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Selected AbstractsMedicine-taking behavior: Implications of suboptimal compliance in Parkinson's diseaseMOVEMENT DISORDERS, Issue 11 2005Katherine A. Grosset MBChB Abstract Management of Parkinson's disease (PD) depends primarily on oral medication. There are several drug classes and multiple doses and formulations, which make optimizing therapy complex. Variable drug absorption and the short half-life of most antiparkinson treatments, especially levodopa, are a main focus in understanding complications and have encouraged alternative delivery systems to limit fluctuation and dyskinesia at later stages. Comparatively little attention is paid to the way patients take their oral medication. Variable medicine-taking behavior can affect the clinician's understanding of the diagnosis and rate of progression, and further prescription of PD medication. Medicine overuse in later stage PD is well documented and causes psychiatric disturbance and increases motor complications, but evidence of undertreatment and erratic intake is emerging, which is likely to affect motor control and quality of life adversely. Methods of quantifying compliance are compared for accuracy and limitations. Understanding medicine-taking behavior is a first step in optimizing therapy and requires consideration of a patient's personal beliefs about their medicines. Although the benefits of regularizing oral medicine-taking in a practical, achievable way in PD remain untested, such an approach might prolong and smooth the benefits of oral medication and is worthy of further research. © 2005 Movement Disorder Society [source] Implementing the severe sepsis care bundles outside the ICU by outreachNURSING IN CRITICAL CARE, Issue 5 2007Chris Carter Abstract Sepsis is not a new challenge facing the health care team, it remains a complex disease, which is difficult to identify and treat. Mortality from sepsis remains high and continues to be a common cause of death among critically ill patients, despite advances in critical care. Sepsis accounts for an estimated 27% of all intensive care admissions in England, Wales and Northern Ireland, and accounted for 46% of all intensive care bed days. Recent research studies and the surviving sepsis campaign have shown that identifying and providing key interventions to patients with severe sepsis and septic shock prior to their admission to the intensive care unit significantly improve outcomes. The aim of this paper was to identify how the Critical Care Outreach Team at one local hospital implemented the severe sepsis resuscitation care bundle for patients in the emergency department (ED) and on the general wards. It will include a presentation on the various ways the team raised the profile of severe sepsis and the care bundle at hospital and at national level. It also includes audit data that have been collected. The results showed that if the resuscitation care bundle was implemented within the first 24 h of hospital admission, mortality was 29%, whereas if the care bundle was instigated after this time mortality was more than at 49%. Audit data showed that the commonest sign of severe sepsis seen in patients in the ED and on wards was tachypnoea. This article discusses the successful implementation of the severe sepsis resuscitation care bundle and the positive impact an Outreach team can have in changing practice in the way patients are managed with severe sepsis. The audit data support the need for regular physiological observations and the use of a Patient At Risk Trigger scoring tool to identify patients at risk of deterioration. This allows referral to the Outreach team, who assess the patient and if appropriate initiate the care bundle. [source] The genetics of antiplatelet drug resistanceCLINICAL GENETICS, Issue 1 2009G Feher Platelets have a central role in the development of arterial thrombosis and subsequent cardiovascular events. An appreciation of this complex process has made antiplatelet therapy the cornerstone of cardiovascular disease management. However, numerous patients will experience a recurrent atherothrombotic vascular event despite adequate antiplatelet therapy. Individual differences in the rate of platelet activation and reactivity markedly influence normal hemostasis and the pathological outcome of thrombosis. Such an individual variability is largely determined by environmental and genetic factors. These are known to either hamper platelets' response to agonists, and thereby mimic the pharmacological modulation of platelet function or mask therapy effect and sensitize platelets. In this article, we reviewed the antiplatelet mechanisms of aspirin and clopidogrel and the possible role of different polymorphisms, which may affect the efficacy of antiplatelet therapy. Heterogeneity in the way patients respond to aspirin and clopidogrel may in part reflect variation in cyclooxygenase (COX)-1, COX-2, glycoprotein (GP) Ib alpha, GP Ia/IIa, GP IIb/IIIa, UGT1A6*2, P2Y1, P2Y12, CYP2C9, CYP3A4 and CYP3A5 genotypes. [source] Qualitative techniques to investigate how patients evaluate dentists: a pilot studyCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 4 2000Philip R. H. Newsome Abstract ,Objectives: Most previous studies have portrayed patient satisfaction as a rather simple outcome based solely on patient perceptions. The goal of this pilot study was to determine if evidence could be found to support the view that patient evaluation is a more complex process better explained by drawing on the theories of ,disconfirmation of expectations' and ,attribution'. Methods: A qualitative methodological approach was chosen with data collection being achieved by means of four focus group interviews comprising a total of 25 participants (16 women and 9 men, mean age 43.8 years, standard deviation of 14.45) representing a wider population of adults (over the age of 18) who had attended for dental treatment within the previous 12 months. Results: Analysis suggests that patient perceptions of dental practice alone do not fully account for the way patients evaluate dentists. Disconfirmation of expectations does take place during the evaluation process. Equally, patients appear to apply the attributional concepts of ,duty' and ,culpability' to determine either satisfaction or dissatisfaction. Conclusions: A better understanding of patient satisfaction, and the evaluation process that leads to satisfaction, can only be achieved if, in addition to patient perceptions, other antecedent factors such as patient expectations and desires are considered. Disconfirmation and attribution theory do appear to play an important role in this process and warrant further investigation. [source] Promoting the health of people with chronic obstructive pulmonary disease: patients' and carers' viewsJOURNAL OF CLINICAL NURSING, Issue 3-4 2010Ann Caress Aims and objectives., The aim of this study was to generate in-depth insights into patients' and family members' understanding of the causation, progression and prevention of chronic obstructive pulmonary disease and the role of health promotion with this population. In particular, we were interested in identifying the ways patients and family members considered that they could maximise their (patients') health, in the presence of this disease. Background., Chronic obstructive pulmonary disease is highly prevalent and a significant cause of morbidity and mortality, impacting on quality of life and healthcare expenditure. Health promotion is, therefore, an important consideration. There are few examples in the literature of health promotion programmes for this population, including those directed at smoking cessation, which also focus on the family or significant others. Design., An exploratory, descriptive design was employed. Method., Semi-structured, audio-recorded interviews were conducted with 14 patients and 12 family caregivers. Interviews were transcribed verbatim and thematically analysed using content analysis procedures which captured the meaning of the data. Results., The three main themes were ,health promotion: what's that?', ,community resources for health promotion' and ,it wasn't just the smoking'. Many participants seemed unaware that their health might benefit from a healthier life style and provided little spontaneous information on any activities they carried out to maintain or improve their health. Conclusions., This study highlighted a dearth of health promoting activity amongst people affected by chronic obstructive pulmonary disease. The reality for most patients was to manage the day-to-day demands that the symptoms of the disease imposed on them. Our data suggest that a more wide-ranging approach, encompassing aspects of health promotion, might be welcomed by many patients and their family carers. Relevance to clinical practice., The findings from this study highlight gaps in patients' and carers' understanding of the potential role of health promotion in chronic obstructive pulmonary disease and areas for intervention by health professionals. With the increase in smoking rates of women and predicted future increases in chronic obstructive pulmonary disease, it is imperative that health professionals find effective ways to provide support and health promotive care for patients and families. [source] Persons, Places, and Times: The Meanings of Repetition in an STD ClinicMEDICAL ANTHROPOLOGY QUARTERLY, Issue 2 2007Lori Leonard In this article we work the tensions between the way clinical medicine and public health necessarily construct the problem of "repetition" in the context of a sexually transmitted disease (STD) clinic and the ways patients narrate their illness experiences. This tension,between clinical and epidemiological exigencies and the messiness of lived experience,is a recurring theme of work conducted at the intersections of epidemiology, anthropology, and clinical medicine. Clinically, repeated infections are a threat to the individual body and to "normal" biological processes like reproduction. From a public health perspective, "repeaters" are imagined to be part of a "core group" that keeps infections in circulation, endangering the social body. Yet patients' accounts are anchored in particular social histories, and their experiences rely on different time scales than those implicated in either of these types of readings. Extended analyses are provided of two such accounts: one in which repetition can be "read" as part of a performance of recovery, and one in which repetition is bound up in the effort to avoid becoming the involuntary subject of institutionally administered intervention. We argue the need to open up the category of repeaters to include the social and draw on work by Cheryl Mattingly to suggest that one way to do this in the context of the STD clinic might be to adopt forms of therapeutic practice that make use of interpretive, in addition to technical, skills. [source] | ||||||||||