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Specific Patients (specific + patient)
Terms modified by Specific Patients Selected AbstractsInformation 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] Is nurse,patient agreement of importance to cancer nurses' satisfaction with care?JOURNAL OF ADVANCED NURSING, Issue 3 2010Gunilla Mårtensson mårtensson g., carlsson m. & lampic c. (2010) Is nurse,patient agreement of importance to cancer nurses' satisfaction with care? Journal of Advanced Nursing66(3), 573,582. Abstract Aim., This paper is a report of a study of situational (nurse,patient agreement), personal and occupational factors of potential importance to oncology nurses' satisfaction with care provided and general work satisfaction. Background., Nurses have a general tendency to attribute to patients with cancer more problems and suffering than patients themselves report. However, little is known about whether dis/agreement between oncology nurses and patients with cancer concerning perceptions of patients' situation is of importance to nurses' satisfaction with their work. Methods., The study had a comparative and prospective design. Data were collected in 2005 using self-administrated questionnaires with 81 consecutively recruited nurse,patient pairs. Data were analysed with non-parametric tests (for comparison between subgroups) and with multiple regression analyses (for identifying predictors). Results., Initial nurse,patient agreement concerning patients' emotional distress, coping resources and quality of life did not appear to be important to nurses' subsequent satisfaction with the care directed at a specific patient. However, higher satisfaction with care provided as well as general work satisfaction was reported by nurses with more experience of cancer care and with a lower workload. Conclusion., To improve oncology nurses' opportunities to provide high quality cancer care, novice nurses and advanced beginners in particular should receive support and nurses' working conditions must be improved. Further research is needed to examine whether there are other aspects of the nurse,patient relationship that contribute to oncology nurses' satisfaction with the care provided to specific patients. [source] The challenge of using the low back pain guidelines: a qualitative researchJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2007Rachel Dahan MD MClSc Abstract Purpose, Current low back pain (LBP) clinical guidelines have helped to summarize the scientific evidence and research, but have failed to provide tools and guide family physicians (FPs). The purpose of this study is to identify barriers and facilitators for the implementation of LBP guidelines from family FPs' perspective. Methods, A qualitative focus group study of FPs in the north of Israel. Purposeful sampling was used to recruit participants, all of them board-certified FPs. Four focus groups were created, and discussions were taped, transcribed and analysed for major themes. Results, Focus groups findings have expanded the understanding of the intellectual and mental challenges faced by Israeli FPs caring for LBP patients and highlighted the many obstacles to implementing LBP guidelines. Physicians' decision-making, pertaining to LBP, functions on three levels simultaneously: the physicians' agenda based on familiarity with the guidelines; their need to remain grounded in the context of the specific patient,doctor relationship; and the constraints and demands of the physician's workplace, medical system and environment. Conclusions, Despite an overall positive attitude towards LBP guideline implementation, FPs found it hard to come to terms with the conflicting dimensions of LBP patient care. The patient,doctor interaction determined the outcome of the encounter, whether it complied with the guidelines and whether the encounter leads to a healing process or to a vicious circle of unnecessary utilization of services. [source] Comparative velocity investigations in cerebral arteries and aneurysms: 3D phase-contrast MR angiography, laser Doppler velocimetry and computational fluid dynamicsNMR IN BIOMEDICINE, Issue 8 2009Dorothea I. Hollnagel Abstract In western populations, cerebral aneurysms develop in approximately 4% of humans and they involve the risk of rupture. Blood flow patterns are of interest for understanding the pathogenesis of the lesions and may eventually contribute to deciding on the most efficient treatment procedure for a specific patient. Velocity mapping with phase-contrast magnetic resonance angiography (PC-MRA) is a non-invasive method for performing in vivo measurements on blood velocity. Several hemodynamic properties can either be derived directly from these measurements or a flow field with all its parameters can be simulated on the basis of the measurements. For both approaches, the accuracy of the PC-MRA data and subsequent modeling must be validated. Therefore, a realistic transient flow field in a well-defined patient-specific silicone phantom was investigated. Velocity investigations with PC-MRA in a 3,Tesla MR scanner, laser Doppler velocimetry (LDV) and computational fluid dynamics (CFD) were performed in the same model under equal flow conditions and compared to each other. The results showed that PC-MRA was qualitatively similar to LDV and CFD, but showed notable quantitative differences, while LDV and CFD agreed well. The accuracy of velocity quantification by PC-MRA was best in straight artery regions with the measurement plane being perpendicular to the primary flow direction. The accuracy decreased in regions with disturbed flow and in cases where the measurement plane was not perpendicular to the primary flow. Due to these findings, it is appropriate to use PC-MRA as the inlet and outlet conditions for numerical simulations to calculate velocities and shear stresses in disturbed regions like aneurysms, rather than derive these values directly from the full PC-MRA measured velocity field. Copyright © 2009 John Wiley & Sons, Ltd. [source] Teratogenicity of antiepileptic drugs: role of drug metabolism and pharmacogenomicsACTA NEUROLOGICA SCANDINAVICA, Issue 1 2007R. Sankar The approach to clinical decision-making pertaining to the use of antiepileptic drugs (AEDs) during pregnancy has relied on previous accumulated experience and, since the 1990s, on data from pregnancy registries. The limitations of this process are that no information regarding the chemical attributes of the AED under consideration, nor the role of a number of enzyme systems that are known to interact with foreign compounds to modify their potential for harm, are included. The role of the hepatic mixed function oxidase system may be especially important in conferring teratogenic risk. However, systems such as epoxide hydrolase, glutathione reductase, superoxide dismutase and other toxin-scavenging systems may be important modifiers that lower the risk. Knowledge is also accumulating on the interactions of AEDs with molecular targets such as histone deacetylase and peroxisome proliferator-activated receptors that may play important roles in teratogenesis. While our knowledge of these factors are incomplete, progress can be achieved by beginning to include these concepts in our discussion on the topic and by promoting research that may improve our ability to individualize the analysis of risk for a specific patient with regards to specific AEDs. [source] Clinical Use of Sirolimus-Eluting StentsCARDIOVASCULAR THERAPEUTICS, Issue 4 2007Ajay J. Kirtane ABSTRACT Drug-eluting stents, or intracoronary stents that combine the local delivery of antirestenotic pharmacologic therapies while maintaining the mechanical advantage of bare metal stents over balloon angioplasty alone, are a highly complex technology that have profoundly affected the practice of percutaneous coronary intervention over the last 5 years. These devices were designed specifically to treat the neointimal hyperplasia occurring after conventional bare metal stent placement, and have been remarkably successful in this regard. However, recent concerns have been raised regarding the long-term safety of these devices, particularly when used outside of the specific patient and lesion subsets studied in the pivotal randomized trials that led to device approval by regulatory bodies within the United States and abroad. This review aims to present a brief description of the sirolimus-eluting stent device platform and its mechanism of action, followed by an overview of current data regarding efficacy and safety regarding the clinical use of sirolimus-eluting stent technology. [source] Myocardial Revascularization: PCI/Stent or Coronary Artery Bypass Graft,What Is Best for Our Patients?CLINICAL CARDIOLOGY, Issue 11 2009C. Richard Conti MD, MACC Editor-in-Chief In my opinion, decisions regarding which type of revascularization is to be performed on a specific patient depends on vessel anatomic pathology, (ie, coronary lesion complexity). Thus, for proper decision-making regarding the selection of the revascularization procedure, the details of the coronary angiogram, not just the number of vessels involved, must be discussed by the interventional cardiologist as well as the cardiovascular surgeon. Copyright © 2009 Wiley Periodicals, Inc. [source] Consensus guidelines for ,rainy day' autologous stem cell harvests in New South WalesINTERNAL MEDICINE JOURNAL, Issue 4 2008J. Trotman Abstract Autologous stem cell transplantation (ASCT) has a well-established role in the treatment of haematological malignancies. Stem cells are commonly collected following salvage chemotherapy although there may be advantages in collecting earlier in the disease course. A 'rainy day' harvest (RDH) refers to the collection of autologous haemopoietic stem cells for long-term storage. Although there are few data to support RDH, there is increasing evidence that such harvests are being carried out, creating storage pressures in stem cell laboratories across New South Wales. The Bone Marrow Transplant Network New South Wales conducted a three-staged exercise to develop consensus-based RDH guidelines. Using available evidence, guidelines were developed supporting RDH for specific patients with acute and chronic myeloid leukaemias, follicular and other lymphomas, and multiple myeloma. Physician agreement with these disease-specific guidelines ranged between 58 and 100%. These consensus guidelines will improve equity of access to appropriate RDH and assist the planning of future storage requirements in New South Wales. [source] On the segmentation of vascular geometries from medical imagesINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING, Issue 1 2010A. G. Radaelli Abstract A comprehensive analysis of vascular morphology and the application of generic models of vascular biomechanics to specific patients require the ability of extracting a geometrical representation of the vascular anatomy from medical images. Owing to the wide range of clinical manifestations of vascular disease and associated imaging modalities and protocols, several segmentation methods have been proposed over the last 20 years and are available in the literature. In this paper, we review the methods of segmentation of angiographic medical images and identify major advantages and disadvantages of state-of-the-art techniques. We further discuss the performance of some of the most popular intensity-based and gradient-based methods using a set of images of peripheral by-pass grafts acquired with magnetic resonance angiography (MRA). We then propose a threshold front method for the segmentation of MRA images and assess its performance using two anatomic scale replica models, reproducing a normal and a stenotic peripheral artery. The threshold front algorithm is a simple, fast and parameter-free (still adaptive) method achieving segmentation errors below pixel resolution. Copyright © 2009 John Wiley & Sons, Ltd. [source] Is nurse,patient agreement of importance to cancer nurses' satisfaction with care?JOURNAL OF ADVANCED NURSING, Issue 3 2010Gunilla Mårtensson mårtensson g., carlsson m. & lampic c. (2010) Is nurse,patient agreement of importance to cancer nurses' satisfaction with care? Journal of Advanced Nursing66(3), 573,582. Abstract Aim., This paper is a report of a study of situational (nurse,patient agreement), personal and occupational factors of potential importance to oncology nurses' satisfaction with care provided and general work satisfaction. Background., Nurses have a general tendency to attribute to patients with cancer more problems and suffering than patients themselves report. However, little is known about whether dis/agreement between oncology nurses and patients with cancer concerning perceptions of patients' situation is of importance to nurses' satisfaction with their work. Methods., The study had a comparative and prospective design. Data were collected in 2005 using self-administrated questionnaires with 81 consecutively recruited nurse,patient pairs. Data were analysed with non-parametric tests (for comparison between subgroups) and with multiple regression analyses (for identifying predictors). Results., Initial nurse,patient agreement concerning patients' emotional distress, coping resources and quality of life did not appear to be important to nurses' subsequent satisfaction with the care directed at a specific patient. However, higher satisfaction with care provided as well as general work satisfaction was reported by nurses with more experience of cancer care and with a lower workload. Conclusion., To improve oncology nurses' opportunities to provide high quality cancer care, novice nurses and advanced beginners in particular should receive support and nurses' working conditions must be improved. Further research is needed to examine whether there are other aspects of the nurse,patient relationship that contribute to oncology nurses' satisfaction with the care provided to specific patients. [source] Barriers to physician adherence to nonsteroidal anti-inflammatory drug guidelines: a qualitative studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2008J. M. CAVAZOS Summary Background, Despite wide availability of physician guidelines for safer use of nonsteroidal anti-inflammatory drugs (NSAIDs) and widespread use of these drugs in the US, NSAID prescribing guidelines have been only modestly effective. Aim, To identify and describe comprehensively barriers to provider adherence to NSAID prescribing guidelines. Methods, We conducted interviews with 25 physicians, seeking to identify the major influences explaining physician non-adherence to guidelines. Interviews were standardized and structured probes were used for clarification and detail. All interviews were audio-taped and transcribed. Three independent investigators analysed the transcripts, using the constant-comparative method of qualitative analysis. Results, Our analysis identified six dominant physician barriers explaining non-adherence to established NSAID prescribing guidelines. These included (i) lack of familiarity with guidelines, (ii) perceived limited validity of guidelines, (iii) limited applicability of guidelines among specific patients, (iv) clinical inertia, (v) influences of prior anecdotal experiences and (vi) medical heuristics. Conclusions, A heterogeneous set of influences are barriers to physician adherence to NSAID prescribing guidelines. Suggested measures for improving guideline-concordant prescribing should focus on measures to improve physician education and confidence in guidelines, implementation of physician/pharmacist co-management strategies and expansion of guideline scope. [source] State of the art and new horizons in the diagnosis and management of egg allergyALLERGY, Issue 3 2010A. H. Benhamou To cite this article: Benhamou AH, Caubet J-C, Eigenmann PA, Nowak-We,grzyn A, Marcos CP, Reche M, Urisu A. State of the art and new horizons in the diagnosis and management of egg allergy. Allergy 2010; 65: 283,289. Abstract Egg allergy is one of the most frequent food allergies in children below the age of three. Common symptoms of egg allergy involve frequently the skin as well as the gut and in more severe cases result in anaphylaxis. Non-IgE-mediated symptoms such as in eosinophilic diseases of the gut or egg-induced enterocolitis might also be observed. Sensitization to egg white proteins can be found in young children in absence of clinical symptoms. The diagnosis of egg allergy is based on the history, IgE tests as well as standardized food challenges. Ovomucoid is the major allergen of egg, and recent advances in technology have improved the diagnosis and follow-up of patients with egg allergy by using single allergens or allergens with modified allergenic properties. Today, the management of egg allergy is strict avoidance. However, oral tolerance induction protocols, in particular with egg proteins with reduced allergenic properties, are promising tools for inducing an increased level of tolerance in specific patients. [source] The association between mutations in the lysosomal protein glucocerebrosidase and parkinsonism,MOVEMENT DISORDERS, Issue 11 2009John DePaolo BA Abstract A body of work has emerged over the past decade demonstrating a relationship between mutations in glucocerebrosidase gene (GBA), the gene implicated in Gaucher disease (GD), and the development of parkinsonism. Several different lines of research support this relationship. First, patients with GD who are homozygous for mutations in GBA have a higher than expected propensity to develop Parkinson's disease (PD). Furthermore, carriers of GBA mutations, particularly family members of patients with GD, have displayed an increased rate of parkinsonism. Subsequently, investigators from centers around the world screened cohorts of patients with parkinsonism for GBA mutations and found that overall, subjects with PD, as well as other Lewy body disorders, have at least a fivefold increase in the number of carriers of GBA mutations as compared to age-matched controls. In addition, neuropathologic studies of subjects with parkinsonism carrying GBA mutations demonstrate Lewy bodies, depletion of neurons of the substantia nigra, and involvement of hippocampal layers CA2,4. Although the basis for this association has yet to be elucidated, evidence continues to support the role of GBA as a PD risk factor across different centers, synucleinopathies, and ethnicities. Further studies of the association between GD and parkinsonism will stimulate new insights into the pathophysiology of the two disorders and will prove crucial for both genetic counseling of patients and family members and the design of relevant therapeutic strategies for specific patients with parkinsonism. © 2009 Movement Disorder Society [source] Ethical issues in the management of sickle cell painAMERICAN JOURNAL OF HEMATOLOGY, Issue 2 2001Samir K. Ballas Abstract Care providers who manage patients with sickle cell disease (SCD) often face several questions. Most prominent among these pertain to the importance of pain and its treatment. The duties of the health care providers concerning pain management are often not well defined and vary considerably among providers and institutions. Despite the availability of national guidelines that address the ethical issues of pain management, patients with SCD often receive suboptimal pain control, especially during acute painful episodes. Although there are many reasons for this situation, an important aspect of the problem pertains to the complexity of applying ethical standards to specific patients with sickle cell pain. Decisions are frequently made according to perceptions and circumstances without taking ethical principles into consideration. The purpose of this paper is to present the range of ethical principles pertinent to sickle pain management and discuss specific examples of physician-patient interactions where ethical dilemmas occur. Am. J. Hematol. 68:127,132, 2001. © 2001 Wiley-Liss, Inc. [source] Vancomycin dosing assessment in intensive care unit patients based on a population pharmacokinetic/pharmacodynamic simulationBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2010Natalia Revilla WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT , Despite the frequent use of vancomycin in intensive care unit (ICU) patients, few studies aimed at characterizing vancomycin population pharmacokinetics have been performed in this critical population. , Population pharmacokinetics coupled with pharmacodynamic analysis, in order to optimize drug exposure and hence antibacterial effectiveness, has been little applied in these specific patients. WHAT THIS STUDY ADDS , Our population model characterized the pharmacokinetic profile of vancomycin in adult ICU patients, higher distribution volume values (V) being observed when the patient's serum creatinine (CrSe) was greater than 1 mg dl,1. , Age and creatinine clearance (CLcr) were identified as the main covariates explaining the pharmacokinetic variability in vancomycin CL. , Our pharmacokinetic/pharmacodynamic (PK/PD) simulation should aid clinicians to select initial vancomycin doses that will maximize the rate of response in the ICU setting, taking into account the patient's age and renal function as well as the susceptibility of Staphylococcus aureus. AIM To estimate the vancomycin pharmacokinetic profile in adult ICU patients and to assess vancomycin dosages for increasing the likelihood of optimal exposure. METHODS Five hundred and sixty-nine concentration,time data from 191 patients were analysed using a population pharmacokinetic approach (NONMENÔ). External model evaluation was made in 46 additional patients. The 24 h area under the concentration,time curve (AUC(0,24 h)) was derived from the final model. Minimum inhibitory concentration (MIC) values for S. aureus were obtained from the EUCAST database. AUC(0,24 h) : MIC , 400 was considered as PK/PD efficacy index. The probability of different dosages attaining the target considering different strains of S. aureus and patient subgroups was estimated with Monte Carlo simulation. RESULTS Vancomycin CL showed a significant dependence on patient age and renal function whereas CrSe > 1 mg dl,1 increased V more than twofold. For our representative ICU patient, 61 years, 73 kg, CrSe= 1.4 mg dl,1, measured CLCr= 74.7 ml min,1, the estimated values were CL = 1.06 ml min,1 kg,1 and V= 2.04 l kg,1. The cumulative fraction of response for a standard vancomycin dose (2 g day,1) was less than 25% for VISA strains, and 33% to 95% for susceptible S. aureus, depending on patient characteristics. CONCLUSIONS Simulations provide useful information regarding the initial assessment of vancomycin dosing, the conventional dosing regimen probably being suboptimal in adult ICU patients. A graphic approach provides the recommended dose for any selected probability of attaining the PK/PD efficacy target or to evaluate the cumulative fraction of response for any dosing regimen in this population. [source] Morbidity and complications of protective loop ileostomyCOLORECTAL DISEASE, Issue 6 2009G. F. Giannakopoulos Abstract Objective, The creation of a loop ileostomy is considered suitable to protect a distal anastomosis in colorectal surgery. This technique is, however, associated with failure, complications and even mortality. The aim of this study was to quantify retrospectively the morbidity associated with an ileostomy and its subsequent closure. Method, One hundred and nineteen patients with a temporary loop ileostomy, created between January 2000 and July 2007 were retrospectively analysed from a review of patient records. Results, All ileostomies were closed after a median period of 106 days (interquartile range: 69,174 days). Stoma-related morbidity occurred in 23 (19%) patients. After ileostomy closure, 16 major complications were seen in 14 (12%) patients and 43 minor complications occurred in 25 (21%) patients. Sixty-three patients (53%) had neither stoma-related morbidity or peri- or postoperative complications after stoma closure. Conclusion, Protective loop ileostomy was found to be associated with a high morbidity. This raises the question of the mode of identifying the specific patients with a low anastomosis who should be provided an ileostomy for protection, set against the potential complications of the formation and closure of the ileostomy. [source] | |||||||||||||||||||