Patient Support System Research Articles

COVID-19: Obstetric anesthesia care considerations

• Pre-hospital COVID-19 screening should be implemented for all pregnant patients. • Limit the number of staff in a delivery room or operating room when feasible • Encourage the use of video messaging with other members of the patient's support system • An experienced provider should perform neuraxial procedures and intubations, whenever possible.

Religious Belief and Social Support Among Cancer Patients in Saudi Arabia.

BackgroundPeople with cancer usually experience some degree of depression, anxiety, and fear, as if embracing the fact that cancer has become part of their lives. Additionally, religious beliefs can influence a patient's support system, as well as the patient's own emotional response, behavior, and decision-making, which can create a conflict with medical treatment. The objective of this study was to assess cancer patients' religious beliefs and social support.MethodsA cross-sectional study was conducted in 294 adult patients at the Comprehensive Cancer Center of King Fahad Medical City in Riyadh, Saudi Arabia. Patients were interviewed using the System of Belief Inventory (SBI-15R) questionnaire, and responses were noted in the survey form.ResultsThe majority (82.3%) of patients were newly diagnosed with cancer and in the treatment phase, whereas 9.9% were in the metastatic phase. The total mean score of the SBI-15R scale was 27.9. The mean score of the social support subscale was 13.1 ± 1.68, whereas the mean score for the beliefs and practice subscale was 29.7 ± 0.81. For the social support subscale, a statistically significant difference was found in age (P < 0.001), gender (P < 0.001), and occupation (P = 0.009). However, for the beliefs and practice subscale, a statistically significant difference was found only with gender (P = 0.001). ConclusionsThis study concluded that social support is important for the study participants, and they were attached to their beliefs and cultural practices, as indicated by the high total mean score on the SBI-15R. Understanding this topic is important in order for healthcare organizations to provide holistic patient care.

Deprescribing benzodiazepines.

Deprescribing benzodiazepines.

Supporting the Support System: How Assessment and Communication Can Help Patients and Their Support Systems.

The benefits of having a support system, such as social relationships with close friends and family, have been well documented for patients with serious health issues. As scientific evidence has shown, individuals who have the lowest level of involvement in social relationships face a greater mortality risk. Support systems, however, are not infallible. Relationship stress can have a negative impact on people-patient and caregiver alike-behaviorally, psychosocially, and physiologically. The purpose of this article is to encourage case managers who take a patient-centered approach to also consider the existence and extent of the support system, as well as any stresses or tensions that are observable within the support system. Although the case manager is ethically obliged to advocate for the individual receiving case management services, that advocacy can be extended to the support system for the good of all. This discussion applies to numerous case management practices and work settings including (but not limited to) hospital-based case management, home health, geriatrics, catastrophic case management, mental health, palliative care, and end of life/hospice. As part of the assessment phase of the case management process, case managers determine the extent of the patient's support system or social support network such as family and close friends. Although their advocacy is primarily for the patient receiving case management services, case managers also become aware of the needs of the support system members as they face their loved one's serious illness, severe injury, geriatric care demands, or end of life. Case managers can use their communication skills, especially motivational interviewing, with patients and their support systems to identify stresses and issues that can impact the pursuit of health goals. In addition, case managers ensure that individuals and their support systems are kept informed such as about the health condition, stage of disease, plan of care, treatment options, and care transition plan. Professional case managers expand their role as advocates, serving primarily the patients ("clients") who receive case management services and also members of the support system. By becoming more aware and sensitive to the needs of the support system, case managers help reduce stress on the support system, which can contribute to positive outcomes for patients ("clients").

Design of a moving bed for a radiation therapy system with multiple linear accelerators

Radiation therapy system is preferred to surgery for the most cancer because it is noninvasive. In radiotherapy, respiratory motion is an obstacle of high-precision therapy. The patient support system (PSS) is a method to compensate respiratory motion without increasing treatment time. But treatment time could not be decreased dramatically with conventional PSS because it increases duty cycle of linear accelerator (LINAC). To apply multiple LINACs, the conventional PSS is not suitable as the structure of PSS interrupt workspace of LINACs. In this study, we designed a new moving bed to apply multiple LINACs as well under the bed. A force distribution method and dynamics of the bed were identified. Rigid body simulation model was made to verify that the bed can operate well as expected. And a real size model was manufactured on a basis of the simulation model. Experiments were conducted to identify that the bed can move in desired objectives.

Éducation thérapeutique de familles de patients schizophrènes : le modèle de l’Hôtel-Dieu de France au Liban

IntroductionSchizophrenia is a chronic illness that causes considerable functional disability. The care of a schizophrenic patient is a heavy burden which impacts negatively the patient's family. It alters the quality of life of the caregiver and creates a distress and dissatisfaction with respect to his/her role due to several factors. This negative effect on the patient's support system can also indirectly affect the prognosis of the patient's disease through the increase of relapse rate, therefore entering a vicious cycle. The therapeutic education of families of patients suffering of schizophrenia has revealed to be an efficient and positive intervention on many levels. An efficient psychoeducation program can improve the knowledge of the family members, decrease the burden of the disease and reduce the patient's relapse rate. ObjectivesGiven the frequent solicitation of the psychiatric team by the caregivers, a psychoeducation program for the family members of schizophrenic patients was implemented at the psychiatric department of Hôtel-Dieu de France, a University Hospital in Lebanon, aiming to help these families in acquiring a realistic vision of the disease, thus enabling them to actively collaborate in psychiatric care, and to tackle and discuss the common daily encountered problems in the management of such patients, finally suggesting ways to deal with these problems. DescriptionSelected family members of three schizophrenic patients attended the psychoeducation program after obtaining the consent of the patients. The intervention consisted of ten sessions, of one hour and a half each, at the pace of one session per week and it was led by a multidisciplinary team: a psychiatrist, a psychologist, a nursing manager and an occupational therapist. The psychoeducation program consisted of the presentation of the disease and of related important information, of debriefing sessions and of experience-sharing sessions between the three families. An assessment of knowledge related to schizophrenia was made before and after the implementation of the program. ContributionThe psychoeducation program enabled the families to acquire new and useful knowledge about the disease, helped in relieving their distress and in dealing with negative emotions caused by the presence of the disease in a family member. Since the family constitutes a central hub in the patient's life in Lebanese society, such therapeutic education of families of patients with schizophrenia is found to be essential in the management of the disease. Many psychoeducational approaches have been described in the literature. They differ from one another by the program's content and/or duration and the composition of the attending group. In our case, we implemented a relatively short program to a multiple-family group without the participation of the patients. ConclusionThe implementation of a psychoeducation program to the families of patients suffering of schizophrenia is important because the family members continually face particularly difficult circumstances. Such programs have several positive effects on both family members and patient. However, their long-term effects should be further evaluated and the duration of the program should be adapted accordingly. Such interventions may also be of benefit when implemented to families of patients with chronic mental disorders other than schizophrenia.

Psychosocial factors associated with frequent rehospitalization of patients with mental health disorders

International research, which focuses on frequent users of the psychiatric services and on the psychosocial factors that are associated with frequent rehospitalization, emphasize that the problem of revolving door patient still stands and is severe. Research concerning the above mentioned issue has not been conducted in Georgia, therefore, this study aimed to explore the revolving door patients and psychosocial factors that contribute to their relapse and frequent readmission to acute psychiatric unit. Study was conducted at psychiatric department of Ghudushauri National Medical Center. Qualitative and quantitative analysis based on medical files of 34 adult patients with psychotic disorders, rehospitalized in acute psychiatric unit 60 days after their last discharge in 2012–2014 years, was conducted. Results of the study are in line with international research findings concerning the psychosocial factors that contribute to frequent rehospitalization of patients with psychotic disorders, such as: unemployment (97%), lack of support system (76,5%), non-compliance with treatment (91.2%), emotional reactivity to stressful life events, etc. However, according to the study, family atmosphere turned out to be the central problem which influences the index of conflict and expressed aggression in the family, has impact on the size of patient's support system, on substance abuse, on patient's relapse and on their emergency rehospitalization. According to the results of the study, family atmosphere is one of the most active and multifaceted factors that contribute to patient's relapse and frequent rehospitalization in Georgia. Therefore, implementing and developing interventions discussed in the research paper that will target this factor is essential.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Long-term home parenteral nutrition: it takes an interdisciplinary approach.

Home parenteral nutrition (HPN) is indicated for adults and children who cannot digest and absorb food and who are able to receive therapy safely outside of a hospital. How successful this therapy is depends on the patient's support system and ability to learn and independently administer medically complex procedures. Transition to home is facilitated by identifying all necessary therapies, obtaining information to demonstrate medical necessity, establishing central venous access, reaching goal infusion rate, identifying who will write HPN orders, and coordinating care among all home care providers. An interdisciplinary team provides the most successful process to ensure safe HPN.

Model Predictive Control for Real-Time Tumor Motion Compensation in Adaptive Radiotherapy

This paper presents the development and real-time implementation of a control system to automatically adjust the patient support system (PSS) position, thereby compensating for tumor motion caused by respiration and patient movements during radiotherapy treatment. The control scheme utilizes an observer to estimate the PSS state feedback, and a tumor position prediction algorithm to provide the reference for a model predictive controller. The real-time control algorithm was implemented using the Matlab and Simulink environments, with the communication with the clinical PSS performed through the dSPACE real-time system. The controller was shown to be able to position the PSS accurately and was able to track and compensate for organ motion with an accuracy of less than 1 mm in terms of root mean square error, giving rise to dose distributions indistinguishable from a static beam on a fixed target. From a clinical perspective, the increased targeting accuracy will enable an increased dose to the tumor without compromising the surrounding healthy tissues.

Best Practices: Psychiatrists and Primary Caring: What Are Our Boundaries of Responsibility?

Best Practices: Psychiatrists and Primary Caring: What Are Our Boundaries of Responsibility?

Predictive Tracking for Respiratory Induced Motion Compensation in Adaptive Radiotherapy

This paper considers a compensation strategy for respiratory-induced tumour motion for adaptive radiotherapy using a controlled patient support system (PSS). A model predictive control (MPC) scheme for the PSS to track the tumour motion is proposed together with two methods for predicting tumour motion, including a Kalman filter and neural networks. Simulation results using a clinical data set consisting of 27 traces of respiratory motion show the potential of the proposed control strategy.

A new method of assessing the mechanical properties of patient support systems (PSS) using a phantom. A preliminary communication

Pressure ulcers are a major problem worldwide believed to affect over 5% of all hospital in-patients, and countless others in the community at large. Many types of Patient Support Systems (PSS) are sold as pressure ulcer prevention equipment, but no consensus exists as to their mechanical efficacy. The use of human volunteers to assess the mechanical properties of PSS introduces non-repeatability and variability in results which cannot give a statistically significant difference in performance between systems. Mechanical testing without human volunteers provides faster evaluations of PSS, with improved precision and repeatability. An instrumented articulated anthropometric phantom has been developed to investigate the distortion of simulated soft body “tissues” of the buttock and sacral areas due to precise and repeatable static loading on a PSS. The weight of the phantom can be adjusted to 50, 70 and 90 kg and can be applied with the torso inclined at 0°, 45° and 80°. Validation of the phantom by measuring interface pressure using a force sensing array mat indicates that the phantom represents realistic physiological loading conditions. The new method of measuring the distortion of the “artificial tissues” provides a highly selective ranking of PSS.

Social support, life stress, pain and emotional adjustment to advanced breast cancer.

The purpose of this study was to examine relationships between emotional adjustment to advanced breast cancer, pain, social support, and life stress. The cross-sectional sample was compromised of 102 women with metastatic and/or recurrent breast cancer who were recruited into a randomized psychosocial intervention study. All women completed baseline questionnaires assessing demographic and medical variables, social support, life stress, pain, and mood disturbance. Three types of social support were assessed: (1) number of persons in support system; (2) positive support; and (3) aversive support. On the Profile of Mood States (POMS) total score, we found significant interactions between life stress and social support; having more people in the patient's support system was associated with less mood disturbance, but only among patients who had undergone greater life stress. Also, aversive social contact was significantly related to total mood disturbance (POMS), and having more aversive social contact was particularly associated with total mood disturbance (POMS) among patients who had undergone greater life stress. Pain intensity was associated with greater total life stress, and was not significantly related to social support. These results are consistent with the 'buffering hypothesis' that social support may shield women with metastatic breast cancer from the effects of previous life stress on their emotional adjustment; however, aversive support may be an additional source of life stress associated with emotional distress. Also, pain is greater among women with greater life stress, regardless of social support.

Consultation in Palliative Medicine

Palliative medicine is an emerging medical discipline in the United States, modeled after similar efforts in Great Britain, Australia, and Canada. Increasingly, academic medical centers are starting clinical programs in palliative medicine including inpatient consultation services. A description of the essential components of a palliative medicine consultation is presented, based on the author's experience of more than 600 patient encounters at the Medical College of Wisconsin in Milwaukee. A palliative medicine consultation consists of 6 features: assessment and management of physical symptoms; assisting patients to identify personal goals for end-of-life care; assessment and management of psychological and spiritual needs; assessment of the patient's support system; assessment and communication of estimated prognosis; and assessment of discharge planning issues.

Concurrent medical illness in the schizophrenic patient: Epidemiology, diagnosis, and management

The management of the medically ill schizophrenic patient presents a dual dilemma for the physician. The patient may have a serious medical illness that must be diagnosed and effectively treated, yet the patient's psychiatric disorder may interfere with effective management. Thus, undiagnosed and untreated medical illness can result in significant morbidity for schizophrenic patients. Because schizophrenic patients may appear to be less cooperative than medical patients without concurrent psychiatric illness, they can cause countertransference reactions on the part of physicians and nursing staff that can interfere with treatment. Schizophrenic patients also have deficits in the processing of sensory information. These deficits require the staff to make changes in management in order to facilitate the patient's ability to cooperate with treatment and to give reliable informed consent. A host other factors complicate the medical management and treatment of schizophrenic patients. Such factors include medication side effects of psychotropic medication, the potential interactions between medications used to treat the patient's physical illness with psychotropics, pregnancy in the female patient, and the strength of the patient's support system. The ability to successfully diagnose and treat concurrent medical illness in the schizophrenic patient will depend on the physician's ability to be flexible and to understand the implications of the patient's underlying disorder for his relationship to hospital staff. This paper reviews some of the relevant literature and describes possible treatment strategies integrating what we know about schizophrenia with medical management.

Inpatient psychosocial treatment of chronic schizophrenia: negative effects and current guidelines.

In the inpatient psychosocial treatment of schizophrenia, therapies that are intense and overstimulating often promote or prolong regression and negatively affect long-term adjustment. These approaches fail to take into account the chronicity of the disorder, the special vulnerabilities of the schizophrenic patient, and the appropriate goals of an inpatient admission. Based on a review of these problems, the authors offer several prescriptions for inpatient psychotherapy of schizophrenia: modest, well-defined goals; gentle, supportive, educational interactions with the patient; inclusion of the patient's support system and outpatient caregivers in the treatment; and attention to long-term adjustment as well as to short-term symptom removal.

Compliance with cancer therapy by patients and physicians

Although compliance with treatment regimens has been shown to be a significant problem in many areas of medicine, there are little data quantitatively describing the extent of the compliance problem for cancer patients. Traditionally, compliance has been understood as the degree to which a patient's behavior coincides with the prescribed medical regimen. However, patient behavior may be only one of several factors that determine comoliance; other important components may include physician behavior, the patient-physician relationship, and the patient's support system, including family. In this report, we review the literature on cancer compliance in terms of the patient, the physician, and patient-physician relationships. Subgroups of patients are identified as appropriate for compliance research, and methodologic considerations and research strategies are explored.

"Community support systems assessment" for use in clinical interviews.

This article addresses the practical problem of economically assessing a patient's support systems within the exigencies of a psychiatric emergency service and the limits of a routine intake interview. The methodology described includes an open-ended clinical interview, in both brief and expanded form, which can be integrated into standard clinic procedures and records. The focus of the interview, the Community Support Systems Assessment, is on the naturally occurring supports available to the patient, with sensitivity to the subcultural and clinical variations that influence the supports that might be expected. The instruments described are essentially clinical tools but serve research purposes as well.