Home About us Contact
|
Home About us Contact | ||
|
|
||
Patient's Illness (patient + illness)
Selected AbstractsEvaluation of a Pediatric-sedation Service for Common Diagnostic ProceduresACADEMIC EMERGENCY MEDICINE, Issue 6 2006Wendalyn K. King MD Abstract Background: Pediatric patients often require sedation for diagnostic procedures such as magnetic resonance imaging and computed tomography scanning. In October 2002, a dedicated sedation service was started at a tertiary care pediatric facility as a joint venture between pediatric emergency medicine and pediatric critical care medicine. Before this service, sedation was provided by the department of radiology by using a standard protocol, with high-risk patients and failed sedations referred for general anesthesia. Objectives: To describe the initial experience with a dedicated pediatric-sedation service. Methods: This was a retrospective analysis of quality-assurance data collected on all sedations in the radiology department for 23-month periods before and after sedation-service implementation. Study variables were number and reasons for canceled or incomplete procedures, rates of referral for general anesthesia, rates of hypoxia, prolonged sedation, need for assisted ventilation, apnea, emesis, and paradoxical reaction to medication. Results are reported in odds ratios (OR) with 95% confidence intervals (95% CI). Results: Data from 5,444 sedations were analyzed; 2,148 before and 3,296 after sedation-service activation. Incomplete studies secondary to inadequate sedation decreased, from 2.7% before the service was created to 0.8% in the post,sedation-service period (OR, 0.29; 95% CI = 0.18 to 0.47). There also were decreases in cancellations caused by patient illness (3.8% vs. 0.6%; OR, 0.16; 95% CI = 0.10 to 0.27) and rates of hypoxia (8.8% vs. 4.6%; OR, 0.50; 95% CI = 0.40 to 0.63). There were no significant differences between the groups in rates of apnea, need for assisted ventilation, emesis, or prolonged sedation. The implementation of the sedation service also was associated with a decrease in both the number of patients referred to general anesthesia without a trial of sedation (from 2.1% to 0.1%; OR, 0.33; 95% CI = 0.06 to 1.46) and the total number of general anesthesia cases in the radiology department (from 7.5% to 4.4% of all patients requiring either sedation or anesthesia; OR, 0.56; 95% CI = 0.45 to 0.71). Conclusions: The implementation of a dedicated pediatric-sedation service resulted in fewer incomplete studies related to inadequate sedation, in fewer canceled studies secondary to patient illness, in fewer referrals for general anesthesia, and in fewer recorded instances of sedation-associated hypoxia. These findings have important implications in terms of patient safety and resource utilization. [source] One woman's journey is a journey we all may shareINTERNAL MEDICINE JOURNAL, Issue 5 2006I. H. Kerridge Abstract In recent years, there has been a growing awareness of the need to take account of the patient's own experience of illness. Although this is to be welcomed, it is also important to hear the stories of those most affected by the patient's illness, their partners, their families, their communities and those who care for them. ,On being both professional and human: one woman's journey' provides a powerful example of how narrative may assist clinicians to learn about communication, care, presence and the effect of illness and death on those left behind. [source] Use of the Zarit scale for assessing caregiver burden and collapse in caregiving at home in dementiasINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2007Ana M. Gort Abstract Objectives The main objective was to analyse the Zarit scale's (ZS) ability to identify signs of caregiver collapse amongst people looking after patients suffering from dementia. We also evaluated the dimensions most affected by the ZS and risk factors associated with caregiver burden and collapse. Methods We administered the ZS and semi-structured interviews to identify signs of caregiver collapse amongst 66 people looking after patients suffering from dementia. We evaluated the risk factors associated with the patient: age, sex, type of dementia, place of residence, length of illness, behavioural disorders, incontinence, the Barthel index (IB), the Global Deterioration Scale (GDS), Folstein's Mini-Mental State Examination (MMSE) and the use of day-care centres and also risk factors associated with the caregiver: age, sex, relationship with the patient, help received with caring, the patient's illness, other family responsibilities and other work outside the home. Results There was a large degree of agreement between the findings from the interview and the ZS (Kappa,=,0.545; p,<,0.001). With regard to the risk factors evaluated in this study, there was a statistically significant relationship between behavioural disorders and both burden (p,<,0.27) and collapse (p,<,0.17) and between caregiver collapse and the caregiver and patient not living at the same home (p,<,0.27). Conclusion The ZS is not only useful for identifying caregiver burden, but also for predicting main caregiver collapse. Behavioural disorders and not living with the patient are the main causes of caregiver burden and collapse. Copyright © 2007 John Wiley & Sons, Ltd. [source] Unmet Desire for Caregiver-Patient Communication and Increased Caregiver BurdenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2005Terri R. Fried MD Objectives: To examine the adequacy of caregiver-patient communication in serious illness and its relationship to caregiver burden. Design: Cross-sectional cohort study. Setting: Participants' homes. Participants: One hundred ninety-three persons aged 60 and older seriously ill with cancer, congestive heart failure, or chronic obstructive pulmonary disease and their caregivers. Measurements: Communication concerns, measured in terms of agreement with statements regarding desire for and difficulty with communication about the patient's illness. Caregiver burden, measured using a 10-item subset of the Zarit Burden Inventory, with scores ranging from 0 to 40 and higher scores indicating greater burden. Results: Of caregivers, 39.9% desired more communication, and 37.3% reported that communication was difficult. Of patients, 20.2% desired more communication, and 22.3% reported that communication was difficult. Disagreement regarding communication concerns was frequent in caregiver-patient pairs; of caregivers who desired more communication, 83.1% of patients did not, and of patients who desired more communication, 66.7% of caregivers did not. Caregivers who desired more communication had significantly higher caregiver burden scores than did caregivers who did not (9.2 vs 4.7, P<.001), even after adjusting for patient's diagnosis, income, and functional status and caregivers' age, sex, and relationship to the patient. Conclusion: A large proportion of caregivers and seriously ill older persons had an unmet desire for increased communication, although they frequently disagreed with each other about this desire. Caregivers' desire for increased communication may be a modifiable determinant of caregiver burden. [source] How Should Clinicians Describe Hospice to Patients and Families?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2004David J. Casarett MD Objectives: To describe hospice enrollment from the perspective of bereaved family members and to identify information about hospice that would encourage patients and families to enroll sooner. Design: Cross-sectional interviews. Setting: Three Medicare-certified hospice organizations. Participants: One hundred family members of 100 patients who died in hospice. Measurements: Semistructured interviews assessed prior knowledge of hospice, patients' and physicians' involvement in the enrollment process, features of hospice that motivated enrollment, and features that patients and families wished they had learned about sooner. Results: Almost all family members (n=92) and patients (n=71) knew about hospice before the patient's illness. Almost half the patients (n=44) were not involved at all in the hospice enrollment decision. The patient's physician (n=51) or the patient or family (n=34) initiated most hospice discussions, but patients and families usually obtained information about hospice from a hospice representative (n=75) rather than from the patient's physician (n=22). Family members identified several kinds of information about hospice that were particularly helpful in deciding whether to enroll and described several aspects of hospice that they wished they had known about sooner. Conclusion: Many patients and families learn about hospice from someone other than the patient's physician, and most learn about valuable hospice features and services only after enrollment. By providing more information about hospice earlier in the illness course, clinicians may be able to facilitate more-informed and more-timely decisions about hospice enrollment. [source] Direct effects of short-term psychoeducational intervention for relatives of patients with schizophrenia in JapanPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2006HAJIME YAMAGUCHI md Abstract, This study examined the direct effects of short-term psychoeducation on relatives of inpatients with schizophrenia, with the goal of introducing this type of support program into standard care. The subjects were 46 relatives of inpatients with schizophrenia who attended three or four sessions of psychoeducation. Levels of anxiety and subjective burden and distress were measured before and after sessions using self-administered rating scales. In addition, levels of expressed emotion were also measured. Results showed that both state and trait anxiety on the State-Trait Anxiety Inventory were significantly lower after psychoeducational intervention than before intervention. In addition, subjective burden and distress reported by the family significantly decreased on the subscales for family confusion resulting from a lack of knowledge of the illness and anxiety about the future, subjective burden and depression resulting from the patient's illness, and difficulties in the relatives' relationships with the patient. Comparison of high and low expressed emotion families showed that the intervention was almost equally effective for the two groups. However, its effectiveness with regard to the subjective burden and depression experienced by the families was significantly greater among high expressed emotion families. The present study confirmed that family psychoeducation during hospitalization, even for a short period, is effective for all families, whether high or low expressed emotion. Moreover, the results suggested that the intervention may have a greater effect on emotional factors in high expressed emotion families than in low expressed emotion families. [source] Rewarding Excellence and Efficiency in Medicare PaymentsTHE MILBANK QUARTERLY, Issue 3 2007KAREN DAVIS Medicare could become an innovative leader in using financial incentives to reward health care providers for providing excellent and efficient care throughout a patient's illness. This article examines the variations in cost and quality in the provision of episodes of care and describes how a pay-for-performance payment system could be designed to narrow those variations and serve as a transition to a new Medicare payment policy that would align physicians' incentives with improvements in both quality and efficiency. In particular, Medicare could stimulate greater efficiency by developing new payment methods that are neither pure fee-for-service nor pure capitation, beginning with a pay-for-performance payment system that rewards quality and efficiency and moving to a blended fee-for-service and case-rate system. [source] Quality of life in multiple sclerosis: a Kuwaiti MSQOL-54 experienceACTA NEUROLOGICA SCANDINAVICA, Issue 6 2008A. F. Alshubaili Objectives,,, We compared the quality of life (QOL) self-ratings of relapsing,remitting multiple sclerosis (RRMS) and progressive multiple sclerosis (PMS) patients with those of the general population; and assessed the association of demographic, clinical, and caregiver variables with patients' QOL. Methods,,, Consecutive clinic attendees were assessed with MSQOL-54, Beck's Depression Inventory, and Expanded Disability Status Scale. Caregivers rated their impression of patients' QOL and attitudes to patients' illness. Results,,, Of 170 patients (35.5% M, 64.5% F), 85.3% had RRMS and 14.7% PMS. RRMS had higher QOL domain scores (P < 0.001). Patients had lower QOL than controls (P < 0.001). Depression was the commonest significant covariate of QOL domains. After controlling for depression and disability, differences between the MS groups were less significant. Predictors of overall QOL were caregiver impression of patient's QOL, depression, and treatment side effects. Conclusion,,, Programs that address depression, disability, the impact of treatment side effects, caregiver attitudes and education should enhance QOL outcomes. [source] | ||||||||||