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Patient Support (patient + support)
Selected AbstractsThermodynamic Considerations in Solid Adsorption of Bound Solutes for Patient Support in Liver FailureARTIFICIAL ORGANS, Issue 7 2008John F. Patzer II Abstract:, New detoxification modes of treatment for liver failure that use solid adsorbents to remove toxins bound to albumin in the patient bloodstream are entering clinical evaluations, frequently in head-to-head competition. While generally effective in reducing toxin concentration beyond that obtainable by conventional dialysis procedures, the solid adsorbent processes are largely the result of heuristic development. Understanding the principles and limitations inherent in competitive toxin binding, albumin versus solid adsorbent, will enhance the design process and, possibly, improve detoxification performance. An equilibrium thermodynamic analysis is presented for both the molecular adsorbent recirculating system (MARS) and fractionated plasma separation, adsorption, and dialysis system (Prometheus), two advanced systems with distinctly different operating modes but with similar equilibrium limitations. The Prometheus analysis also applies to two newer approaches: sorbent suspension reactor and microsphere-based detoxification system. Primary results from the thermodynamic analysis are that: (i) the solute,albumin binding constant is of minor importance to equilibrium once it exceeds about 105 L/mol; (ii) the Prometheus approach requires larger solid adsorbent columns than calculated by adsorbent solute capacity alone; and (iii) the albumin-containing recycle stream in the MARS approach is a major reservoir of removed toxin. A survey of published results indicates that MARS is operating under mass transfer control dictated by solute,albumin equilibrium in the recycle stream, and Prometheus is approaching equilibrium limits under current clinical protocols. [source] Improving glycaemic control in children and adolescents: which aspects of therapy really matter?DIABETIC MEDICINE, Issue 4 2010T. C. Skinner Diabet. Med. 27, 369,375 (2010) Abstract In paediatric diabetes, the concept of intensive therapy in the post-Diabetes Control and Complications Trial period has become subverted by a pharmaco-technological paradigm at the expense of other aspects of care such as goal-setting and psychosocial support. This review examines which patients benefit most from intensive therapy in terms of glycaemic control (HbA1c). It also reviews published controlled trial and observational data relating to the impact of various insulin types and delivery systems on glycaemic control and canvasses the literature dealing with the impact of patient support, philosophy of care, goal setting and treating team dynamic on HbA1c. Taking into account the characteristics of those patients who benefit most from intensive therapy, the quantum of HbA1c change and the persistence of changes that have been reported in selected and non-selected patient groups, it appears that there is a clear hierarchy in aspects of therapy that improve glycaemic control for children and adolescents with Type 1 diabetes. Prime issues appear to be patient support, team cohesion and goal setting. The reported glycaemic benefits achieved by an isolated emphasis upon a pharmaco-technological paradigm are limited in children and adolescents. It appears that only after the prime issues have been first considered will the potential benefits of the insulin types and regimens then be realized. [source] Information Therapy: the strategic role of prescribed information in disease self-managementINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2005Molly METTLER Abstract Information Therapy is a new disease management tool that provides cost-effective patient support to a much larger portion of the chronically ill population than is generally reached. Defined as the prescription of specific, evidence-based medical information to a specific patient, caregiver, or consumer at just the right time to help them make a specific health decision or take a self-management action, Information Therapy can be electronically integrated into the process of care. Information prescriptions made available through Information Therapy will support efforts to improve health outcomes and quality in disease management. [source] Anxiety as a factor influencing satisfaction with emergency department care: perspectives of accompanying personsJOURNAL OF CLINICAL NURSING, Issue 24 2009Anna Ekwall Aim., To measure levels of anxiety among people accompanying consumers to the emergency department and to explore how anxiety influences satisfaction with care. Background., When people seek treatment in an emergency department they are often accompanied by a next-of-kin, family member or friend. While the accompanying person plays a vital role in providing psycho-social support to consumers, little is known about how they perceive the quality of care. Learning more about how accompanying persons perceive care may inform the development of strategies to enhance communication processes between staff, consumers and accompanying persons. Design., A prospective cross-sectional survey design. Methods., Data were collected from a consecutive sample of accompanying persons at one Australian metropolitan teaching hospital. Of all eligible individuals approached, 128/153 (83·7%) returned completed questionnaires. The questionnaire comprised a series of open- and close-ended questions about perceptions of medical need, urgency and satisfaction with the overall visit. Anxiety was assessed using the Visual Analogue Scale for Anxiety (VAS-A). Results., There was a significant association between the accompanying person's levels of anxiety and satisfaction at point of discharge. In the satisfied group, mean VAS-A scores were 17·4 (SD 17·5) compared to 42·9 (SD 26·6) in the not satisfied group (p = 0·011). Moreover, those participants who were not satisfied with the visit did not show a significant reduction in VAS-A scores from triage to point of discharge. Conclusion., The lower the level of anxiety reported by accompanying persons when leaving the emergency department, the more satisfied they are likely to be with their emergency department visit. Ultimately, well informed and confident accompanying persons are beneficial for ensuring quality patient support. Relevance to clinical practice., Asking accompanying persons about their anxiety level before discharge gives them the opportunity to pose clarifying questions and is, therefore, an effective way of improving their satisfaction with the emergency department visit. [source] Asymmetric quadrature split birdcage coil for hyperpolarized 3He lung MRI at 1.5TMAGNETIC RESONANCE IN MEDICINE, Issue 2 2008Nicola De Zanche Abstract An asymmetric quadrature birdcage body coil for hyperpolarized (HP) 3He lung imaging at 1.5T is presented. The coil is designed to rest on top of the patient support and be used as a temporary insert in a clinical system. A two-part construction facilitates patient access and the asymmetric design makes maximal use of available bore space to ensure comfort. Highly homogeneous, circularly polarized RF magnetic fields are produced at 48.5 MHz using a conformal mapping method for the geometrical design, combined with an algebraic method to calculate the individual capacitance values on the birdcage coil's ladder network. Efficiency and isolation from the system's proton body coil are ensured by an integrated RF screen. The design methodology is readily applicable to other field strengths or nuclei. Improvements over existing 3He coils were found in terms of sensitivity and transmit field homogeneity, an important feature in HP MRI. Magn Reson Med 60:431,438, 2008. © 2008 Wiley-Liss, Inc. [source] Developing and setting up a patient and relatives intensive care support groupNURSING IN CRITICAL CARE, Issue 1 2009Maureen Peskett Abstract Aim:, The purpose of this article was to highlight the need to provide support for patients and relatives following critical illness and discharge from hospital and how this can be improved through the establishment of user support groups. Background:, Critical illness predisposes patients to extended physical and psychological ill health with the potential for a reduced quality of life. The authors' personal experience, patient feedback and current literature suggested that there was a need for further support during their recovery. Methods:, Building on an existing formal follow-up service, Intensive Care Unit (ICU) Support Team for Ex-Patients established a patient-centred forum, where patients and relatives could share experiences with others who had also been through critical illness by holding drop-in sessions. Feedback from those attending these flexible and informal sessions indicates that support was needed and that patients and families have found benefit in sharing experiences with others who can empathise, having been through critical illness themselves. Conclusions:, Our experience has shown there is a need that can be met simply with minimal investment of time and funding but that addresses a gap in patient support that otherwise goes unmet. Although this was a service development in one local area, it could be adapted to ICU patients and relatives more widely. [source] Clinical scale ex vivo manufacture of neutrophils from hematopoietic progenitor cellsBIOTECHNOLOGY & BIOENGINEERING, Issue 4 2009Nicholas E. Timmins Abstract Dose-intensive chemotherapy results in an obligatory period of severe neutropenia during which patients are at high risk of infection. While patient support with donor neutrophils is possible, this option is restricted due to donor availability and logistic complications. To overcome these problems, we explored the possibility of large scale ex vivo manufacture of neutrophils from hematopoietic progenitor cells (HPC). CD34+ HPC isolated from umbilical cord blood (UCB) and mobilized peripheral blood (mPB) were expanded in serum-free medium supplemented with stem cell factor, granulocyte colony stimulating factor, and a thrombopoietin peptide mimetic. After 15 days of cultivation a 5,800-fold expansion in cell number was achieved for UCB, and up to 4,000-fold for mPB, comprising 40% and 60% mature neutrophils respectively. Ex vivo expanded neutrophils exhibited respiratory burst activity similar to that for donor neutrophils, and were capable of killing Candida albicans in vitro. These yields correspond to a more than 10-fold improvement over current methods, and are sufficient for the production of multiple neutrophil transfusion doses per HPC donation. To enable clinical scale manufacture, we adapted our protocol for use in a wave-type bioreactor at a volume of 10,L. This is the first demonstration of a large scale bioprocess suitable for routine manufacture of a mature blood cell product from HPC, and could enable prophylactic neutrophil support for chemotherapy patients. Biotechnol. Bioeng. 2009; 104: 832,840 © 2009 Wiley Periodicals, Inc. [source] Magnitude and polarization of P53-specific T-helper immunity in connection to leukocyte infiltration of colorectal tumorsINTERNATIONAL JOURNAL OF CANCER, Issue 3 2003Sjoerd H. van der Burg Abstract The tumor antigen p53 is mutated frequently and overexpressed in colorectal cancer. As a result, patients with this type of cancer commonly display p53-specific T-helper (Th) immunity. Examination of the cytokines produced by these Th-cells showed that a majority of the proliferative p53-specific T cell cultures produced none of the key cytokines (IFN,, TNF,, IL-4, IL-5 or IL-10), indicating that these p53-specific Th-responses are not polarized. In patients who exhibited p53-specific reactivity against multiple p53-epitopes, non-polarized responses could be found side by side with polarized Th-responses that produced INF, or other cytokines such as IL-10. Patients who exhibited p53-specific IFN,-producing Th cell-immunity before surgical excision of the tumor displayed higher numbers of tumor infiltrating intraepithelial leukocytes (p = 0.04) than patients lacking such responses, suggesting that the systemic presence of p53-specific Th-cells positively affects local tumor-immunity. Our data concerning the polarization-state of p53-specific Th immunity in colorectal cancer patients support the use of vaccine formulations that induce strong Th1-polarized p53-specific immunity to ensure proper (re-)programming of the anti-tumor response. © 2003 Wiley-Liss, Inc. [source] The central role of Fas-ligand cell signaling in inflammatory lung diseasesJOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 3 2004G. A. DosReis Abstract Following inflammation and injury in the lung, loss of epithelial cell precursors could determine the balance between tissue regeneration and fibrosis. This review discusses evidence that proapoptotic Fas-Fas ligand (FasL) signaling plays a central role in pulmonary inflammation, injury and fibrosis. FasL signaling induces inflammatory apoptosis in epithelial cells and alveolar macrophages, with concomitant IL-1, and chemokine release, leading to neutrophil infiltration. FasL signaling plays a critical role in models of acute lung injury, idiopathic pulmonary fibrosis and silicosis; blockade of Fas-FasL interactions either prevents or attenuates pulmonary inflammation and fibrosis. Serologic and immunohistochemical studies in patients support a major pathogenic role of Fas and FasL molecules in inflammatory lung diseases. Identification of the pathogenic role of FasL could facilitate the discovery of more effective treatments for currently untreatable inflammatory lung diseases. [source] Prostate cancer patients' support and psychological care needs: Survey from a non-surgical oncology clinicPSYCHO-ONCOLOGY, Issue 8 2003Kathleen Lintz While there are numerous uncertainties surrounding prostate cancer's detection and treatment, more research focusing on the psychological needs of prostate patients is required. This study investigated the support and psychological care needs of men with prostate cancer. Patients were approached during urological oncology clinics and asked to complete the: Support Care Needs Survey (SCNS), Support Care Preferences Questionnaire, EORTC QLQ-C30 (Version 3) Measure plus Prostate Module, and the Hospital Anxiety and Depression Scale (HADS). Of the 249 patients meeting study entry criteria, there was an 89% response rate resulting in a cohort of 210 patients. The data showed that significant unmet need exists across a number of domains in the areas of psychological and health system/information. The more commonly reported needs were ,fears about cancer spreading (44%),' ,concerns about the worries of those close to you (43%),' and ,changes in sexual feelings (41%).' Half of all patients reported some need in the domain of sexuality, especially men younger than 65 years. Needs were being well met in the domain of patient care and support. A significant number of patients reported having used or desiring support services, such as information about their illness, brochures about services and benefits for patients with cancer (55%), a series of talks by staff members about aspects of prostate cancer (44%), and one-on-one counselling (48%). Quality of life (QoL) was most negatively impacted in those who: were ,65 years old, had been diagnosed within one year, or had metastatic disease. Men ,65 had decreased social functioning, greater pain, increased sleep disturbance, and were more likely to be uncomfortable about being sexually intimate. Patients recently diagnosed had increased fatigue, more frequent urination, greater disturbance of sleep, and were more likely to have hot flushes. Those with advanced disease scored lower on 12 out of 15 QoL categories. PSA level had no effect on QoL or anxiety/depression scores. Men with advanced disease had greater levels of depression and those ,65 years old were more likely to be anxious. Although most men with prostate cancer seem to function quite well, a substantial minority report areas of unmet need that may be targets for improving care. Copyright © 2003 John Wiley & Sons, Ltd. [source] | ||||||||||