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Chronic Illness (chronic + illness)
Kinds of Chronic Illness Selected AbstractsCHRONIC ILLNESS IN COUPLES: A CASE FOR EMOTIONALLY FOCUSED THERAPYJOURNAL OF MARITAL AND FAMILY THERAPY, Issue 3 2003John Kowal The onset of chronic illness is one of the most pervasive health problems facing North Americans today. Only recently have researchers and clinicans seriously examined chronic physical conditions in the context of close relationships. This article briefly reviews the literature on chronic illness in adult couples. Initially, the focus is on the reciprocal link between close relationships and chronic physical conditions. A number of clinical approaches for working with chronic illness in couples are outlined, a particular case is made for the utility of emotionally focused therapy, and a case study is presented. [source] Coherent Accounts of Coping with a Chronic Illness: Convergences and Divergences in Family Measurement Using a Narrative AnalysisFAMILY PROCESS, Issue 4 2003BARBARA H. FIESE Ph.D. Researchers and clinicians have shown increasing interest in family narratives as an avenue for accessing the family meaning-making process. In this study, we examine the convergences and divergences between narrative assessment, family self-report, and verbal accounts of family climate. Sixty-two families with a child with pediatric asthma were interviewed about the impact that asthma had on family life. These interviews were coded for narrative coherence, relationship expectations, and engagement with the interviewer. Primary caregivers were also interviewed using the Five Minute Speech sample (FMSS) and completed self-report assessments of family functioning (Family Assessment Device [FAD] Impact on the Family Scale [IOF]). Contrary to prediction. Narrative coherence was higher in those cases where Emotional Over-involvement (EOI) was present on the FMSS. Narrative coherence and engagement with the interviewer were positively related to self-report of family problem solving, communication, and affective responsiveness as measured on the FAD. Divergences and convergences between different types of family measurement are discussed in light of meaning-making processes associated with coping with a chronic illness. [source] Systematic review: role of health promotion in vascular dementiaJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2010BSc(Hons), Rachel S Price MSc price rs & keady j (2010) Journal of Nursing and Healthcare of Chronic Illness 2, 88,101 Systematic review: role of health promotion in vascular dementia Aims., This narrative synthesis of the literature investigates the areas of vascular dementia and modifiable risk factors in order to identify the evidence base and opportunities for specific health promotion work and nursing involvement. Background., Strategies for well-being, prevention and health promotion are becoming increasingly important determinants of a quality dementia care service. In England, this emphasis is manifest in the recently launched National Dementia Strategy (February 2009) and areas that address modifiable vascular risk factors are helpful starting points for the enactment of such goals. Design and methods., A comprehensive search strategy identified primary and secondary search terms that were used systematically in order to search for relevant information and literature; 128 articles were finally included in the overall design and these were broken down into 116 articles obtained through the formal search process using the online databases and 12 articles from the ,grey literature'. Results., A narrative synthesis of the included material generated a thematic framework that revealed four discrete but overlapping themes: vascular risk factors (1); prevention and reduction of vascular risk factors (2); treatment and intervention in vascular dementia (3); and vascular health promotion (4). Relevance to clinical practice., Nursing is in a prime position to undertake health promotion initiatives in modifiable risk behaviours in vascular dementia, an approach that should be commenced for the general population in mid-life (50 years and over). [source] Dementia and risk: contested territories of everyday lifeJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2010Charlotte L Clarke DSocSc clarke cl, keady j, wilkinson h, gibb ce, luce a, cook a & williams l (2010) Journal of Nursing and Healthcare of Chronic Illness 2, 102,112 Dementia and risk: contested territories of everyday life Aims., The project aimed to understand the construction of risk in dementia care from the perspective of the person with dementia, family carers and practitioners with the intention of developing negotiated partnerships in risk management. Background., This paper addresses a gap in the literature by embedding constructions of risk within everyday events and social contexts, and communicates such constructions through the voices of people with dementia, carers and practitioners. Method., This symbolic interactionalist study involved data collection by interview with 55 people with dementia (sometimes twice), and their nominated carer and practitioner. The sample was drawn from three regions of the United Kingdom. Data were collected during 2004. Conclusions., Five ,contested territories' of everyday living with dementia are outlined in this paper: friendships, smoking, going out, domestic arrangements, and occupation and activity. These contested territories are purposeful and allow for sense making, maintenance of self, claiming and relinquishing decision making, and creating purpose(lessness) in people's lives. Relevance to clinical practice., Assessing and managing risk in a way that respects the dynamics and purposes of contested territories will support care that is person centred, and moreover respectful of the relationships that contribute to maintaining the individual's sense of self and purpose. [source] Health-Related Hardiness and Chronic Illness: A Synthesis of Current ResearchNURSING FORUM, Issue 3 2003Mirella Vasquez Brooks APRN, PhD(C) TOPIC A critical analysis of the relationship between health-related hardiness and chronic illnesses based on a review of the literature. PURPOSE To synthesize the current literature in order to provide an understanding of the state of knowledge and the implications for nursing regarding health-related hardiness and chronic illness. SOURCES Three computerized databases, which yielded 125 articles published from 1966 to 2002. CONCLUSIONS The presence of the health-related hardiness characteristic was significantly related to psychological, psychosocial, and physiologic adaptation. Higher levels of hardiness had positive outcomes in patients with chronic illness. The implications are that the current knowledge base regarding health-related hardiness and chronic illness could be used to assist patients who have to manage not only one but also multiple chronic illnesses. [source] Ethnic Differences in Pain Among Outpatients with Terminal and End-Stage Chronic IllnessPAIN MEDICINE, Issue 3 2005Michael W. Rabow MD ABSTRACT Objective., To explore ethnic and country of origin differences in pain among outpatients with terminal and end-stage chronic illness. Design., Cohort study within a year-long trial of a palliative care consultation. Setting., Outpatient general medicine practice in an academic medical center. Patients., Ninety patients with advanced congestive heart failure, chronic obstructive pulmonary disease, or cancer, and with a prognosis between 1 and 5 years. Outcome Measures., Patients' report of pain using the Brief Pain Inventory and analgesic medications prescribed by primary care physicians. Differences in pain report and treatment were assessed at study entry, at 6 and 12 months. Results., The overall burden of pain was high. Patients of color reported more pain than white patients, including measures of least pain (P = 0.02), average pain (P = 0.05), and current pain (P = 0.03). No significant ethnic group differences in pain were found comparing Asian, black, and Latino patients. Although nearly all patients who were offered opioid analgesics reported using them, opioids were rarely prescribed to any patient. There were no differences in pain between patients born in the U.S. and immigrants. Conclusions., Pain is common among outpatients with both terminal and end-stage chronic illness. There do not appear to be any differences in pain with regard to country of origin, but patients of color report more pain than white patients. Patients of all ethnicities are inadequately treated for their pain, and further study is warranted to explore the relative patient and physician contributions to the finding of unequal symptom burden and inadequate treatment effort. [source] Chronic Illness: "Chronic" BoredomPUBLIC HEALTH NURSING, Issue 4 2003Sarah E. Abrams Ph.D. No abstract is available for this article. [source] Unhealthy Disabled: Treating Chronic Illnesses as DisabilitiesHYPATIA, Issue 4 2001SUSAN WENDELL Chronic illness is a major cause of disability, especially in women. Therefore, any adequate feminist understanding of disability must encompass chronic illnesses. I argue that there are important differences between healthy disabled and unhealthy disabled people that are likely to affect such issues as treatment of impairment in disability and feminist politics, accommodation of disability in activism and employment, identification of persons as disabled, disability pride, and prevention and "cure" of disabilities. [source] Assessing Emergency Preparedness of Families Caring for Young Children With Diabetes and Other Chronic IllnessesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2006Lynda G. Stallwood PURPOSE.,To help children with chronic illnesses and their caregivers assess emergency preparedness. CONCLUSIONS.,Little work has been done to ascertain patient adherence levels to these recommendations. Additionally, little is known about the seeking patterns of healthcare providers and/or changes in interventions based on certain elements of emergency preparedness, such as the presence of medical alert identification and an emergency kit. PRACTICE IMPLICATIONS.,,Healthcare providers must discover their patients' level of emergency preparedness and facilitate the acquisition and implementation of elements of emergency preparedness that meet their patients' needs. [source] Unhealthy Disabled: Treating Chronic Illnesses as DisabilitiesHYPATIA, Issue 4 2001SUSAN WENDELL Chronic illness is a major cause of disability, especially in women. Therefore, any adequate feminist understanding of disability must encompass chronic illnesses. I argue that there are important differences between healthy disabled and unhealthy disabled people that are likely to affect such issues as treatment of impairment in disability and feminist politics, accommodation of disability in activism and employment, identification of persons as disabled, disability pride, and prevention and "cure" of disabilities. [source] A literature review of the potential effects of having a parent with chronic renal failureJOURNAL OF CLINICAL NURSING, Issue 5a 2008Frances Coldstream MSc, PGCEA Aims and objectives., This review aims to answer the question ,What are the possible effects on children of having a parent with chronic renal failure?' Background., Chronic illness affects the whole family, not just the individual with the illness. It would appear that little research has been undertaken to consider the potential effects on children when a parent has chronic renal failure. Method., Systematic review. Conclusions., There are many potential effects of parental chronic renal failure that have been documented. These are both negative, for example depression and under achievement and positive, for example , enhanced self-esteem. Children, in particular, appear to have a need for information that is not being met. The review has helped to refine a project looking at the information needs of children who have a parent with chronic renal failure, from the perspective of the child. Relevance to clinical practice., There appears to be a lack of information to direct nursing practice in this area. Practitioners need to be aware that chronic parental illness impacts on the whole family. Appropriate referral mechanisms for the child and family are necessary, in addition to an understanding of the needs of these children. [source] Chronic illness as a family process: A social-developmental approach to promoting resilienceJOURNAL OF CLINICAL PSYCHOLOGY, Issue 11 2002Ester R. Shapiro This paper describes a social-developmental approach to interventions in chronic illness using naturally occurring processes of change during family life-cycle transitions to promote more positive developmental outcomes. Clinical interventions can help build resilience by creating a therapeutic collaboration designed to help patients improve their use of existing and new resources in multiple systems. They can then better meet demands of the illness as it impacts on shared development. A case example of a 13-year-old daughter with complex, chronic health problems and developmental disabilities illustrates clinical interventions designed to promote family resilience during the entry into adolescence and a transition in schooling. This approach involves focusing on the family's own definition of the current problem and relevant history, constructing a multidimensional, coherent story of the illness and its impact that recognizes stressors yet highlights strengths, and normalizing their strategies for stability under circumstances of developmental stress. These interventions with mother, daughter, and family helped improve health efficacy, communication toward mutual understanding and shared problem solving, and better use of existing and new resources to enhance current and future developmental adaptation. © 2002 Wiley Periodicals, Inc. J Clin Psychol/In Session 58: 1375,1384, 2002. [source] Suffering in a productive world: Chronic illness, visibility, and the space beyond agencyAMERICAN ETHNOLOGIST, Issue 2 2010M. CAMERON HAY ABSTRACT Is coping with illness really a matter of agency? Drawing on ethnographic research among people with rheumatological and neurological chronic diseases in the United States, I argue that patients' coping strategies were informed by a cultural expectation of productivity that I call the "John Wayne Model," indexing disease as something to be worked through and controlled. People able to adopt a John Wayne,like approach experienced social approval. Yet some people found this cultural model impossible to utilize and experienced their lack of agency in the face of illness as increasing their suffering, which was made all the worse if their sickness was invisible to others. Unable to follow the culturally legitimated John Wayne model, people fell into what I call the "Cultured Response",the realm beyond the agency embedded in cultural models, in which people do not resist but embrace as ideal the cultural expectations they cannot meet and that oppress their sense of value in the world. [suffering, cultural models, agency, chronic illness, United States, cultural anthropology, medical anthropology] [source] Psychopathology and familial stress , comparison of boys with Fragile X syndrome and Spinal Muscular AtrophyTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 7 2002A. Von Gontard Background: Chronic illness and mental retardation are both associated with an increased rate of behavioural problems in children and with considerable emotional strain in families. The aim of the study was to analyse and compare the specific effects of two exemplary conditions on familial stress and coping. Methods: Forty-nine boys with Fragile X syndrome (FXS) were compared with 46 boys with Spinal Muscular Atrophy (SMA) and 32 male controls. Intelligence was measured with the RAVEN or K-ABC tests. Psychopathology was assessed with the CBCL questionnaire and a structured psychiatric interview (Kinder-DIPS), parental stress with the QRS, coping with the F-COPES and social support with the F-SOZU questionnaires. Results: The mean age of the FXS boys was 8.6, of the SMA boys 12.7 and of the controls 11.2 years. The mean IQ was 47 for the FXS, 112 for the SMA and 103 for the control groups. According to the CBCL, 89.8% of the FXS boys, 21.7% of the SMA and 15.7% of the controls had a total score in the borderline or clinical range. The rates were 63.3%, 34.8% and 21.9% for internalising and 67.3%, 10.9% and 18.8% for externalising behaviour, respectively. 81.6% of the FXS and 10.9% of the SMA patients had a DSM-IV or ICD-10 psychiatric diagnosis. The most common were ADHD (FXS: 36) and Separation Anxiety Disorder (SMA: 4). In total, parental stress was significantly higher in the FXS than in the SMA families (and in both compared to controls). There were no major inter-group differences regarding social support and familial coping. Conclusions: Children with FXS are severely mentally retarded and have a high rate of mainly externalising disorders. Despite good coping abilities and social support, this is associated with high familial stress. The SMA boys, with an intelligence in the upper normal range, are no more deviant than their healthy controls. Parental stress is lower in the SMA families with good coping abilities. In conclusion, families with mentally retarded children are in even greater need of help than those of children with severe chronic illness/physical handicap. Abbreviations: SMA: Spinal Muscular Atrophy; FXS: Fragile X syndrome. [source] Does the School Nurse-to-Student Ratio Make a Difference?JOURNAL OF SCHOOL HEALTH, Issue 1 2004Martha Guttu ABSTRACT: Public schools must provide an appropriate education for students with complex health needs. Chronic illnesses such as asthma and diabetes, social morbidities, injuries, and conditions that limit learning such as poor vision commonly affect school-aged children. School nurses often assume a leadership role in providing services for these children. However, although a national standard for school nurse/student ratio has been proposed, little research has examined the relationship between different school nurse-to-student ratios, level of health services provided in schools, and student outcomes. This study examined data in a 21-county region in eastern North Carolina served by a regional school nurse consultant. The school nurse-to-student ratio in these counties ranged from 1:451 to 1:7,440 based on full-time equivalencies. Two systems offered no school nursing services.*** Data from school years ending in 2000,2002 were considered in the analysis. A significant correlation was found between the increased presence of school nurses and services provided to children with diabetes (r = ,.52, p = .000) and asthma (r = ,.43, p = .002). Schools with better ratios provided more counseling services to children for social conditions such as depression and unintended pregnancy (r = ,.38, p = .006), and more follow-up for school-related injuries (r = ,.43, p = .003), and a higher percentage of children with vision problems received follow-up care (r = ,.37, p = .007). A case analysis of one school district that experienced a significant improvement in nurse/student ratio over the study period provides further evidence that school nurses make a difference. [source] Relationship of illness perceptions with depression among individuals diagnosed with lupus,DEPRESSION AND ANXIETY, Issue 6 2009Errol J. Philip M.A Abstract Background: The purpose of this study was to investigate the relationship of illness perceptions, as outlined in the Self-Regulatory Model of illness, with depression among individuals diagnosed with lupus. Methods: A mail-out questionnaire was completed by 154 members of the Australia Lupus Foundation and Lupus Foundation of New South Wales. Each questionnaire consisted of a Lupus Medical and Symptoms Questionnaire, the Illness Perceptions Questionnaire-Revised and the Cardiac Depression Scale. Results: Hierarchical regression analysis revealed that individuals who reported a perception of their illness as having negative life consequences, an unpredictable nature and themselves possessing little understanding of lupus, reported high levels of depression. Conclusions: This study indicated the existence of a high level of depressive symptoms among individuals diagnosed with lupus, and reinforces the need for screening procedures in chronic illness, and treatment interventions that target maladaptive illness perceptions. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source] Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible-dose, progressive-titration, placebo-controlled trialDEPRESSION AND ANXIETY, Issue 3 2008Moira Rynn M.D. Abstract Generalized anxiety disorder (GAD), a prevalent and chronic illness, is associated with dysregulation in both serotonergic and noradrenergic neurotransmission. Our study examined the efficacy, safety, and tolerability of duloxetine hydrochloride, a dual reuptake inhibitor of serotonin and norepinephrine, for short-term treatment of adults with GAD. In a 10-week, double-blind, progressive-titration, flexible-dose trial, 327 adult outpatients with a DSM-IV,defined GAD diagnosis were randomized to duloxetine 60,120,mg (DLX, N=168) or placebo (PLA, N=159) treatment. The primary efficacy measure was mean change from baseline to endpoint in Hamilton Anxiety Scale (HAMA) total score. Secondary outcome measures included response rate (HAMA total score reduction ,50% from baseline), Clinician Global Impression,Improvement (CGI-I) scores, and Sheehan Disability Scale (SDS) scores. Patients who received duloxetine treatment demonstrated significantly greater improvement in HAMA total scores (P=.02); a higher response rate (P=.03), and greater improvement (P=.04) than patients who received placebo. Duloxetine-treated patients were also significantly more improved than placebo-treated patients on SDS global functional (P<.01) and work, social, and family/home impairment scores (P<.05). The rate of discontinuation due to adverse events (AEs) was higher for the duloxetine group compared with the placebo group (P=.002). The AEs most frequently associated with duloxetine were nausea, dizziness, and somnolence. Duloxetine was an efficacious, safe, and well-tolerated treatment that resulted in clinically significant improvements in symptom severity and functioning for patients with GAD. Depression and Anxiety 0:1,8, 2007. © 2007 Wiley-Liss, Inc. [source] The functional impact of anxiety sensitivity in the chronically physically illDEPRESSION AND ANXIETY, Issue 4 2005Sonya B. Norman Ph.D. Abstract The symptoms and physical limitations resulting from chronic physical illness often diminish physical functioning. Comorbidity of chronic physical illness and an anxiety disorder is associated with greater impairment in functioning than chronic illness alone. One potential contributor to anxiety in the chronically ill is anxiety sensitivity (AS). The goal of this study was to explore the role of AS on functioning in the chronically ill. Participants were 267 primary care patients. Logistic regression showed that physical AS (but not social or psychological), controlling for age, gender, and negative affect, was associated with hypertension, heart disease, and high cholesterol (P<.01). Higher AS was associated with poorer vitality, mental functioning, and social functioning (P<.05). AS may be a correlate of poorer adjustment to chronic illness. Depression and Anxiety 21:154,160, 2005. © 2005 Wiley-Liss, Inc. [source] Managing young people with Type 1 diabetes in a ,rave' new world: metabolic complications of substance abuse in Type 1 diabetesDIABETIC MEDICINE, Issue 4 2009P. Lee Abstract The taxing transition from adolescence towards adulthood intensifies the impact of a chronic illness such as Type 1 diabetes. It is not uncommon for young people with Type 1 diabetes to use recreational drugs for emotional relief to escape the day-to-day burden of chronic disease. Despite increasing use, especially in the setting of ,rave' parties, there is professional lack of understanding of the impact of recreational drug use on glycaemia and metabolic complications. The current review describes the prevalence of substance abuse in Type 1 diabetes and the acute impact of designer drugs on its management. We propose a practical approach to improve care of young people with Type 1 diabetes using designer drugs. [source] Emergency Nurses' Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult-access PatientsACADEMIC EMERGENCY MEDICINE, Issue 12 2004Larry Brannam MD Objectives: Emergency nurses (ENs) typically place peripheral intravenous (IV) lines, but if repeated attempts fail, emergency physicians have to obtain peripheral or central access. The authors describe the patient population for which ultrasound (US)-guided peripheral IVs are used and evaluate the success rates for such lines by ENs. Methods: This was a prospective observational study of ENs in a Level I trauma center with a census of 75,000, performing US-guided IV line placement on difficult-to-stick patients (repeated blind IV placement failure or established history). ENs were trained on an inanimate model after a 45-minute lecture. Surveys were filled out after each US-guided IV attempt on a patient. ENs could decline to fill out surveys, which recorded the reason for use of US, type of patient, and success. Successful cannulation was confirmed by drawing blood and flushing fluids. Descriptive statistics were used to evaluated data. Results: A total of 321 surveys were collected in a five-month period no ENs declined to participate. There were 280 (87%) successful attempts. Twelve (29%) of the 41 failure patients required central lines, 9 (22%) received external jugular IVs, and 20 (49%) had peripheral IV access placed under US guidance by another nurse or physician. Twenty-eight percent (90) of all patients were obese, 18% (57) had sickle cell anemia, 10% (31) were renal dialysis patients, 12% (40) were IV drug abusers, and 19% (61) had unspecified chronic illness. The remainder had no reason for difficult access given. There were four arterial punctures. Conclusions: ENs had a high success rate and few complications with use of US guidance for vascular access in a variety of difficult-access patients. [source] ,I'm living with a chronic illness, not . . . dying with cancer': a qualitative study of Australian women's self-identified concerns and needs following primary treatment for breast cancerEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2008M. OXLAD m.psych, research assistant This study aimed to identify the current concerns and needs of Australian women who had recently completed primary treatment for breast cancer in order to develop a workbook-journal for this population. Focus groups were utilized to allow women to use their own frames of reference, and to identify and verbalize the topics that were important to them following treatment. All focus groups were conducted in a patient education and relaxation room, familiar to the women to assist them to feel more at ease. Ten women aged 36,68 years who had recently completed treatment for early-stage breast cancer at a South Australian public hospital took part in one of three focus groups. Topics covered included current physical, emotional and social needs. Participants reported a sense of apprehension about the future at the completion of primary treatment. In addition to this, five specific areas of concern were identified including physical sequelae of treatment, intimacy issues, fear of recurrence, benefit finding, and optimism versus pessimism about the future. Means of addressing post-treatment concerns were also discussed. Following the presentation of these findings, suggestions to aid health-care professionals in their clinical practice are provided. [source] Cancer as a chronic illness?EUROPEAN JOURNAL OF CANCER CARE, Issue 3 2002Reconsidering categorization, exploring experience Cancer as a chronic illness? Reconsidering categorization and exploring experience This article explores the different ways that user experience is defined and conceptualized, and the various policy and professional contexts in which emphasis is placed on exploring users' views. We go on to examine the experience of cancer as a chronic illness and argue that, although there are common features in the experience of cancer and people with chronic illness, the differences are too significant and cancer should not be defined as a chronic condition. We conclude with a consideration of the methodological difficulties of documenting user experience and identify the need for further methodological development. [source] Coherent Accounts of Coping with a Chronic Illness: Convergences and Divergences in Family Measurement Using a Narrative AnalysisFAMILY PROCESS, Issue 4 2003BARBARA H. FIESE Ph.D. Researchers and clinicians have shown increasing interest in family narratives as an avenue for accessing the family meaning-making process. In this study, we examine the convergences and divergences between narrative assessment, family self-report, and verbal accounts of family climate. Sixty-two families with a child with pediatric asthma were interviewed about the impact that asthma had on family life. These interviews were coded for narrative coherence, relationship expectations, and engagement with the interviewer. Primary caregivers were also interviewed using the Five Minute Speech sample (FMSS) and completed self-report assessments of family functioning (Family Assessment Device [FAD] Impact on the Family Scale [IOF]). Contrary to prediction. Narrative coherence was higher in those cases where Emotional Over-involvement (EOI) was present on the FMSS. Narrative coherence and engagement with the interviewer were positively related to self-report of family problem solving, communication, and affective responsiveness as measured on the FAD. Divergences and convergences between different types of family measurement are discussed in light of meaning-making processes associated with coping with a chronic illness. [source] Epidemiologic Analysis of an Urban, Public Emergency Department's Frequent UsersACADEMIC EMERGENCY MEDICINE, Issue 6 2000Joshua H. Mandelberg BA Abstract. Objectives: To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. Methods: A cross-sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Francisco General Hospital ED during a five-year period (July 1, 1993, to June 30, 1998). A "frequent user" visited the ED five or more times in a 12-month period. Results: Frequent users constituted 3.9% of ED patients but accounted for 20.5% of ED visits. The relative risk (RR) of frequent use was high among patients who were homeless (RR = 4.5), African American (RR = 1.8), and Medi-Cal sponsored (RR = 2.1). Frequent users were more likely to be seen for alcohol withdrawal (RR = 4.4), alcohol dependence (RR = 3.4), and alcohol intoxication (RR = 2.4). Frequent users were also more likely to visit for exacerbations of chronic conditions, including sickle cell anemia (RR = 8.0), renal failure (RR = 3.6), and chronic obstructive pulmonary disease (RR = 3.3). They were less likely to visit for all forms of trauma (RR = 0.43). Survival analysis showed that only 38% of frequent users for one year remained frequent users the next year. However, 56% of frequent users for two consecutive years remained frequent users in the third year. Conclusions: Frequent use of the ED reflects the urban social problems of homelessness, poverty, alcohol abuse, and chronic illness. Frequent use of the ED shows a high rate of decline from one year to the next. This rate of decline slows after the first year and suggests the existence of a smaller group of chronic frequent users. [source] Self-efficacy, social support and service integration at medical cannabis facilities in the San Francisco Bay area of CaliforniaHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2008Amanda E. Reiman PhD MSW Abstract In an effort to examine and possibly utilise the community-based, bottom-up service design of medical cannabis facilities in the San Francisco Bay area of California, 130 adults who had received medical cannabis recommendations from a physician were surveyed at seven facilities to describe the social service aspects of these unique, community-based programmes. This study used an unselected consecutive sample and cross-sectional survey design that included primary data collection at the medical cannabis facilities themselves. In this exploratory study, individual level data were collected on patient demographics and reported patient satisfaction as gathered by the Patient Satisfaction Questionnaire III. Surveys were filled out onsite. In the case of a refusal, the next person was asked. The refusal rate varied depending on the study site and ranged between 25% and 60%, depending on the facility and the day of sampling. Organisational-level data, such as operating characteristics and products offered, created a backdrop for further examination into the social services offered by these facilities and the attempts made by this largely unregulated healthcare system to create a community-based environment of social support for chronically ill people. Informal assessment suggests that chronic pain is the most common malady for which medical cannabis is used. Descriptive statistics were generated to examine sample- and site-related differences. Results show that medical cannabis patients have created a system of dispensing medical cannabis that also includes services such as counselling, entertainment and support groups , all important components of coping with chronic illness. Furthermore, patients tend to be male, over 35, identify with more than one ethnicity, and earn less than US$20 000 annually. Levels of satisfaction with facility care were fairly high, and higher than nationally reported satisfaction with health care in the USA. Facilities tended to follow a social model of cannabis care, including allowing patients to use medicine onsite and offering social services. This approach has implications for the creation and maintenance of a continuum of care among bottom-up social and health services agencies. [source] A policy analysis of the Expert Patient in the United Kingdom: self-care as an expression of pastoral power?HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2001Patricia M. Wilson BEd (Hons) NursEd RGN NDN Abstract The rise in chronic illness and comorbidity in Western society has resulted in an increasing emphasis on self-care initiatives. In the United Kingdom this is exemplified by the Expert Patient policy. This paper discusses the Expert Patient initiative as an example of the State's third way approach to public health. The extent to which this policy challenges conventional power relationships between professional and patient, and fosters equal partnership is examined. In particular, how expert is defined and whether a professional understanding of the term is reconcilable with a patient's expertise is debated. The paper argues that the Expert Patient initiative is unlikely to reconstruct chronic illness and may further complicate the State's responsibility in meeting the needs of those with chronic illness. Issues of power within self-care are explored to illuminate the policy, and this paper argues that the Expert Patient initiative is an example of Foucault's notion of pastoral power. Although the Expert Patient policy focuses on the rights and responsibilities of those with chronic illness, this paper concludes that there is no corresponding strategy to challenge professionals' assumptions toward those with chronic illness. [source] Clinical decision-making in the context of chronic illnessHEALTH EXPECTATIONS, Issue 1 2000Susan Watt DSW CSW This paper develops a framework to compare clinical decision making in relation to chronic and acute medical conditions. Much of the literature on patient-physician decision making has focused on acute and often life-threatening medical situations in which the patient is highly dependent upon the expertise of the physician in providing the therapeutic options. Decision making is often constrained and driven by the overwhelming impact of the acute medical problem on all aspects of the individual's life. With chronic conditions, patients are increasingly knowledgeable, not only about their medical conditions, but also about traditional, complementary, and alternative therapeutic options. They must make multiple and repetitive decisions, with variable outcomes, about how they will live with their chronic condition. Consequently, they often know more than attending treatment personnel about their own situations, including symptoms, responses to previous treatment, and lifestyle preferences. This paper compares the nature of the illness, the characteristics of the decisions themselves, the role of the patient, the decision-making relationship, and the decision-making environment in acute and chronic illnesses. The author argues for a different understanding of the decision-making relationships and processes characteristic in chronic conditions that take into account the role of trade-offs between medical regimens and lifestyle choices in shaping both the process and outcomes of clinical decision-making. The paper addresses the concerns of a range of professional providers and consumers. [source] Effect of Prescription Drug Coverage on Health of the ElderlyHEALTH SERVICES RESEARCH, Issue 5p1 2008Nasreen Khan Objective. To estimate the effect of prescription drug insurance on health, as measured by self-reported poor health status, functional disability, and hospitalization among the elderly. Data. Analyses are based on a nationally representative sample of noninstitutionalized elderly (,65 years of age) from the Medicare Current Beneficiary Survey (MCBS) for years 1992,2000. Study Design. Estimates are obtained using multivariable regression models that control for observed characteristics and unmeasured person-specific effects (i.e., fixed effects). Principal Findings. In general, prescription drug insurance was not associated with significant changes in self-reported health, functional disability, and hospitalization. The lone exception was for prescription drug coverage obtained through a Medicare HMO. In this case, prescription drug insurance decreased functional disability slightly. Among those elderly with chronic illness and older (71 years or more) elderly, prescription drug insurance was associated with slightly improved functional disability. Conclusions. Findings suggest that prescription drug coverage had little effect on health or hospitalization for the general population of elderly, but may have some health benefits for chronically ill or older elderly. [source] Psychological Symptoms Are Greater in Caregivers of Patients on Hemodialysis Than Those of Peritoneal DialysisHEMODIALYSIS INTERNATIONAL, Issue 4 2003M. Tugrul Sezer Background:,The purpose of this study was to evaluate and compare psychosocial characteristics in caregiving relatives (caregivers) of hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods:,Thirty-three caregivers (17 women, 16 men) of HD patients, 27 caregivers (11 women, 16 men) of PD patients, and a control group of 49 subjects who do not care for family members with chronic illness (23 women, 26 men) are included in this study. The brief symptom inventory (BSI), social disability schedule (SDS), and brief disability questionnaire (BDQ) were used for the psychosocial evaluation. Results:,The mean age, men-to-women ratios, duration of education, and distribution of marital status did not differ significantly among the three groups. In addition, dialysis duration and distribution of caregiver type were not different between the HD and PD groups. Although the mean global severity index scores of the three groups were similar, somatization and depression scores from BSI subitems were greater in the HD group than the scores of the PD and control groups. Although the mean SDS and BDQ scores were higher in the HD group, the differences did not achieve statistical significance. BSI subitems such as somatization, obsession,compulsion, interpersonal sensitivity, depression, and anxiety were positively correlated among themselves. Hostility and somatization were negatively correlated with age and education, respectively. Nevertheless, somatization was positively correlated with age. Social disability was negatively correlated with duration of education. Conclusion:,Somatization and depression are greater in the caregivers of center HD patients compared to PD and control groups. According to the findings of this study, we suggest that caregiving family members of dialysis patients especially on HD also should be evaluated for psychosocial problems and supported as needed. Further studies are needed to explore whether psychosocial parameters of caregivers predict outcomes for caregivers and patients. [source] Neurodevelopmental impairment: Predictors of its impact on the families of extremely low birth weight infants at 18 months,INFANT MENTAL HEALTH JOURNAL, Issue 6 2008Bonnie E. Stephens Effects on a family of a child with chronic illness have been described. The Impact on Family Scale (IOF) was developed to measure these effects. The impact of extremely low birth weight (ELBW) infants with neurodevelopmental impairment on families is unknown. This study determined IOF scores for families of ELBW infants with increasing degree of impairment at 18 months and identified factors that increase vulnerability to impact. A total of 3,849 ELBW infant survivors born at the 16 centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 1993 and February 2001 were assessed at 18 to 22 months. Infants were divided into four groups by degree of impairment. IOF scores were analyzed by impairment group. Multivariate analyses assessed effects of impairment, social/demographic factors, unmet service needs, and resource utilization on the IOF. A total of 1,624 (42.2%) infants had moderate/severe impairment. Increasing severity of impairment was associated with higher IOF scores. Severity of impairment contributed 6% of variance to the IOF scores. Twenty-one percent of variance was contributed by additional medical needs, low socioeconomic status (SES), and lack of social support. Although increasing severity of impairment impacts families of ELBW infants, significantly more impact is contributed by additional medical needs, low SES, and lack of social support. [source] | ||||||||||||||||||||||||||||||||||||||||