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Patient Needs (patient + need)
Kinds of Patient Needs Selected AbstractsConsiderations when choosing oral chemotherapy: identifying and responding to patient needEUROPEAN JOURNAL OF CANCER CARE, Issue 2010S. IRSHAD mrcp, specialist registrar in medical oncology IRSHAD S. & MAISEY N. (2010) European Journal of Cancer Care19, 5,11 Considerations when choosing oral chemotherapy: identifying and responding to patient need Oral chemotherapeutics are becoming increasingly accepted for the treatment of cancers and their future has never been brighter. They offer a more convenient and less invasive therapeutic option, moving cancer treatment from a predominantly hospital-based day unit into the ambulatory setting. Oral chemotherapy has the potential to maintain patient's quality of life and avoid the complications and costs of intravenous chemotherapy. It offers sustained drug exposure by providing prolonged therapy compared with intermittent IV exposure and lends itself more easily to the delivery of combination therapy. In this article we highlight the expansion of oral chemotherapeutic drug development in cancer treatment and the challenges posed by this change in treatment delivery. [source] Cool dialysate reduces asymptomatic intradialytic hypotension and increases baroreflex variabilityHEMODIALYSIS INTERNATIONAL, Issue 2 2009Lindsay J. CHESTERTON Abstract Intradialytic hypotension (IDH) remains an important cause of morbidity and mortality in chronic hemodialysis (HD) patients and can be ameliorated by cool temperature HD. The baroreflex arc is under autonomic control and is essential in the short-term regulation of blood pressure (BP). This study aimed to investigate if the baroreflex sensitivity (BRS) response to HD differed between standard and cool-temperature dialysate. Ten patients (mean age 67±2 years) prone to IDH were recruited into a randomized, crossover study to compare BRS variation at dialysate temperatures of 37 °C (HD37) and 35 °C (HD35). Each patient underwent continuous beat-to-beat BP monitoring during a dialysis session of HD37 and HD35. During HD37 2 patients developed symptomatic IDH, as opposed to 1 with HD35. However, asymptomatic IDH occurred with a frequency of 0.4 episodes per session with HD35 and 6.2 episodes per session during HD37 (odds ratio15.5; 95%CI 5.6,14.2). Although absolute BRS measurements did not differ between the 2 modalities, BRS variability increased during HD35. Our study has demonstrated that in IDH-prone patients, cool HD resulted in a reduction in heart rate and a greater reduction in cardiac output and stroke volume. Mean arterial pressure was maintained through a significantly greater increase in total peripheral resistance. Furthermore, although absolute BRS values during HD were not significantly altered by a reduction in dialysate temperature, there was a greater percentage increase in BRS values during cool HD. Understanding the varied causes of, and categorizing impaired hemodynamic responses to HD will enable further individualization of HD prescriptions according to patient need. [source] The utilization of rare blood donorsISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue 2 2007S. J. Nance When transfusion is needed for a patient with a rare blood type and the corresponding antibody, it can be challenging and lead to delays in transfusion. Sometimes, the blood cannot be found. Globally, the community of rare donor facilities is extremely collaborative and is quickly engaged in locating and delivering blood to the patients in need of rare blood types. Identifying the rare donor is a resource-intensive activity in every country especially in times of shrinking human and reagent resources. This paper will discuss the process flow for obtaining blood for patient's requiring rare types and the critical steps for each facility in the supply chain. The local facility plays a vital role in the knowledge of patient need and interaction with the patient's physician. The national facility that coordinates obtaining rare blood internationally also plays a vital role. The International Blood Group Reference Laboratory in Bristol as one of its roles, maintains the International Rare Donor Panel and also plays a vital role. These three roles hold the responsibility for collaboration to identify and obtain blood for patients in need. While there are differences in each country's definition of rare blood types, all are in agreement to assist when a country needs blood products. The International Society Blood Transfusion working party for rare donors plays a critical, collaborative role in developing processes between countries to further rare blood transfers between countries and providing expertise when needed. Outcome data are difficult to obtain, therefore success and ultimate improvement is a challenge. This challenge is one that the needs to be met to improve patient outcomes in cases where rare blood is needed throughout the world. [source] Bodily change following faecal stoma formation: qualitative interpretive synthesisJOURNAL OF ADVANCED NURSING, Issue 9 2009Gabrielle Thorpe Abstract Title.,Bodily change following faecal stoma formation: qualitative interpretive synthesis. Aim., This paper is a report of a literature review conducted to answer the question ,How has the experience of bodily change following stoma formation been explored and interpreted through existing qualitative research?'. Background., A faecal stoma alters the function, appearance and sensation of the body. Quantitative research highlights the importance of bodily change following stoma formation but is limited in being able to explore what this experience means to ostomists. Qualitative research can identify ways in which ostomists experience their changed body but a conceptual framework of their experience drawn from qualitative findings which can inform patient-centred care has not yet been identified. Method., The Amed, ASSIA, CINAHL, Embase, Medline and Psycinfo databases were searched from inception to April 2009 using predefined inclusion criteria. Of 144 papers identified, 11 were selected for review. An interpretive review methodology for qualitative research synthesis was employed. Findings., Three broad themes of bodily experience following stoma formation were identified: loss of embodied wholeness, awareness of a disrupted lived body and disrupted bodily confidence. These highlight the impact of the experience of living with a stoma on the embodied self and the ostomist's embodiment within their lifeworld. Conclusion. A loss of embodied wholeness which underpins the experience of stoma formation can be represented through awareness of the disrupted lived body and impact on the lifeworld. Findings suggest the need for further research to identify a comprehensive conceptualization of bodily change, which can more closely match healthcare service to individual patient need. [source] Bioengineered tissues: the science, the technology, and the industryORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 3 2005T Ahsan Structured Abstract Authors ,, Ahsan T, Nerem RM Objective ,, The bioengineering of tissues and organs, sometimes called tissue engineering and at other times regenerative medicine, is emerging as a science, as a technology, and as an industry. The goal is the repair, replacement, and/or the regeneration of tissues and organs. The objective of this paper is to identify and discuss the major issues that have become apparent. Results ,, One of the critical issues is that of cell source, i.e. what will be the source of the cells to be employed? Another critical issue is the development of approaches for the fabrication of substitute tissues/organs and/or vehicles for the delivery of biological active molecules for use in the repair/regeneration of tissues. A third critical issue, one very much related to cell source, is that of immune acceptance. In addition, there are technological hurdles; there are additional issues such as the scale-up of manufacturing processes and the preservation of living-cell products for off-the-shelf availability. Although the initial products have been superficially applied skin substitutes, as this fledgling industry continues to evolve, it is beginning to focus on a wider range of more invasive and complicated products. From a public health perspective, the real opportunity may be in addressing chronic diseases, as well as the transplantation crisis (i.e. the tremendous disparity between patient need for vital organs and donor availability) and, equally important is the challenge of neural repair. Conclusion ,, These are the grand challenges, and the scientific community, business/private sector, and federal government must mobilize itself together in this emerging area to translate the benchtop science to the patient bedside. [source] Connecting patient needs with treatment managementACTA PSYCHIATRICA SCANDINAVICA, Issue 2009R. Kerwin Objective:, To propose ideas for the development of a core strategy for monitoring patients with schizophrenia to ensure physical health and optimal treatment provision. Method:, A panel of European experts in the field of schizophrenia met in Bordeaux in June 2006 to discuss, ,Patient management optimisation through improved treatment monitoring.' Results:, Key consensus from the discussion deemed that weight gain, oral health and ECG parameters were core baseline parameters to be monitored in all patients with schizophrenia. Further, an identification of a patient's own barriers to treatment alongside local health service strategies might comprise elements of an individualised management strategy which would contribute to optimisation of treatment. Any monitoring strategy should be kept simple to encourage physician compliance. Conclusion:, A practical solution to the difficulties of providing holistic patient care would be to suggest a limited set of physical parameters to be monitored by physicians on a regular basis. [source] The elusive NHS consumer: 1948 to the NHS PlanECONOMIC AFFAIRS, Issue 4 2001Will Anderson Since the creation of the National Health Service in 1948, patients have never been fully-fledged consumers of healthcare; they have never held personal economic power with which to express their needs and preferences to service providers. Nonetheless, the history of the NHS has demonstrated an ever-increasing policy interest in the needs of individual patients and in the responsiveness of services to these needs. Following the collapse of the postwar consensus which gave birth to the welfare state, successive governments have pledged to give priority to consumer needs, but have struggled to realise this priority in practice.Professional and state paternalism in defining patient needs and choices have endured. current policy emphasis on ,patient and public involvement' and ,partnership working' sustains a top-down bureaucratic approach but tempers practice with input from all stakeholders in local health economies. There is much to do to make the culture of the NHS genuinely responsive to consumer needs. [source] An evidence-based specialist breast nurse role in practice: a multicentre implementation studyEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2003National breast cancer centre's specialist breast nurse project team The objective of this study was to examine the feasibility, implementation, acceptability and impact of an evidence-based specialist breast care nurse (SBN) model of care in Australia. Primary data were collected from four diverse Australian breast cancer treatment centres over a 12-month period. The design was a multicentre demonstration project. Information about the provision of care and patient needs was collected through prospective logs. Structured interviews were conducted with women who received the SBN intervention (N = 167) and with a control group of women treated prior to the intervention period (N = 133). Health professionals (N = 47) were interviewed about their experience of the SBN. Almost all women had contact with an SBN at five scheduled consultations and 67% of women in the intervention group requested at least one additional consultation with the SBN. Women in the intervention group were more likely to receive hospital fact sheets and to be told about and participate in clinical trials. Ninety-eight per cent of women reported that the availability of an SBN would affect their choice of hospital, with 48% indicating that they would recommend only a hospital with a SBN available. Health professionals reported that SBNs improved continuity of care, information and support for the women, and resulted in more appropriate referrals and use of the time of other members of the team. In conclusion, the SBN model is feasible and acceptable within diverse Australian treatment centres; there is evidence that some aspects of care were improved by the SBN. [source] Behavioral Facilitation of Medical Treatment for Headache,Part II: Theoretical Models and Behavioral Strategies for Improving AdherenceHEADACHE, Issue 9 2006Jeanetta C. Rains PhD This is the second of 2 articles addressing the problem of noncompliance in medical practice and, more specifically, compliance with headache treatment. The companion paper describes the problem of noncompliance in medical practice and reviews literature addressing compliance in headache care (Behavioral Facilitation of Medical Treatment for Headache,Part I: Review of Headache Treatment Compliance). The present paper first summarizes relevant health behavior theory to help account for the myriad biopsychosocial determinants of adherence, as well as patient's shifting responsiveness or "readiness for change" over time. Appreciation of health behavior models may assist in optimally tailoring interventions to patient needs through instructional, motivational, and behavioral treatment strategies. A wide range of specific cognitive and behavioral compliance-enhancing interventions are described, which may facilitate treatment adherence among headache patients. Strategies address patient education, patient/provider interaction, dosing regimens, psychiatric comorbidities, self-efficacy enhancement, and other behavioral interventions. [source] Zolmitriptan Intranasal: A Review of the Pharmacokinetics and Clinical EfficacyHEADACHE, Issue 1 2006Peter J. Goadsby MD Migraine is a common disabling neurological disorder, associated with headache, nausea, and on occasions vomiting. Zolmitriptan is a widely available serotonin 5HT1B/1D receptor agonist with a long track record in clinical studies and in the treatment of acute migraine. A nasal formulation has been developed that has clear evidence for local absorption, resulting in plasma drug concentrations within 2 minutes of dosing, central nervous system penetration 3 minutes later, and a significant efficacy benefit versus placebo 10 to 15 minutes after dosing. Intranasal zolmitriptan offers advantages to migraineurs, particularly those seeking a more rapid onset of effect without wishing to self-inject, or those with gastrointestinal upset. The comparison of pharmacokinetic and clinical data available from different formulations of zolmitriptan contributes both to the understanding of its mode of action and the characteristics required of an acute migraine treatment if it is to meet patient needs. [source] Patient-friendly hospital environments: exploring the patients' perspectiveHEALTH EXPECTATIONS, Issue 1 2004Calbert H. Douglas BSc MSc PhD Abstract Objective, To investigate the perceptions and attitudes of patients to the built environments of NHS Trust hospitals, in order to inform design excellence so as to make future hospitals places and spaces responsive to patient needs. Design, An exploratory study of patients perceptions based on qualitative semi-structured personal interviews. Setting and participants, Fifty one-to-one interviews held with hospital in-patients across the four directorates of surgery, medicine, care of the elderly and maternity at Salford Royal Hospitals NHS Trust, Salford, UK. Results, The research found that there was much similarity in the priorities, issues and concerns raised by patients in each of the four directorates. Patients perceived the built environment of the hospital as a supportive environment. Their accounts in each area pointed to the significance of the factors that immediately impacted on them and their families. Patients identified having a need for personal space, a homely welcoming atmosphere, a supportive environment, good physical design, access to external areas and provision of facilities for recreation and leisure. Responses suggest that patient attitudes and perceptions to the built environment of hospital facilities relates to whether the hospital provides a welcoming homely space for themselves and their visitors that promotes health and wellbeing. Conclusions, The findings have important implications for capital development teams, clinical staff, managers and NHS Estates personnel. Although the study has immediate relevance for Salford Royal Hospitals Trust, findings and recommendations reported provide NHS Estates and other relevant stakeholders with evidence-based knowledge and understanding of patients' perceptions and expectations of and preferences for particular facilities and estates provision in NHS hospitals. [source] Aftercare intervention through text messaging in the treatment of bulimia nervosa,Feasibility pilotINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 8 2006Sarah Robinson BSc Abstract Objective: Even with the best available treatment, most bulimia nervosa (BN) sufferers are not symptom free at the end of therapy and, for those who have achieved remission, risk of relapse is high. Thus, there is a need for aftercare or relapse prevention interventions after therapy. It is not yet known what type of intervention should be delivered, and how to suit patient needs while being mindful of cost and time constraints of service providers. This pilot study was conducted to explore the feasibility, acceptability, and efficacy of a text messaging (short messaging service [SMS])-based intervention in the aftercare of BN patients who had received outpatient psychotherapy. Method: A total of 21 patients with BN participated in the 6-month SMS-based intervention as a step-down treatment AFTER outpatient therapy. Results: Levels of use of the program were relatively low and attrition high, indicating limited acceptance of the intervention. Conclusion: This study suggests that the SMS-based intervention would benefit from further adaptation to make it a more useful tool for the aftercare of patients after outpatient treatment for bulimia nervosa. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:633,638 [source] Strategic decision-making in healthcare organizations: it is time to get serious,INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2006David W. Young Abstract New and continuing environmental demands and competitive forces require healthcare organizations to be increasingly careful in thinking about their strategies. They must do so in a highly unusual (multi-actor) marketplace where a variety of system interdependencies complicate decision-making. A good strategy requires an attempt to understand the real, as distinct from the perceived, environment, and is characterized by explicit tradeoffs along three dimensions: service or program variety, patient needs, and patient access. The quality of these tradeoffs can be assessed in terms of whether the strategy is (a) attuned to critical success factors in the organization's environment, (b) highly focused, (c) linked to the organization's capabilities, and (d) accompanied by an activity set that is difficult for competitors to imitate. An organization also must be capable of adapting appropriately to changes in its environment. Thus, even the best strategy must be reviewed constantly if it is to remain viable. A strategy's sustainability can be adversely affected by increased buyer or supplier power, lowered barriers to entry, growing rivalry, the threat of substitutes, and increased slack in resource usage. By thinking more creatively in the future than they have in the past, healthcare organizations can make tradeoffs and choose a focused strategic position. They then can design an activity set that is appropriate for that position, and that will assist them to achieve both financial viability and superior programmatic performance. A well-designed activity set also will assist them to sustain their performance in the face of changing environmental demands and competitive forces. Copyright © 2006 John Wiley & Sons, Ltd. [source] The importance of ,knowing the patient': community nurses' constructions of quality in providing palliative careJOURNAL OF ADVANCED NURSING, Issue 4 2000Karen A. Luker PhD BNurs RGN RHV NDNCert The importance of ,knowing the patient': community nurses' constructions of quality in providing palliative care This paper reports findings from a study conducted in one community health care trust where 62 members of the district nursing team (grades B,H) were interviewed. An adaptation of the critical incident technique was used to determine factors which contributed or detracted from high quality care for a number of key areas including palliative care. The centrality of knowing the patient and his/her family emerged as an essential antecedent to the provision of high quality palliative care. Factors enabling the formation of positive relationships were given prominence in descriptions of ideal care. Strategies used to achieve this included establishing early contact with the patient and family, ensuring continuity of care, spending time with the patient and providing more than the physical aspects of care. The characteristics described by the community nurses are similar to those advocated in ,new nursing' which identifies the uniqueness of patient needs, and where the nurse,patient relationship is objectified as the vehicle through which therapeutic nursing can be delivered. The link with ,new nursing' emerges at an interesting time for community nurses. The past decade has seen many changes in the way that community nursing services are configured. The work of the district nursing service has been redefined, making the ideals of new nursing, for example holism, less achievable than they were a decade ago. This study reiterates the view that palliative care is one aspect of district nursing work that is universally valued as it lends itself to being an exemplar of excellence in terms of the potential for realizing the ideals of nursing practice. This is of increasing importance in the context of changes that militate against this ideal. [source] A literature review of principles, policies and practice in extended nursing roles relating to UK intensive care settingsJOURNAL OF CLINICAL NURSING, Issue 20 2008Namita Srivastava Aims., To provide an overview of the literature relating to the principles, policy and practice of extended nursing roles in UK intensive care settings to date; to review and critically assess evidence of impact, outcomes and effect on practice and provide suggestions for future research. Background., It is known that career development opportunities, new technologies, patient needs, as well as the reduction in junior doctors' hours, are driving the development of new roles for nurses. Policy initiatives aim to expand nursing roles to support professional substitution. In adult, neonatal and paediatric intensive care, specialist trained nurses and designated advanced nursing practitioners are increasingly taking on extended practice of clinical tasks previously undertaken by medical staff. As yet there are no statutory regulations on the perceived scope and definition of the role of extended and advanced roles. Design., Systematic review. Methods., Search of electronic databases and selection of policy and peer-reviewed reports and reviews of extended nursing roles or advanced nursing practitioners in UK intensive care settings. Results., Chronological review shows policy development proceeding in a relatively ad hoc way. There is limited information available about how extensively or effectively extended nursing roles are being implemented in intensive care settings in the UK, particularly in adult and paediatric intensive care. To test local initiative findings for reliability and generalisability, a more robust evidence base is required. Conclusions., More data are needed on definition and outcomes of extended nursing roles in intensive care and care process measures should be developed to better inform implementation of nurse role development in the UK. Relevance to clinical practice., The review of policy and research evidence in this paper may better inform clinicians working in adult, neonatal or paediatric intensive care, as they continue to be challenged by expansion and development of their role. It may also help to form a basis and evaluation for future research into extended and advanced nursing roles in intensive care settings. [source] The anatomy of interprofessional leadership: An investigation of leadership behaviors in team-based health careJOURNAL OF LEADERSHIP STUDIES, Issue 3 2009June M. S. Anonson Increasing specialization among health care professions has heightened the need for proficient interprofessional teamwork. Within the team context for practice, leadership becomes a competency expected of all practitioners who must recognize the necessity of situational leadership dependent on patient needs and the professional competencies to meet those needs. Although this need for leadership within interprofessional practice is recognized, the behavioral components of that leadership competency have not been delineated. In this article, the authors report on a study to identify the behavioral components of interprofessional practice and highlight the indicators of leadership competency in interprofessional patient-centered care. This qualitative study involved in-depth interviews with 24 participants from nine professions engaged in collaborative team care of clients or patients in a variety of community and acute-based health care facilities. Interprofessional competencies were explored using grounded theory, with coding of participants' responses. In this article, the authors have highlighted leadership in interprofessional practice, and discussed the behavioral indicators of leadership that could be used in preparation of students, faculty, and practitioners for interprofessional practice, as well as in evaluation of that practice for purposes of professional growth. [source] Occult hepatitis B virus infection: a covert operationJOURNAL OF VIRAL HEPATITIS, Issue 1 2010F. B. Hollinger Summary., Detection of occult hepatitis B requires assays of the highest sensitivity and specificity with a lower limit of detection of less than 10 IU/mL for hepatitis B virus (HBV) DNA and <0.1 ng/mL for hepatitis B surface antigen (HBsAg). This covert condition is relatively common in patients with chronic hepatitis C virus (HCV) that seems to exert some influence on the replicative capacity and latency of HBV. Detection of virus-specific nucleic acid does not always translate into infectivity, and the occurrence of primer-generated HBV DNA that is of partial genomic length in immunocompetent individuals who have significant levels of hepatitis B surface antibody (anti-HBs) may not be biologically relevant. Acute flares of alanine aminotransferase (ALT) that occur during the early phase of therapy for HCV or ALT levels that remain elevated at the end of therapy in biochemical nonresponders should prompt an assessment for occult hepatitis B. Similarly, the plasma from patients with chronic hepatitis C that is hepatitis B core antibody (anti-HBc) positive (±anti-HBs at levels of <100 mIU/mL) should be examined for HBV DNA with the most sensitive assay available. If a liver biopsy is available, immunostaining for hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) should be contemplated and a portion of the sample tested for HBV DNA. This is another reason for optimal collection of a specimen (e.g. two passes with a 16-guage needle under ultrasound guidance). Transmission of HBV to immunosuppressed orthotopic liver transplant recipients by donors with occult hepatitis B (OHB) will continue to occupy the interests of the transplant hepatologist. As patients with OHB may have detectable HBV DNA in serum, peripheral blood mononuclear cells (PBMC) and/or liver that can be reactivated following immunosuppression or intensive cytotoxic chemotherapy, the patient needs to be either monitored or treated depending on the pretreatment serological results such as an isolated anti-HBc reaction or a detectable HBV DNA. [source] Meeting patient needs in the hospital setting, are written nutrition education resources too hard to understand?NUTRITION & DIETETICS, Issue 3 2008Louise PERKINS Abstract Aims:, To determine the readability of written nutrition education resources currently used in the Nutrition and Dietetics Department in a large teaching hospital and assess whether these resources are of an appropriate readability level for the target population. Methods:, Dietitians in the department (n = 17) were interviewed to identify resources in use. Readability analysis of current resources (n = 235) followed, using the Simplified Measure of Gobbledegook (SMOG). The SMOG scores were compared with census data for the average reading ability of the target population based on the number of school years completed. Results:, The readability level for the resources ranged from 6 to 15. The mean was 10.4 ± 1.89 (n = 235). This compared with a reading ability in the target population of between years 6 and 8. This discrepancy suggests that the resources may be too complex and are unlikely to be well understood by the target population. Conclusions:, In the time-poor clinical environment where there is reliance on written nutrition resources to support and reinforce education messages, it is pertinent to pay more attention to readability level. Written resources are unlikely to be effective if they are too complex. It is therefore suggested that dietitians consider the readability when developing and reviewing written nutrition education resources to ensure best-quality patient care. The results of this project suggest that the SMOG index is a useful method to use for this purpose as it is widely available, easy to use and expedient in implementation. [source] Psychologic Treatment for Hypertension Can Be EfficaciousPREVENTIVE CARDIOLOGY, Issue 1 2003Wolfgang Linden PhD The traditional view of psychologic treatments and their efficacy for treating primary hypertension is that they may be of some benefit for borderline hypertension and that they can be potentially useful adjuncts to medical treatment. This review challenges such cautious conclusions by critically analyzing previous reviews and by also considering innovative, newer clinical trials. One reason for cautious conclusions has been selective reviewing and a lack of well-designed trials. Measurement and study protocol differences as well as differences in treatment modality have all been shown to have major effects on observed outcomes. Studies that promise better results have the following characteristics: 1) use of 24-hour ambulatory monitoring as an end point to rule out white coat hypertension that does not need treatment in the first place; 2) inclusion of patients with truly elevated blood pressure at pretreatment; and 3) multicomponent treatments that are tailored to individual patient needs. [source] An investigation of dose titration with darifenacin, an M3 -selective receptor antagonistBJU INTERNATIONAL, Issue 4 2005William Steers OBJECTIVES To evaluate the efficacy, tolerability and safety of a flexible-dosing strategy with darifenacin, an M3 -selective receptor antagonist, in patients with symptoms of overactive bladder (OAB). PATIENTS AND METHODS In this multicentre double-blind 12-week study, 395 patients (aged 22,89 years; 84% female) with OAB symptoms for >6 months were randomized (2 : 1) and received once-daily treatment with darifenacin controlled-release tablets 7.5 mg (268 patients) or matching placebo (127). After 2 weeks of treatment, the efficacy, safety and tolerability were assessed and the dose increased to 15 mg once daily (pseudo-increase for placebo recipients) if additional efficacy was required by both the patient and physician. In the week before clinic visits (at 2 and 12 weeks), patients recorded incontinence episodes (primary efficacy endpoint) and several secondary efficacy variables in an electronic daily diary. Safety and tolerability were evaluated from withdrawal rates and adverse-event reports. RESULTS The treatment groups had comparable baseline characteristics. Similar proportions of darifenacin (59%) and placebo (68%) recipients increased the dose at 2 weeks; at 12 weeks patients on darifenacin (overall group) had a significantly greater reduction in the median number of incontinence episodes per week than had those on placebo, at ,,8.2 (,62.9%) and ,,6.0 (,48.1%), respectively (P = 0.035). There were also significant improvements in voiding frequency (P = 0.001), bladder capacity (volume voided; P=,0.036), frequency of urgency (P < 0.001), severity of urgency (P = 0.013) and number of significant leaks/week (i.e. incontinence episodes needing a change of clothing or pads, per week; P = 0.010) for darifenacin over placebo. Subset analysis suggested that some patients (those remaining on darifenacin 7.5 mg) were more sensitive to darifenacin than those who increased the dose, based on both efficacy and adverse events. Continued treatment with 7.5 mg for ,sensitive' patients, and an increased dose (to 15 mg) for remaining patients, resulted in comparable outcomes by 12 weeks. The most common treatment-related adverse events were mild-to-moderate dry mouth and constipation, which led to discontinuation in <,3.0% of darifenacin-treated patients and <1.0% of the placebo group. Central nervous system and cardiovascular adverse events were comparable to those with placebo. CONCLUSIONS Darifenacin appears to be an effective, well-tolerated and flexible treatment for patients with OAB, allowing individualized dosing according to patient needs. [source] Exploiting patient labour at Kew Cottages, Australia, 1887,1950BRITISH JOURNAL OF LEARNING DISABILITIES, Issue 2 2010Lee-Ann Monk Accessible summary ,,This article looks at the work carried out by people with learning disabilities who lived in the Kew Cottages in Australia. ,,It argues that these people were treated unfairly because they were not paid for the work they did, even though that work was valuable and important. ,,Even though they were being treated unfairly, some people at the Cottages may have chosen to work because it gave them a way to spend their time and because people who worked had more freedom and were better treated. Summary This article examines the exploitation of patient labour at Kew Cottages, Australia's first purpose-built state institution for people with learning disabilities. Analysing historical evidence for the period 1887,1950 shows that unpaid patient labour contributed significantly to the economy of the Cottages and so to the government department of which they were a part. It also argues that government failure to provide adequately for patient needs and to rectify unsafe working conditions further exploited working patients. The final section of the article examines why some patient-labourers may have chosen to work, arguing that the restrictive, materially impoverished and relatively isolated social world in which they found themselves were an important influence on their decisions to do so. [source] IS THE ANALYST A GOOD OBJECT?BRITISH JOURNAL OF PSYCHOTHERAPY, Issue 3 2006Warren Colman ABSTRACT This paper suggests that the prohibition against ,taking the role of the good object' may inhibit therapists from an appropriate recognition of loving relation between the patient and themselves. It is argued that the prohibition actually refers to a defensive attempt to get the analyst to take the role of the idealized object as a defence against the emergence of bad objects in the transference. This clinical scenario is contrasted with one where the patient needs to find in their therapist a real good object who genuinely cares for them. [source] Effectiveness and cost of bisphosphonate therapy in tumor bone diseaseCANCER, Issue S3 2003Jean-Jacques Body M.D., Ph.D. Abstract BACKGROUND Tumor-induced osteolysis due to breast carcinoma and myeloma is responsible for a considerable morbidity that severely impairs patients'quality of life. Osteoclast-mediated bone resorption is reported to be increased markedly in patients with tumor bone disease and can be inhibited by bisphosphonate therapy. METHODS The incidence of skeletal complications and the effectiveness of bisphosphonate therapy in patients with breast carcinoma metastatic to bone or in those with myeloma were derived from large-scale, long-term, placebo-controlled trials with clodronate or pamidronate. To the authors' knowledge, there are few studies published to date evaluating the cost-effectiveness of bisphosphonate therapy, and the majority that do exist often are based on models and are applicable only to a particular health care system. RESULTS From the placebo groups of the above-mentioned trials, one can estimate that approximately 25,40% of the patients with breast carcinoma metastatic to bone will require radiotherapy for bone pain and approximately 17,50% will sustain incident vertebral fractures yearly. The incidence of complications is reported to be lower in myeloma patients. The prolonged administration of bisphosphonates reportedly can reduce the frequency of skeletal-related events by approximately 25,50%. Maximal efficacy appears to have been achieved with the current therapeutic schemes based on monthly intravenous infusions. Beneficial effects appear to be obtained more readily using the intravenous route rather than the oral route. The costs of bisphosphonate therapy appear to be higher than the cost savings from the prevention of skeletal-related events. The costs per quality of life-adjusted year have been estimated to be > $100,000, but more research is needed. Limited data suggest that zoledronic acid will not reduce treatment costs but the short infusion time will lead to substantial time savings for patients and for outpatient oncology facilities. CONCLUSIONS As is the case for many agents used in oncology, bisphosphonates remain a relatively expensive therapy. More studies are needed to evaluate their cost-effectiveness ratio correctly. A ceiling effect has been reached with current therapeutic schemes and tailoring therapy to the individual patient needs to be evaluated correctly to increase therapeutic effectiveness and improve quality of life further without increasing treatment costs. Cancer 2003;97(3 Suppl):859,65. © 2003 American Cancer Society. DOI 10.1002/cncr.11139 [source] TOWARD CASE-BASED REASONING FOR DIABETES MANAGEMENT: A PRELIMINARY CLINICAL STUDY AND DECISION SUPPORT SYSTEM PROTOTYPECOMPUTATIONAL INTELLIGENCE, Issue 3 2009Cindy Marling This paper presents a case-based decision support system prototype to assist patients with Type 1 diabetes on insulin pump therapy. These patients must vigilantly maintain blood glucose levels within prescribed target ranges to prevent serious disease complications, including blindness, neuropathy, and heart failure. Case-based reasoning (CBR) was selected for this domain because (a) existing guidelines for managing diabetes are general and must be tailored to individual patient needs; (b) physical and lifestyle factors combine to influence blood glucose levels; and (c) CBR has been successfully applied to the management of other long-term medical conditions. An institutional review board (IRB) approved preliminary clinical study, involving 20 patients, was conducted to assess the feasibility of providing case-based decision support for these patients. Fifty cases were compiled in a case library, situation assessment routines were encoded to detect common problems in blood glucose control, and retrieval metrics were developed to find the most relevant past cases for solving current problems. Preliminary results encourage continued research and work toward development of a practical tool for patients. [source] The Relationship of Post-acute Home Care Use to Medicaid Utilization and ExpendituresHEALTH SERVICES RESEARCH, Issue 3 2002Susan M. C. Payne Research Objectives: To describe the use of post-acute home care (PAHC) and total Medicaid expenditures among hospitalized nonelderly adult Medicaid eligibles and to test whether health services utilization rates or total Medicaid expenditures were lower among Medicaid eligibles who used PAHC compared to those who did not. Study Population: 5,299 Medicaid patients aged 18,64 discharged in 1992,1996 from 29 hospitals in the Cleveland Health Quality Choice (CHQC) project. Data Sources: Linked Ohio Medicaid claims and CHQC medical record abstract data. Data Extraction: One stay per patient was randomly selected. Design: Observational study. To control for treatment selection bias, we developed a model predicting the probability (propensity) a patient would be referred to PAHC, as a proxy for the patient's need for PAHC. We matched 430 patients who used Medicaid-covered PAHC ("USE") to patients who did not ("NO USE") by their propensity scores. Study outcomes were inpatient re-admission rates and days of stay (DOS), nursing home admission rates and DOS, and mean total Medicaid expenditures 90 and 180 days after discharge. Principal Findings: Of 3,788 medical patients, 12.1 percent were referred to PAHC; 64 percent of those referred used PAHC. Of 1,511 surgical patients, 10.9 percent were referred; 99 percent of those referred used PAHC. In 430 pairs of patients matched by propensity score, mean total Medicaid expenditures within 90 days after discharge were $7,649 in the USE group and $5,761 in the NO USE group. Total Medicaid expenditures were significantly higher in the USE group compared to the NO USE group for medical patients after 180 days (p<.05) and surgical patients after 90 and 180 days (p<.001). There were no significant differences for any other outcome. Sensitivity analysis indicates the results may be influenced by unmeasured variables, most likely functional status and/or care-giver support. Conclusions: Thirty-six percent of the medical patients referred to PAHC did not receive Medicaid-covered services. This suggests potential underuse among medical patients. The high post-discharge expenditures suggest opportunities for reducing costs through coordinating utilization or diverting it to lower-cost settings. Controlling for patients' need for services, PAHC utilization was not associated with lower utilization rates or lower total Medicaid expenditures. Medicaid programs are advised to proceed cautiously before expanding PAHC utilization and to monitor its use carefully. Further study, incorporating non-economic outcomes and additional factors influencing PAHC use, is warranted. [source] THE WEBSITE,GIRL': CONTEMPORARY THEORIES ABOUT MALE,FEMININITY'BRITISH JOURNAL OF PSYCHOTHERAPY, Issue 1 2005Marie Maguire ABSTRACT I explore a bisexual male patient's need to differentiate highly problematic,feminine'identifications - originating in childhood sexual abuse and impingement by men as well as women - from identifications with more admired aspects of his mother. My main focus is on the patient's sexual identity - the personal meaning he gave to being male - rather than on his bisexuality - his desire for both sexes. In psychoanalytic literature powerful opposite-sex identifications are usually associated either with psychotic confusion or celebrated as a source of psychic strength. The co-existence of problematic and highly valued cross-sex identifications is rarely discussed. I also look at how this patient re-negotiated his identity through the transference relationship with a female psychotherapist, given that his,masculinity'derived mainly from childhood experiences of 'stealing'his mother's phallic power. Through a wideranging theoretical review I conclude that we need to draw together opposing psychoanalytic perspectives about maternal and paternal power, opening up new ways of thinking about triangular relationships in the transference. [source] New Insights into the Clinical Management of Partial EpilepsiesEPILEPSIA, Issue S5 2000Prof. Edouard Hirsch Summary The diagnosis, treatment, and prognosis of seizure disorders depend on the correct identification of epileptic syndromes. Partial epilepsies are heterogeneous and can be divided into idiopathic, cryptogenic, and symptomatic epilepsies. The most common of the idiopathic localization-related epilepsies is benign epilepsy with rolandic or centrotemporal spikes (BECTS). Seizures remain rare and the use of antiepileptic drug (AED) treatment in all patients does not appear justified. Children who present with some of the electroclinical characteristics of BECTS may also display severe unusual neurologic, neuropsychological, or atypical symptoms. In some cases, carbamazepine has been implicated as a triggering factor. Primary reading epilepsy and idiopathic occipital lobe epilepsies with photosensitivity are examples of an overlap between idiopathic localization-related and generalized epilepsies and respond well to sodium valproate. Autosomal dominant nocturnal frontal lobe epilepsy and benign familial infantile convulsions are recently described syndromes, differing in several ways from classical idiopathic localization-related epileptic syndromes. In cryptogenic or symptomatic epilepsy, the topography of the epileptogenic zone might influence drug efficacy. An individualized approach to AED selection, tailored to each patient's needs, should be used. Resistance of seizures to antiepileptic therapy may be due to diagnostic and/or treatment error or may be the result of noncompliance. Increasing the dosage, discontinuation or replacement of a drug, or addition of a second drug is indicated in truly resistant cases. The use of more than two AEDs rarely optimizes seizure control, and in some cases reduction of treatment may improve seizure control while lessening side effects. EEG-video assessment of patients with refractory epilepsy is important. Indications for and timing of epilepsy surgery should be reconsidered. Surgical therapy should probably be used more often and earlier than it is at present. [source] A French, abridged version of the Hospitals and Hostels Practices Profile ScheduleINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2001Marc Corbière Abstract This study aims to validate the Hospitals and Hostels Practices Profile Schedule (HHPPS) in the French version according to the statistical requirements of factor analysis and internal consistency, and to arrive at as parsimonious a version of the questionnaire as possible. As no validation of the original English instrument exists to our knowledge, the most parsimonious factor structure suggested by hypothetical constructs was used. Analyses of variance of six categories of residential settings served to underscore their points of convergence and divergence in terms of degree of autonomy allowed to patients. The following seven scales emerged from the analyses: ,activities: house rules', ,activities: morning wake-up', ,health and hygiene', ,activities: curfew', ,personal effects', ,activities: night-time surveillance' and ,meals'. These accounted for 65% of the cumulative explained variance. Of the residential settings considered, supervised apartments allowed patients the most autonomy, compared with psychiatric hospital wards, hostels, nursing homes, foster families and group homes. Aside from its primary role of measuring the degree of autonomy that residential settings allow patients, this questionnaire seems suitable for gauging the adequacy of fit between a patient's needs and available residential facilities. This should help to direct persons with severe and persistent mental disorders towards facilities better tailored to their needs. Copyright © 2001 Whurr Publishers Ltd. [source] Home care with regard to definition, care recipients, content and outcome: systematic literature reviewJOURNAL OF CLINICAL NURSING, Issue 6 2003Bibbi Thomé MSc Summary ,,In spite of the fact that home care has grown considerably during the last few years and will continue to grow even more in the future, home care as a phenomenon and a concept is not clearly defined. ,,The aim of this study was to review the empirical literature for the description of home care as a phenomenon and as a concept, especially with regard to who the care recipients are, what actions and assessments are performed and what effects are achieved for the care recipient in terms of functional health status and quality of life (QoL). ,,Twenty-six relevant studies meeting the inclusion criteria and requirements for methodological quality were identified. ,,The phenomenon of home care is described through content, outcome and objectives. The content of home care involved a range of activities from actions preventing decreased functional abilities in old people to palliative care in advanced diseases. ,,The outcome had two different underlying foci: (1) for the benefit of the patient based on the assumption that being cared at home increases their QoL, (2) in the interests of the society, to minimize hospital care by moving activities to the home of the patient. ,,The objectives were found to be aiming at improving the QoL and/or maintaining independence, by means of actions and assessments, based on the patient's needs, undertaken to preserve and increase functional ability and make it possible for the person to remain at home. ,,In conclusion, home care as a phenomenon was the care provided by professionals to people in their own homes with the ultimate goal of not only contributing to their life quality and functional health status, but also to replace hospital care with care in the home for societal reasons; home care covered a wide range of activities, from preventive visits to end-of-life care. [source] Doctor,Patient Gender Concordance and Patient Satisfaction in Interpreter-Mediated Consultations: An Exploratory StudyJOURNAL OF TRAVEL MEDICINE, Issue 1 2008Alexander Bischoff PhD Background Research suggests that doctor,patient communication patterns and patient satisfaction are influenced by gender. However, little is known about the effect of gender in consultations with foreign language,speaking patients and in interpreter-mediated consultations. Methods The objective of the study was to explore the effect of doctor,patient gender concordance on satisfaction of foreign language,speaking patients in consultations with and without a professional interpreter. Its design consists of a cross-sectional analysis of patients' reports. A total of 363 consultations with foreign language,speaking patients were included in the analysis. We measured the mean scores of six items on the quality of communication (answer scale 0,10): the doctor's response to the patient's needs, the doctors' explanations, the doctor's respectfulness toward the patient, the quality of communication in general, the overall consultation process, and information provided regarding follow-up. Results When interpreters were used, mean scores were similar for doctor,patient concordant and discordant pairs. However, in the absence of interpreters, doctor,patient gender discordance was associated with lower overall ratings of the quality of communication (,0.46, p= 0.01). Conclusions Our results suggest that the presence of a professional interpreter may reduce gender-related communication barriers during medical encounters with foreign language,speaking patients. [source] | |||||||||||||||||||||||||||||||||||||