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Patient Concerns (patient + concern)
Selected AbstractsThe Psychological Impact of Implantable Cardioverter-Defibrillator Recalls and the Durable Positive Effects of CounselingPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2009JOHN D. FISHER M.D. Background: It is known that patients with lifesaving devices such as implantable cardioverter-defibrillators (ICDs) may be alarmed and worried by recalls or alerts related to their ICDs. Objectives: This study aimed to determine whether counseling has any short- or long-term benefits, and to look for characteristics that identify those most worried and those most in need of counseling. Methods: Among 100 patients with recall or alert ICDs, 14 were pacer dependent; 50 had ICDs for 1° prevention and 22 were women. Patients completed a survey indicating how worried they were on learning of the recall or alert (0,10 scale). After counseling and advice in accordance with manufacturer guidelines, patients were asked to indicate their level of worry, and were again asked after 6 months. Results: For all patients, the "worry level" at the initial interview was 5.0±3.7, falling to 2.2±3.0 after counseling (P < 0.001) and 1.4±2.3 after 6 months (P < 0.001 vs both earlier levels). There were no significant differences between those implanted for 1° versus 2° prevention or for pacer dependency. Women were initially more worried than men, but not for the long term. The 49 patients whose ICDs could be managed by reprogramming or software fix had significant reduction in worry after counseling and at 6 months compared to others. The 18 patients recommended for operative intervention remained more concerned after counseling (3.5±3.3 vs 1.9±2.9, P = 0.043). Conclusions: Patients' concerns resulting from ICD recalls or alerts can be reduced by appropriate counseling. Those patients whose ICDs could be reprogrammed to safer parameters had the most reduction in worry levels. [source] 2451: What's new in neuroprotectionACTA OPHTHALMOLOGICA, Issue 2010L WHEELER Purpose Vision loss is a an important patient concern in glaucoma and retinal diseases. This talk will update recent findings with alpha-2 agonists and NMDA antagonists in light of recent clinical experience in neuroprotection. Alpha-2 agonists have been shown to be neuroprotective in many animal models by mechanisms thought to enhance neuronal survival. The physiological role of alpha-2 receptors is still an emerging area of research in the retina and optic nerve. Methods Recent experiments suggest that alpha-2 agonists can improve retinal performance in laboratory animals. The new methods to demonstrate this will be presented. How is this different than neuroprotection? Or is it? Results A number of ideas are being pursued to explain the observation of improved retinal performance: increased axonal transport in rats; changes in down stream receptor signalling, etc. Conclusion Understanding the mechanism(s)of action for how alpha-2 agonists affect neuroportection and retinal performance may lead to new medical therapies and the role of these receptors in the physiology and function of the eye. Commercial interest [source] Could interchangeable use of dry powder inhalers affect patients?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2005D. Price Summary The aim of asthma treatment is optimal disease control. Poor asthma control results in considerable patient morbidity, as well as contributing to the considerable burden placed by the disease on healthcare budgets. There is a need for costs to be carefully scrutinised, with the switching of patients to inhaler devices with lower acquisition costs likely to be increasingly considered. However, before such practice becomes widespread, it is important to establish whether or not this could adversely impact on patients and the level of disease control. For approval to have been given, all marketed inhalers must have satisfied current regulatory requirements for devices. Full preclinical and clinical development programmes are not required when application is made for authorisation to market a new inhaler containing an existing chemical entity, although clinical equivalence testing must be used. Both beneficial and adverse effects should be tested, and the limits of equivalence must be clearly defined, based on therapeutic relevance. It should be noted that equivalence studies are invalid when the end point is not responding (i.e. at the top of the dose,response curve) and when equivalence limits approach or are equal to the magnitude of the drug effect. Approval on the basis of regulations designed to safeguard quality of dry powder inhalers does not mean that devices are interchangeable. When using an inhaler, there are many stages between the patient and the therapeutic effect, involving device design, pharmaceutical performance and patient behaviour. Regulations governing new devices cover only a few of the many factors affecting disease control. Furthermore, clinical trials to assess equivalence may not take into account factors in patient behaviour or variations in patient inhaler technique that may affect use of devices in real-life situations. When assessing the consequences of interchangeable use of dry powder inhalers on healthcare costs, it is important to ensure that the acquisition cost of the devices is not the only cost considered. Other costs that should be considered include the cost of time spent demonstrating to the patient how to use the new device, the cost of additional physician visits to address patient concerns and the management costs if disease control is adversely affected. [source] A review of the benefits of whole body exercise during and after treatment for breast cancerJOURNAL OF CLINICAL NURSING, Issue 1 2007Marilyn N Kirshbaum PhD RN (NY) RGN DipAdultOnc Aim., A current critical review of the literature was deemed necessary to evaluate the strength of evidence to inform clinical practice. Background., Recently, there has been a noticeable increase in empirical literature surrounding the benefits of exercise for breast cancer patients. Methods., A systematic search strategy was used to identify relevant literature. Twenty-nine articles were retained for critical review, appraised for quality and synthesized. Results., Many early studies had limited internal and external validity. Recent studies were considerably more rigorous and robust. Consistent support for all types of aerobic exercise was most evident in studies of patients during adjuvant cancer treatments (chemotherapy and radiotherapy), compared with post-treatment studies. The evidence which suggested that aerobic exercise limits cancer-related fatigue was particularly strong. For other patient concerns, the empirical support was less robust, however, the potential for beneficial and measurable patient outcomes was indicated for cardiopulmonary function, overall quality of life, global health, strength, sleep, self-esteem and reduced weight gain, depression, anxiety and tiredness. Conclusions., Additional studies with higher methodological quality are required in this clinically relevant area to substantiate current indications particularly for patient subgroups (e.g. older people, those with advanced cancer and the disadvantaged). Relevance to clinical practice., It is important for all healthcare professionals involved in the care of individuals affected by breast cancer to be aware of the evidence surrounding the benefits of exercise and to encourage patients to increase physical activity and improve their overall health and well-being. [source] The use of psychiatric medications to treat depressive disorders in African American womenJOURNAL OF CLINICAL PSYCHOLOGY, Issue 7 2006Allesa P. Jackson Review of the current literature confirms that African American women as a group are underdiagnosed and undertreated for psychiatric disorders. Hence, much effort is targeted towards awareness, screening, and improving access to health care for this population. However, once an African American woman is diagnosed with a major mental health disorder, determining the optimal course of treatment is a process that must be approached carefully because of gender and racial/ethnic differences in response and metabolism of psychiatric medications. African American women fall into both of these understudied categories. Given the small numbers of African American women represented in the clinical trials on which clinical practice is based, one must consider the limitations of current knowledge regarding psychoactive medications in this population. Culturally based attitudes or resistance to pharmacotherapy can complicate the use of psychoactive medicines, often a first-line approach in primary care clinics. Communication with patients is key, as well as openness to patient concerns and tolerance of these medications. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 793,800, 2006. [source] Making amends or making things worse?LEGAL STUDIES, Issue 4 2007Clinical negligence reform, patient redress in England This paper examines the government's reform of the current system of clinical negligence litigation in England, focusing on an analysis of the redress scheme for low value claims to be established under the NHS Redress Act 2006. The Act establishes a scheme to provide a package of redress to patients in circumstances where they have suffered harm as a result of negligence during the course of medical treatment provided by the NHS. One of the British Government's central aims in embarking upon reform in this area was to provide a low cost, quick and genuine alternative to the current clinical negligence litigation system. This paper critically analyses this reform of the current system by reference to an examination of what constitutes a just redress scheme in the circumstances. Such analysis shows that the government has missed a golden opportunity to establish a scheme which truly ,makes amends' to patients who have suffered harm through medical treatment in the NHS. Instead, the scheme is likely to operate in practice as an administrative scheme for low value claims that serves the institutional and financial interests of the NHS, and therefore fails to address longstanding patient concerns over the provision of redress arising out of harm suffered through medical treatment. As a result, patient confidence in the scheme is likely to be undermined in the long term. [source] Long-Term Outcomes of a Telephone Intervention After an ICDPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2005CYNTHIA M. DOUGHERTY Background: The purpose of this study was to determine the long-term benefits of participating in a structured, 8-week educational telephone intervention delivered by expert cardiovascular nurses post-ICD. The intervention was aimed to (1) increase physical functioning, (2) increase psychological adjustment, (3) improve self-efficacy in managing the challenges of ICD recovery, and (4) lower levels of health care utilization over usual care in the first 12 months post-ICD. This article reports on the 6- and 12-month outcomes of the nursing intervention trial. Methods and Results: A two-group (N = 168) randomized control group design was used to evaluate intervention efficacy with persons receiving an ICD for the secondary prevention of sudden cardiac arrest. Measures were obtained at baseline, 6 and 12 months post hospitalization. Outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI], Centers for Epidemiologic Studies,Depression [CES-D], fear of dying), (3) self-efficacy (Sudden Cardiac Arrest,Self-Efficacy [SCA-SE], Sudden Cardiac Arrest,Behavior [SCA-B], Sudden Cardiac Arrest,Knowledge [SCA-K]), and (4) health care utilization (emergency room [ER] visits, outpatient visits, hospitalizations). Using repeated measures ANOVA, the 6- and 12-month benefits of the intervention over usual care were in reductions in physical concerns (P = 0.006), anxiety (P = 0.04), and fear of dying (P = 0.01), with enhanced self-confidence (P = 0.04) and knowledge (P = 0.001) to manage ICD recovery. There were no statistically significant differences between the groups on total outpatient visits, hospitalizations, or ER visits over 12 months. Conclusion: A structured 8-week post-hospital telephone nursing intervention after an ICD had sustained 12-month improvements on patient concerns, anxiety, fear of dying, self-efficacy, and knowledge. Results may not apply to individuals with congestive heart failure who receive an ICD for primary prevention of sudden cardiac arrest. [source] Long-term Management of the Liver Transplant Patient: Recommendations for the Primary Care DoctorAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009B. M. McGuire No official document has been published for primary care physicians regarding the management of liver transplant patients. With no official source of reference, primary care physicians often question their care of these patients. The following guidelines have been approved by the American Society of Transplantation and represent the position of the association. The data presented are based on formal review and analysis of published literature in the field and the clinical experience of the authors. These guidelines address drug interactions and side effects of immunosuppressive agents, allograft dysfunction, renal dysfunction, metabolic disorders, preventive medicine, malignancies, disability and productivity in the workforce, issues specific to pregnancy and sexual function, and pediatric patient concerns. These guidelines are intended to provide a bridge between transplant centers and primary care physicians in the long-term management of the liver transplant patient. [source] Quality of life issues in nonmetastatic skin cancerBRITISH JOURNAL OF DERMATOLOGY, Issue 1 2010D. Burdon-Jones Summary Background, Current knowledge of quality of life (QOL) issues affecting patients with nonmetastatic skin cancer is unsatisfactory, being based either on the use of QOL questionnaires derived from dermatology patients with predominantly benign lesions or inflammatory skin rashes, or on the use of general health QOL questionnaires. Objectives, We sought to determine the impact of nonmetastatic skin cancer on patients' lives by asking such patients for their written opinions. Methods, An open-ended ,Skin Cancer Quality of Life Question Sheet' was given to 100 consenting patients with nonmetastatic skin cancer [50 with malignant melanoma (MM) and 50 with nonmelanoma skin cancer (NMSC)]. Results, In total, 82 ,Skin Cancer Quality of Life Question Sheets' were returned complete (40 MM and 42 NMSC). There were 44 different patient concerns voiced overall in the responses. The concerns were grouped into 10 main themes. Patients with MM were significantly more likely than those with NMSC to mention ,a sense of relief/gratitude following treatment and/or a commitment to enjoy life here on' (P = 0·001), ,feelings of anxiety/depression/guilt/stress towards oneself or family/friends' (P < 0·001) and ,strengthening of emotional relationships with family and/or friends' (P = 0·02). Patients with NMSC were significantly more likely than those with MM to mention ,concern about the public's lack of understanding and recognition of skin cancer' (P = 0·02). The theme ,realization of one's mortality' was commoner among patients with MM than with NMSC, while the theme ,concern regarding possible scarring/disfigurement or the reaction of others' was commoner among patients with NMSC than with MM, although neither of these two differences was statistically significant (P = 0·07 and P = 0·11, respectively). Conclusions, QOL issues expressed by patients with nonmetastatic skin cancer highlight concerns we must address during their care. A disease-specific QOL measure suitable for both nonmetastatic MM and nonmetastatic NMSC is needed. The psychosocial impact on patients with nonmetastatic MM must not be underestimated. [source] Seeing and being seen: Narcissistic pride and narcissistic humiliationTHE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS, Issue 4 2006JOHN STEINER Seeing and being seen are important aspects of narcissism, where self-consciousness is always a feature, and one which becomes acute when a patient loses the protection of a narcissistic relationship and is obliged to tolerate a degree of separateness. Having felt hidden and protected, he now feels conspicuous and exposed to a gaze which makes him vulnerable to humiliation. This often has a devastating and unbearable quality to it, particularly when it is felt to arise in retaliation to the patient's own use of gaze to establish a superiority which allowed the patient to look down on others. The need to avoid or cut short such humiliation may be so acute that the patient cannot deal with guilt and other emotions connected with loss which might otherwise be bearable. The author argues that development is impeded unless the patient is able to gain support to make the humiliation better understood and hence better tolerated. He describes some sessions from an analysis to illustrate how, in some analytic situations, much of the patient's concern and many of his defensive manoeuvres aim to reduce or to reverse experiences of humiliation. An understanding of the mechanisms involved seemed to enable some development to proceed. [source] Cast titanium overlay denture for a geriatric patient with a reduced vertical dimensionGERODONTOLOGY, Issue 4 2005Satyabodh Guttal An older patient reporting to the dental surgery for his/her dental treatment is becoming a common occurrence. Improved oral hygiene has meant that teeth are retained for a longer time, along with the potential problems of attrition, decreased vertical dimension, temporomandibular joint discomfort/strain, and poor aesthetics. The case in question is that of a 65-year-old male patient who had severe attrition in the lower arch, temporomandibular joint pain and reduced vertical dimension. The maxillary arch had previously been restored with a fixed partial prosthesis. For restoration of the lower teeth, a removable cast titanium overlay denture was fabricated incorporating an increased vertical dimension. Porcelain facings were placed to restore the aesthetics of the anterior teeth. The titanium was cast in a semi-automatic electric arc, pressure type casting machine. A titanium overlay denture with porcelain facing on the anterior teeth may provide a means of restoring a patient's concerns regarding aesthetics and function. [source] The Danish version of the Medication Adherence Report Scale: Preliminary Validation in Cancer Pain PatientsPAIN PRACTICE, Issue 1 2009Ramune Jacobsen MS Abstract Objective: To examine the psychometric properties of the Danish version of the Medication Adherence Report Scale (DMARS-4) adapted to measure adherence to analgesic regimen among cancer patients. Methods: The validated English version of the Medication Adherence Report Scale was translated into Danish following the repeated back-translation procedure. Cancer patients for the study were recruited from specialized pain management facilities. Thirty-three patients responded to the DMARS-4, the Danish Barriers Questionnaire II, The Danish version of Patient Perceived Involvement in Care Scale measuring the quality of patient-physician pain communication, and the Danish Brief Pain Inventory pain severity scale. Results: A factor analysis of the DMARS-4 resulted in one factor. Mean (SD) score on the cumulative scale ranging from 4 to 20, with higher scores indicating better medication adherence, was 17.8 (0.42). The DMARS-4 scores were related to the measures of patients' concerns about pain management and patients' pain communication. The internal consistency of the DMARS-4 was 0.70. Conclusions: The DMARS-4 seems to be a valid and reliable measure of self-reported adherence to analgesic regimen in the context of cancer pain. [source] Obtaining informed consent for clinical pain research: patients' concerns and informational needs. (University of Pennsylvania Center for Bioethics, Philadelphia, PA) Pain.PAIN PRACTICE, Issue 4 20012001;92:7 Investigators who conduct pain research are required to obtain voluntary informed consent from patients. However, little is known about what information patients expect when they decide whether to enroll in such studies. It is important that the investigators understand the need for information so that they can effectively and clearly describe the research risks and potential benefits that matter to the potential subjects. This study was designed to define information needs that patients have when they decide whether to participate in clinical pain research and identified clinical and demographic variables associate with specific needs. [source] Assessment is not enough: a randomized controlled trial of the effects of HRQL assessment on quality of life and satisfaction in oncology clinical practicePSYCHO-ONCOLOGY, Issue 12 2007Sarah K. Rosenbloom Abstract The potential benefits of health-related quality of life (HRQL) assessment in oncology clinical practice include better detection of problems, enhanced disease and treatment monitoring and improved care. However, few empirical studies have investigated the effects of incorporating such assessments into routine clinical care. Recent randomized studies have reported improved detection of and communication about patients' concerns, but few have found effects on patient HRQL or satisfaction. This study examined whether offering interpretive assistance of HRQL results would improve these patient outcomes. Two hundred and thirteen participants with metastatic breast, lung or colorectal cancer were randomly assigned to one of three conditions: usual care; HRQL assessment or HRQL assessment followed by a structured interview and discussion. Interviews about patients' assessment responses were conducted by a research nurse, who then presented HRQL information to the treating nurse. HRQL and treatment satisfaction outcomes were assessed at 3 and 6 months. No significant differences were found between study conditions in HRQL or satisfaction. Results suggest that routine HRQL assessment, even with description of results, is insufficient to improve patient HRQL and satisfaction. It is suggested that positive effects may require supplementing assessment results with specific suggestions for clinical management changes. Copyright © 2007 John Wiley & Sons, Ltd. [source] Medication errors: the role of the patientBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 6 2009Nicky Britten 1. Patients and their carers will usually be the first to notice any observable problems resulting from medication errors. They will probably be unable to distinguish between medication errors, adverse drug reactions, or ,side effects'. 2. Little is known about how patients understand drug related problems or how they make attributions of adverse effects. Some research suggests that patients' cognitive models of adverse drug reactions bear a close relationship to models of illness perception. 3. Attributions of adverse drug reactions are related to people's previous experiences and to their level of education. The evidence suggests that on the whole patients' reports of adverse drug reactions are accurate. However, patients do not report all the problems they perceive and are more likely to report those that they do perceive as severe. Patients may not report problems attributed to their medications if they are fearful of doctors' reactions. Doctors may respond inappropriately to patients' concerns, for example by ignoring them. Some authors have proposed the use of a symptom checklist to elicit patients' reports of suspected adverse drug reactions. 4. Many patients want information about adverse drug effects, and the challenge for the professional is to judge how much information to provide and the best way of doing so. Professionals' inappropriate emphasis on adherence may be dangerous when a medication error has occurred. 5. Recent NICE guidelines recommend that professionals should ask patients if they have any concerns about their medicines, and this approach is likely to yield information conducive to the identification of medication errors. [source] | |||||||||||||