealed that 10 patients (47.61% had an abnormal increase in the latency of Wave III and 6 (28.57% had an abnormal prolongation of the inter peak latency between Wave I and III. There was no correlation between age, duration of disease, and any of the recorded parameters. Conclusion: This study highlights the involvement of the auditory system in patients with vitiligo, suggesting that vitiligo is a systemic disease rather than a purely cutaneous problem.

  12. 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.

  13. Patient adherence to allergy immunotherapy.

    Science.gov (United States)

    Reisacher, William R; Visaya, Jiovani M

    2013-06-01

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

  14. Buccal health in asthmatic patients.

    Directory of Open Access Journals (Sweden)

    Nora Sexto Delgado

    2003-04-01

    Full Text Available Background: Buccal health as integral and determinant part of general health makes us find different ways and methods to elevate life quality in the population. Objective: To establish the risk of suffering from dental cavities in asthmatic patients. Methods: A non match case and control study constituted by 100 children selected at simple random from the universe of asthmatic patients belonging to the General Comprehensive doctor offices number 7,9,10, 11, 43, and 44 from Area II in Cienfuegos municipality. The controlled group was selected in the same offices but from the universe of non asthmatic children. The age in both groups was from 6 to 15 years old. Visits to the children´s home were carried out for the record of the information through health oral dental and buccal health knowledge surveys. Results: The index of cavities, lost, and obturated permanent teeth was higher (3, 28 than in the control group (0, 44. The buccal hygiene indexes and the level of knowledge in both groups did not show significant differences. The most used drugs in asthma therapy were salbutamol and ketotifeno which change the buccal milieu. The odds ratio technique between asthmatic and non asthmatic patients showed 4, 9 times more at risk of suffering from dental cavities in the first group. Finally, it can be stated that the asthmatic patients are more at risk of suffering from cavities than the non asthmatic ones, so a program for buccal health in these patients should be performed.

  15. Psychoneuroimmunology in critically ill patients.

    Science.gov (United States)

    DeKeyser, Freda

    2003-02-01

    Psychoneuroimmunology is the study of the interactions among behavior, neural, and endocrine functions and the immune system. The purpose of this review is to briefly summarize the evidence concerning interactions among behavior, the neuroendocrine system, and the immune system, and to show how this evidence relates to critical care patients. It has been shown that the immune function of many patients in the intensive care unit is suppressed as a result of trauma, sepsis, or profound physiologic and psychological stress. Three of the most common stressors among patients in the intensive care unit are pain, sleep deprivation, and fear or anxiety. Findings have shown each of these stressors to be associated with decreased immune functioning. Nurses have an important responsibility to protect their patients from infection and promote their ability to heal. Several actions are suggested that can help the nurse achieve these goals. It is hoped that nurses would keep these interactions in mind while caring for their patients in the intensive care unit.

  16. Falls in elderly hemodialysis patients.

    Science.gov (United States)

    Abdel-Rahman, E M; Turgut, F; Turkmen, K; Balogun, R A

    2011-10-01

    The elderly, (age ≥ 65 years) hemodialysis (HD) patient population is growing rapidly across the world. The risk of accidental falls is very high in this patient population due to multiple factors which include aging, underlying renal disease and adverse events associated with HD treatments. Falls, the most common cause of fatal injury among elderly, not only increase morbidity and mortality, but also increase costs to the health system. Prediction of falls and interventions to prevent or minimize fall risk and associated complications will be a major step in helping these patients as well as decreasing financial and social burdens. Thus, it is vital to learn how to approach this important problem. In this review, we will summarize the epidemiology, risk factors, pathophysiology and complications of falls in elderly HD patients. We will also focus on available methods to assess and predict the patients at higher risk of falling and will provide recommendations for interventions to reduce the occurrence of falls in this population.

  17. MyUMC Patient Portal: patient and professional perspectives

    Science.gov (United States)

    Ros, Wynand J.G

    2012-01-01

    Introduction In 2010 the UMC Utrecht started with the introduction of patient portals for patients with chronic conditions. The evaluation concerned portals of three patient groups: adults with HIV, adolescents with CF and parents of children with CF. The portals had six modules: ‘overview treatment appointments’, ‘overview of medication and test results’, ‘e-consult (a-synchronous)’, ‘request for medical prescription’, ‘diaries’ and ‘questionnaires’. Aim and objectives To evaluate patient’s use, their experiences and to detect factors that influence use and appreciation of the portal. Method One hundred and nine patients were followed during seven months. They completed a digital questionnaire at baseline, and at 2 and 7 months. The questionnaire contains items with fixed response categories on personal characteristics (including internet use and computer skills), actual use of the portal (frequency and modules), total websites’ ease-of-use (attractiveness, controllability, efficiency, helpfulness and learnability with WAMMI), patients’ experiences with the modules and overall appreciation of the portal (10-point scale). Two open questions were add on specific positive and specific negative experiences. Results Most respondents were regular (almost daily) users of the internet and considered themselves competent computer users. Over 80% of the patients used the portal at least once. More than half of them used the portal recently, i.e. the last month. Reasons for not using the portal were lack of actual health problems, problems with login procedures, too busy with other things. Related to regular care, most patients used the portal complementary to regular care for the same questions. However, about half of the patients stated that they used the portal as a substitution for regular consultations (face to face or telephone). On the other hand, one-third stated that they used the portal in addition to regular care. The users find the

  18. Spiritual Exploration in the Prenatal Genetic Counseling Session.

    Science.gov (United States)

    Sagaser, Katelynn G; Shahrukh Hashmi, S; Carter, Rebecca D; Lemons, Jennifer; Mendez-Figueroa, Hector; Nassef, Salma; Peery, Brent; Singletary, Claire N

    2016-10-01

    Religion and spirituality (R/S) are important components of many individuals' lives, and spirituality is often employed by women coping with pregnancy complications. To characterize how prenatal genetic counselors might address spiritual issues with patients, 283 English and Spanish speaking women receiving prenatal genetic counseling in Houston, Texas were surveyed post-counseling using both the Brief RCope and questions regarding interest in spiritual exploration. Genetic counselors were concurrently surveyed to identify religious/spiritual language used within sessions and perceived importance of R/S. Genetic counselors were significantly more likely to identify R/S as important to a patient when patients used religious/spiritual language (p spiritual terms were present, the counselor felt uncertain about the importance of R/S 63 % of the time. However, 67 % of patients reported that they felt comfortable sharing their faith as it relates to their pregnancy, and 93 % reported using positive religious coping. Less than 25 % reported a desire for overt religious actions such as prayer or scripture exploration. Therefore, most patients' desires for spiritual exploration center in the decision making and coping processes that are in line with the genetic counseling scope of practice. Thus, counselors should feel empowered to incorporate spiritual exploration into their patient conversations.

  19. 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.

  20. PATIENT REGISTRIES FOR RARE DISEASES

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    Mariela Deliverska

    2016-06-01

    Full Text Available Rare diseases are diseases with a particularly low prevalence. The specificities of rare diseases - limited number of patients and scarcity of relevant knowledge and expertise - single them out as a distinctive domain of very high added value. The international reference for classification of diseases and conditions is the International Classification of Diseases (ICD, coordinated by the World Health Organization (WHO. Patient registries and databases constitute key instruments for the development of clinical research in the field of rare diseases. Rare disease registries include not only diseases that are inherently rare, but also common diseases that are rare in specific populations, especially those defined by demographics. Disease registries create the possibility of assessing the long-term safety and benefit of different treatments, perhaps leading to treatment algorithms that allow more choices for patients and clinicians.

  1. Zinc supplementation in burn patients.

    Science.gov (United States)

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

    2012-01-01

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

  2. Patient advocacy: the technologist's role.

    Science.gov (United States)

    Church, Elizabeth J

    2004-01-01

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

  3. Antibiotic resistance in cancer patients.

    Science.gov (United States)

    Gudiol, Carlota; Carratalà, Jordi

    2014-08-01

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

  4. Adenovirus infection in immunocompromised patients

    Directory of Open Access Journals (Sweden)

    Sylwia Rynans

    2013-09-01

    Full Text Available Human adenoviruses belong to the Adenoviridae family and they are divided into seven species, including 56 types. Adenoviruses are common opportunistic pathogens that are rarely associated with clinical symptoms in immunocompetent patients. However, they are emerging pathogens causing morbidity and mortality in recipients of hematopoietic stem cell and solid organ transplants, HIV infected patients and patients with primary immune deficiencies. Clinical presentation ranges from asymptomatic viraemia to respiratory and gastrointestinal disease, haemorrhagic cystitis and severe disseminated illness. There is currently no formally approved therapy for the treatment of adenovirus infections.This article presents current knowledge about adenoviruses, their pathogenicity and information about available methods to diagnose and treat adenoviral infections.

  5. 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.

  6. Cancer Patients Versus Cancer Survivors

    Science.gov (United States)

    Mosher, Catherine E.; Danoff-Burg, Sharon

    2013-01-01

    Two studies examined the social and emotional implications of different linguistic classifications of individuals with cancer. Undergraduates were randomly assigned to rate their reactions to either cancer patients or cancer survivors. Across studies, participants held more favorable perceptions of the character of cancer survivors relative to cancer patients and displayed more positive attitudes toward the former group. In addition, participants in Study 1 reported greater willingness to interact with cancer survivors compared with cancer patients. Positive perceptions of prognosis did not appear to account for favorable attitudes toward cancer survivors; most participants in Study 2 did not assume that cancer survivors were beyond the treatment phase of their illness or cured of their disease. Findings point to a potentially powerful effect of word choice on reactions to individuals with cancer. PMID:24371366

  7. ANTIFUNGAL PROPHYLAXIS IN IMMUNOCOMPROMISED PATIENTS

    Directory of Open Access Journals (Sweden)

    Lourdes Vazquez

    2016-09-01

    Full Text Available Invasive fungal infections (IFIs represent significant complications in patients with hematological malignancies. Chemoprevention of IFIs may be important in this setting, but most antifungal drugs have demonstrated poor efficacy, particularly in the prevention of invasive aspergillosis. Antifungal prophylaxis in hematological patients is currently regarded as the gold standard in situations with a high risk of infection, such as acute leukemia, myelodysplastic syndromes, and autologous or allogeneic hematopoietic stem cell transplantation. Over the years, various scientific societies have established a series of recommendations for antifungal prophylaxis based on prospective studies performed with different drugs. However, the prescription of each agent must be personalized, adapting its administration to the characteristics of individual patients and taking into account possible interactions with concomitant medication.

  8. Thromboembolism in Patients with Cancer.

    Science.gov (United States)

    Büyükçelik, Abdullah; Akbulut, Hakan

    2004-03-01

    One hundred and forty years ago, Armand Trousseau described phlegmasia alba dolens as a sign of internal malignancy. Nowadays, it is commonly believed that the presence malignant tumaor increases the risk of venous thromboembolism (i.e deep vein thrombosis and pulmonary embolism) However, cancer is usually associated with other factors such as old age, extensive surgery,immobility, etc., which may predispose to thromboembolism. The majority of thrombotic events occur in the venous system; the incidence of arterial thrombosis is much lower.Recurrent thromboembolism in cancer patients frequently and diminishes the quality of life of the patients.Furthermore, if the thromboembolism is massive, destipte of early and aggressive treatment, it may result in death. In this article, we review thromboembolic complications in cancer patients.

  9. Infant Neurobehavioral Dysregulation Related to Behavior Problems in Children with Prenatal Substance Exposure

    Science.gov (United States)

    Lester, Barry M.; Bagner, Daniel M.; Liu, Jing; LaGasse, Linda L.; Seifer, Ronald; Bauer, Charles R.; Shankaran, Seetha; Bada, Henrietta; Higgins, Rosemary D.; Das, Abhik

    2010-01-01

    OBJECTIVE To test a developmental model of neurobehavioral dysregulation relating prenatal substance exposure to behavior problems at age 7. PATIENTS AND METHODS The sample included 360 cocaine-exposed and 480 unexposed children from lower to lower middle class families of which 78% were African American. Structural equation modeling (SEM) was used to test models whereby prenatal exposure to cocaine and other substances would result in neurobehavioral dysregulation in infancy, which would predict externalizing and internalizing behavior problems in early childhood. SEM models were developed for individual and combined parent and teacher report for externalizing, internalizing, and total problem scores on the Child Behavior Checklist. RESULTS The Goodness of Fit Statistics indicated that all of the models met criteria for adequate fit with 7 of the 9 models explaining 18 to 60% of the variance in behavior problems at age 7. The paths in the models indicate that there are direct effects of prenatal substance exposure on 7-year behavior problems as well as indirect effects, including neurobehavioral dysregulation. CONCLUSIONS Prenatal substance exposure affects behavior problems at age 7 through two mechanisms. The direct pathway is consistent with a teratogenic effect. Indirect pathways suggest cascading effects where prenatal substance exposure results in neurobehavioral dysregulation manifesting as deviations in later behavioral expression. Developmental models provide an understanding of pathways that describe how prenatal substance exposure affects child outcome and have significant implications for early identification and prevention. PMID:19822596

  10. Classic Galactosemia: Study on the Late Prenatal Development of GALT Specific Activity in a Sheep Model.

    Science.gov (United States)

    Coelho, Ana I; Bierau, Jörgen; Lindhout, Martijn; Achten, Jelle; Kramer, Boris W; Rubio-Gozalbo, M Estela

    2017-09-01

    Classic galactosemia results from deficient activity of galactose-1-phosphate uridylyltransferase (GALT), a key enzyme of galactose metabolism. Despite early diagnosis and early postnatal therapeutic intervention, patients still develop neurologic and fertility impairments. Prenatal developmental toxicity has been hypothesized as a determinant factor of disease. In order to shed light on the importance of prenatal GALT activity, several studies have examined GALT activity throughout development. GALT was shown to increase with gestational age in 7-28 weeks human fetuses; later stages were not investigated. Prenatal studies in animals focused exclusively on brain and hepatic GALT activity. In this study, we aim to examine GALT specific activity in late prenatal and adult stages, using a sheep model. Galactosemia acute target-organs-liver, small intestine and kidney-had the highest late prenatal activity, whereas the chronic target-organs-brain and ovary-did not exhibit a noticeable pre- or postnatal different activity compared with nontarget organs. This is the first study on GALT specific activity in the late prenatal stage for a wide variety of organs. Our findings suggest that GALT activity cannot be the sole pathogenic factor accounting for galactosemia long-term complications, and that some organs/cells might have a greater susceptibility to galactose toxicity. Anat Rec, 300:1570-1575, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  11. Fatores associados ao ganho ponderal excessivo em gestantes atendidas em um serviço público de pré-natal na cidade de Recife, Pernambuco, Brasil Factors associated with excessive gestational weight gain among patients in prenatal care at a public hospital in Recife, Pernambuco, Brazil

    Directory of Open Access Journals (Sweden)

    Luciana Marques Andreto

    2006-11-01

    Full Text Available Este estudo teve como objetivo avaliar a evolução do ganho ponderal excessivo durante o segundo e o terceiro trimestre da gestação e a influência de fatores biológicos, sócio-demográficos, comportamentais, reprodutivos e morbidades associadas a este ganho. Foi realizado um estudo descritivo com dados de 240 gestantes de baixo risco obstétrico coletadas para um ensaio clínico sobre tratamento de anemia no período de maio de 2000 a julho de 2001. O banco de dados original continha 347 registros, porém foram excluídas 107, sendo 42 por idade menor que 18 anos e 65 por falta de registro dos pesos das gestantes nos prontuários até o final do pré-natal. Foi observado elevado percentual de ganho de peso semanal excessivo em todas as categorias de peso inicial, embora, no segundo trimestre, o ganho de peso tenha sido significativamente maior naquelas que já iniciaram a gestação com sobrepeso/obesidade. No terceiro trimestre, as variáveis que apresentaram associação significante com o ganho de peso semanal excessivo foram a escolaridade materna e a situação marital.This study assessed excessive weight gain in the second and third trimesters of pregnancy and the influence of biological, socio-demographic, behavioral, and reproductive factors and co-morbidity. The cross-sectional sample included 240 pregnant women at low risk of obstetric complications, followed from May 2000 to July 2001. There were 347 patient records in the original database, but 107 were excluded because of age (42 patients were younger than 18 years or lack of data on weight (65 women. Excessive weight gain was common in all categories of baseline nutritional status, but was more frequent in the second trimester among women who were already overweight or obese upon entering pregnancy. In the third trimester, variables associated with excessive weekly weight gain were schooling and marital status.

  12. Candidemia in major burns patients.

    Science.gov (United States)

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

    2016-06-01

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

  13. Chronic constipation in hemiplegic patients

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To assess the prevalence of bowel dysfunction in hemiplegic patients, and its relationship with the site of neurological lesion, physical immobilization and pharmacotherapy.METHODS: Ninety consecutive hemiplegic patients and 81 consecutive orthopedic patients were investigated during physical motor rehabilitation in the same period, in the same center and on the same diet. All subjects were interviewed ≥ 3 mo after injury using a questionnaire inquiring about bowel habits before injury and at the time of the interview. Patients' mobility was evaluated by the Adapted Patient Evaluation Conference System. Drugs considered for the analysis were nitrates, angiogenic converting enzyme (ACE) inhibitors,calcium antagonists, anticoagulants, antithrombotics,antidepressants, anti-epileptics.RESULTS: Mobility scores were similar in the two groups. De novo constipation (OR = 5.36) was a frequent outcome of the neurological accident.Hemiplegics showed an increased risk of straining at stool (OR: 4.33), reduced call to evacuate (OR: 4.13),sensation of incomplete evacuation (OR: 3.69), use of laxatives (OR: 3.75). Logistic regression model showed that constipation was significantly and independently associated with hemiplegia. A positive association was found between constipation and use of nitrates and antithrombotics in both groups. Constipation was not related to the site of brain injury.CONCLUSION: Chronic constipation is a possible outcome of cerebrovascular accidents occurring in 30% of neurologically stabilized hemiplegic patients.Its onset after a cerebrovascular accident appears to be independent from the injured brain hemisphere,and unrelated to physical inactivity. Pharmacological treatment with nitrates and antithrombotics may represent an independent risk factor for developing chronic constipation.

  14. "In patient" medical abortion versus surgical abortion: patient's satisfaction.

    Science.gov (United States)

    Di Carlo, Costantino; Savoia, Fabiana; Ferrara, Cinzia; Sglavo, Gabriella; Tommaselli, Giovanni Antonio; Giampaolino, Pierluigi; Cagnacci, Angelo; Nappi, Carmine

    2016-08-01

    To compare patients' satisfaction with medical and surgical abortion, implementing the Italian guidelines on medical abortion entailing an "in patient" procedure. A total of 1832 pregnant chose between surgical (vacuum aspiration) or medical abortion (mifepristone p.o. followed after 3 days by sublingual misoprostol) and expressed their expected satisfaction on a visual analog scale (VAS). A total of 885 women chose surgical and 947 medical abortion. The primary end-point was satisfaction VAS score 20 days after the procedure. Secondary end-points were: difference between pre- and post-abortion VAS score; difference in satisfaction VAS scores according to parity and previous abortion; incidence of side effects. VAS score was high in each group but significantly higher for the 1-day surgical than for the 3-day medical abortion procedure (7.9 ± 1.0 versus 7.2 ± 1.2; p after the treatment (6.9 ± 1.6 versus 7.9 ± 1.0, p abortion; women with a previous abortion preferred surgical abortion. Both procedures are considered satisfactory by the patients. Performing medical abortion as a 3-day "in patient" procedure, decreased women's satisfaction scores from their baseline expectations.

  15. Diabetes in patients with HIV: patient characteristics, management and screening

    NARCIS (Netherlands)

    Roerink, M.E.; Meijering, R.; Bosch, M.; Galan, B.E. de; Crevel, R. van

    2015-01-01

    BACKGROUND: As HIV management has become more successful during the past years, non-communicable diseases have become more prevalent among HIV-infected individuals. As a result, more HIV-infected patients die of cardiovascular diseases, with diabetes being one of the main risk factors. This study ev

  16. [Hilarein, a patient education game for kidney transplant patients].

    Science.gov (United States)

    Césarini, Carole; Callens, Cécile

    2013-03-01

    At Nice university hospital, an educational board game has been designed by the kidney transplant team for patients suffering from kidney failure. Hilarein is a tool to support therapeutic education which demonstrates that it is possible to learn while having fun.

  17. Analysis of patient falls among hospitalised patients in Makkah region.

    Science.gov (United States)

    Flimban, Mohammed Abdulwahab; Abduljabar, Dalal Fouad; Dhafar, Khalid Obaid; Deiab, Basma Abdulhameed; Gazzaz, Zohair Jamil; Bansuan, Abasra Usman; Balbed, Abeer Ahmad; Al-Shaikhi, Ahmad Mohammed; Al-Motari, Sultan Saad; Suliman, Muhammad Imran

    2016-08-01

    To assess the frequency and its correlation of patient fall with preventing or precipitating factors among inpatients. The observational study was conducted in Makkah Region, Saudi Arabia from October 15 2012 to November 4, 2013. Data was collected using a questionnaire from 16 hospitals in four districts of Makkah province. The material was sampled through systematic randomisation from inpatient files and data was collected for those who had fallen inside the hospital. The questionnaire, validated through a pilot study run under the Directorate of Quality and Patient Safety in Makkah, was used to see whether the hospitals had adopted and applied international standards for assessment of adult and paediatric patients for falls as well as effectiveness of these applications. Of 4,799 beds, occupancy rates ranged from 1680(35%) to 4,799(100%). Out of 291 falls in all, 144(49.48%) were in Jeddah. Besides, 116(40%) of the falls occurred in the last quarter of the Islamic calendar. Statistically significant difference was found in fall episodes in different months (p=0.007). Statistical analysis indicated that the factors that significantly raised the number of patient falls were increase in hospital beds and their occupancy rate (Spearman's correlation: 0.621 and 0.579 respectively). The frequency of falls varied from hospital to hospital and factors like higher number of bed capacity and occupancy rate increased the falls.

  18. 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)

  19. 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.

  20. The patient as skilled practitioner

    DEFF Research Database (Denmark)

    Kilbourn, Kyle

    2012-01-01

    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...... of these changes, basic and fundamental questions are left unanswered. Who is this person? How do they get through everyday life? What tactics do they use as part of—and distancing themselves from—the medical regime?...

  1. 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.

  2. Patient diaries: charting the course.

    Science.gov (United States)

    Zanni, Guido R

    2007-06-01

    Clinical diaries are a way for patients to assess their own health status without clinician bias or interpretation. Diaries are especially useful in understanding symptoms' temporal dynamics, including triggers that exacerbate symptoms; they also help individuals to evaluate the impact of their treatment. Diary format should be patient-specific, with thoughtful consideration given to rating scales, symptom descriptors, number of daily entries required, and the duration of diary recording. While compliance, recall biases, and diary fatigue affect data quality, a diary's potential for individualizing treatment strategies is tremendous.

  3. 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...... in the metastatic processes required for cancer dissemination, and there are emerging data showing that, at least in some clinical situations, the use of bone-targeted treatments can reduce metastasis to bone and has potential impact on patient survival....

  4. New methodologies for patients rehabilitation.

    Science.gov (United States)

    Fardoun, H M; Mashat, A S; Lange, B

    2015-01-01

    The present editorial is part of the focus theme of Methods of Information in Medicine titled "New Methodologies for Patients Rehabilitation", with a specific focus on technologies and human factors related to the use of Information and Communication Technologies (ICT) for improving patient rehabilitation. The focus theme explores different dimensions of empowerment methodologies for disabled people in terms of rehabilitation and health care, and to explores the extent to which ICT is a useful tool in this process. The focus theme lists a set of research papers that present different ways of using ICT to develop advanced systems that help disabled people in their rehabilitation process.

  5. Patient advocacy: barriers and facilitators

    Directory of Open Access Journals (Sweden)

    Nikravesh Mansoure

    2006-03-01

    Full Text Available Abstract Background During the two recent decades, advocacy has been a topic of much debate in the nursing profession. Although advocacy has embraced a crucial role for nurses, its extent is often limited in practice. While a variety of studies have been generated all over the world, barriers and facilitators in the patient advocacy have not been completely identified. This article presents the findings of a study exploring the barriers and facilitators influencing the role of advocacy among Iranian nurses. Method This study was conducted by grounded theory method. Participants were 24 Iranian registered nurses working in a large university hospital in Tehran, Iran. Semi-structured interviews were used for data collection. All interviews were transcribed verbatim and simultaneously Constant comparative analysis was used according to the Strauss and Corbin method. Results Through data analysis, several main themes emerged to describe the factors that hindered or facilitated patient advocacy. Nurses in this study identified powerlessness, lack of support, law, code of ethics and motivation, limited communication, physicians leading, risk of advocacy, royalty to peers, and insufficient time to interact with patients and families as barriers to advocacy. As for factors that facilitated nurses to act as a patient advocate, it was found that the nature of nurse-patient relationship, recognizing patients' needs, nurses' responsibility, physician as a colleague, and nurses' knowledge and skills could be influential in adopting the advocacy role. Conclusion Participants believed that in this context taking an advocacy role is difficult for nurses due to the barriers mentioned. Therefore, they make decisions and act as a patient's advocate in any situation concerning patient needs and status of barriers and facilitators. In most cases, they can not act at an optimal level; instead they accept only what they can do, which we called 'limited advocacy' in

  6. [Weight loss in cancer patients].

    Science.gov (United States)

    Lordick, Florian; Hacker, Ulrich

    2016-02-01

    Cancer patients are regularly affected by malnutrition which often leads to a worsened quality of life and activity in daily living, more side effects and complications during anticancer treatment and shorter survival times. The early diagnosis and treatment of malnutrition are therefore relevant components of oncological treatment. The assessment of the nutritional status and determination of the body-mass-index should be done in every patient with cancer. The clinical examination delivers important findings and indications for malnutrition. Bioimpedance analysis can deliver additional objective information. The treatment of malnutrition should start early and follows a step-wise escalation reaching from nutritional counseling to enteral nutritional support to parenteral nutrition.

  7. Characterization of a group unrelated patients with arthrogryposis multiplex congenita

    Directory of Open Access Journals (Sweden)

    Margarita Valdés-Flores

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: Arthrogryposis multiplex congenita is a relatively rare neuromuscular syndrome, with a prevalence of 1:3000-5000 newborns. In this study, the authors describe the clinical features of a group of 50 unrelated Mexican patients with arthrogryposis multiplex congenita. METHODS: Patients were diagnosed by physical and radiographic examination and the family history was evaluated. RESULTS: Of the 50 cases, nine presented other features (pectum excavatum, cleft palate, mental retardation, ulnar agenesis, etc.. Environmental factors, as well as prenatal and family history, were analyzed. The chromosomal anomalies and clinical entities associated with arthrogryposis multiplex congenita were reported. No chromosomal aberrations were present in the cases with mental retardation. Three unrelated familial cases with arthrogryposis multiplex congenita were observed in which autosomal recessive, autosomal dominant and X-linked inheritance patterns are possible. A literature review regarding arthrogryposis multiplex congenita was also conducted. CONCLUSIONS: It is important to establish patient-specific physical therapy and rehabilitation programs. A multidisciplinary approach is necessary, with medical, surgical, rehabilitation, social and psychological care, including genetic counseling.

  8. 45,X/46,XY mosaicism: contrast of prenatal and postnatal diagnosis.

    Science.gov (United States)

    Wheeler, M; Peakman, D; Robinson, A; Henry, G

    1988-03-01

    The process of prenatal diagnosis is unique in that the diagnosis and prognosis are made without seeing the patient. 45,X/46,XY mosaicism presents a special problem in this regard. The phenotype of 45,X/46,XY postnatally diagnosed children (pediatric group) was compared to that of 6 fetuses who were diagnosed from 7,000 amniocenteses (prenatal group). These amniocenteses were performed primarily because of an increased risk of chromosome abnormality. The pediatric group (age birth-18 yr) were all phenotypically abnormal, although none were mentally retarded. Seven patients presented with ambiguous genitalia, while 2 had primary amenorrhea. Sexual assignment was changed in 2. Abnormalities included rudimentary phallus, urogenital sinus, hypospadias, undescended testes, and short stature. All 9 patients required at least one surgical procedure. In contrast, the prenatally diagnosed fetuses (ages 3 months to 3 1/2 yr) were all phenotypically normal males. Four were noted to have male genitalia on ultrasonography. Thus, the phenotype of 45,X/46,XY mosaicism in prenatally diagnosed fetuses can be markedly different from that of individuals diagnosed postnatally. This must be considered when counseling patients.

  9. Determinants of prenatal health care utilisation by low-risk women: a prospective cohort study.

    Science.gov (United States)

    Feijen-de Jong, Esther I; Jansen, Danielle E M C; Baarveld, Frank; Boerleider, Agatha W; Spelten, Evelien; Schellevis, François; Reijneveld, Sijmen A

    2015-06-01

    Prenatal health care is pivotal in providing adequate prevention and care to pregnant women. We examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands. We used longitudinal data from the population-based DELIVER study with 20 midwifery practices across the Netherlands in 2009 and 2010 as the experimental setting. The participants were 3070 pregnant women starting pregnancy care in primary midwifery care. We collected patient-reported data on potential determinants of prenatal care utilisation derived from the Andersen model. Prenatal health care utilisation was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and number of visits. Low-risk pregnant women (not referred during pregnancy) were more likely to use prenatal care inadequately if they intended to deliver at a hospital, if they did not use folic acid adequately periconceptionally, or if they were exposed to cigarette smoke during pregnancy. Among those who were referred to secondary care, women reporting a chronic illnesses or disabilities, and women who did not use folic acid periconceptionally were more likely to make inadequate use of prenatal care. Inadequate prenatal health care use in primary midwifery care is more likely in specific groups, and the risk groups differ when women are referred to secondary care. The findings suggest routes that can target interventions to women who are at risk of not adequately using prenatal prevention and care services. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  10. [Do the quality of prenatal care have an impact on obstetrical outcomes?].

    Science.gov (United States)

    Léticée, N; Vendittelli, F; Ughetto, S; Janky, E

    2013-05-01

    To assess the rate of pregnant women not having accurate prenatal care utilization. The others goals were to assess the impact of an inadequate quantitative or qualitative prenatal care on obstetrical outcomes. Historical cohort study with a prospective data registration. Hospitalised patients at the maternity ward of the University Hospital of Pointe-à-Pitre were eligible if they gave birth after 22 weeks (or≥500g) at home, outside a maternity ward or in another maternity ward. Early postpartum maternal transfers were included but not medical abortions. The principal outcome was preterm birth (before 37 weeks' gestation). Patients without an appointment before 15weeks or without an appointment each month before their delivery represented 27.4% of women (n=2344). We stressed more preterm deliveries outside the maternity ward among the group with an inadequate prenatal care utilization vs. the other group (3,89% vs. 0,88%) (pinadequate quality prenatal care. Our study did not stress a difference concerning perinatal outcomes among women with an inadequate quantitative or qualitative prenatal care utilization. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  11. Molecular confirmation of nine cases of Cornelia de Lange syndrome diagnosed prenatally.

    Science.gov (United States)

    Dempsey, M A; Knight Johnson, A E; Swope, B S; Moldenhauer, J S; Sroka, H; Chong, K; Chitayat, D; Briere, L; Lyon, H; Palmer, N; Gopalani, S; Siebert, J R; Lévesque, S; Leblanc, J; Menzies, D; Haverfield, E; Das, S

    2014-02-01

    Cornelia de Lange syndrome (CdLS) is characterized by distinct facial features, growth retardation, upper limb reduction defects, hirsutism, and intellectual disability. NIPBL mutations have been identified in approximately 60% of patients with CdLS diagnosed postnatally. Prenatal ultrasound findings include upper limb reduction defects, intrauterine growth restriction, and micrognathia. CdLS has also been associated with decreased PAPP-A and increased nuchal translucency (NT). We reviewed NIPBL sequence analysis results for 12 prenatal samples in our laboratory to determine the frequency of mutations in our cohort. This retrospective study analyzed data from all 12 prenatal cases with suspected CdLS, which were received by The University of Chicago Genetic Services Laboratories. Diagnostic NIPBL sequencing was performed for all samples. Clinical information was collected from referring physicians. NIPBL mutations were identified in 9 out of the 12 cases prenatally (75%). Amongst the NIPBL mutation-positive cases with clinical information available, the most common findings were upper limb malformations and micrognathia. Five patients had NT measurements in the first trimester, of which four were noted to be increased. We demonstrate that prenatally-detected phenotypes of CdLS, particularly severe micrognathia and bilateral upper limb defects, are associated with an increased frequency of NIPBL mutations. © 2013 John Wiley & Sons, Ltd.

  12. Prenatal diagnosis of foetuses with congenital abnormalities and duplication of the MECP2 region.

    Science.gov (United States)

    Fu, Fang; Liu, Huan-ling; Li, Ru; Han, Jin; Yang, Xin; Min, Pan; Zhen, Li; Zhang, Yong-ling; Xie, Gui-e; Lei, Ting-ying; Li, Yan; Li, Jian; Li, Dong-zhi; Liao, Can

    2014-08-10

    MECP2 duplication results in a well-recognised syndrome in 100% of affected male children; this syndrome is characterised by severe neurodevelopmental disabilities and recurrent infections. However, no sonographic findings have been reported for affected foetuses, and prenatal molecular diagnosis has not been possible for this disease due to lack of prenatal clinical presentation. In this study, we identified a small duplication comprising the MECP2 and L1CAM genes in the Xq28 region in a patient from a family with severe X-linked mental retardation and in a prenatal foetus with brain structural abnormalities. Using high-resolution chromosome microarray analysis (CMA) to screen 108 foetuses with congenital structural abnormalities, we identified additional three foetuses with the MECP2 duplication. Our study indicates that ventriculomegaly, hydrocephalus, agenesis of the corpus callosum, choroid plexus cysts, foetal growth restriction and hydronephrosis might be common ultrasound findings in prenatal foetuses with the MECP2 duplication and provides the first set of prenatal cases with MECP2 duplication, the ultrasonographic phenotype described in these patients will help to recognise the foetuses with possible MECP2 duplication and prompt the appropriate molecular testing.

  13. [Enriching patient care with aromatherapy].

    Science.gov (United States)

    Sogno-Lalloz, Isabelle

    2014-01-01

    There are increasing numbers of initiatives in healthcare institutions focusing on the benefits of essential oils. Received positively by patients who appreciate the resulting wellbeing, these innovative approaches around aromatherapy are based on the initiative of pioneering caregivers. Following on from an international congress held each year in Grasse, this article presents some example schemes.

  14. Life Quality of Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Noorallah Tahery

    2013-05-01

    Full Text Available Introduction: Patients with chronic and advanced kidney failure undergo hemodialysis treatment and because of various drug therapies have basic problems in their life style which affects their psychosocial operation. The purpose of this study was to determine the hemodialysis patients’ quality of life in Abadan and Khorramshahr in 2011. Methods: This is a cross - sectional study in which all patients (80 cases referring to Abadan and Khorramshahr hemodialysis clinics completed a questionnaire which included two sections of demographic data and kidney diseases quality of life (KDQOL. Data analysis was done using SPSS-17 software and statistical tests such as ANOVA, Pearson correlation coefficient, and Independent T test were used. Results: The mean score of life quality of the participants was 47.22 ± 8.82 which indicates their low quality of life. Result showed that between quality of life and age (P = 0.04 & r = 0.5 and ESRD patience period (P=0.03 & r= 0.23, there exists a statistically significant relationship. A positive and significant association was also observed between education and quality of life (p= 0.003 and between income level and quality of life (P<0.0001. Conclusion: Life quality of Hemodialysis patients is low and authorities need to provide these patients with more social support and see into their welfare.

  15. 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....

  16. Probiotics for severe trauma patients

    OpenAIRE

    Rijkers, Ger T

    2011-01-01

    Probiotics are live micro-organisms with a health promoting effect. Because of their immunomodulating capacity as well as improvement of gut barrier function, probiotics have the capacity to prevent infectious complications in a variety of clinical settings. Now selected probiotics show potential for improving the clinical outcome of severe trauma patients.

  17. Intensive care of haematological patients

    DEFF Research Database (Denmark)

    Magid, Tobias; Haase, Nicolai; Andersen, Jakob Steen

    2012-01-01

    This article presents the treatment results of 320 consecutive patients with malignant haematological diagnoses admitted to a tertiary intensive care unit at a Danish University hospital over a six-year period (2005-2010). With reference to international publications, we describe the development...

  18. Patient education in The Netherlands

    NARCIS (Netherlands)

    Bensing, J.; Visser, Adriaan; Saan, Hans

    2001-01-01

    This article presents the development of patient education (PE) in The Netherlands from a historical perspective. A description is given of the first pioneering years from the 70s till the late 80s, in which early topics like the organization of PE, the orchestration of PE between different

  19. 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...

  20. 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