Home About us Contact
|
Home About us Contact | ||
|
|
||
Difficult Patients (difficult + patient)
Selected AbstractsTHE NATURE OF THE PROBLEMS OF PSYCHOANALYSIS WITH SO-CALLED ,DIFFICULT' PATIENTSTHE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS, Issue 3 2002Rudi Vermote First page of article [source] Review of bupropion for smoking cessationDRUG AND ALCOHOL REVIEW, Issue 2 2003ROBYN RICHMOND Abstract The advent of bupropion hydrochloride sustained release (Zyban) has heralded a major change in the options available for smoking cessation pharmacotherapy. Bupropion is a selective re-uptake inhibitor of dopamine and noradrenalin which prevents or reduces cravings and other features of nicotine withdrawal. Bupropion is a useful oral and non-nicotine form of pharmacotherapy for smoking cessation. For this review a total of 221 papers were reviewed plus poster presentations. This review examines in detail original clinical trials on efficacy, categorised according to whether they were acute treatment trials in healthy smokers; studies in specific populations such as people with depression, chronic obstructive pulmonary disease (COPD) or cardiovascular disease; or relapse prevention studies. Overall, these studies in varying populations comprising over four thousand subjects, showed bupropion consistently produces a positive effect on smoking cessation outcomes. The evidence highlights the major public health role that bupropion has in smoking cessation. The methodological issues of published clinical trials reporting one year outcomes were examined in detail including: completeness of follow-up; loss to follow-up; intention to treat analysis; blindness of assessment; and validation of smoking status. The review discusses contraindications, adverse effects, dose and overdose, addictive potential, and the role of bupropion in reducing cessation-related weight gain. Bupropion combined with or compared to other pharmacotherapies (nicotine patch; nortriptyline) is considered. Impressive evidence exists for the use of bupropion in smoking cessation among difficult patients who are hard-core smokers such as those with cardiovascular disease, chronic obstructive pulmonary disease (COPD) and depression. Bupropion reduces withdrawal symptoms as well as weight gain and is effective for smoking cessation for people with and without a history of depression or alcoholism. Serious side effects of bupropion use are rare. The major safety issue with bupropion is risk of seizures (estimated at approximately 0.1%) and it should not be prescribed to patients with a current seizure disorder or any history of seizures. In clinical trials of bupropion for smoking cessation no seizures were reported. Allergic reactions occur at a rate of approximately 3% and minor adverse effects are common including dry mouth and insomnia. [source] Pharmacological Approaches to Managing Migraine and Associated Comorbidities,Clinical Considerations for Monotherapy Versus PolytherapyHEADACHE, Issue 4 2007Stephen D. Silberstein MD Comorbidity is defined as an illness that occurs more frequently in association with a specific disorder than would be found as a coincidental association in the general population. Conditions that are frequently comorbid with migraine include depression, anxiety, stroke, epilepsy, sleep disorders, and other pain disorders. In addition, many common illnesses occur concomitantly (at the same time) with migraine and influence the treatment choice. Migraine management, and especially migraine prevention, can be challenging when patients have comorbid or concomitant illnesses. The objectives of this initiative are to review the literature on managing patients who have migraine and common comorbidities, present additional clinical approaches for care of these difficult patients, and evaluate the areas in which research is needed to establish evidence-based guidelines for the management of migraine with associated comorbid conditions. [source] Shared patients: multiple health and social care contactHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2001J. Keene PhD Abstract The paper describes results from the ,Tracking Project', a new method for examining agency overlap, repeat service use and shared clients/patients amongst social and health care agencies in the community. This is the first project in this country to combine total population databases from a range of social, health care and criminal justice agencies to give a multidisciplinary database for one county (n = 97 162 cases), through standardised anonymisation of agency databases, using SOUNDEX, a software programme. A range of 20 community social and health care agencies were shown to have a large overlap with each other in a two-year period, indicating high proportions of shared patients/clients. Accident and Emergency is used as an example of major overlap: 16.2% (n = 39 992) of persons who attended a community agency had attended Accident and Emergency as compared to 8.2% (n = 775 000) of the total population of the county. Of these, 96% who had attended seven or more different community agencies had also attended Accident and Emergency. Further statistical analysis of Accident and Emergency attendance as a characteristic of community agency populations (n = 39 992) revealed that increasing frequency of attendance at Accident and Emergency was very strongly associated with increasing use of other services. That is, the patients that repeatedly attend Accident and Emergency are much more likely to attend more other agencies, indicating the possibility that they share more problematic or difficult patients. Research questions arising from these data are discussed and future research methods suggested in order to derive predictors from the database and develop screening instruments to identify multiple agency attenders for targeting or multidisciplinary working. It is suggested that Accident and Emergency attendance might serve as an important predictor of multiple agency attendance. [source] The harassment and stalking of plastic surgeons by their patients in AustralasiaANZ JOURNAL OF SURGERY, Issue 7-8 2009Stephen Allnutt Abstract Medical professionals come into direct contact with the public. The relationships are often personal. The aim of the survey is to examine the prevalence of harassment of plastic surgeons by their patients. Survey questionnaires were mailed to all plastic surgeons listed in the 1999 Australasian Society of Aesthetic Plastic Surgery List of Members. A very wide definition of harassment was then provided and information in regard to the nature of the harassment was obtained. This was a descriptive survey of plastic surgeons' experiences of harassment by patients in Australia and New Zealand. More than half of the plastic surgeons in Australia and New Zealand who responded to the questionnaire reported having been a victim of harassment at some point of their careers. One quarter had been harassed in the previous year. Over 20% of cases met the legal criteria for stalking. These estimates are in excess of those reported in the other studies of the general community. Harassment persisted in the majority of cases for at least a month and in a third of cases for up to 5 years. The recognition of psychiatric disorder, particularly personality dysfunction, prior to embarking on surgery may limit the likelihood of harassment by difficult patients. Formal teaching may be helpful to surgical registrars and consultants. Expert intervention could assist in reducing clinician anxiety. [source] | |||||||||||||