Day Care Of Patients Research Articles

Burnout and secondary traumatic stress in medical-surgical nursing

Day to day care of patients throughout the continuum of life puts nurses at risk for burnout and secondary traumatic stress (STS). This mixed-methods study explores Medical-Surgical (MS) nursing burnout, STS, and support from professional nursing organization leadership and membership perspectives. Seventy-two nurses were recruited from a nursing organization website and surveyed to provide demographic and Professional Quality of Life Scale Version 5 (ProQOLv5) data. After quantitative data collection, nurse respondents were asked if they would like to participate in a Zoom interview. Qualitative data was derived from in-depth interviews of six medical-surgical nurses and free-text responses from three other participants. The nurses interviewed provided detailed personal definitions of burnout, which led to the identification of themes of “awareness” and “triggers: fueling the fire of burnout,” and also exposed the fluctuating nature of burnout. Participants defined STS as “invasiveness into one’s life” and reflected on the impact that it can have both personally and professionally. Despite the fluctuating nature of burnout and the invasiveness of STS, the nurses interviewed revealed a passion for nursing that served as a driving force for the day-to-day struggle, affirming, “I am a med-surg nurse.” Overcoming burnout and STS lead nurses to “lessons learned: I did not know what I did not know,” which focused on personal and professional growth and development. An overarching theme of “dream vs. reality” captures these stabilizing and destabilizing forces at play in bedside MS nursing.

Modern Day Care of Patients With Single Ventricle Heart Disease: Late Complications of Fontan Palliation

The majority of individuals who have undergone Fontan palliation are surviving into adulthood, yet complications are common. This review will focus on late complications—cardiac and extra-cardiac—which may present insidiously. Recent meta-analysis of patients after Fontan operation suggests that over 80% will survive 20 years beyond surgery. This group is at risk for structural complications, arrhythmias, vascular complications, and heart failure. Not all forms of Fontan failure are the same, and categorization into separate entities such as failure with preserved versus reduced function may help guide therapies. Pulmonary vasodilators in particular may be useful to improve hemodynamics. Novel therapies aimed at lymphatic complications are emerging and promising. Late hepatic complications including ascites and liver cancer may be seen, and scoring systems may identify patients at higher risk. Individuals who have undergone a Fontan surgery face challenges as they age which include both cardiac and non-cardiac systems.

Alzheimer’s desease: challenges faced by family caregivers

Abstract Gaps identified in Brazilian health policies and the need to develop and implement strategies for the empowerment and monitoring of family caregivers support the development of care proposals aimed at the family. The present study aimed to analyze the challenges faced by family members providing day to day care of patients with Alzheimer's disease in the city of Chapecó, Santa Catarina. The method employed was the qualitative approach through semi-structured interviews. The speeches were grouped, categorized and analyzed using the hermeneutic method. The results showed that during the period of Alzheimer's disease, caregivers experience a range of situations, including: a need to learn about the disease; dealing with guilt; and handling situations of pain, addiction and physical and psychological suffering. In conclusion the study described the challenges of the daily lives of these families, explaining the importance of and highlighting the need to adopt tools and strategies that provide physical, emotional, psychological and financial support to family caregivers of patients with Alzheimer's disease.

SIMULTANEOUS BILATERAL SHOULDER DISLOCATION: A CASE REPORT

Introduction: Bilateral shoulder dislocations are relatively uncommon. Bilateral shoulder dislocationwas first described in 1902, because of muscular contractions in camphor overdose. Among thebilateral shoulder dislocation posterior are most common usually following convulsions or electricshocks. Simultaneous bilateral anterior dislocations of shoulder following trauma is a rareoccurrence. Case Report: A 28 year old male presented to emergency department with history offall on outstretched hand. He complained of pain and difficulty in moving both the shoulders. Onclinical examination, patient's both upper limbs were abducted and externally rotated. Bilaterallyshoulder contour was lost with flattening. Other classical signs of shoulder dislocation like Bryantstest, Callway sign, Hamilton's ruler test were positive. Diagnosis was confirmed on X rays. Bothshoulders were reduced in emergency operation theater under general anaesthesia by Kocher'smethod and were immobilized in sling. Conclusion: Simultaneous bilateral dislocation of theshoulder are uncommon during clinical practice but have to be diagnosed and adequately treated.Though posterior shoulder dislocations are common secondary to convulsions and electric shocksanterior shoulder dislocations should be kept in mind. The bilateral dislocations also presents withpractical problem of immobilization of both limbs and day to day care of patients. Hence thedislocations require special attention and proper care .

Is BRIEF a useful instrument in day to day care of patients with phenylketonuria?

Despite early and continuous treatment many patients with phenylketonuria (PKU) still experience neurocognitive problems. Most problems have been observed in the domain of executive functioning (EF). For regular monitoring of EF, the use of the Behavior Rating Inventory of Executive Function (BRIEF) has been proposed. The aim of this study was to investigate whether the BRIEF is indeed a useful screening instrument in monitoring of adults with PKU. Adult PKU patients (n = 55; mean age 28.3 ± 6.2 years) filled out the BRIEF-A (higher scores=poorer EF) and performed computerized tasks measuring executive functions (inhibition, cognitive flexibility, and working memory). The outcome of the BRIEF-A questionnaire was compared with the neurocognitive outcome as measured by three tasks from the Amsterdam Neuropsychological Tasks (ANT). Forty-two percent of the PKU patients scored in the borderline/clinical range of the BRIEF-A. Six of the 55 patients (11%) scored >1 SD above the normative mean, mostly on the Metacognition Index. With respect to ANT measurements, patients mainly showed deficits in inhibitory control (34-36%) and cognitive flexibility (31-40%) as compared to the general Dutch population. No significant correlations between the two methods were found, which was confirmed with the Bland-Altman approach where no agreement between the two methods was observed. Only with respect to inhibitory control, patients scored significantly worse on both BRIEF-A and ANT classifications. No other associations between classification according to the BRIEF-A and classifications according to the ANT tasks were found. Patients reporting EF problems in daily life are not necessarily those that present with core EF deficits. The results of this study suggest that regular self-administration of the BRIEF-A is not a sufficient way to monitor EF in adult PKU patients.

IS4-1 - Pharmaceutical Care for Patients Receiving Cancer Treatment

The role of the Pharmacist in providing pharmaceutical care for oncology patients is dynamically changing. In the United States, the profession of Pharmacy has grown dramatically over the past decade. The Pharmacist's degree has changed from a Bachelor of Science to an entry level Doctor of Pharmacy. Graduates are flooding into the Hospital, Academic, and Ambulatory Clinic settings. As a result, postDoctoral training is becoming more common. In order to provide pharmaceutical care for patients receiving cancer treatment two years of postdoctoral training is recommended. Following postdoctoral specialty training, Oncology Specialty Pharmacists must continue to learn and read literature daily in order to keep up with the fast paced Oncology environment. Furthermore, Pharmacists are encouraged to take their board exams to become board certified in oncology pharmacy (BCOP). Oncology Pharmacist Specialists are involved in designing, monitoring, and changing chemotherapy for patients. They also play a prominent role in medical rounds in the day to day care of patients receiving chemotherapy. This entails formulating supportive care treatment plans for chemotherapy induced toxicities, infections, and their underlying comorbidities such as hypertension, diabetes, dyslipidemia, etc. Providing education is paramount to pharmaceutical care. Patients are educated by a Pharmacist on their chemotherapy regimen and their supportive care medications. Pharmacists also provide education to their Attending Physicians, fellows, residents, and students. Lastly, Oncology Pharmacists indirectly impact patients through clinical research, institutional guideline implementation, chemotherapy orderset building, and reporting of safety events.

L06 Specialised Multidisciplinary Day Care For Patients With Huntington's Disease, Living At Home

<h3>Background</h3> Independent living of patients with a chronic disease is preferred by most citizens A chronic progressive disease, such as Huntington’s disease (HD) may threaten this independent living. <h3>Aim</h3> To assess whether a specialised, multidisciplinary day care program for patients with HD, is effective in preserving or improving self-efficacy and self-management skills, in order to maintain independent living and postpone admission. Baseline data are presented in this paper. <h3>Methods</h3> In a cohort study, patients with HD and their informal caregiver were interviewed. The primary outcome was self-management (SMAS-30). Secondary outcomes included self-efficacy (SES-NL), care needs (CANE), quality of life (EQ-5D), functioning (KATZ and Lawton iADL, TUG, PPT), satisfactory specialised care program (VAS), caregiver burden (SRB scale). <h3>Results</h3> A total of 26 patients with HD (mean age: 51.7 years, range: 29–72), and 22 informal caregivers were interviewed. Patients tend to classify themselves as self-manageable (SMAS-30: mean 71.1, SD = 12.6), self-efficable (SES-NL: mean 31.5, SD = 5.4), and pertain a high level of functioning (KATZ: mean 6.7, SD = 1.2), whereas informal caregivers observe several existing care needs (CANE: mean 9.0, SD = 2.4) and experience themselves a moderate to severe care burden (SRB: 76% between score 50–80). In general, both patients and informal caregivers appreciate the specialised care provided. <h3>Conclusion</h3> Patients, as well as informal caregivers, appreciate the specialised care program. Future research will determine if this program is effective in preserving self-management abilities to maintain independent living and to postpone admission.

Palliative day care: A qualitative study of service users' experiences in the United Kingdom

In many countries, specialist palliative day care for patients with life-limiting conditions is provided by specific teams of professionals from a range of relevant disciplines. During 2006 to 2007, the day care services at a hospice in the U.K. were redesigned so that specialist palliative care sessions replaced the existing long-established, traditional day care model. The purpose of this study was to enhance the understanding of those aspects of the service that the users valued most (the "X-factor"). Qualitative data were collected via semistructured interviews with 29 patients and eight carers. These data were subjected to a framework analysis. The users of the service used poignant and powerful words to describe the special qualities that they valued, some phrasing it as the X-factor. The data are presented under three themes: the quality of the staff; the sense of community; and relationships. Of these, the relationships between and within the staff and patient groups held the greatest significance for the patients. Service providers need to recognize that opportunities for the formation of relationships between the patients, staff, and carers are of utmost importance when designing palliative day care services.

One size does not fit all - time to regionalize Helicobacter pylori eradication?

Sirs, As clinicians responsible for the day to day care of patients, we want our evidence-based medicine to be quick, clean and to the point. Although the study by Molina-Infante et al. fragments the directive concerning the first line eradication therapy for patients with Helicobacter pylori (H. pylori), the authors should still be congratulated, as more important than an unambiguous treatment regimen is the desire to have one that works at the coal face. The study by Molina-Infante et al.1 highlights the regional heterogeneity of responses to various H. pylori eradication treatments. The authors point out that standard triple therapy with omeprazole, clarithromycin and amoxicillin (OCA) in the Spanish population achieved per protocol cure rates of only 66%, whilst levofloxacin-based triple therapy (OLA), and sequential therapy with either clarithromycin (OACM) or levofloxacin (OALM) achieved adequate cure rates of greater than 80%. This contrasts with our experience in Hong Kong, China, where we found that standard esomeprazole, clarithromycin and amoxicillin (ECA) comprised still the most effective empirical first line treatment for H. pylori [92.7% for ECA vs. 85.7% for esomeprazole, levofloxacin and amoxicillin(ELA)], as rates of H. pylori resistance here to amoxycillin and clarithromycin are still low.2 Molina-Infante et al. also studied the intriguing sequential therapy concept. On the basis of the rationale that initial treatment with amoxicillin lowers the gastric bacterial load, thereby amplifying the impact of the metronidazole and clarithromycin subsequently delivered,3, 4 the authors found that of the four H. pylori eradication regimens studied, the OALM achieved the highest intention to treat cure rate, but at 82.5%, falls below the >90% threshold required to be deemed a ‘good’ first treatment. This ‘average’ response to sequential therapy has also been seen in France5 and Korea,6 whilst ‘good’ responses have been reported in Italy,3, 4 Thailand7 and Taiwan.8 Given the balance of the evidence thus far, perhaps in the H. pylori realm, regionalized treatment regimens may be the way forward, as one size may no longer fit all. Declaration of personal and funding interests: None.

The Clinic for Integrative Medicine in Essen, Germany

In integrative medicine (IM) the basic concept is the combination of mainstream with Complementary and Alternative Medicine (CAM) supposedly leading to synergistic therapeutic effects. In an extended version the methods of Mind/Body Medicine (MBM) are also added. A recent survey screening the German population concerning their preferences for cam, mainstream medicine or combining both of them (IM) showed that most Germans were in favour of integrative medicine. This shows the development of a new understanding of medicine in Germany. In 1999 the first hospital for Internal and Integrative Medicine with 54 beds was established at the Teaching Hospital Kliniken Essen-Mitte as a model institution of the county North Rhine-Westphalia, Germany. In October 2004, after a 5-year period of scientific evaluation by the university board, the first German Chair for Complementary and Integrative Medicine was founded by the Alfried Krupp von Bohlen and Halbach-Foundation at the University Clinic Duisburg-Essen. In this model institution Western trained doctors specialized in CAM as well as mind–body instructors offering Mind–Body Medicine (MBM) are working together. Besides the task of teaching students the Chair and institution is focussing on clinical and basic research on Traditional European and Chinese Medicine as well as Mind–Body Medicine. Besides that an intensive program evaluating the outcome of more than 2500 patients, who have been treated during the past 5 years has been established. The stay in the hospital is paid by all German insurance companies for patients. In the talk the concept of Integrative Medicine in a regular hospital setting combining Complementary Medicine and Mainstream Medicine will be introduced. Indications and expected benefits, for in-patients, day-care in-patients and out-patients will be discussed.

A cost calculation model for specialist palliative care for patients with non-small cell lung cancer in a tertiary centre

Five-year survival of patients with non-small cell lung cancer (NSCLC) is below 15%. Therefore, an early integration of palliative care according to the 2002 WHO definition is indispensable. In this paper, we describe methodical and financial aspects of prospective pricing of palliative care within a concept of integrated care for patients with NSCLC in Germany. Four structures of palliative care services were defined (hospital support, home care, day care and in-patient care). Prospectively, resource use was estimated, using real cost data from the finance department of the University Hospital. Resource use was forecasted on the basis of operating experience, data of the national core documentation of palliative care patients and recommendations from the European Commission. Expected average hospital support team services were priced at 483 euros and budgeted for 10% (stage 1) to 90% (stage 4) of patients. Home care (60 visits, 4,573 euros) and day-care (5 visits) services were budgeted for between 5% (stage 1) and 30% (stage 4). The resulting prospective reimbursements range from 393 euros (stage 1) to 2,503 euros (stage 4). In-patient care was excluded from the prospective payments and reimbursed separately. For the first time, global reimbursements covering palliative care hospital support, home care and day care for patients with NSCLC were prospectively calculated and successfully negotiated. The contractual specification of palliative care services may contribute to transparency and quality in cancer care.

Use of a national endoscopic database to determine the adoption of emerging pharmacological and endoscopic technologies in the every day care of patients with upper GI bleeding: the RUGBE initiative

Use of a national endoscopic database to determine the adoption of emerging pharmacological and endoscopic technologies in the every day care of patients with upper GI bleeding: the RUGBE initiative

ACE inhibitors in heart failure: an update.

Angiotensin-converting enzyme (ACE) inhibitors are now accepted as part of the routine management of patients with heart failure. Their use has been mandated in all the new major mortality trials to test the efficacy of beta-blockers in heart failure. Morbidity and mortality remain high in those with heart failure even with the benefits proven for both these groups of agents. In spite of the evidence for benefit of ACE inhibitors they are persistently used in lower doses in clinical practice than tested in the large-scale trials. This was so prevalent as to allow the conduct of a substantial study, the ATLAS trial, to compare high and low dose ACE inhibition. Its equivocal findings have allowed different interpretations. Clinical experience would suggest that starting with a low dose is appropriate but the dose should be titrated then without undue delay to the levels used in the trials wherever possible. The evidence for benefit with these drugs had been obtained largely in patients with impaired systolic function. However the AIRE study selected patients with clinical evidence of heart failure after myocardial infarction rather than with impaired systolic function. A substantial and long-term benefit was found from ACE inhibition. A cohort of patients had ventricular function assessed and as anticipated almost one half had preserved systolic function. Whilst the absolute benefit in lives saved was greater in the higher risk/low ejection fraction group, the relative risk reduction was not significantly different between those with preserved or impaired systolic function. The publication of the HOPE trial, although not a study of patients with heart failure, has clarified the situation considerably for those taking day to day care of patients. The HOPE study selected patients on the basis of high cardiovascular risk excluding those with known impaired systolic function. Although not an entry requirement for the study, ejection fraction was measured in a substantial majority and was above 40% indicating preservation of systolic function. The ACE inhibitor ramipril markedly reduced the combined end-point of cardiovascular death, stroke and myocardial infarction. Importantly there was a highly significant 20% risk reduction in the rate of myocardial infarction, a prospectively defined end-point, over the average four and a half year follow-up. Taken together with the retrospectively derived evidence from the heart failure trials there is now compelling evidence that the ACE inhibitors prevent myocardial infarction. The majority of patients with clinical heart failure have underlying ischaemic heart disease. Prevention of myocardial infarction and control of blood pressure are two key factors in the management of these patients irrespective of systolic ventricular function. The ACE inhibitors like the beta-blockers therefore have a pivotal role in their management. A challenge to current clinical trials is to determine whether these properties are shared to the same degree by the angiotensin antagonists or if even further gains in benefit can come from their combination. The neutral findings of the ELITE II study comparing the angiotensin antagonist, losartan, with the ACE inhibitor, captopril, have heightened interest in the on-going trials addressing these issues.

A review of studies on day care for patients with borderline personality disorders

A review of studies on day care for patients with borderline personality disorders

Cost-effectiveness analysis of day care for patients with dementia disorders.

In a cost-effectiveness analysis, the costs of 55 demented patients in day care (DC) and 45 patients on a waiting list were related to the effects on indices measuring quality of life. Based on one year's study, the costs per patient per day, was USD 55 for the DC-group and USD 63 for the controls (p > 0.05). Both groups deteriorated in the indices during the study year. The trend was that DC was both cheaper and better in the indices, and some of the underlying variables for the used indices also showed significantly better results in favour of DC. However, since the changes between the groups were not significant regarding the basic question at issue, it cannot be stated that DC is more cost-effective than a care organisation without DC. Different interpretations of the results are presented.

Community hospitals in the new NHS

The future of community hospitals has always been uncertain within the National Health Service despite widespread support for them, particularly from general practitioners.1 Government policies have successively threatened, promoted, and ignored community hospitals, but the number of hospitals has grown over the past two decades. What role do they have now that hospital care is being redefined, and how might they fare in the NHS internal market? In the 1960s the development of district general hospitals threatened the existence of many of these small hospitals, but in 1974 the Department of Health issued a paper setting out its vision for community hospitals2 - and that view has not yet been formally superseded. This document suggested that community hospitals were needed to provide medical and nursing care, including outpatient, day patient, and inpatient care, for people who do not need the specialised facilities of district general hospitals and cannot be properly cared for at home or in residential accommodation. General practitioners were expected to provide the day to day care of patients. As a result of this guidance several …

Why do patients occupy acute psychiatry beds? A pilot study

The main aim of this pilot study was to identify factors influencing acute psychiatry bed use. The reasons for occupying a bed vary with time, so patients in the study were assessed on a weekly basis to monitor the changes in the factors thought to be responsible for continued stay. The reasons for bed occupancy also are often only known to those professionals directly involved in day to day care of patients, and it is suspected that the reasons often have little to do with manifest psychiatric illness. The reason for this study was to investigate this question.

Day care for patients with psychiatric disorders

Day care for patients with psychiatric disorders

Cancer patients: knowledge and attitudes.

Fifty patients undergoing treatment were interviewed on what they knew about radiotherapy and their attitudes towards their disease and those treating their disease. Ninety-four percent used the word "cancer" or "malignant tumor" to describe the reason for being treated. All patients were told their diagnosis by the physician who referred them for therapy. Nineteen patients remembered feeling frightened by the equipment at first, but all had a lessening of anxiety with time. All patients perceived the role of the radiation technologist as that of operating the treatment machine and spoke only about trivialities to them. Eighty percent felt that the radiotherapist gave them satisfactory information about their treatment before commencing treatment. In contrast, the referring physician was thought to have been of no help in preparing for the experience of undergoing radiotherapy by 52% of those interviewed. Eighty-two percent of the patients expressed the opinion that both the referring physician and therapist were not the people to whom they would bring emotional problems. Therefore, mental health professionals could make a major contribution in the total program if they were involved in the day to day care of patients receiving radiotherapy.