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Care Centres (care + centre)
Kinds of Care Centres Selected AbstractsCytotoxic chemotherapy for incurable colorectal cancer: living with a PICC-lineJOURNAL OF CLINICAL NURSING, Issue 18 2008Doreen Molloy Aims., (i) To determine which aspects of living with a peripherally inserted central catheter (PICC) line cause Modified de Gramont (MdG) patients most difficulty. (ii) To explore MdG patients' views of the PICC-line experience. (iii) To determine if patients view PICC-lines as a benefit or a burden when receiving ambulatory MdG chemotherapy. Design., A two-stage, descriptive study. Methods., Phase 1 comprised semi-structured interviews. Phase 2 surveyed the MdG population. Phase 1 interview data informed the Phase 2 questionnaire. The setting was a West of Scotland Cancer Care Centre and the sample was: Phase 1, a convenience sample of 10 MdG patients; Phase 2, 62 consecutive patients. Results., A response rate of 93·9% for Phase 2. The majority of PICC-line patients held favourable views towards having a PICC-line and adapted well with minimal disruption to daily life. Concerns were evident regarding coping at home with a PICC-line, chemotherapy spillage, dealing with complex information and the responsibility of patients/carers regarding PICC-line management. Patients preferred ambulatory chemotherapy to in-patient treatment. Conclusions., PICC-lines should be considered for more chemotherapy patients but service development is necessary to ensure individual needs are addressed. Relevance to clinical practice., Contributes to the PICC-line literature by providing a national patient perspective on a range of daily living activities (DLAs). PICC-line patients prefer out-patient ambulatory chemotherapy rather than in-patient treatment. The longer a patient has a PICC-line, the more able they are to manage activities such as dressing. Concerns remain over chemotherapy spillage, partner/carer responsibility for PICC-line maintenance and the proper balance between required information and what the patient wants to know. [source] Atypical attack of acute intermittent porphyria , paresis but no abdominal painJOURNAL OF INTERNAL MEDICINE, Issue 3 2002C. Andersson Abstract.,Andersson C, Nilsson A, Bäckström T (University Hospital, Umeå, Sweden; and Primary Health Care Centre, Arvidsjaur). Atypical attack of acute intermittent porphyria , paresis but no abdominal pain (Case report). J Intern Med 2002; 252: 265,270. We report a case of acute intermittent porphyria (AIP) in a 45-year-old woman. Her first attack occurred at the age of 38. Because of escalating cyclical premenstrual attacks, the following 2 years, depletion of the endogenous sex hormone was considered as haeme arginate treatment proved insufficient. Gonadotropin releasing hormone agonist treatment with low-dose oestradiol add back was quite successful initially but was abandoned after 18 months when progesterone add back precipitated a severe attack. Following hysterectomy and oophorectomy at age 42 and oestradiol add back, a remarkable monthly regularity of attacks ensured periodically but with milder symptoms. Two years after surgery, preceded by six attack-free months, a puzzling symptom-shift occurred, from abdominal pain, back and thigh pain during the attacks, to solely severe distal extensor paresis in the arms. Haeme arginate treatment interrupted the progress of the paresis almost immediately and motor function improved considerably up to the 9-month follow-up. Electrophysiological examination revealed only motor neuropathy, consistent with axonal degeneration. Subsequently the symptoms changed yet again, to sensory disturbances with numbness and dysesthesia as the primary expression followed by rather mild abdominal pain. However, cyclical attacks occurred, despite absence of endogenous ovarial hormone production, possibly attributable to impaired oestrogen metabolism in the liver, or adrenal oestrogen production. Treatment comprising oophorectomy, low-dose oestradiol add back and haeme arginate infusion for 2 days on the appearance of early AIP symptoms is now quite successful affording improvement in life quality. [source] Recurrent ovarian cancer: Treatment with pegylated liposomal doxorubicin; a Westmead Cancer Care Centre experienceASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 1 2010Rachel F DEAR Abstract Aim: To describe the overall survival, progression-free survival, response rate and toxicity of pegylated liposomal doxorubicin (PLD) in recurrent ovarian cancer. Methods: A retrospective study of 45 patients with recurrent or progressive ovarian cancer was conducted at the Westmead Cancer Care Centre. Patients received PLD at a starting dose of 30,50 mg/m2 every 4 weeks. Results: A total of 43 patients were included for analysis. The starting dose was 40 mg/m2 in 67% of cases, and 21 % had a dose increase. A median of 2 cycles (mean 3, range 1,7) was given. All patients were assessable for response and 77% stopped treatment due to progressive disease. The overall response rate to PLD assessed by CA-125 criteria was 14 percent (six of 43 patients). Five patients (12 percent) were from the potentially platinum-sensitive group and one (2 percent) was from the platinum-resistant group. The overall median progression-free survival was 52 days (2 months), which was greater in the platinum-sensitive than in the platinum-resistant group (4.4 months vs 1.7 months, respectively, P = 0.030). The median overall survival was 296 days (10.6 months) with a trend for this to be longer in the platinum-sensitive than in the platinum-resistant group (13 vs 9 months, P = 0.393). Overall 25 percent of patients had grade 2 or 3 toxicity. Conclusion: The benefit of PLD in platinum-resistant recurrent ovarian cancer is small and the treatment has considerable toxicity. These data support the need to establish whether chemotherapy in this setting has any favorable effect on quality of life. The Australian New Zealand Gynaecological Oncology Group is currently addressing this question in a large prospective study measuring both the subjective and objective benefit (response and survival) of palliative chemotherapy in platinum-resistant or refractory ovarian cancer in Australia. Clinicians are urged to enter their patients in this study to address this important question. [source] Staff Morale in Day Care Centres for Adults with Intellectual DisabilitiesJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2007Katerina Mascha Background, Levels of burnout, job satisfaction and intended turnover of staff working in day care centres for adults with intellectual disabilities are investigated in relation to role clarity, staff support and supervision, and coping strategies used by staff. Materials and methods, Thirty six direct-care staff of four day care centres in the UK were administered the Maslach Burnout Inventory, The Staff Support Questionnaire (SSQ), and The Shortened Ways of Coping (Revised) Questionnaire (SWC-R). Results, Although staff reported high levels of job satisfaction, they experienced moderate degrees of emotional exhaustion and personal accomplishment and reported a high propensity to leave the service. Factors identified as relating to staff morale were staff support and supervision, role clarity, wishful thinking, staff cooperation, and other practical issues regarding the day-to-day running of the service. Conclusions, Staff in day care services for people with intellectual disabilities experience similar stressors to those experienced by staff in residential facilities with the informal culture of the service being of most importance to staff morale. Suggestions for the enhancement of staff morale are provided. [source] Seroprevalence of HIV infection in hospitalized paediatric patients at a tertiary care centre in western IndiaHIV MEDICINE, Issue 4 2007I Shah The prevalence of HIV infection in children in India is not known. In this study, a total of 270 children admitted to paediatric wards in Mumbai were screened for HIV infection by enzyme-linked immunosorbent assay (ELISA). Eight patients (2.96%) had a positive HIV ELISA. Of these two patients (25%) were less than 15 months of old and hence HIV infection in them could not be confirmed. The prevalence of HIV was 2.3%. Three out of 11 patients with tuberculosis (27.3%) and four out of 15 patients with nutritional anaemia (26.7%) had HIV infection (P<0.0001 in each case). Vertical transmission was the cause in all children, suggesting that implementation of Prevention of Parent to Child Transmission of HIV (PPTCT) is required to reduce the rate of paediatric HIV infection. [source] A study of a training scheme for Macmillan nurses in Northern IrelandJOURNAL OF CLINICAL NURSING, Issue 2 2008BSocSc, Cert Ed., DipDN, Johnston Gail PhD Aim., To evaluate a one year training scheme for Macmillan Nurses. Background., The role of the clinical nurse specialist has evolved and expanded greatly over the past few years so that it now encompasses components far beyond the traditional nursing remit of direct clinical practice. While several studies have looked at the barriers and facilitators to this process for clinical nurse specialists in particular, none has looked at the benefits of a structured training scheme which involves both a theoretical and clinical component. Methods., Tape recorded, semi-structured interviews were undertaken with a purposive sample of trainees who undertook the scheme, their practice-based facilitators and another person(s) involved in the trainee's support Analysis., Tapes were transcribed verbatim and each transcript anonymized to prevent identification of participants. Data were analysed thematically using the main headings of expectations, experience and impact and the structured prompts from the aide-memoir within these headings. Results., Results showed that the majority of respondents felt the scheme had been successful with one of the main achievements being that trainees were perceived to be adequately prepared to take on the role of a CNS on completion of the scheme. While the Role Development Programme was thought to provide a good academic structure for the scheme some participants thought that more theory on symptom control and communication skills and a placement in a specialist palliative care centre should also be included. Conclusion., The Macmillan Trainee Scheme has succeeded in its objectives to facilitate the transition from generalist to specialist nursing. It should be extended to include an induction and consolidation period and more theoretical input on communication skills and symptom control. Relevance to clinical practice., With these improvements, the scheme could be used as a standard model for training specialist practitioners and a means to address the current issues of workforce planning. [source] Risk factors for coronary heart disease in 55- and 35-year-old men and women in Sweden and EstoniaJOURNAL OF INTERNAL MEDICINE, Issue 6 2002J. Johansson Abstract., Johansson J, Viigimaa M, Jensen-Urstad M, Krakau I I, Hansson L-O (Karolinska Hospital, Stockholm, Sweden, Tartu University Hospital, Tartu, Estonia). Risk factors for coronary heart disease in 55- and 35-year-old men and women in Sweden and Estonia. J Intern Med 2002; 252:551,560. Objective., To illustrate the geographical West-to-East division of coronary heart disease (CHD) by comparing a population from Sweden, that represents a Western country to a population from Estonia, that represents an Eastern country. Estonia has an approximately 2,4-fold higher CHD prevalence for 55-year-old women and men, respectively, than Sweden. Design., Randomized screening of 35- and 55-year-old men and women in Sollentuna county, Sweden and Tartu county, Estonia. Eight hundred subjects, 100 from each cohort, were invited to participate in the study, 272 Swedes and 277 Estonians participated. Setting., Preventive cardiology, administered by a primary health care centre at the Karolinska Hospital, Sweden and a cardiology centre at Tartu University Hospital, Estonia. Main outcome measures., The CHD risk factors (smoking, blood pressure, concentrations of lipoproteins, fibrinogen, and glucose) and certain environmental factors and attitudes related to CHD risk by questionnaires (fat-type and alcohol ingestion, self-assessed rating of CHD susceptibility). Results., Of the 55-year-old men, 57% smoked in Estonia and 20% smoked in Sweden. Similar, although less pronounced differences showing higher smoking prevalence, were seen for 35-year-old Estonian men and women, whilst for 55-year-old women, less than 20% smoked in either country. Estonian 55-year-old women had lower HDL cholesterol and higher LDL cholesterol serum concentrations than Swedish 55-year-old women. Estonians reportedly ate food containing more saturated fats than Swedes, as indicated by the scale-score questionnaire. Estonians, relative to Swedes, rated their chance of developing CHD higher, and paradoxically, Estonians did to a much lesser degree believe that life style influences the risk of developing CHD. Conclusions., Elevated smoking prevalence is a striking difference between the Estonian and Swedish populations likely to explain the much higher CHD prevalence in Estonian men. The lower HDL cholesterol and higher LDL cholesterol in Estonian 55-year-old women may explain the higher CHD prevalence in Estonian women. Furthermore, the SWESTONIA CHD study (i.e. comparison between Sweden and Estonia) shows several environmental differences between the countries populations related to fat content in food, alcohol drinking patterns, and views on CHD risk and the importance of lifestyle intervention, that could contribute to the higher CHD prevalence in Estonia. [source] Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral densityJOURNAL OF INTERNAL MEDICINE, Issue 5 2002H. A. Deutschmann Abstract. Deutschmann HA, Weger M, Weger W, Kotanko P, Deutschmann MJ, Skrabal F (Krankenhaus der Barmherzigen Brüder, Marschallgasse, Teaching Hospital of the Karl-Franzens University Graz, Austria). Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density. J Intern Med 2002; 252: 389,397. Objectives. To determine whether the use of more elaborate diagnostic tests can identify possible risk factors for secondary osteoporosis and to evaluate the impact of these possible risk factors on the severity of bone disease in the study population. Design. Cross-sectional study. Setting and participants. ,We have investigated 377 subjects (285 females, 92 males) with osteoporosis (T-score less than ,2.5 in dual energy X-ray absorption) or nontraumatic lumbar vertebral fractures; these patients were referred to our hospital, a secondary care centre, for evaluation and treatment of osteoporosis. Results. Osteoporosis without attributable risk factor was diagnosed in 106 women (37%) and 30 men (33%). In 241 patients (179 women, 62 men) one or more possible risk factors for osteoporosis (in this paper also called subclinical disease) were revealed. The most common were lactose malabsorption, disturbed exocrine pancreatic function and renal tubular disturbances, including renal hypercalciuria, incomplete renal tubular acidosis and mild phosphate diabetes. The number of possible risk factors in the individual patient was significantly related to the severity of osteoporosis as assessed by Z-scores (Spearman correlation r = ,0.43, P < 0.001, n = 172 for females; r = ,0.28, P < 0.05, n = 65 for males). Conclusions. All the identified subclinical diseases would have remained undetected if the currently accepted guidelines for the investigation of patients with osteoporosis were applied. The statistically significant correlation between the number of identified possible risk factors and the severity of bone disease in the individual patient strongly suggests the pathogenetic significance of the identified subclinical diseases. It is yet to be shown, whether specific treatment of these subclinical diseases yields additional improvement of bone mass as compared with standard treatment of osteoporosis. [source] Oral lesions among persons with HIV disease with and without highly active antiretroviral therapy in southern IndiaJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 3 2007K. M. R. Umadevi Background:, The advent of highly active antiretroviral therapy (HAART) has changed the scenario of human immunodeficiency virus (HIV) infection. HIV patients in India have now access to generic HAART and this is the first report describing oral lesions in patients on HAART from our country. Methods:, Oral lesions were studied in HIV seropositive patients (n = 50 on HAART and n = 50 not on HAART) attending a tertiary HIV referral care centre in India and patients on HAART were followed up. Results:, There was a difference in the occurrence of oral candidiasis (OC) between HAART and non-HAART participants (8%, 24%; P < 0.05). Pseudomembranous candidiasis was 4% and 18% in HAART and non-HAART groups respectively (P < 0.05). In patients with CD4 count ,200, OC was 5.6% in the HAART group and 39.1% in the non-HAART group (P < 0.05). Among patients with CD4 count >200, pigmentation was 43.8% in the HAART group and 14.8% in the non-HAART group (P < 0.05). Conclusion:, The prevalence of OC in patients who had access to HAART was less when compared with those who did not have access to HAART. [source] The clinical presentation and prognostic factors for intrahepatic and extrahepatic cholangiocarcinoma in a tertiary care centreALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2010A. G. SINGAL Aliment Pharmacol Ther,31, 625,633 Summary Background, The incidence of cholangiocarcinoma is rising. Accurate predictors of survival at diagnosis are not well defined. Aim, To clarify the clinical presentation and prognostic factors of intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma in a contemporary cohort of patients. Methods, Records for consecutive patients at the University of Michigan hospital diagnosed with cholangiocarcinoma between January 2003 and April 2008 were reviewed. Results, In all, 136 patients had cholangiocarcinoma (79 intra- and 57 extrahepatic cholangiocarcinoma). Median survival was 27.3 months,25.8 months for intrahepatic cholangiocarcinoma and 30.3 months for extrahepatic cholangiocarcinoma. Independent predictors of mortality at presentation on multivariate analysis were elevated bilirubin level (HR 1.04, 95%CI 1.01,1.07), CA 19-9 levels >100 U/mL (HR 1.90, 95%CI 1.17,3.08) and stage of disease (HR 1.51, 95%CI 1.16,1.96). After adjusting for baseline prognostic factors, surgical therapy was associated with improved survival (HR 0.48; 95% CI 0.26,0.88). There were no significant differences regarding clinical presentation, disease stage (P = 0.98), and survival (P = 0.51) between intra- and extrahepatic cholangiocarcinoma. Conclusions, Survival for cholangiocarcinoma remains poor with no significant difference in outcomes between intra- and extrahepatic cholangiocarcinoma. Stage of disease, bilirubin level and CA 19-9 level are important prognostic factors at presentation. Surgical therapy provides similar efficacy for both tumours when adjusted for other prognostic variables. [source] Penile rehabilitation protocol after robot-assisted radical prostatectomy: assessment of compliance with phosphodiesterase type 5 inhibitor therapy and effect on early potencyBJU INTERNATIONAL, Issue 3 2010Daniel J. Lee Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate factors that affect compliance in men who enrol in a phosphodiesterase type 5 inhibitor (PDE5I) protocol after nerve-sparing robot-assisted prostatectomy (RAP), and report on short-term outcomes, as PDE5Is may help restore erectile function after RAP and patient adherence to the regimen is a factor that potentially can affect outcome. PATIENT AND METHODS We prospectively followed 77 men who had nerve-sparing RAP and enrolled in a postoperative penile rehabilitation protocol. The men received either sildenafil citrate or tadalafil three times weekly. The minimum follow-up was 8 weeks. Potency was defined as erection adequate for penetration and complete intercourse. Compliance was defined as men adhering to the regimen for ,2 months. RESULTS The mean age of the cohort was 57.8 years and the median follow-up was 8 months. In all, 32% of the men discontinued the therapy <2 months after RAP and were deemed noncompliant with an additional 39% discontinuing therapy by 6 months, with the high cost of medication being the primary reason (65%). Long-term compliance and preoperative erectile dysfunction were independent predictors of potency return after adjusting for age and nerve sparing. CONCLUSIONS The high cost of medication remains a significant barrier to maintaining therapy. Noncompliance to PDE5I therapy in a tertiary care centre was much higher than reported in clinical trial settings. With longer-term follow-up, we need to further define the factors that improve overall recovery of sexual function after RAP. [source] 4132: Factors influencing donor cornea utilization in a tertiary care centre: results from 5-year dataACTA OPHTHALMOLOGICA, Issue 2010P SANKARAN Purpose To evaluate utilization of corneal tissue procured by the eye bank of a tertiary care centre in north India, to determine factors that were responsible for labeling corneas unsuitable for transplantation, and to identify methods to improve donor tissue utilization. Methods We retrospectively reviewed records from our eye bank from May 2005 to April 2010. We compared donor demographics, death- enucleation interval, and biologic contamination of utilized and non- utilized corneal tissues. Results 3951 corneas were received during the study period. Of these, 2561 donor corneas (65%) were used for surgical purposes. Of the 1390 corneas not utilized for transplantation, 703 corneas (50.6%) were excluded due to poor tissue quality. Other causes were logistical reasons, such as no suitable recipient, in 267 (19.2%), bacterial growth on culture in128 (9.2%), contraindication in the donor's medical history in 102(7.3%), and serological results in 83(6%). Mean age of donors in the utilized cornea group was 58.9 years (± 21.57 years) as compared to 67.52 years (± 19.82 years) in the non-utilized cornea group. The difference was statistically significant (P=0.000). Mean death-enucleation interval was comparable in the 2 groups (5.38 hours versus 4.62 hours; P=0.54). Conclusion Increase in age of donors results in poorer tissue quality and emerges as a significant factor in non,utilization of donor corneas for transplantation. [source] Use of the Kidcope to identify socio-economically diverse Spanish school-age children's stressors and coping strategiesCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2009N. Pereda Abstract Background The process by which children cope with stressful events is a very relevant topic. However, few systematic efforts have been made to design age-specific measures. Methods This study examined problems commonly experienced by children, ages between 7 and 12 years, from two different sources: a primary school mainly enrolling families of medium socio-economic status, and an after-school social care centre from a socially and economically deprived neighbourhood. Data were obtained using the younger version of the Kidcope. Results Almost 55% of the sample reported a problem related to others with no differences observed in age, gender or school group. The strategies that children considered the most effective were ,social support' (35%), ,emotional regulation' (33%) and ,wishful thinking' (32%). The children from disadvantaged backgrounds reported different problems mainly related with ,victimization and violence', ,moving house' and conflicts with ,norms and rules' and tended to use avoidant strategies to face them, which could be related to the perception of uncontrollability of these stressors. Conclusions This study reported the first descriptive results in the type of problems and coping strategies of two different social groups of Spanish children using the Kidcope. The Kidcope can be useful to screen children for coping abilities at an early age living under stressful conditions in underprivileged sectors of society. [source] Effects of a booster seat education and distribution program in child care centers on child restraint use among children aged 4 to 8 yearsCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2009Richard ReadingArticle first published online: 5 JUN 200 Effects of a booster seat education and distribution program in child care centers on child restraint use among children aged 4 to 8 years . ThoresonS., MyersL., GossC. & DiGuiseppiC. ( 2009 ) Archives of Pediatrics & Adolescent Medicine , 163 , 261 , 267 . Objective To compare child care centre-based booster seat education and distribution with no intervention when implemented immediately after booster seat legislation. Design Cluster randomized controlled trial. Setting Thirty-nine urban child care centres. Participants A total of 854 parents and 1010 children aged 4 to 8 years in vehicles leaving centres. Intervention We trained 168 staff members at 20 centres to give parents and children messages promoting booster seats and supplied lesson plans, children's activities, and free booster seats. Main outcome measures Observed booster seat use, ,good practice' restraint use and legal restraint use. Results Parents at intervention centres were more likely to report receiving restraint information from the centre [adjusted odds ratio (AOR), 4.06; 95% confidence interval (CI), 2.48,6.67], speaking with staff about booster seats (AOR, 3.95; 95% CI, 2.26,6.88) and using fit to decide when to move children into seat belts (AOR, 3.39; 95% CI, 1.91,5.99). Groups did not differ in proportions using booster seats (44% vs. 43%; AOR, 1.03; 95% CI, 0.62,1.73), good practice (42% vs. 41%; AOR, 1.11; 95% CI, 0.70,1.74) or legal restraints (65% vs. 65%; AOR, 0.79; 95% CI, 0.48,1.31). Results were similar for children aged 4 to 5 and 6 to 8 years. All outcomes were significantly less likely among children riding in pickup trucks or with Hispanic or black drivers. Conclusions The intervention increased parents' receipt of information from centre staff and knowledge about booster seats but not booster seat use. Research is needed to identify methods and messages that will empower centre providers to promote booster seats effectively and reach high-risk populations. [source] The therapeutic power of play: examining the play of young children with leukaemiaCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2003N. Gariépy Abstract Background The therapeutic function of play has been investigated in relation to recognized stressors such as hospitalization, illness and medical treatments for ill children. While medical treatments in the past 30 years have improved survival rates, children's psychological experiences and quality of life during and after their illness have received limited attention. Objective The present study investigated the therapeutic effects of play on 3- to 5-year-old children with leukaemia compared with a control group of healthy children. Method The participants with leukaemia (n = 11) were from the external oncology clinic of an urban children's hospital; control children (n = 11) attended a day care centre. Measures included children's experience of stress, social and cognitive play behaviours, and daily mood. Results A series of manova revealed that the children with leukaemia, compared with the control children, engaged in (a) significantly fewer total play behaviours, and in particular less (b) parallel, (c) group and (d) dramatic play. Pearson correlations revealed significant relationships between reports of ,being happy' and play only for children with leukaemia. Quantitative and qualitative analyses revealed a pattern of repetitive play activities week after week for children with leukaemia, but not controls. Discussion Findings are discussed in light of the theoretical and practical implications for children undergoing treatment for leukaemia. [source] Children with chronic organ failure possibly ending in organ transplantation: a survey in an Italian region of 5 000 000 inhabitantsACTA PAEDIATRICA, Issue 9 2008R Camilla Abstract Aim: The Italian Piedmont region sponsored in 2005 a population-based registry to assess the epidemiology of childhood chronic organ failure involving kidneys, liver, heart or lungs. Methods: Patients in chronic organ failure who were younger than 18 years were selected, and entered the registry when accomplishing the standard failure criteria for each organ. The cases were reported by the general paediatricians of the region and integrated with the data gathered by the Children University Hospital, a tertiary care centre. Results: In Piedmont (647 727 inhabitants < 18 years), a total of 146 children (217 cases per million of paediatric population) were found to be affected by chronic organ failure (mean age 10 years; range 0,17). The organ failure involved kidneys in 68 subjects (48%), liver in 24 (17%), heart in 21 (15%) and lungs in 28 (20%), and was severe in 32 subjects (6 on transplantation waiting list). The most represented disease leading to chronic renal failure was renal hypodysplasia (79%). Chronic liver failure was mostly caused by biliary atresia (30%), autoimmune hepatitis (25%) and Wilson's disease (21%). Dilated cardiomyopathy (62%) and surgically treated congenital cardiopathy were the two leading causes of chronic heart failure. The most represented disease leading to chronic lung failure was cystic fibrosis (89%). Conclusion: This is the first report of the literature focusing on the epidemiology of chronic organ failure in children encompassing a region of 4 000 000 inhabitants. This clinical condition is rare, but medically and socially very demanding not only in childhood but the life along, as most of these patients will need solid organ transplantation decades later. [source] Rectal cancer in young adults: a series of 102 patients at a tertiary care centre in IndiaCOLORECTAL DISEASE, Issue 5 2009J. Nath Abstract Objective, Rectal cancer in young patients is uncommon. There is little information on rectal cancer in young adults in India. The aim of this study was to determine the relative incidence of rectal cancer in young patients in India and identify any differences in histological grade and pathological stage between younger and older cohorts. Method, All adult patients presenting at a tertiary colorectal unit with primary rectal adenocarcinoma between September 2003 and August 2007 were included. Patients were divided into two groups: 40 years and younger, and older than 40 years. Details regarding patient demographics, preoperative assessment, management and tumour grade and stage were obtained from a prospectively maintained database. Results, One hundred and two of 287 patients (35.5%) were 40 or younger at presentation. Younger patients were more likely to present with less favourable histological features (52.0%vs 20.5% (P < 0.001)) and low rectal tumours (63.0%vs 50.0%) (P = 0.043), but were equally likely to undergo curative surgery compared to the older group (P = 0.629). Younger patients undergoing surgery had a higher pathological T stage (T0,2 18.9%, T3 62.3%, T4 19.7%vs 34.5%, 56.0%, 9.5%) (P = 0.027) and more advanced pathological N stage (N0 31.1%, N1 41.0%, N2 27.9%vs 53.4%, 26.7%, 17.2%) (P = 0.014). Conclusion, The relative number of young patients with rectal cancer in this Indian series is higher than figures reported in western populations. The reasons for this are not clear. The histopathological features of rectal tumours in young patients in this study are consistent with similar studies in Western populations. [source] Suicidal feelings run high among mothers in refugee camps: a cross-sectional surveyACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2003A. Rahman Objective: To study levels of mental distress in a sample of Afghan mothers caring for children in two refugee camps in North West Frontier Province (NWFP) of Pakistan. Method: Cross-sectional survey of 297 consecutive mothers with young children, attending primary care centres, using a psychiatric screening instrument, the Self-Reporting Questionnaire (SRQ-20). Results: One hundred and six (36%) of women in the sample screened positive for a common mental disorder. Ninety-six (91%) of those screening positive had had suicidal thoughts in the previous month, and nine (8%) rated suicidal feeling as their topmost concern. Conclusion: There is a high prevalence and severity of mental distress in Afghan mothers caring for young children in refugee camps. This may have serious long-term effects on the psychological and physical development of their children. [source] The relationships between parenting stress, parenting behaviour and preschoolers' social competence and behaviour problems in the classroomINFANT AND CHILD DEVELOPMENT, Issue 2 2005Laura Gutermuth Anthony Abstract Young children develop social and emotional competence through interactions with others in the two major contexts in which they spend time: home and preschool. This study examined whether parenting stress in the home context is related to the children's behaviour while in preschool. Previous research has suggested that parenting stress negatively influences parenting behaviour, which in turn has been shown to impact children's development. This study examined the direct relationship between parenting stress and children's behaviour in two types of preschool programmes: private day care centres and Head Start. Parenting stress was significantly related to teacher ratings of social competence, internalizing behaviours, and externalizing behaviours, and the effects of parenting behaviour do not appear to mediate this relationship. Parenting stress was most strongly related to children's social competence. Parents' reports of expectations for their child's behaviour appear to weakly moderate the relationship between externalizing behaviour and parenting stress. This study suggests that examination of a parent's level of stress, in addition to parenting practices, may be important in research and interventions with preschool children's behaviour and social competence. Copyright © 2005 John Wiley & Sons, Ltd. [source] The post-amalgam era: a selection of materials and their longevity in the primary and young permanent dentitionsINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2003H. Forss Summary. Objectives. During the last decade there has been a rapid change in the selection of dental restorative materials as the use of amalgam has decreased. The aim of this study was to obtain information on children's restorative dental care in Finland and to analyse the longevity of failed restorations. Design. A random sample of public dental health care centres was drawn from the registers and the dentists working there were asked to record information for each restoration they placed during a three-day period. The survey data comprised a total of 2186 restorations in patients younger than 17 years. Results. Of the children in need of restorative treatment, only a few had previous amalgam restorations. Primary caries was the main reason for restorative treatment in both primary and permanent dentitions (80% and 83%, respectively). In primary teeth, the most common restorative material was resin-modified glass ionomer cement (57·4%), whereas in permanent teeth, composite resin dominated (58·7%). Amalgam was not used at all in the primary dentition and in only 0·6% of permanent teeth. Eighteen per cent of treatments in primary and 12% in permanent teeth were replacements of previous fillings. The mean age of failed glass ionomer restorations was 2·8 years (n = 101) in the primary dentition, and 3·5 years (n = 54) in the permanent dentition. Conclusions. Until better restorative materials are developed, more attention should be paid to the prevention of dental caries as well as to the proper handling of alternative materials. [source] Personal understandings of illness among people with type 2 diabetesJOURNAL OF ADVANCED NURSING, Issue 2 2004Åsa Hörnsten MSc RN Background., Professionals and patients understand the experience of illness from different worlds. Professionals' explanatory models focus on aetiology, diagnosis, pathophysiology and treatment, while patients' explanatory models are more focused on consequences and influences on daily life. The differences between patients and professionals in their understanding often result in conflicting expectations about treatment, priorities and outcomes of care. Aim., The aim of this study was to describe personal understandings of illness among people with type 2 diabetes in Sweden. Method., A sample of 44 patients, 47,80 years, diagnosed with type 2 diabetes within the last 2 years, was recruited from four health care centres. Narrative thematic interviews were used covering the areas of developing, coping with and living with diabetes. Qualitative content analysis was performed. Findings., The findings were formulated into six categories: image of the disease, meaning of the diagnosis, integration of the illness, space for the illness, responsibility for care and future prospects. Conclusions., The findings demonstrate that patients' personal understanding of illness is an important complement to the traditional professional view of diabetes. They could serve as a foundation for development of health history interviewing, as well as development of systems of documentation. Patients' personal understandings of diabetes in their daily lives are considered to be an important shared source of information for planning meaningful care. [source] Staff Morale in Day Care Centres for Adults with Intellectual DisabilitiesJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2007Katerina Mascha Background, Levels of burnout, job satisfaction and intended turnover of staff working in day care centres for adults with intellectual disabilities are investigated in relation to role clarity, staff support and supervision, and coping strategies used by staff. Materials and methods, Thirty six direct-care staff of four day care centres in the UK were administered the Maslach Burnout Inventory, The Staff Support Questionnaire (SSQ), and The Shortened Ways of Coping (Revised) Questionnaire (SWC-R). Results, Although staff reported high levels of job satisfaction, they experienced moderate degrees of emotional exhaustion and personal accomplishment and reported a high propensity to leave the service. Factors identified as relating to staff morale were staff support and supervision, role clarity, wishful thinking, staff cooperation, and other practical issues regarding the day-to-day running of the service. Conclusions, Staff in day care services for people with intellectual disabilities experience similar stressors to those experienced by staff in residential facilities with the informal culture of the service being of most importance to staff morale. Suggestions for the enhancement of staff morale are provided. [source] A combination of HbA1c, fasting glucose and BMI is effective in screening for individuals at risk of future type 2 diabetes: OGTT is not neededJOURNAL OF INTERNAL MEDICINE, Issue 3 2006M. NORBERG Abstract. Objective., To identify a screening model that predicts high risk of future type 2 diabetes and is useful in clinical practice. Design and methods., Incident case-referent study nested within a population-based health survey. We compared screening models with three risk criteria and calculated sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and attributable proportion. We used fasting plasma glucose (FPG) alone or with an oral glucose tolerance test (OGTT), glycosylated haemoglobin A (HbA1c) (normal range 3.6,5.3%), body mass index (BMI), triglycerides and family history of diabetes (FHD). Setting., Participants in a health survey at all primary care centres (n = 33 336) and subjects with diagnosed type 2 diabetes in primary and hospital care (n = 6088) in Umeå during 1989,2001. Subjects., Each of the 164 subjects who developed clinically diagnosed type 2 diabetes (median time to diagnosis of 5.4 years) and 304 sex- and age-matched referents without diabetes diagnosis. Results., Screening models with at least one criterion present had sensitivities of 0.90,0.96, specificities of 0.43,0.57 and PPVs of 8,9%. Combinations of the criteria, FPG , 6.1 mmol L,1 (capillary plasma), HbA1c , 4.7% and BMI , 27 in men and BMI , 30 in women, had sensitivities, specificities and PPVs of 0.66%, 0.93% and 32%, and 0.52%, 0.97% and 46% respectively. Using FHD as one of three risk criteria showed comparable results. Addition of triglycerides or OGTT did not improve the prediction. Conclusions., The combination of HbA1c, FPG and BMI are effective in screening for individuals at risk of future clinical diagnosis of type 2 diabetes. OGTT or FHD is not necessary. [source] Primary health care practitioners' tools for mental health careJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2004S. HYVÖNEN rn mnsc The purpose of this study was to describe and analyse the content of mental health care from the practitioner's point of view. The specific aim of this paper was to outline the types of mental health care tools and the ways in which they are used by primary health care practitioners. The data were derived from interviews with doctors and nurses (n = 29) working in primary health care in six different health care centres of the Pirkanmaa region in Finland. The data were analysed by using qualitative content analysis. The tools of mental health care used in primary health care were categorized as communicative, ideological, technical and collaborative tools. The interactive tools are either informative, supportive or contextual. The ideological tools consist of patient initiative, acceptance and permissiveness, honesty and genuineness, sense of security and client orientation. The technical tools are actions related to the monitoring of the patient's physical health and medical treatment. The collaborative tools are consultation and family orientation. The primary health care practitioner him/herself is an important tool in mental health care. On the one hand, the practitioner can be categorized as a meta-tool who has control over the other tools. On the other hand, the practitioner him/herself is a tool in the sense that s/he uses his/her personality in the professional context. The professional skills and attitudes of the practitioner have a significant influence on the type of caring the client receives. Compared with previous studies, the present informants from primary health care seemed to use notably versatile tools in mental health work. This observation is important for the implementation and development of mental health practices and education. [source] The importance of knowing the patient in weaning from mechanical ventilationNURSING IN CRITICAL CARE, Issue 6 2009Cheryl Crocker ABSTRACT Aim: The aim of the research was to understand how nurses used technology to wean patients from mechanical ventilation. Background: The literature concerned with the development of critical care centres on the role of technology with little emphasis on the nursing contribution. Design: An ethnographic approach was used to understand how nurses used technology to wean patients from mechanical ventilation. Methods: Data were gathered by participant observation and interviewing over a 6-month period. In total, 250 h of field notes were recorded. Results: Data were analysed by the content analysis method. Knowing the patient was a central theme identified. Three sub-themes were identified: ways of knowing, continuity of care and the role of the patient in the weaning trajectory. Conclusion: ,Knowing the patient' was implied during the interviews as essential to the delivery of patient-centred care. There were two main factors that needed to be present in order for nurses to know their patients: continuity of care and expertise. ,Ways of knowing' was reliant on gaining information about the patient. The role of the patient was a passive recipient of treatment. Implications for practice: Knowing the patient has been defined as a characteristic of expert nursing. To be truly patient-centred nursing needs to address the barriers that prevent nurses from getting to ,know' their patients. [source] Maternal factors associated with the duration of breast feeding in Jeddah, Saudi ArabiaPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2003Sherine Shawky Summary Recently, there has been increasing concern about the decline in breast-feeding pattern in developing countries. The objectives of this study were to document the recent breast-feeding trends in Jeddah during the first year of an infant's life and identify the probable maternal risk factors implicated in breast-feeding cessation. Data were collected from six randomly selected primary health care centres in Jeddah City. All married women with an infant , 12 completed months of age were interviewed, and information on socio-demographic characteristics, breast feeding and contraceptive use were collected. Cox proportional hazard regression model was used to calculate the adjusted odds ratios for the various maternal risk factors related to breast-feeding cessation. A total of 400 women were enrolled in the study. Their mean age at delivery was 28.0 years (SD = 4.1 years). Approximately 40.0% had never attended school, 43.0% had at least five children and 13.8% were smokers. Deliveries by caesarean section were reported by 13.0% of women and contraceptive use by 44.7%, among whom oral contraceptives were the commonest method. Around 94.0% of women ever initially breast fed their infants, and this proportion dropped to 40.0% by the infant's 12th month. Women who delivered by caesarean section (OR = 1.9 [95% CI 1.3, 2.8]P = 0.001) and those who used oral contraceptives (OR = 1.5 [95% CI 1.1, 2.2]P = 0.031) were at higher risk of stopping breast feeding and lower probability of maintaining breast feeding to the 12th month post partum than those who delivered vaginally and did not use oral contraceptives. Breast-feeding practice seems to decline rapidly during the first year of the infant's life. Health care professionals should promote breast-feeding practice as early as the antenatal period. They should also take into consideration the impact of caesarean section deliveries and early oral contraceptive use to avoid their negative impact on breast-feeding practice. [source] Diabetes mellitus in Sudan: the size of the problem and the possibilities of efficient carePRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 9 2001Awad Mohamed Ahmed MBBS MD Consultant Physician Assistant Professor of Medicine Abstract Sudan has, for a long time, suffered economic collapse, drought and civil war. Diabetes mellitus is currently emerging as an important health problem, especially in urban areas. The actual prevalence of diabetes is unknown although one small study showed a prevalence of 3.4%. Diabetes is the commonest cause of hospital admission and morbidity due to a non-communicable disease (7 and 10% respectively). The problems of diabetes care in Sudan include the lack of efficient diabetes care centres, lack of specially trained personnel, the high cost of anti-diabetic treatments, poor compliance with therapy or diet, ignorance and wrong beliefs, food and dietary factors and gender-related problems. The goal of efficient diabetes care can be achieved through implementing a national diabetes programme. This programme should be responsible for personnel training, establishing model care centres, patients' education, availability and affordability of insulin, scientific and clinical research and primary prevention. Copyright © 2001 John Wiley & Sons, Ltd. [source] What stresses remote area nurses?AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009Current knowledge, future action Abstract Objective:,Review and synthesise the literature identifying the stresses experienced by remote area nurses (RANs). Identify interventions implemented to address identified stresses. Explore the use of the job demands,resources (JD-R) model. Methods:,A comprehensive literature review was conducted using the meta-databases Ovid and Informit. Setting:,Remote Australian primary health care centres. Results:,The reported demands experienced by RANs can be grouped into four themes: (i) the remote context; (ii) workload and extended scope of practice; (iii) poor management; and (iv) violence in the workplace and community. In this high-demand, low-resource context, the JD-R model of occupational stress is particularly pertinent to examining occupational stress among RANs. The demands on RANs, such as the isolated geographical context, are immutable. However, there are key areas where resources can be enhanced to better meet the high level of need. These are: (i) adequate and appropriate education, training and orientation; (ii) appropriate funding of remote health services; and (iii) improved management practices and systems. Conclusion:,There is a lack of empirical evidence relating to stresses experienced by RANs. The literature identifies some of the stresses experienced by RANs as unique to the remote context, while some are related to high demands coupled with a deficit of appropriate resources. Use of models, such as the JD-R model of occupational stress, might assist in identifying key areas where resources can be enhanced to better meet the high level of need and reduce RANs' levels of stress. [source] Maternal mortality and serious maternal morbidity in Jehovah's witnesses in the NetherlandsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2009ME Van Wolfswinkel Objective, To determine the risk of maternal mortality and serious maternal morbidity because of major obstetric haemorrhage in Jehovah's witnesses in the Netherlands. Design, A retrospective study of case notes. Setting, All tertiary care centres, general teaching hospitals and other general hospitals in the Netherlands. Sample, All cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of serious maternal morbidity in the Netherlands between 2004 and 2006. Methods, Study of case notes using two different nationwide enquiries over two different time periods. Main outcome measures, Maternal mortality ratio (MMR) and risk of serious maternal mortality. Results, The MMR for Jehovah's witnesses was 68 per 100 000 live births. We found a risk of 14 per 1000 for Jehovah's witnesses to experience serious maternal morbidity because of obstetric haemorrhage while the risk for the total pregnant population was 4.5 per 1000. Conclusions, Women who are Jehovah's witnesses are at a six times increased risk for maternal death, at a 130 times increased risk for maternal death because of major obstetric haemorrhage and at a 3.1 times increased risk for serious maternal morbidity because of obstetric haemorrhage, compared to the general Dutch population. [source] The effect of cigarette or sheesha smoking on first-trimester markers of Down syndromeBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2007MSM Ardawi Objective, To investigate the influence of cigarette or sheesha smoking on first-trimester markers of Down syndrome. Design, A prospective observational study. Setting, Primary care centres and antenatal clinics of Maternity and Children Hospital, King Abdulaziz University Hospital and New Jeddah Clinic Hospital, Jeddah, Saudi Arabia. Population, Women with a singleton pregnancy who were either nonsmokers (n= 1736) or cigarette smokers (n= 420) or sheesha smokers (n= 181). Methods, Fetal nuchal translucency thickness (fetal NT), maternal serum free beta-human chorionic gonadotrophin (free ,-hCG) and pregnancy-associated plasma protein-A (PAPP-A) were measured at 11 weeks 0 days to 13 weeks 6 days of gestation in all women. Women were grouped according to smoking status, confirmed by maternal serum cotinine measurements, and analyte levels between groups were compared. Main outcome measures, Fetal NT, maternal serum free ,-hCG, PAPP-A and cotinine measurements. Results, Compared with nonsmoking women, fetal NT was significantly increased and free ,-hCG and PAPP-A levels were significantly decreased in both cigarette and sheesha smokers. There were significant relationships between all three markers and the number of sheeshas consumed per day. Conclusions, Cigarette and sheesha smoking significantly affect first-trimester markers of Down syndrome (fetal NT, free ,-hCG and PAPP-A). Correction for this effect in women who smoke might improve the effectiveness of first-trimester screening for Down syndrome in these women. The underlying mechanism(s) relating smoking to the changes in first-trimester markers require further studies. [source] | ||||||||||