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Medical Conditions (medical + condition)
Kinds of Medical Conditions Selected AbstractsComorbidity of Alcohol Abuse and Dependence with Medical Conditions in 2 American Indian Reservation CommunitiesALCOHOLISM, Issue 4 2006Jay H. Shore Background: The objective was to examine the association of self-reported Diagnostic and Statistical Manual,IV edition alcohol abuse and dependence with medical conditions among American Indians (AIs). Methods: We analyzed data previously collected in a large epidemiological study of members of 2 culturally distinct AI tribes from the Southwest (SW; n=1,446) and the Northern Plains (NP; n=1,638) living on or near their reservations. Associations of combined self-reported alcohol abuse and alcohol dependence with 19 medical conditions were examined through multinomial logistic regression. Results: Medical conditions that had significant relationships with alcohol abuse/dependence were sprains and strains [odds ratio (OR) 2.04, p<0.001], hearing and vision problems (OR 2.05, p<0.001), kidney and bladder problems (OR 1.55, p<0.01), head injuries (OR 2.20, p<0.001), pneumonia/tuberculosis (OR 1.49, p<0.01), dental problems (OR 1.89, p<0.001), and liver problems/pancreatitis (OR 2.18, p<0.001). The total count of medical conditions was also significantly related to alcohol abuse/dependence, with a higher count being associated with the outcome (OR 1.17, p<0.001). Conclusions: In this community-based study of rural AIs, diverse medical conditions were associated with alcohol abuse and dependence. Further research should examine, and confirm, the nature, extent, and tribal variation of the medical consequences of alcohol abuse and dependence in these unique populations. [source] Serum IgM Concentrations in Normal, Fit Horses and Horses with Lymphoma or Other Medical ConditionsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2003G.A. Perkins The purposes of this study were to (1) prospectively establish serum IgM and IgG concentrations in normal, fit, adult horses over time and (2) determine the accuracy of serum IgM concentrations for diagnosing lymphoma. Serial IgM and IgG concentrations were measured with a radial immunodiffusion assay in 25 regularly exercised horses at 6-week intervals. Horses had serum IgM concentrations ranging from 50 to 242 mg/dL over 5 months, with 20% of horses having IgM , 60 mg/dL. The normal range for IgM in fit horses should be considered 103 ± 40 mg/dL and a cut-point for an IgM deficiency, ,23 mg/dL. IgG concentrations ranged from 1,372 to 3,032 mg/dL. Retrospectively, medical records of adult horses (n = 103) admitted to the Cornell University Hospital for Animals for which serum IgM was measured were examined. Horses were categorized as "lymphoma negative" (n = 34) or "lymphoma positive" (n = 18). The sensitivity and specificity of a serum IgM concentration (,60 mg/dL) for detecting equine lymphoma was 50 and 35%, respectively. At the new cut-point (,23 mg/dL), the sensitivity was low at 28% and the specificity improved to 88%. The negative predictive values at various population prevalences indicate that a horse with a high serum IgM (>23 mg/dL) is unlikely to have lymphoma, whereas the positive predictive value (70%) does not allow for reliable determination of lymphoma in a horse with serum IgM , 23 mg/dL. Therefore, serum IgM concentrations should not be used as a screening test for equine lymphoma. [source] Comorbidity of Alcohol Abuse and Dependence with Medical Conditions in 2 American Indian Reservation CommunitiesALCOHOLISM, Issue 4 2006Jay H. Shore Background: The objective was to examine the association of self-reported Diagnostic and Statistical Manual,IV edition alcohol abuse and dependence with medical conditions among American Indians (AIs). Methods: We analyzed data previously collected in a large epidemiological study of members of 2 culturally distinct AI tribes from the Southwest (SW; n=1,446) and the Northern Plains (NP; n=1,638) living on or near their reservations. Associations of combined self-reported alcohol abuse and alcohol dependence with 19 medical conditions were examined through multinomial logistic regression. Results: Medical conditions that had significant relationships with alcohol abuse/dependence were sprains and strains [odds ratio (OR) 2.04, p<0.001], hearing and vision problems (OR 2.05, p<0.001), kidney and bladder problems (OR 1.55, p<0.01), head injuries (OR 2.20, p<0.001), pneumonia/tuberculosis (OR 1.49, p<0.01), dental problems (OR 1.89, p<0.001), and liver problems/pancreatitis (OR 2.18, p<0.001). The total count of medical conditions was also significantly related to alcohol abuse/dependence, with a higher count being associated with the outcome (OR 1.17, p<0.001). Conclusions: In this community-based study of rural AIs, diverse medical conditions were associated with alcohol abuse and dependence. Further research should examine, and confirm, the nature, extent, and tribal variation of the medical consequences of alcohol abuse and dependence in these unique populations. [source] Aetiology of childhood vision impairment, metropolitan Atlanta, 1991,93PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2000Cynthia A. Mervis Data from the population-based Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) were used to describe the underlying causes of vision impairment (VI; corrected visual acuity in the better eye of 20/70 or worse) in young children (n = 228) in metropolitan Atlanta in 1991,93. Children with VI were identified through record review at multiple educational and medical sources. Children were categorised as having isolated VI or multiple disabilities (i.e. VI plus one or more of four additional developmental disabilities) and as having low vision (visual acuity 20/70,20/400) or blindness (visual acuity worse than 20/400). Medical conditions abstracted from MADDSP sources were reviewed to determine the probable aetiology of a child's VI. Aetiologies were assigned to one of three developmental time periods: prenatal, perinatal, or postnatal. Prenatal aetiologies were identified in 43% of the children; 38% of the prenatal aetiologies were genetic. Perinatal aetiologies were found in 27% of the children. Postnatal aetiologies were rare. Prenatal aetiologies were more common in children with isolated VI; perinatal and postnatal aetiologies were more common in children with multiple disabilities. Children with prenatal aetiologies tended to have less severe vision loss than did children with perinatal or postnatal aetiologies. The distribution varied by birthweight, but did not differ significantly by sex or race. [source] CASE REPORTS: Male Anorgasmia Treated with OxytocinTHE JOURNAL OF SEXUAL MEDICINE, Issue 4 2008FAPA, Waguih William IsHak MD ABSTRACT Introduction., This is a case report on male anorgasmia that was successfully treated with oxytocin. Oxytocin is increased during arousal and peaks during orgasm. More recently, a study on humans published in Nature has shown its value in social bonding, increasing trust, and enhancing the sense of well-being. Aim., To test the effectiveness of administering oxytocin in a case of treatment-resistant anorgasmia. Methods., The patient underwent a biopsychosocial evaluation by a psychiatrist trained in sexual medicine and sex therapy for male orgasmic disorder, acquired type. Medical conditions, effect of substances, and psychological issues were ruled out. The patient was properly consented to using oxytocin as an off-label trial. Oxytocin was administered using a nasal spray intracoitally because of its ultra-short half-life. Results., Oxytocin was effective in restoring ejaculation. Conclusions., A case of treatment-resistant male anorgasmia was successfully treated with intracoital administration of intranasal oxytocin. Ishak WW, Berman DS, and Peters A. Male anorgasmia treated with oxytocin. J Sex Med 2008;5:1022,1024. [source] Obsessive,compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V,DEPRESSION AND ANXIETY, Issue 6 2010James F. Leckman M.D. Abstract Background: Since the publication of the DSM-IV in 1994, research on obsessive,compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. Methods: The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. Results: This review presents a number of options and preliminary recommendations to be considered for DSM-V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions (criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered "time-consuming" for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a "general medical condition"; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to "poor insight," and adding "tic-related OCD"); and (7) highlighting in the DSM-V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). Conclusions: A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM-V process progresses. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source] Addiction: a chronic medical conditionDRUG AND ALCOHOL REVIEW, Issue 4 2008Mph Director, Robert G. Newman Md No abstract is available for this article. [source] Student experiences of neurodiversity in higher education: insights from the BRAINHE projectDYSLEXIA, Issue 1 2009Edward Griffin Abstract The number of students with identified learning differences (LDs) of all kinds is increasing in higher education. This qualitative study explored the experiences of 27 current and previous students with a range of specific LDs by means of semi-structured interviews, using a thematic approach. The findings revealed that participants shared many life experiences and preferences for learning irrespective of their type of LD. Participants generally held one of two views about their identity as ,neurodiverse': a ,difference' view,where neurodiversity was seen as a difference incorporating a set of strengths and weaknesses, or a ,medical/deficit' view,where neurodiversity was seen as a disadvantageous medical condition. The former view was associated with expressions of greater career ambition and academic self-esteem, while the latter view was associated more with processes for obtaining the Disabled Students' Allowance. Many of the participants reported similar experiences in education and with university support; many did not feel adequately supported by their institutions. Recommendations are made for increased awareness training among lecturers and better liaison between university departments. Copyright © 2009 John Wiley & Sons, Ltd. [source] Inducing safer oblique trees without costsEXPERT SYSTEMS, Issue 4 2005Sunil Vadera Abstract: Decision tree induction has been widely studied and applied. In safety applications, such as determining whether a chemical process is safe or whether a person has a medical condition, the cost of misclassification in one of the classes is significantly higher than in the other class. Several authors have tackled this problem by developing cost-sensitive decision tree learning algorithms or have suggested ways of changing the distribution of training examples to bias the decision tree learning process so as to take account of costs. A prerequisite for applying such algorithms is the availability of costs of misclassification. Although this may be possible for some applications, obtaining reasonable estimates of costs of misclassification is not easy in the area of safety. This paper presents a new algorithm for applications where the cost of misclassifications cannot be quantified, although the cost of misclassification in one class is known to be significantly higher than in another class. The algorithm utilizes linear discriminant analysis to identify oblique relationships between continuous attributes and then carries out an appropriate modification to ensure that the resulting tree errs on the side of safety. The algorithm is evaluated with respect to one of the best known cost-sensitive algorithms (ICET), a well-known oblique decision tree algorithm (OC1) and an algorithm that utilizes robust linear programming. [source] Staunch protections: the ethics of haemophilia gene transfer researchHAEMOPHILIA, Issue 1 2008J. KIMMELMAN Summary., Haemophilia has long been considered an ideal system for validating human gene transfer (GT). However, haemophilia GT trials present a particular ethical challenge because they involve subjects whose medical condition is stabilized by standard therapies. Below, I review the ethics and risks of haemophilia GT clinical research. I propose several conditions and practices that strengthen the ethical basis for such trials. These include consultation with haemophilia advocacy organizations as trials are designed and executed, high standards of supporting evidence before trials are initiated, pretrial publication of this evidence, and the offer of indemnification for participants. I further argue against the conduct of paediatric haemophilia GT studies at this time, and raise questions about the fairness of recruiting economically disadvantaged subjects into studies that are primarily directed towards the health needs of persons in the developed world. [source] Population-Based U.S. Study of Severe Headaches in Adults: Psychological Distress and ComorbiditiesHEADACHE, Issue 2 2006Objective.,To examine the associations between severe headaches (SH), psychological distress, and comorbid conditions among U.S. adults. Background.,The lifetime prevalence of headaches is over 90% and headaches, particularly migraines, have been associated with disability, increased healthcare costs, and mood disorders. Methods.,We analyzed data obtained from adults aged 18 years or older (n = 29,828) who participated in the 2002 National Health Interview Survey, an ongoing, computer-assisted personal interview of a representative sample of the U.S. population. Results.,Approximately 15.1% of adults aged 18 years or older reported SH in the previous 3 months. Those reporting such headaches were significantly more likely, than those who did not, to report insomnia, excessive sleepiness, recurrent pain, and depressive or anxiety symptoms during the preceding 12 months. Approximately 88% of those who reported having had SH within the previous 3 months also indicated that they had at least one comorbid medical condition, relative to 67% of those without SH. Conclusion.,Despite their episodic nature, our results suggest that SH are associated with impairments in both physical and mental health. As the presence of SH may serve as an indicator of significant psychological distress and medical comorbidities, eliciting information about their occurrence during a standard medical examination appears to be warranted. [source] Short- and Long-Term Mortality after an Acute Illness for Elderly Whites and BlacksHEALTH SERVICES RESEARCH, Issue 4 2008Daniel Polsky Objective. To estimate racial differences in mortality at 30 days and up to 2 years following a hospital admission for the elderly with common medical conditions. Data Sources. The Medicare Provider Analysis and Review File and the VA Patient Treatment File from 1998 to 2002 were used to extract patients 65 or older admitted with a principal diagnosis of acute myocardial infarction, stroke, hip fracture, gastrointestinal bleeding, congestive heart failure, or pneumonia. Study Design. A retrospective analysis of risk-adjusted mortality after hospital admission for blacks and whites by medical condition and in different hospital settings. Principal Findings. Black Medicare patients had consistently lower adjusted 30-day mortality than white Medicare patients, but the initial survival advantage observed among blacks dissipated beyond 30 days and reversed by 2 years. For VA hospitalizations similar patterns were observed, but the initial survival advantage for blacks dissipated at a slower rate. Conclusions. Racial disparities in health are more likely to be generated in the posthospital phase of the process of care delivery rather than during the hospital stay. The slower rate of increase in relative mortality among black VA patients suggests an integrated health care delivery system like the VA may attenuate racial disparities in health. [source] Long slow night hemodialysis and quality of lifeHEMODIALYSIS INTERNATIONAL, Issue 1 2005P. Hakkarainen Background:,Long slow hemodialysis (LS-HD) improves many biochemical parameters compared with conventional HD. However, its influences on quality of life are less well known. Aims:,The objective of this study was to examine the quality of life of patients on LS-HD performed overnight compared to the patients on standard hemodialysis. This extends the previous study, conducted in 2001, which examined the LS-HD patients, quality of life. Patients and methods:,We sent questionnaires to 12 LS-HD (overnight, treatment time 8 h × 3/wk) patients and 15 day HD (4.5 h × 3/wk) patients, all being treated using the limited care method. Data was collected using two different structured questionnaires. One was constructed for a previous study (2001) and the other one was a standardized set of questionnaires (RAND-36). Research material was collected from patient documents, such as the essential biochemical parameters, blood pressure, weight gain, and weekly EPO doses were recorded. Ten of the LS-HD patients (83%) and 13/15 (87%) of day HD patients returned the questionnaires. Three day hemodialysis patients returned empty questionnaires, which were disqualified. Results:,Based on the medical facts, the results showed that the patients of LS-HD felt better than the patients in another group. Patients on the LS-HD had higher Kt/V (2.623 vs. 1.577) and Hb (118 vs. 111) and lower Pi (1.36 vs. 1.63) and EPO dose (epoietin-beta 2667 ky/week vs. 5833 ky/week; darbepoetin 16 ky/week vs. 37 ky/week). However, their predialysis BP as well as the weight gain between treatments and salt and fluid balances caused problems furthermore. The experiences of the therapy of the LS-HD patients were more positive than of the control group: they felt their medical condition was better than of the patients on day HD. However we didn't observe significant differences in the replies showing physical or psychosocial conditions between the two groups. Conclusions:,The study suggests that when patients can themselves make the choice between treatment modalities, it improves the quality of life of the patients. Control of anemia is improved in LS-HD overnight patients with lower doses of EPO. The LS-HD gives the patients more freedom of diet. However, more attention must be paid to salt and fluid restriction. The LS-HD makes it possible for many patients to work normally. [source] How Do Mothers Feel About Their Very Low Birth Weight Infants?INFANT MENTAL HEALTH JOURNAL, Issue 2 2006Development of a New Measure The early relationship between a mother and her very low birth weight (VLBW; <1.5 kg) infant may be difficult to evaluate. Therefore, we aimed to develop a useful and practical method to describe a mother's early relationship with her VLBW infant. Mothers (mean age=27 years, 46% married) of 119 singleton VLBW infants (mean BW=1,056 g, mean GA=28 weeks) admitted to the neonatal ICU at Rainbow Babies and Children's Hospital completed a novel questionnaire regarding their feelings about their infant at 3 weeks' postnatal age, and at 35 weeks', 40 weeks' (term), and 4 months' postmenstrual ages. Factor analysis of initial interview data was used to construct subscales to measure unique domains hypothesized to underpin the beginning maternal,infant relationship. Three subscales were identified: (a) The Worry subscale focuses on the mother's concerns about her infant's current medical condition and future development, (b) the Enjoyment subscale examines the mother's positive feelings about and responsiveness to her infant, and (c) the Separation Anxiety subscale examines the mother's mental anxiety about being physically separated from her infant. Statistical and clinical validation of the subscales produced positive supporting evidence that the subscales are a meaningful measure of the mother,infant relationship. We have developed a unique and practical measure for describing the early mother,VLBW infant relationship. [source] Parenting and attachment among toddlers with congenital anomalies: Examining the Strange Situation and attachment Q-sortINFANT MENTAL HEALTH JOURNAL, Issue 6 2002Melissa Clements This study assessed parent and child predictors of attachment in a sample of 72 toddlers with neurological (e.g., cerebral palsy) and non-neurological (e.g., cleft lip and palate) birth defects and their mothers. Parenting quality (e.g., sensitivity) was expected to be more important in predicting the attachment relationship than type and severity of child medical condition. Parenting and indices of severity of child condition were measured via researcher observation. Attachment was measured via the Strange Situation and parent reported Attachment Q-sort. Parenting quality was better for children with more severe appearance disfigurements. Strange Situation and Q-sort assessments of attachment were not significantly related. Children with neurological impairments were at greater risk for developing insecure attachments than were children with non-neurological conditions. Parenting quality also directly predicted Strange Situation assessed attachment security and Q-sort comfort seeking/exploration but not standard Q-sort criterion scores. Parenting quality partially mediated the relation between child medical condition and attachment security. Results suggest child medical factors influence parenting, and thereby, child attachment. ©2002 Michigan Association for Infant Mental Health. [source] Consumers' views on generic medicines: A review of the literatureINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2009Mohamed A. A. Hassali Abstract Objectives To review the literature on consumers' knowledge, attitudes and opinions of the use of generic medicines. Method A narrative review of studies conducted from 1970 to 2008 on consumers' perceptions and views towards generic medicines was performed. An extensive literature search was undertaken using indexing services available at the authors' institution library. The following keywords were used for the search: brand, generic, multisource, medications, medicines, drugs, pharmaceuticals and consumers, customers, and patients. Electronic databases searched were Medline, Inside Web, ISI Web of Knowledge, Science Direct, Springer Link, JSTOR, Proquest, Ebsco Host and Google Scholar. These electronic databases were searched for full text papers published in English from 1970 to October 2008. Key findings Twenty studies were identified. Eleven were from the USA, four were from Europe, two were from Canada and one each was from Australia, Brazil and Malaysia. In general, consumers showed mixed reactions towards the use of generic medicines. This was evident from the divergence of views observed by country development level, consumers' socioeconomic characteristics, drug product characteristics, pharmaceutical reimbursement system, policy environment, contact with health care professionals, past experience with medications, and knowledge of the seriousness of a medical condition. Conclusions Patient confidence and knowledge pertaining to generic medicines use have increased over the past four decades, especially in developed countries. Mass educational efforts, financial incentives, and greater communication among patients and health care professionals were seen as major drivers to the uptake of generic medicines among consumers. [source] Music-assisted relaxation to improve sleep quality: meta-analysisJOURNAL OF ADVANCED NURSING, Issue 7 2009Gerrit De Niet Abstract Title.,Music-assisted relaxation to improve sleep quality: meta-analysis. Aim., This paper is a report of a meta-analysis conducted to evaluate the efficacy of music-assisted relaxation for sleep quality in adults and elders with sleep complaints with or without a co-morbid medical condition. Background., Clinical studies have shown that music can influence treatment outcome in a positive and beneficial way. Music holds the promise of counteracting psychological presleep arousal and thus improving the preconditions for sleep. Data sources., We conducted a search in the Embase (1997 , July 2008), Medline (1950 , July 2008), Cochrane (2000 , July 2008), Psychinfo (1987 , July 2008) and Cinahl (1982 , July 2008) databases for randomized controlled trials reported in English, German, French and Dutch. The outcome measure of interest was sleep quality. Methods., Data were extracted from the included studies using predefined data fields. The researchers independently assessed the quality of the trials using the Delphi list. Only studies with a score of 5 points or higher were included. A pooled analysis was performed based on a fixed effect model. Results., Five randomized controlled trials with six treatment conditions and a total of 170 participants in intervention groups and 138 controls met our inclusion criteria. Music-assisted relaxation had a moderate effect on the sleep quality of patients with sleep complaints (standardized mean difference, ,0·74; 95% CI: ,0·96, ,0·46). Subgroup analysis revealed no statistically significant contribution of accompanying measures. Conclusion., Music-assisted relaxation can be used without intensive investment in training and materials and is therefore cheap, easily available and can be used by nurses to promote music-assisted relaxation to improve sleep quality. [source] The Perceived Efficacy and Risks of Complementary and Alternative Medicine and Conventional Medicine: A Vignette Study,JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 1 2001Adrian Furnham Participants (N= 148), including CAM users and general practitioner (GP) patients who had never used CAM treatments, read a series of 6 vignettes describing 3 medical conditions being treated using orthodox and CAM methods. As expected, results indicated that both CAM users and GP patients were more likely to agree that their own treatments were effective and were associated with fewer generic risks. Contrary to expectation, both CAM and GP patients were more likely to agree that orthodox treatments were associated with more actual risks than were CAM treatments, and all orthodox treatments for each medical condition were perceived as having more side effects than CAM treatments. [source] Relatives' information needs and the characteristics of their search for information , in the words of relatives of stroke survivorsJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Catarina Wallengren Aim and objectives., To explore relatives' information needs and the characteristics of their information-seeking process shortly after the stroke event and six months later. Background., Providing relatives of stroke survivors with information is important, as lack of information increases their uncertainty and risk becoming the ,second patient in the family' and early death. Therefore, it is essential to be aware of relatives' information needs and information-seeking process the first six months after stroke. Design., This qualitative study has a descriptive design. Method., Open-ended interviews were conducted with sixteen relatives after stroke survivor's admission to stroke unit and six months later with nine of these relatives. Data were analysed by means of content analysis. Results., The identified information needs covered the spectrum from stroke survivor's medical condition because nurses' actions to relatives' changed health and life situation. Furthermore, relatives' information-seeking process was found to be related to their level of personal involvement, situational circumstances, different forms of knowledge and sources of information. Conclusions., Relatives' search for information emerges when health and lifestyle changes occur in survivors or themselves. It is important that this information affect them personally. Also, they need to develop different forms of knowledge when they cannot trust their own competences. As a result, instead of following established curricula based on their beliefs of relatives' information needs, nurses need to practice on identifying relatives' information needs. Relevance to practice., Different information needs and characteristics described in the study can serve as guidance in the development and implementation of pedagogical interventions to support relatives of stroke survivors. One pedagogical implication is to explore what a specific relative wants to know by how he/she talks or thinks about it. Thus, it must be taken into consideration that level of personal involvement, situational circumstances, sources of information and factual knowledge, understanding and skills are intertwined. [source] The influence of patient acuity on satisfaction with emergency care: perspectives of family, friends and carersJOURNAL OF CLINICAL NURSING, Issue 6 2008Anna Ekwall PhD Aims and objectives., To investigate the factors that influence satisfaction with emergency care among individuals accompanying patients to the emergency department and explore agreement between the triage nurse and accompanying person regarding urgency. Background., Many patients seeking treatment in hospital are escorted by an accompanying person, who may be a friend, family member or carer. Several factors influence patient satisfaction with emergency care, including waiting time and time to treatment. It is also influenced by provision of information and interpersonal relations between staff and patients. Research on satisfaction has focused on the patient perspective; however, individuals who accompany patients are potential consumers. Knowledge about the ways accompanying persons perceive the patient's medical condition and level of urgency will identify areas for improved patient outcomes. Design and methods., A prospective cross-sectional survey with a consecutive sample (n = 128 response rate 83·7%) was undertaken. Data were collected in an Australian metropolitan teaching hospital with about 32,000 visits to the emergency department each year. The Consumer Emergency Satisfaction Scale was used to measure satisfaction with nursing care. Results., Significant differences in perceptions of patient urgency between accompanying persons and nurses were found. Those people accompanying patients of a higher urgency were significantly more satisfied than those accompanying patients of a lower urgency. These results were independent of real waiting time or the accompanying person's knowledge of the patients' triage status. In addition, older accompanying persons were more satisfied with emergency care than younger accompanying persons. Discussion., Little attention has been paid to the social interactions that occur between nurses and patients at triage and the ways in which these interactions might impact satisfaction with emergency care. Relevance to clinical practice., Good interpersonal relationships can positively influence satisfaction with the emergency visit. This relationship can contribute to improved patient care and health outcomes. [source] Score system for elective tracheotomy in major head and neck tumour surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2005B. Kruse-Lösler Background:, This study was designed to evaluate prognostic parameters for respiratory failure after major oropharyngeal resections in head and neck cancer surgery, focusing on a score system to identify patients requiring an elective tracheotomy and to avoid tracheotomy under emergency conditions. Methods:, One hundred and fifty-two out of 928 patients with oropharyngeal cancers, treated between January 1993 and June 2000 at our hospital, fulfilled the inclusion criteria for a retrospective analysis. This collective underwent tumour resection in different regions of the oropharynx combined with bony resection of the mandible and neck dissection without primary tracheotomy. The reconstruction was accomplished using radial forearm flaps (n1 = 59) or local flaps (n2 = 93). These two groups were subdivided into patients treated post-operatively by tracheotomy due to respiratory failure (n1 = 26; n2 = 12) and those without such treatment (n1 = 33; n2 = 81). The database comprising tumour localization and size, staging, general medical condition, smoking and alcohol consumption was evaluated by logistic regression. Results:, We developed a score system which predicts the likelihood of post-operative respiratory failure. For indication of tracheotomy, tumour size and localization, multimorbidity, alcohol consumption and pathologic chest X-ray findings were identified as significant parameters with different weightings. The predictive value for tracheotomy (yes/no) using the score system was 96.7% for the total collective. Conclusion:, The decision on whether or not an elective tracheotomy in major head and neck tumour surgery is necessary can be facilitated using this score system which is based on objective facts. It may reduce post-operative complications and contribute to safer treatment. [source] The risks and benefits of being a young female adolescent standardised patientMEDICAL EDUCATION, Issue 1 2006KD Blake Objective, To follow the progress of young female adolescents, as risk-taking standardised patients (SPs), and to monitor for adverse affects that role-playing may have on the adolescents. Methods, A prospective design was used in which 11 female adolescents, aged 13,15 years, were recruited from 2 schools. The adolescents were trained to portray risk-taking individuals with a medical condition and were interviewed with their SP mother by final-year medical students 1,3 times a month over 6,14 months. A control group was selected from both schools (n = 6). Main outcome measures were pre- and post-interviews using standardised questionnaires [Achenbach's Youth Self-Report (YSR) and Piers Harris Children's Self Concept Scale (SCS),] and focus groups. Results, The adolescent group simulated 111 interviews (mean per adolescent 10.1, SD = 6.2) each lasting 60,70 minutes. Quantitative data, The pre- and post-scores from the YSR and SCS demonstrated no significant differences within the SP study participants or between the control group vs. the study group. Focus group findings, The initial focus group acted as a debriefing exercise and prompted the adolescents to request that they come out of their role when giving feedback. Subsequent focus group discussion was around the medical student performance and their family doctors. Conclusion, Adolescent females showed no adverse effects when used extensively to portray risk-taking SPs. The focus groups provided the adolescents with an opportunity to debrief together. The adolescent SPs reported benefiting from this study but requested unanimously that they come ,out of character' when giving feedback to the medical students. [source] Secondary social anxiety in hyperkinesiasMOVEMENT DISORDERS, Issue 5 2008Erguvan Tugba Ozel-Kizil MD Abstract This is a comparison study that is aimed to investigate and compare the frequency and severity of secondary social anxiety disorder (SAD) in patients with hyperkinesias, which is associated with a significant sense of disfigurement and compromised social interaction. Patients with hemifacial spasm (n = 20), cervical dystonia (n = 20), and essential tremor (n = 20) were evaluated by SCID-I, Liebowitz Social Anxiety Scale, Hamilton Anxiety and Depression Rating Scales, and Sheehan Disability Scale. The DSM-IV H criterion excluding social anxiety related to a medical condition was disregarded for the diagnosis of secondary SAD. The control group (n = 60) consisted of matched healthy subjects. The frequency of the diagnosis and severity of symptoms were compared and associations with sociodemographic and clinical factors were explored. There was no difference between three patient groups in terms of the frequency or the severity of secondary SAD. Younger age and depressive symptoms were associated with the severity of secondary SAD, while severity or duration of the movement disorder or social disability was not. This study revealed a high frequency of secondary SAD in hyperkinesias, emphasizing the need for psychiatric assessment, especially for younger and depressed patients, who seem to be at greater risk. © 2007 Movement Disorder Society [source] The mind-body connection in elderlyNURSING & HEALTH SCIENCES, Issue 1 2005Oksoo Kim rn Depression is an illness affecting mind and body. Depression in people aged 65 years and older is a major public health problem. Because many older people are unaware that they need treatment for depression, as depression in the elderly is insidious. The consequences of undiagnosed depression can be fatal, as depression is a leading cause of suicide among elders. Late-life depression is particularly tricky in that the relationship between depression, disability and illness is very difficult to disentangle. Specific symptoms and signs of depression may impair some functions and not others. Medical disorders accompanying geriatric depression can cause disability, independent of the depressive syndrome or in synergy with it. There is growing evidence that treating depression in patients with a chronic physical condition may improve their medical condition, reduce the degree of pain, increase activity and lessen disability, enhance their quality of life and increase their ability to follow their treatment plan. Health care providers, elderly and their family should be aware of geriatric depression. [source] Levels of empathy in undergraduate occupational therapy studentsOCCUPATIONAL THERAPY INTERNATIONAL, Issue 3 2010Ted Brown Abstract Empathy is an important attribute for occupational therapists in establishing rapport and in better understanding their clients. However, empathy can be compromised by high workloads, personal stressors and pressures to demonstrate efficacy. Occupational therapists also work with patients from a variety of diagnostic groups. The objective of this study was to determine the extent of empathy and attitudes towards clients amongst undergraduate occupational therapy students at one Australian University. A cross-sectional study was undertaken using a written survey of the Jefferson Scale of Physician Empathy (JSPE) and the Medical Condition Regard Scale. Overall, a strong level of empathy was reported amongst students. Four medical conditions that occupational therapists work with (stroke, cerebral palsy, traumatic brain injury and depression) were held in high regard. Substance abuse, however, was held in comparatively low regard. Overall, the year of study appeared to have no significant impact on the students' empathy. Despite having a lower reported empathy level than found in health professions from other studies using the JSPE, occupational therapy students were found to have a good level of empathy. Of concern, however, was the bias reported against the medical condition of substance abuse, highlighting that the there may be a need to reinforce that patients from this diagnostic group are equally deserving of quality care irrespective of their clinical condition. Recommendations for future research include completing a longitudinal study of occupational therapy students' empathy levels and investigating the empathy levels of occupational therapists working with different client groups. Limitations of the study include the convenience sampling of occupational therapy students enrolled at one university which limits the generalizability of the results to groups of participants with similar characteristics. Copyright © 2010 John Wiley & Sons, Ltd. [source] Supplementing desflurane with intravenous anesthesia reduces fetal cardiac dysfunction during open fetal surgeryPEDIATRIC ANESTHESIA, Issue 8 2010ANNE BOAT MD Summary Objective:, To lower the incidence and severity of fetal cardiovascular depression during maternal fetal surgery under general anesthesia. Aim:, We hypothesized that supplemental intravenous anesthesia (SIVA) with propofol and remifentanil would lower the need for high-dose inhalational anesthesia and provide adequate maternal depth of anesthesia and uterine relaxation. SIVA technique would minimize prolonged fetal exposure to deep inhalational anesthetics and significant intraoperative fetal cardiovascular depression. Background:, Fetal hypoxia and significant fetal hemodynamic changes occur during open fetal surgery because of the challenges such as surgical manipulation, hysterotomy, uterine contractions, and effects of anesthetic drugs. Tocolysis, a vital component of fetal surgery, is usually achieved using volatile anesthetic agents. High concentrations of volatile agents required to provide an appropriate degree of uterine relaxation may cause maternal hypotension and placental hypoperfusion, as well as direct fetal cardiovascular depression. Methods:, We reviewed medical records of 39 patients who presented for ex utero intrapartum treatment and mid-gestation open fetal surgery between April 2004 and March 2009. Out of 39 patients, three were excluded because of the lack of echocardiographic data; 18 patients received high-concentration desflurane anesthesia and 18 patients had SIVA with desflurane for uterine relaxation. We analyzed the following data: demographics, fetal medical condition, anesthetic drugs, concentration and duration of desflurane, maternal arterial blood pressure, intraoperative fetal echocardiogram, presence of fetal bradycardia, and need for intraoperative fetal resuscitation. Results:, Adequate uterine relaxation was achieved with about 1.5 MAC of desflurane in the SIVA group compared to about 2.5 MAC in the desflurane only anesthesia group (P = 0.0001). More fetuses in the high-dose desflurane group compared to the SIVA group developed moderate-severe left ventricular systolic dysfunction over time intraoperatively (P = 0.02). 61% of fetuses in the high-dose desflurane group received fetal resuscitative interventions compared to 26% of fetuses in the SIVA group (P = 0.0489). Conclusion:, SIVA as described provides adequate maternal anesthesia and uterine relaxation, and it allows for decreased use of desflurane during open fetal surgery. Decreased use of desflurane may better preserve fetal cardiac function. [source] The prolonged use of the laryngeal mask airway in a neonate with airway obstruction and Treacher Collins syndromePEDIATRIC ANESTHESIA, Issue 6 2003Martin J.L. Bucx MD Summary Upper airway obstruction and difficult tracheal intubation are often encountered in patients with Treacher Collins syndrome (mandibulofacial dysostosis). In this case report, the use of a laryngeal mask airway (LMATM) in a 10-day-old newborn with severe Treacher Collins syndrome and acute airway obstruction is described. It successfully relieved the airway obstruction and was left in situ for an exceptionally long period of 4 days. The difficult decisions with respect to the management of the airway and specifically the role of the laryngeal mask are described. In our opinion, in some newborns with severe mandibulofacial disorders and upper airway obstruction, where conservative airway management procedures have failed, the laryngeal mask can be considered not only to relieve the obstruction but also to buy time until there is full insight into the medical condition and its consequences. [source] Evolving concepts of management of febrile neutropenia in children with cancerPEDIATRIC BLOOD & CANCER, Issue 2 2002Elmar Orudjev MD Abstract Background Recent investigations of febrile neutropenia in pediatric cancer patients have identified subsets of low-risk patients who can be managed with less antibiotic therapy than previously recommended standards. Methods and Materials PubMed and Medline were searched for prospective trials and reviews of febrile neutropenia in children. Magnitude and duration of fever and neutropenia, comorbidities, and therapeutic strategies were examined. Results Twenty-seven prospective trials and five reviews were identified. The child with cancer and low-risk febrile neutropenia is clinically well and afebrile within 24,96 hr of antibiotic therapy and has evidence of marrow recovery with a rising phagocyte count. Disqualifying comorbidities include leukemia at diagnosis or in relapse, uncontrolled cancer, age under 1 year, medical condition(s) that would otherwise require hospitalization and social or economic conditions that may potentially compromise access to care or compliance. Therapeutic strategies include parenteral or oral antibiotics in the hospital with early discharge or parenteral antibiotics in the outpatient setting followed by oral or parenteral therapy and daily reassessment. Although as many as 25% of low-risk patients require modification of therapy and/or hospitalization, life-threatening or fatal infection is exceptional. Conclusion One-third to one-half the children with febrile neutropenia are at low-risk of serious infection. In the context of clinic trials, they can be safely managed with inpatient or outpatient strategies that maintain close follow-up and reduce the burden of antibiotic therapy. Adoption of these alternative strategies as the standard of care should proceed with caution guided by written protocols. Med Pediatr Oncol 2002;39:77,85. © 2002 Wiley-Liss, Inc. [source] School re-entry of the pediatric heart transplant recipientPEDIATRIC TRANSPLANTATION, Issue 8 2006Constance M. Weil Abstract:, Pediatric cardiac transplant has become increasingly frequent in the last decade and survival rates have improved remarkably. Outcome research on this population suggests that the majority of children have the capacity for healthy adaptation although 25,40% have been shown to have some type of psychiatric difficulties. As school plays a major role in these children's lives, early intervention and close liaison with schools is indicated to reduce psychological morbidity, enhance adaptation within the school environment and enhance overall adjustment. This paper proposes a model for a school re-entry program for this population. The school re-entry program is aimed at children who are undergoing cardiac transplant and will be entering or re-entering the school system. They may range in academic age from preschool to college level and have been attending private or public schools with placements in regular education programs, regular education programs with resource support, special education programs, and alternative school programs. Others may not have been attending school because of the severity of their medical condition and have been receiving in-home tutoring. Each child is offered school re-entry assistance by a multi-disciplinary team composed of members from the Cardiology Transplant Service. The re-entry program includes cognitive and psychosocial assessment, liaison with the child's school pre- and post-transplant, academic planning and provision of academic, emotional, and behavioral support before, during, and immediately after transplant, a school re-entry visit, and an ongoing school consultation. The goal is to address issues necessary for a successful school re-entry including appropriate academic placement and support, psychosocial adjustment, education of school personnel and ongoing health needs of the student. The next step is to formally evaluate the efficacy of this program in successful school re-entry. [source] Extended-stay hospitalization for childhood asthma in JapanPEDIATRICS INTERNATIONAL, Issue 4 2009Hidekazu Tani Abstract Background:, While recent advances in asthma management have enabled adequate control to be frequently achieved in outpatient settings, children whose asthma remains poorly controlled despite outpatient treatment are often referred to extended-stay hospitals. The aim of the present study was to examine trends concerning extended-stay hospitalization and to evaluate the present status of this approach. Methods:, A retrospective study was conducted to assess changes in the number of admissions among 408 children with extended stays at Kamiamakusa General Hospital between 1989 and 2005. Medical and laboratory data of 236 patients admitted since 1994 were obtained from clinical records. Results:, The number of children with extended-stay hospitalizations since 2000 declined dramatically compared with the early 1990s, while the percentage of patients with complications of childhood asthma, such as severe atopic dermatitis, school absenteeism, and obesity, have increased significantly in the recent past. Practical benefits of extended-stay hospitalization were demonstrated by significant improvement of exercise performance and measurement of pulmonary function parameters and serum IgE concentrations by time of discharge. In addition to improvement in asthmatic symptoms, maintenance drug requirements and frequency of school absenteeism were reduced. Conclusions:, The medical mission of extended-stay hospitalizations is currently limited due to the availability of improved pharmacotherapy. Some patients, however, with exceptionally severe asthma or psychological problems that interact with their medical condition still fare poorly under outpatient care and could benefit from group care. Further study is needed to identify the components of long-term programs essential to produce change. [source] | ||||||||||||||||||||||||||||||||||||||||||||||