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Patient Interviews (patient + interview)
Selected AbstractsQualitative assessment of patient experiences following sacrectomy,JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2010K.M. Davidge MD Abstract Background and Objectives The primary objective was to investigate patient experiences following sacral resection as a component of curative surgery for advanced rectal cancers, soft tissue and bone sarcomas. Methods Qualitative methods were used to examine the experiences, decision-making, quality of life, and supportive care needs of patients undergoing sacrectomy. Patients were identified from two prospective databases between 1999 and 2007. A semi-structured interview guide was generated and piloted. Patient interviews were transcribed verbatim and analyzed using standard qualitative research methodology. Grounded theory guided the generation of the interview guide and analysis. Results Twelve patients were interviewed (6 female, 32,82 years of age). The mean interview time was 34,min. Five themes were identified, including: (1) the life-changing impact of surgery on both patients' and their family's lives, (2) patient satisfaction with immediate care in hospital, (3) significant chronic pain related to sacrectomy, (4) patients' need for additional information regarding long-term recovery, and (5) patients' gratitude to be alive. Conclusions Sacrectomy is a life-changing event for patients and their families. Patients undergoing sacrectomy need further information regarding the long-term consequences of this procedure. This need should be addressed in both preoperative multi-disciplinary consultations and at follow-up visits. J. Surg. Oncol. 2010; 101:447,450. © 2010 Wiley-Liss, Inc. [source] Protracted CRP Elevation after Atrial Fibrillation AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2008JAMES M. McCABE M.D. Background: Atrial fibrillation (AF) has been linked to an inflammatory process detected through various biomarkers, including C-Reactive Protein (CRP). Early recurrence of AF within the first 3 months after curative AF ablation is not felt to reflect success or failure of the procedure. We hypothesized that this early recurrence is due to an inflammatory response to the ablation itself. We therefore sought to evaluate levels of CRP after AF ablation. Methods: We prospectively enrolled subjects undergoing AF ablation. A control group of patients undergoing ablation for supraventricular tachycardia (SVT) was also enrolled. Each patient had CRP drawn on the day of the procedure (prior to ablation) and during their first follow-up (median 49 days, interquartile range [IQR] 37,93) and second follow-up (median 147 days, IQR 141,257) clinic visits. Patient interviews were performed and medical histories reviewed for evidence of recurrent AF prior to the first follow-up. Results: CRP levels significantly increased from baseline to first follow-up in the AF ablation group (P = 0.0017). CRP did not significantly change after SVT ablation (P = 0.92). Seventeen (45%) of the AF subjects exhibited recurrence of AF prior to first follow-up. After adjusting for multiple potential confounders, AF ablation patients with recurrent AF prior to their first follow-up had a statistically significant greater odds of having an increase in CRP (OR 21, 95% CI 1.1,417, P = 0.045). Conclusions: AF ablation generates an inflammatory response that persists for several weeks. This inflammation may explain early recurrence of AF after curative ablation. [source] BODE score is a useful predictor of hospital admission in rural patients with chronic obstructive pulmonary diseaseRESPIROLOGY, Issue 3 2008Alice MCKELLAR Background and objective: COPD is a chronic illness with frequent episodic exacerbations that require admission to hospital. The aim of this study was to identify risk factors (or predictors) for hospital admission in a sample of rural COPD patients. Methods: COPD patients from the Goulburn and Crookwell areas of New South Wales, Australia, were included in the study. Patients were divided into two groups: those with two or fewer admissions, and those with three or more admissions in the last year. Patient interviews were conducted, and data were collected on demographics, consumption of health resources, COPD severity measures (BODE score) and quality of life. Results: There were 32 patients recruited with a median age of 68 years, and 21 (65.6%) were male. There were no significant differences in risk factors (or predictors) identified between the two groups. A statistical difference was found between the two groups, with patients with three or more hospital admissions having a higher BODE score (P = 0.004), poorer quality-of-life score (P = 0.015) and reduced exercise tolerance (P = 0.001). Conclusions: In this small sample of COPD patients, there were no clear differences in terms of risk factors for COPD admission between the two groups. The BODE score was found to be a useful predictor of disease severity and likelihood of hospital admission. [source] Medications used in overdose and how they are acquired , an investigation of cases attending an inner Melbourne emergency departmentAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2010Penny Buykx Abstract Objective: This study aimed to investigate which categories of medication are most commonly implicated in overdose, to compare this information with prescription data and to explore how the medications used in overdoses are typically acquired. Methods: A 12-month audit (11/2003,10/2004) of all medication overdose presentations to an inner-Melbourne ED was conducted and the medications compared to published population-based prescription data. Interviews were conducted with 31 patients who attended the ED following a medication overdose and typical stories regarding the acquisition of medications reported. Results: The same broad categories of medications identified in earlier studies were found to contribute to the majority of overdoses in this study, namely benzodiazepines, antidepressants, analgesics and antipsychotics. Two benzodiazepine medications, diazepam and alprazolam, appeared to be over-represented in the overdose data relative to their population rates of prescription. Patient interviews revealed three main reasons for the original acquisition of the medications used in overdose: treatment purposes (77%); recreational use (16%); and overdose (7%). The most common source of medications (68%) used in overdose was prescription by the patient's usual doctor. Conclusion: The high representation of benzodiazepines among medications used in overdose is of ongoing concern. Implications: The time of medication prescription and dispensing may be an ideal opportunity for overdose prevention, through judicious prescribing, consideration of treatment alternatives, patient education and encouraging the safe disposal of unused medications. [source] Immediate follow-up after ICU discharge: establishment of a service and initial experiencesNURSING IN CRITICAL CARE, Issue 2 2003Eunice Strahan Summary ,Follow-up of patients discharged from the intensive care unit (ICU) is recommended as a means of service evaluation (Department of Health (2000). Comprehensive Critical Care: a Review of Adult Critical Care Services), in order to monitor the quality of the services provided ,Without patient follow-up, ICU staff have only ,death' or ,discharge alive from hospital' as clinical outcomes from which to judge practice performance, and limited evidence exists on which to base decisions about improvements to critical care practice (Audit Commission (1999). Critical to Success , the Place of Efficient and Effective Critical Care Services Within the Acute Hospital ) ,To address these issues the Regional Intensive Care Unit (RICU) obtained information from patient assessment/interview on problems experienced by patients within 8,9 days (mean), following discharge from RICU ,A nurse-administered questionnaire was used to identify functional outcomes, nutrition and psychological issues such as anxiety and sleep disturbances ,Benefits of patient follow-up introduced and planned include: ,patient diaries for long-term patients ,input from clinical psychologist ,review of sedation used in RICU [source] Patterns of stroke recurrence according to subtype of first stroke event: the North East Melbourne Stroke Incidence Study (NEMESIS)INTERNATIONAL JOURNAL OF STROKE, Issue 3 2008Mahmoud Reza Azarpazhooh Background Specific information about the nature of recurrent events that occur after each subtype of index stroke may be useful for refining preventive therapies. We aimed to determine whether stroke recurrence rates, the pattern of subtype recurrence, and prescription of secondary prevention agents differed according to initial stroke subtype. Methods Multiple overlapping sources were used to recruit all first-ever stroke patients from a geographically defined region of Melbourne, Australia over a 3-year period from 1996 to 1999. Potential stroke recurrences (fatal and nonfatal) occurring within 2 years of the initial event were identified following patient interview and follow up of death records. Subjects were classified into the different Oxfordshire groups and the type of first-ever stroke was compared with recurrent stroke events. Results One thousand, three hundred and sixteen first-ever strokes were registered during the 3-year period (mean age 74.4 years). A total of 103 first recurrent stroke events (fatal and nonfatal) occurred among those with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) during the 2-year follow-up period. The recurrent stroke subtype was different to the index stroke subtype in most (78%) patients. People with partial anterior circulation infarct had the greatest proportion of recurrences (13%), with a third of these being the more severe total anterior circulation infarct subgroup. The relative risk of ICH after an index lacunar infarct (LACI) compared with an index non-LACI was 4.06 (95% CI 1.10,14.97, P=0.038). Prescription of secondary prevention agents was greater at 2 years after stroke than at hospital discharge, and was similar between ischemic stroke subtypes. Conclusion Approximately 9% of people with first-ever stroke suffered a recurrent event, despite many being prescribed secondary prevention agents. This has implications for the uptake of current preventive strategies and the development of new strategies. The possibility that ICH is greater among index LACI cases needs to be confirmed. [source] Analyzing the etiology of an extremely worn dentitionJOURNAL OF PROSTHODONTICS, Issue 4 2001Ronald G. Verrett DDS Patients requiring extensive restorative care frequently exhibit significant loss of tooth structure. Specific clinical findings in an extremely worn dentition may vary widely and are often confusing. Severe wear can result from a mechanical cause, a chemical cause, or a combination of causes. The location of the wear, the accompanying symptoms and signs, and information gained from the patient interview are essential components in determining the etiology. A diagnostic decision tree facilitates a systematic analysis and diagnosis of dental wear. [source] Urinary incontinence after radical retropubic prostatectomy: the outcome of a surgical techniqueBJU INTERNATIONAL, Issue 4 2003A. Moinzadeh It is a reflection of the many manuscripts submitted on urological oncology in general, and prostate cancer in particular, that I am publishing 10 papers in this section this month. Seven of these relate to the latter subject. The authors from the Lahey Clinic describe their technique of radial prostatectomy and include a novel method of posterior bladder plication. They report an early return to continence and conclude that the technique is important in achieving their excellent results. In another study the group from Stockport show that patients often make decisions about types of treatment for prostate cancer having been strongly influenced by their partner, who in turn may have had pre-existing conceptions about this. They recommend early involvement of the partner to help in this very important decision-making. The two papers on bladder cancer describe possible prognostic factors, both clinical and laboratory-based, from a large experience in Hamburg and Mansoura. OBJECTIVE To analyse the incidence of incontinence after radical retropubic prostatectomy (RRP) and the time to return of continence, using an RRP technique including a novel posterior bladder plication PATIENTS AND METHODS We retrospectively reviewed the medical records of 200 consecutive patients who underwent RRP between September 1995 and February 1997, by one surgeon, at our institution. Patient characteristics including age, preoperative prostate-specific antigen (PSA) level and Gleason grade, were assessed. Continence was assessed before and after RRP by either a third-party patient interview or a prospective validated questionnaire. Continence was defined as not requiring the use of any sanitary pads or diapers. The continence rate was determined immediately after catheter removal, and at 3, 6, 12 and 15 months after RRP. RESULTS The mean age of the patients was 59.4 years, the preoperative PSA level 8.5 ng/mL and the Gleason grade 6.1. The time to continence and percentage of continent patients was 63.5% immediately, 82% at 3 months, 91% at 6 months, and 98.5% at 12 months after RRP. At 15 months, 199 of 200 consecutive patients were continent (99.5%). CONCLUSION With our technique there was an early return to continence and only a minor incontinence rate at 15 months. The cumulative effect of sequential technical manoeuvres in our RRP technique, including posterior bladder plication, is critical for continence after RRP. [source] Depression and functional status as predictors of death among cancer patientsCANCER, Issue 10 2002Manfred Stommel Ph.D. Abstract BACKGROUND The current study examined the extent to which depression and functional limitations contribute to the mortality of newly diagnosed cancer patients. The analysis focused on differences in survival times among cancer patients with new experiences of depressive symptoms and functional limitations and patients with a history of such limitations. METHODS Data for the current analysis came from two panel studies conducted in Michigan between 1993 and 1997, including 871 adult (, 21 years of age) breast, colon, lung, and prostate carcinoma patients. Information came from four separate sources: the intake patient interview, a self-administered questionnaire, medical record audits, and the Death Certificate Registry of Michigan's Department of Community Health. With time to death as the primary outcome (followup of 571 days), data were analyzed using Kaplan-Meier product limit estimates and the Cox proportional hazard model. RESULTS Cancer patients who, after diagnosis, report only new depressive symptoms or functional limitations, have the same survival chances as those who report none. Cancer patients with either previous emotional problems or previous physical limitations face, within the first 19 months after diagnosis, a 2.6 times greater hazard of dying than patients without prior problems. Patients with both previous emotional problems and physical limitations before diagnosis have a 7.6 times greater hazard of dying within that time frame. CONCLUSIONS The current data show cancer patients with prior limitations and emotional problems have worse survival chances than would be expected on the basis of their cancer diagnosis alone. While depressive symptoms and functional limitations are common short-run responses to a cancer diagnosis and initial treatment, patients with no prior history of such problems appear to be more resilient. Cancer 2002;94:2719,27. © 2002 American Cancer Society. DOI 10.1002/cncr.10533 [source] Scleral wrap increases the long-term complication risk of bone-derived hydroxyapatite orbital implantsCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 8 2008Tze'Yo Toh MBBS(Hons) Abstract Background:, This study was prompted by previous findings that suggested that scleral wrapping increased the rate of complications following insertion of bone-derived hydroxyapatite orbital implants and compared the long-term results of implants inserted with and without scleral wraps. Methods:, This retrospective case series reviewed the long-term outcomes of 159 patients who had undergone enucleation with insertion of a bone-derived hydroxyapatite orbital implant at Dunedin Hospital between 1977 and 2006. Implants were inserted with and without scleral wraps in 85 and 74 cases, respectively. Follow up was 0.5,27.5 years (mean 8.2 years) for the whole series and 9.7 years for the sclera group and 6.7 years for the group without sclera. Patient details were obtained from theatre records, case note review, patient interview and examination, interview of patient relatives and family general practitioner records. The main outcome measures were the rates of minor or major complications and their treatments and outcomes. Results:, Twenty-seven cases (17%) suffered minor complications of limited implant exposure that either healed spontaneously, with implant drilling or wound resuturing and 11 cases (7%) suffered major complications requiring explantation. Of 38 patients with postoperative complications, 31 (82%) had scleral wraps compared with 7 (18%) without sclera (P < 0.001; OR 5.14, 95% CI 2.00,14.78). Conclusion:, Bone-derived hydroxyapatite orbital implants inserted without scleral wrap were associated with better clinical outcomes and a lower rate of long-term complications. It is therefore recommended that these implants be inserted without a scleral wrap. [source] Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite LaserDERMATOLOGIC SURGERY, Issue 11 2001Sorin Eremia MD Background. Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. Objective. To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I,V. Methods. Eighty-nine untanned patients with skin types I,V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4,6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10,15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm2, a spot size of 12 mm was used for fluences of 35,40 J/cm2, and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm2. Fluences ranging from 20 to 50 J/cm2 (mean fluence 36 J/cm2) were used. Results. The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm2 (35,50 J/cm2) and a 10,12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm2 (30,40 J/cm2) and a 12,15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm2 (25,40 J/cm2) and a 12,15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25,35 J/cm2) and a 12,15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm2 (20,25 J/cm2) and a 12,15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. Conclusion. The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I,V. The best results are achieved in untanned patients with skin types I,IV. [source] Laparoscopic paraesophageal hernia repair: quality of life outcomes in the elderlyDISEASES OF THE ESOPHAGUS, Issue 8 2008E. J. Hazebroek SUMMARY Paraesophageal hernias (PEH) occur when there is herniation of the stomach through a dilated hiatal aperture. These hernias occur more commonly in the elderly, who are often not offered surgery despite the failure of medical treatment to address mechanical symptoms and life-threatening complications. The aim of this study was to assess the impact of laparoscopic repair of PEH on quality of life in an elderly population. Data were collected prospectively on 35 consecutive patients aged >70 years who had laparoscopic repair of a symptomatic PEH between December 2001 and September 2005. The change in quality of life was assessed using a validated questionnaire, the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), and by patient interviews. Patients were assessed preoperatively, and at 6 weeks, 6 months, 12 months, 1 year, and 2 years postoperatively. Mean patient age was 77 years (range 70,85); mean American Society of Anesthesiologists class was 2.7 (range 1,3). There were 28 women and 7 men. There was one readmission for acute reherniation, which required open revision. Total complication rate was 17.1%. All complications were treated without residual disability. There was no 30-day mortality, and median hospital stay was 3 days (range 2,14). Completed questionnaires were obtained in 30 of 35 patients (85.7%). There was a significant improvement in quality of life, as measured with QOLRAD, at all postoperative time points (P < 0.001). Laparoscopic PEH repair can be performed with acceptable morbidity in symptomatic patients refractory to conservative treatment and is associated with a significant improvement in quality of life. Our data support elective repair of symptomatic PEH in the elderly, a population who may not always be referred for a surgical opinion. [source] Antireflux stents for palliation of malignant esophagocardial stenosisDISEASES OF THE ESOPHAGUS, Issue 2 2007K. Schoppmeyer SUMMARY., Placement of self-expanding metal stents (SEMS) for palliation of malignant stenoses at the gastroesophageal junction is often associated with stent migration and reflux symptoms. SEMS with an antireflux mechanism have been developed to overcome the latter problem. The aim of this study was to evaluate the safety and efficacy of antireflux Z-stents. Patients with advanced squamous cell or adenocarcinoma of the distal esophagus or cardia suffering from dysphagia received an antireflux Z-stent. Technical success, complications of the procedure, clinical symptoms before and after stent placement, reinterventions and survival were recorded. Follow-up was accomplished by patient interviews and a standardized questionnaire for primary care physicians. Eighteen consecutive patients received an antireflux Z-stent. Seventeen of 18 stents were placed technically successful in a single endoscopic procedure. Mean dysphagia score improved from 2.2 to 0.6. Four patients (22%) had permanent reflux symptoms, an additional nine (50%) were taking proton pump inhibitors on a regular basis. In 10 patients, a re-intervention was necessary mainly due to dislocation of the stent. To ensure adequate nutrition three and two patients received a percutaneous gastrostomy and a jejunostomy, respectively. Median survival from stent insertion was 54 days (range, 3,201). Although placement of an antireflux Z-stent is technically feasible, its application is hampered by frequent stent migration and insufficient prevention of gastroesophageal reflux. Further technical improvements of stents or alternative methods like brachytherapy are required for satisfactory palliation of malignant gastroesophageal stenosis. [source] Alcohol and injuries: a review of international emergency room studies since 1995DRUG AND ALCOHOL REVIEW, Issue 2 2007CHERYL J. CHERPITEL Abstract This paper provides a review of emergency room (ER) studies on alcohol and injury, using representative probability samples of adult injury patients, and focuses on the scope and burden of the problem as measured by estimated blood alcohol concentration (BAC) at the time of the ER visit, self-report drinking prior to injury, violence-related injury and alcohol use disorders. A computerized search of the English-language literature on MEDLINE, PsychINFO and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol and Alcohol Problems Science Database (ETOH) was conducted for articles published between 1995 and 2005, using the following key descriptors: (1) emergency room/emergency department/accident and emergency, (2) alcohol/drinking and (3) injuries (intentional and unintentional). Findings support prior reviews, with injured patients more likely to be positive for BAC and report drinking prior to injury than non-injured, and with the magnitude of the association substantially increased for violence-related injuries compared to non-violence-related injuries. Indicators of alcohol use disorders did not show a strong association with injury. Findings were not homogeneous across studies, however, and contextual variables, including study-level detrimental drinking pattern, explained some of the variation. This review represents a broader range of ER studies than that reported previously, across both developed and developing countries, and has added to our knowledge base in relation to the influence of contextual variables on the alcohol-injury relationship. Future research on alcohol and injury should focus on obtaining representative samples of ER patients, with special attention to both acute and chronic alcohol use, and to organisational and socio-cultural variables that may influence findings across studies. In-depth patient interviews may also be useful for a better understanding of drinking in the injury event and associated circumstances. [source] Using disease risk estimates to guide risk factor interventions: field test of a patient workbook for self-assessing coronary riskHEALTH EXPECTATIONS, Issue 1 2002J. Michael Paterson MSc Objective,To assess the feasibility and acceptability of a patient workbook for self-assessing coronary risk. Design,Pilot study, with post-study physician and patient interviews. Setting and subjects,Twenty southern Ontario family doctors and 40 patients for whom they would have used the workbook under normal practice conditions. Interventions,The study involved convening two sequential groups of family physicians: the first (n=10) attended focus group meetings to help develop the workbook (using algorithms from the Framingham Heart Study); the second (n=20) used the workbook in practice with 40 patients. Follow-up interviews were by interviewer-administered questionnaire. Main outcome measures,Physicians' and patients' opinions of the workbook's format, content, helpfulness, feasibility, and potential for broad application, as well as patients' perceived 10-year risk of a coronary event measured before and after using the workbook. Results,It took an average of 18 minutes of physician time to use the workbook: roughly 7 minutes to introduce it to patients, and about 11 minutes to discuss the results. Assessments of the workbook were generally favourable. Most patients were able to complete it on their own (78%), felt they had learned something (80%) and were willing to recommend it to someone else (98%). Similarly, 19 of 20 physicians found it helpful and would use it in practice with an average of 18% of their patients (range: 1,80%). The workbook helped to correct misperceptions patients had about their personal risk of a coronary event over the next 10 years (pre-workbook (mean (SD) %): 35.2 (16.9) vs. post-workbook: 17.3 (13.5), P < 0.0001; estimate according to algorithm: 10.6 (7.6)). Conclusions,Given a simple tool, patients can and will assess their own risk of CHD. Such tools could help inform otherwise healthy individuals that their risk is increased, allowing them to make more informed decisions about their behaviours and treatment. [source] Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, ChinaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2004Qingyue Meng Abstract Both challenges and opportunities have been created by health sector reforms for TB control programmes in developing countries. China has initiated radical economic and health reforms since the late 1970s and is among the highest TB endemic countries in the world. This paper examines the operation of TB control programmes in a decentralized financial system. A case study was conducted in four counties of Shandong Province and data were collected from document reviews, and key informant and TB patient interviews. The main findings include: direct government support to TB control weakened in poorer counties after its decentralization to township and county governments; DOTS programmes in poorer counties was not implemented as well as in more affluent ones; and TB patients, especially the low-income patients, suffered heavy financial burdens. Financial decentralization negatively affects the public health programmes and may have contributed to the more rapid increase in the number of TB cases seen over the past decade in the poorer areas of China compared with the richer ones. Establishing a financial transfer system at central and provincial levels, correcting financial incentives for health providers, and initiating pro-poor projects for the TB patients, are recommended. Copyright © 2004 John Wiley & Sons, Ltd. [source] Fatigued Elderly Patients With Chronic Heart FailureINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Anna Ehrenberg PURPOSE To compare descriptions of fatigue based on the NANDA characteristics from interviews with elderly people with congestive heart failure (CHF) and data recorded by nurses at a Swedish outpatient heart failure clinic. METHODS Patients were screened for moderate to severe CHF. A total of 158 patients were interviewed using a revised form of the Fatigue Interview Schedule (FIS) based on the NANDA characteristics. Of these patients, half (n= 79) were offered visits at a nurse-monitored heart failure clinic. Nursing documentation of fatigue at the heart failure clinic was reviewed based on the NANDA characteristics and compared with the content in the patient interviews. FINDINGS Tiredness was documented in 43 (75%) records and indicated in 36 patients based on patient scores on the FIS (X,= 5.5; range 1,9). The most frequently recorded observation related to fatigue was the symptom emotionally labile or irritable, followed by notes on lack of energy and decreased performance. Patients' descriptions of their fatigue were expressed as a decreased ability to perform and a perceived need for additional energy. Results indicated poor concordance in patients' descriptions and record content concerning fatigue. Whereas patients emphasized the physical characteristics of fatigue, nurses emphasised the emotional features. Decreased libido was linked to fatigue according to the patients but not according to the nurses' records. Whereas cognitive characteristics of fatigue occurred rarely in the records, they were more frequent in the patient interviews. DISCUSSION Symptoms such as irritability and accident-proneness may be seen as manifestations of the patients' experiencing the need for more energy or a feeling of decreased performance. These consequences of being fatigued, rather than the different dimensions of fatigue, seemed to have been easy for the nurses to observe and document. Earlier studies indicate that poor observation, medication, and diet in patients with heart failure might partly be explained by cognitive impairment. CONCLUSIONS Findings of this study highlight the need for nurses to pay attention to the experience of fatigue in patients who suffer from CHF, and to validate their observations with the patients own expressions. Using the patients' words and expressions and the diagnostic characteristics of fatigue in recording can support the nurses in developing both understanding of patients living with CHF and strategies to help patients cope with their restricted ability in daily life. [source] Risk and protective behaviours of bisexual minority women: a qualitative analysisINTERNATIONAL NURSING REVIEW, Issue 2 2005J. D. Champion phd Background, Public health messages urging women to seek health care services such as sexually transmitted diseases (STD) and cervical cancer screening or family planning services fail to address women who have sex with women (WSW). This negligence may have led to a false sense of security amongst WSW concerning sexual risk behaviour. Research has shown that WSW engaged in more high-risk sexual behaviours than heterosexual women. WSW has been identified as an important vector in the spread of STDs in all populations because of bisexuality. To prevent and reduce transmission of STDs amongst WSW, perceptions of risk for STD amongst WSW need to be understood so that effective interventions may be developed. Aim, To describe the relationship between sexual risk and protective behaviour and STD transmission amongst bisexual minority women with a history of STD. Methods, Life history methods were used to interview 23 African-American bisexual women with a history of STD. Findings, Various themes unfolded during analysis of the patient interviews, including bisexual women's perceptions of STD risk, the context of sexual relationships with women and STD prevention, screening, and treatment practices. Conclusions, The contexts of sexual relationships including multiple or concurrent partner relationships with both men and women placed these women at high risk for STD. Regardless of the type of relationship or belief it is possible to get an STD, protection was often not used. These circumstances identify an extremely high-risk population of women with need for more extensive research to identify strategies for health care interventions. [source] Trust in Nurses Scale: construct validity and internal reliability evaluationJOURNAL OF ADVANCED NURSING, Issue 3 2010Laurel E. Radwin radwin l.e. & cabral h.j. (2010) Trust in Nurses Scale: construct validity and internal reliability evaluation. Journal of Advanced Nursing66(3), 683,689. Abstract Aim., This paper is a report of the continued psychometric evaluation of the Trust in Nurses Scale. Background., Qualitative analyses indicate that trust in nurses is critically important to adult patients. Instruments that distinctively measure this concept are lacking. A middle-range theory of patient-centred nursing care provided the theoretical basis for the Trust in Nurses Scale. Content validity was assessed by an expert panel and patient interviews. Construct validity and reliability were found acceptable using multi-trait/multi-item analysis techniques. These findings were previously reported. Methods., Construct validity and reliability of the Trust in Nurses Scale was assessed in 2007 using data collected during 2004,2005 from 187 hospitalized patients in a haematology-oncology setting. Trust in nurses (the latent factor) was operationalized by five items (manifest variables) using confirmatory factor analyses. Fit statistics included comparative fit index, Tucker-Lewis Index, root mean square error of approximation and the standardized root mean square residual. Internal consistency reliability was assessed using coefficient alpha. Findings., Both a five-item and a four-item version demonstrate acceptable psychometric properties. The five-item version met three fit statistics criteria. Fifty-nine per cent of the variance was explained. A four-item version met all fit statistics criteria. Sixty-six per cent of the variance was explained. Acceptable internal consistency reliability was found for both versions. Conclusion., Previous psychometric testing of the Trust in Nurses Scale provided evidence of the instrument's reliability, content validity and construct validity. The presented analyses further support construct validity. Thus, cumulative findings indicate that the instrument measures with a few items the underlying concept of trust. [source] Differences in Oncologist Communication Across Age Groups and Contributions to Adjuvant Decision OutcomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2009Mary M. Step PhD The objective of this study was to assess potential age-related differences in oncologist communication during conversations about adjuvant therapy decisions and subsequent patient decision outcomes. Communication was observed between a cross-section of female patients aged 40 to 80 with early-stage breast cancer (n=180) and their oncologists (n=36) in 14 academic and community oncology practices in two states. Sources of data included audio recordings of visits, followed by post-visit patient interviews. Communication during the visit was assessed using the Siminoff Communication Content and Affect Program. Patient outcome measures included self-reported satisfaction with decision, decision conflict, and decision regret. Results showed that oncologists were significantly more fluent and more direct with older than middle-aged patients and trended toward expressing their own treatment preferences more with older patients. Satisfaction with treatment decisions was highest for women in their 50s and 60s. Decision conflict was significantly associated with more discussion of oncologist treatment preferences and prognosis. Decision regret was significantly associated with patient age and education. Older adults considering adjuvant therapy may find that oncologists' communication accommodations to perceived deficiencies in older adult cognition or communication challenge their decision-making involvement. Oncologists should carefully assess patient decision-making preferences and be mindful of accommodating their speech to age-related stereotypes. [source] Prevalence of vision, hearing, and combined vision and hearing impairments in patients with hip fracturesJOURNAL OF CLINICAL NURSING, Issue 21 2009Else Vengnes Grue Aims and objectives., To examine the prevalence of hearing and vision impairments in 65+ year-old patients with hip fractures. Background., Many older people believe sensory problems are inevitable and thus avoid medical assessment and assistance. Furthermore, health professionals often overlook sensory problems, though it is known that sensory impairments can increase the risk of falling and sustaining hip fractures. Design., A prospective, observational study. Methods., We admitted 544 consecutive patients to an orthogeriatric ward from October 2004,July 2006; 332 were screened for study inclusion with the Resident Assessment Instrument for Acute Care (InterRAI-AC) and a questionnaire (KAS-Screen). We conducted patient interviews, objective assessments, explored hospital records and interviewed the family and staff. Impairments were defined as problems with seeing, reading regular print or hearing normal speech. Results., Sixteen per cent of the patients had no sensory impairments, 15·4% had vision impairments, 38·6% had hearing impairments and 30·1% had combined sensory impairments. Among the impaired, 80·6% were female, the mean age was 84·3 years (SD 6·8), 79·9% were living alone, 48·0% had cognitive impairments, 89·6% had impaired activities of daily living, 70·6% had impaired instrument activities in daily living, 51·0% had bladder incontinence and 26·.8% were underweight. Comorbidity and polypharmacy were common. Delirium was detected in 17·9% on day three after surgery. Results showed the prevalence of combined sensory impairments was: 32·8% none; 52·2% moderate/severe; and 15·1% severe. Conclusion., Patients with hip fractures frequently have hearing, vision and combined impairments. Relevance to clinical practice., We recommend routine screening for sensory impairments in patients with hip fractures. Most sensory problems can be treated or relieved with environmental adjustments. Patients should be encouraged to seek treatment and training for adapting to sensory deficiencies. This approach may reduce the number of falls and improve the ability to sustain independent living. [source] Usage and status of cobalt,chromium removable partial dentures 5,6 years after placementJOURNAL OF ORAL REHABILITATION, Issue 2 2002A. L. P. Yeung The aim of this study was to describe the usage of cobalt,chromium (Co,Cr) removable partial dentures (RPDs) by patients 5,6 years after denture insertion and to find out the factors that affected their denture usage. A random sample of patients provided with Co,Cr RPDs from a dental teaching hospital in Hong Kong was selected. Patients were interviewed using a structured questionnaire concerning their assessment and use of the dentures. Those who had been constantly wearing their original RPDs were examined by one calibrated examiner under optimal clinical conditions. The response rate of the patients who could be contacted was 98%. The results from 189 patient interviews showed that usage of the RPDs declined with time and that half of the dentures had been discarded or replaced 5,6 years after insertion. These discarded RPDs had been in use for an average of 19·5 months. The main reason given by the patients for not using the RPDs was general dissatisfaction with the dentures in various combinations of comfort, fit and chewing ability and, less importantly, with food trapping and appearance. No statistically significant association between denture usage and their respective Kennedy classification was found. The status of the Co,Cr RPDs that had been constantly used for 5,6 years was generally good. The majority of these RPDs demonstrated fair to good cleanliness, stability and retention and had no defect of any sort. [source] Pharmacy data in epidemiological studies: an easy to obtain and reliable toolPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 5 2002Taco B. M. Monster MPharmSc Abstract Purpose The agreement between drug use measured in computerized pharmacy records and patient interviews or questionnaires is generally good. However, most investigations on this subject studied selected populations or subsets. We studied the coverage of Dutch pharmacy data for our study cohort, and the agreement between the different sources. Methods We used the data from 8592 subjects of an on-going population-based study, focused on the impact of microalbuminuria (PREVEND). Data on drug use was collected in a questionnaire and at community pharmacies. Drug use was measured in the year preceding the questionnaire. Agreement between the sources was measured using kappa-values, sensitivity and positive predictive value. Results Pharmacy data could be collected for 7568 (88%) of the study cohort. Pharmacy data and questionnaires showed good agreement for antihypertensives, lipid lowering drugs, oral antidiabetics and oral contraceptives, but poor agreement for nitrates, hormone replacement therapy and painkillers. Conclusions Pharmacy data could be collected for a large proportion of our cohort. For chronically used drugs pharmacy data generally agrees well with questionnaires. However, for drugs used for shorter periods, as needed, or also available over-the-counter, the agreement is not so good. Pharmacy data can be a valuable source of drug information in epidemiological studies. Copyright © 2002 John Wiley & Sons, Ltd. [source] Increasing oncologists' skills in eliciting and responding to emotional cues: evaluation of a communication skills training program,PSYCHO-ONCOLOGY, Issue 3 2008Phyllis Butow Abstract Purpose: Psychological morbidity in cancer patients is common, but often undetected and untreated. We developed a communication skills training (CST) program targeting this issue, and evaluated its impact on doctor behaviour. Patients and Methods: Thirty of 35 oncologists from six teaching hospitals in six Australian cities, participated. The CST was a 1.5-day intensive face-to-face workshop incorporating presentation of principles, a DVD modelling ideal behaviour and role-play practice, followed by four 1.5 h monthly video-conferences incorporating role-play of doctor-generated scenarios. Doctors were randomized to receive the CST or not. Simulated patient interviews were videotaped and coded at baseline, after CST and 6 months later. Doctors completed questionnaires assessing stress and burnout at the same time points. Results: Doctors in the intervention group displayed more creating environment and fewer blocking behaviours at both follow-ups; however, these differences did not reach statistical significance. Intervention doctors valued the training highly, but did not report substantial reductions in stress and burnout. Conclusions: This short training programme demonstrated a positive effect on aspects of doctor behaviour. Video-conferencing after a short training course may be an effective strategy for delivering CST. Copyright © 2007 John Wiley & Sons, Ltd. [source] Analysis of family history of palmoplantar hyperhidrosis in JapanTHE JOURNAL OF DERMATOLOGY, Issue 12 2009Noriko YAMASHITA Abstract Palmoplantar hyperhidrosis (PPH) is a disorder characterized by excessive sweating of the palmar surfaces of the hands and feet due to emotional sweating. There have been reports based on family histories, and the involvement of genetic factors has been suggested. Among 410 PPH patients who visited our hospital from August 2006 to October 2008, onset age and family history were investigated in order to prepare pedigree charts, and family histories were confirmed in 147 patients (36%). Between the family history and negative family history (sporadic) groups, no significant differences were seen in onset age, sex or sweat volume. With regard to the patterns of incidence within families, parent,child was the most common at 58%, followed by sibling cases at 18%. The incidence of PPH in three generations was 13%. Pedigree charts prepared based on data obtained by patient interviews suggested autosomal dominant inheritance. [source] Physicians' communication with a cancer patient and a relativeCANCER, Issue 11 2005A randomized study assessing the efficacy of consolidation workshops Abstract BACKGROUND Although patients with cancer are often accompanied by a relative during medical interviews, to the authors' knowledge little is known regarding the efficacy of communication skills training programs on physicians' communication skills in this context. The objective of the current study was to assess the efficacy of 6 consolidation workshops, 3 hours in length, that were conducted after a 2.5-day basic training program. METHODS After attending the basic training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Training efficacy was assessed through simulated and actual interviews that were recorded on an audio tape at baseline, after consolidation workshops for the consolidation-workshops group, and 5 months after the end of basic training for the waiting-list group. Communication skills were assessed according to the Cancer Research Campaign Workshop Evaluation Manual. Patients' and relatives' perceptions of and satisfaction with physicians' communication performance were assessed using a 15-item questionnaire. RESULTS Sixty-two physicians completed the training program. Compared with physicians who participated to the basic training program, when addressing the patient, physicians who were randomized to the consolidation workshops used more open, open directive, and screening questions (P = 0.011 in simulated patient interviews and P = 0.005 in actual patient interviews) and elicited and clarified psychologic concerns more often (P = 0.006 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the relative, physicians who were randomized to the consolidation workshops gave less premature information (P = 0.032 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the patient and the relative simultaneously, physicians who were randomized to the consolidation workshops used more empathy, educated guesses, alerting to reality, confronting, negotiating, and summarizing (P = 0.003 in simulated patient interviews and P = 0.024 in actual patient interviews). Patients, but not relatives, who interacted with physicians in the consolidation-workshops group were more satisfied globally with the interviews (P = 0.022). CONCLUSIONS Six 3-hour consolidation workshops resulted in improved communication skills addressed to patients and to relatives. The current results showed that the transfer of skills addressing relatives' concerns remained limited and that consolidation workshops should focus even more systematically on the practice of three-person interviews. Cancer 2005. © 2005 American Cancer Society. [source] Use of the internet by colorectal cancer patientsCOLORECTAL DISEASE, Issue 1 2006S. M. Powell Abstract Objective, To identify the frequency of Internet use by colorectal cancer patients. Materials and methods, Fifty patients interviews. Results, Only four patients (8%) had used the internet to access information about colorectal cancer though 36% would have used it if a site had been recommended. Conclusion, The Internet is a resource rarely used by patients but there is potential for its use as an adjunct to written and verbal information. [source] | ||||||||||||||||||||||||||||