Patients In Different Situations Research Articles

Retrospective Study of Clinicopathologic Features and Outcome of Colonic Cancer in Relation to Primary Tumor Location

Abstract Background Colon cancer is one of the most common cancers worldwide and outcomes of colon cancer are different according to the primary tumor location and could be considered as distinct disease entities of the same organ. Objectives Analyzing and comparing clinical, epidemiological, pathologic features and outcome of colon cancer according to primary location whether the patients are right sided colon cancer (RSCC) and left sided colon cancer (LSCC) patients in different situations. Patients and Methods This is a retrospective, descriptive and analytical study conducted between January 1st, 2013 and January 1st 2019. One hundred and fifty patients diagnosed with colon cancer were enrolled in GIT unit, Department of Clinical Oncology, Ain Shams University Hospital. Results In our study right sided colon cancer patients were more females and clinically presented with higher frequency of anaemia (P value = 0.001) and perforation (P value = 0.02). Left sided colon cancer on the other side were more males (P value = 0.032) and was associated with more constipation (P value <0.001) and intestinal obstruction (P value = 0.085). RSCC was more associated mucinous adenocarcinoma, more advanced T stage (T4), lymphovascular invasion, larger tumor sizes and more poorly differentiated tumor. LSCC was associated with more advanced stage and lymph node positivity. Right side tumor has highest disease-free survival period which is 34.63 months (95% confidence interval [CI] 28.39-40.86) comparing with the left side tumor which was 24.94 months (95% confidence interval [CI] 19.61-30.27). left side tumor has highest progressive free survival period which is 4.77 months (95% confidence interval [CI] 3.33-8.22) comparing with the right-side tumor which was 2.21 months (95% confidence interval [CI] 0.63-3.79). Conclusion RSCCs and LSCCs show different characteristics in clinical presentation and prognostic features, so we can consider the side of tumor is helpful in determining the behavior and the outcome of the disease. We can consider RSCC and LSCC as two separate disease entities.

Legal Protection of Patients' Right to Privacy

With the advent of the era of the rise of individual rights, countries around the world have accelerated the pace of legislation to protect citizens' right to privacy. However, due to historical and practical reasons, some people in China, especially the patients receiving hospital examination and treatment, have not been given due protection. Does the patient have the right to privacy? The answer is yes, but it is a special right of privacy. It is precisely because the subtle relationship between doctors and patients in different situations is a special civil legal relationship, so the protection of patients' privacy also presents its particularity. The author believes that this particularity is reflected in three situations, namely, in the doctor-patient relationship, in clinical teaching and in the "later" relationship. So, how should we protect this special right? This paper argues that, first of all, we should provide legal protection. Affirm that the right of privacy is an independent personal right, add the concept of the right of privacy in the Civil Code, and formulate specific medical regulations and operating systems. Secondly, improve the practical operation technology. Thirdly, the whole society should establish the concept of protecting patients' privacy.

A comparison of the effects of multimedia and peer teaching methods on medication adherence in heart failure patients

Objective: The present study investigated and compared the effects of peer and multimedia teaching methods on medication adherence of heart failure patients. Methods: This quasi-experimental study was done in Arak University of Medical Sciences hospitals, Arak, Iran. Samples were 44 patients with heart failure, studied in two groups. Twenty-two patients received medication adherence education through multimedia content developed by the researchers and a trained peer educated the other 22 patients. The patients’ medication adherence was assessed with a medication adherence questionnaire designed by Girerd et al. (2001) before, immediately after, and 1 month after the intervention. Data was entered the SPSS 23 and analyzed through descriptive and inferential statistics (ANOVA). Results: The study of medication adherence indicated that medication adherence was different in each group before, immediately after, and one month after the intervention; however, there was no statistically significant difference between the two groups. Conclusion: Both peer and multimedia education methods improved medication adherence in patients with heart failure. However, the improvement rate in medication adherence was higher in the multimedia group. Practice Implication: It is suggested to use an appropriate method for teaching patients in different situations based on the available facilities and conditions.

Management of multiple magnetic foreign body ingestion in pediatric patients

BackgroundMultiple magnetic foreign body ingestion in children is increasingly common and can cause serious injury. The present study aimed to analyze the clinical features of such cases and summarize treatment experiences.MethodsA retrospective survey of 91 patients in the Children’s Hospital, Zhejiang University School of Medicine with magnetic foreign body ingestion from October 2018 to October 2021 was performed, the data were collected including the clinical information of the patients, treatment details, and prognosis.ResultsTwenty-two (24.2%) patients were conservatively treated, with the foreign bodies discharged through the anus, 31 (34.1%) underwent laparoscopic surgery, including 18 cases converting from laparoscopic surgery to laparotomy, and 38 (41.8%) underwent laparotomy. In 13 (14.3%) patients, the foreign bodies were partially removed by gastroscope. The remaining foreign bodies were removed by laparoscopy in six patients, including three cases converting from laparoscopy to laparotomy, by laparotomy in four patients, and by conservative treatment in three patients.ConclusionsMultiple magnetic foreign body ingestion can cause significant harm to patients and different clinical techniques must be used for patients in different situations to reduce the harm to children.

Knowledge Level of Pre-Hospital Emergency Medical Services Personnel about Ambulance Equipment in Rasht, Iran

Background: Emergency Medical Services (EMS) personnel are often the first to provide healthcare services to the patient in different situations outside the hospital. Due to the sensitivity of this work, knowledge of ambulance equipment can affect the performance of Emergency Medical Services personnel. Objective This study aims to assess the knowledge of pre-hospital EMS personnel in Rasht, Iran about ambulance equipment. Methods: This cross-sectional analytical study was conducted on 84 EMS personnel who were selected from 17 medical centers in Rasht, Iran using a convenience sampling method. The data collection tool was a two-part questionnaire. The first part surveys demographic characteristics (age, gender, work experience, type of employment, education, field of study, history of retraining courses) and the second part assesses the knowledge of ambulance equipment according to the Pre-hospital Emergency Medicine/Equipment User Manual of Iranian Ministry of Health and Medical Education (fourth edition). The data were analyzed in SPSS v. 22 software and the significance level was set at 0.05. Results: Most of participants had a bachelor’s degree, were under permanent employment, and had a degree in nursing and emergency medicine. Their mean work experience was 9.84±6.41 years, and most of them had a history of participating in retraining courses. Their knowledge of ambulance equipment was at a good level. Kruskal-Wallis test showed that their knowledge level had a significant relationship with their type of employment (P<0.001). Conclusion: It is necessary to increase the knowledge level of pre-hospital EMS personnel about ambulance equipment by holding short-term training courses and using simulation methods.

Clinical decision making approaches and associated factors among nurses working in a tertiary teaching hospital

IntroductionThe clinical decision-making approach is an ongoing process in the nursing clinical setting and has an impact on the survival of the patient under their care. ObjectiveTo assess clinical decision-making approaches among hospital nurses. Methods and materialsAn institutional-based cross-sectional study was conducted from March 20 to April 4, 2018. A single population proportion formula for sample size determination and stratified sampling technique was used to select the study participants. The data was gathered using a pretested, structured, self-administered questionnaire and trained data collectors. The data was analyzed using SPSS version 20. To explain the study variables, frequency tables, figures, and percentages were used. Bivariable and multivariable logistic regressions were used to see the association between independent and dependent variables. ResultsAmong the total participants, 44.3% had intuitive and 55.7% had analytical decision-making approaches. Being at a higher educational level (aOR = 3.49, 95 % CI (1.45, 13.16)), having 10 years experience, having a high workload (aOR = 0.54, 95 % CI (0.37,0.42)) and having training (aOR = 3.11, 95 % CI (1.83, 5.28)) were significantly associated with intuitive clinical decision making. ConclusionThe intuitive decision-making approach was lower as compared to most of the previous studies. Variables such as higher experience, the high workload in the working unit, and talking training in clinical decision-making were significantly associated with the intuitive decision-making approach. Therefore, policymakers ought to implement the standard nurse-to-patient ratio and design training on how to handle the patient in different situations to achieve a good decision-making approach.

Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis

Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.

Pain management in Neonatology

The recognition of the existence of pain in infants hospitalized in the Neonatal Intensive Care Units makes it necessary to reach consensus on prevention, assessment and treatment strategies. Acute pain produces adverse changes in the short term and chronic pain alters the response systems to stress and impacts on neurodevelopment. The objective of this pain management agreement is to unify criteria of attention of these patients in different situations that generate pain and stress that they face during their hospitalization. There are validated scales to assess pain and guide appropriate strategies for its approach that include measures of comprehensive or nonpharmacological care and pharmacological care that we will review.

Загальні правила комунікації студента з пацієнтом

Для більшості студентів початкові кроки навчання спілкування з пацієнтом є дуже тривожними та складними. Це насамперед обумовлено потужною соціальною роллю лікаря в суспільстві, до якої студенти-медики молодших курсів не готові як з точки зору професійної компетентності, так і особистічної психологічної зрілості.
 Саме тому на початках виникає безліч запитань щодо особливостей професійної медичної комунікації, які студенти задають собі і своїм викладачам, коли вони починають навчання комунікативним навичкам лікаря. У статті представлені відповіді на найбільш поширені запитання, що викликають занепокоєння у студентів з приводу спілкування з пацієнтами.

In vitro power profiles of multifocal simultaneous vision contact lenses

To evaluate the power profile of multifocal contact lenses (CLs) using a new technology based on quantitative deflectometry. The Nimo TR1504 was used to analyze the power distribution of multifocal CLs. The CLs under study were: Air Optix Aqua Multifocal Low, Medium and High Addition and Focus Progressives. Three lenses of each model were considered. All multifocal CLs showed a power profile characterized by a change toward more positive power values when aperture sizes become smaller. The near refractive addition of the lenses under study was +2.61 D, +1.44 D, +1.30 D and +0.30 D for the Focus Progressives, the Air Optix Aqua Multifocal High, Medium Add and Low Add, respectively. The refractive power of the Focus Progressives did not reach the value of the nominal distance power until a radial distance of 0.9 mm from the center of the lens. For the Air Optix Aqua Multifocal Low Add the distance nominal power was reached at a radial distance of 1.5mm from the center of the lens, whereas this occurred at a distance of 1.8mm for the Air Optix Aqua Multifocal Medium and High Add. The relation between the pupil diameter of the patients and the power profile of these CLs has a crucial implication on the final distance correction and near addition that these lenses provide to patients. Practitioners should know the power profile of these CLs and measure the pupil diameter of each patient in different situations in order to carry out a customized fitting.

General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study

To identify factors that influence the extent to which general practitioners use absolute risk (AR) assessment in cardiovascular disease (CVD) risk assessment. Semi-structured interviews with 25 currently practising GPs from eight Divisions of General Practice in New South Wales, Australia, between October 2011 and May 2012. Data were analysed using framework analysis. The study identified five strategies that GPs use with patients in different situations, defined in terms of the extent to which AR was used and the reasons given for this: the AR-focused strategy, used when AR assessment was considered useful for the patient; the AR-adjusted strategy, used to account for additional risk factors such as family history; the clinical judgement strategy, used when GPs considered that their judgement took multiple risk factors into account as effectively as AR; the passive disregard strategy, used when GPs lacked sufficient time, access or experience to use AR; and the active disregard strategy, used when AR was considered to be inappropriate for the patient. The strategies were linked with different opportunity, capability and motivation barriers to the use of AR. This study provides an in-depth insight into the factors that influence GPs' use of AR in CVD risk assessment. The results suggest that GPs use a range of strategies in different situations, so different approaches may be required to improve the use of AR guidelines in practice.

Dolor: la verdadera realidad

Pain is a frequent symptom manifest by patients in different situations, including those who are hospitalized in intensive care units (ICU). In such units, pain is occasionally underestimated and, therefore, hardly treated. The psychological, hemodynamic, metabolic and neuroendocrine reactions provoked by inadequate pain control can produce increased illness and even death. This is why pain assessment has become a challenge to health professionals, especially nurses, as it is they who provide direct and permanent care. Nurses also have the ability to detect and control a patient’s pain and suffering, as a fundamental principle in their assessment. The importance of a thorough grasp of the situation, specifically one that allows for an understanding of physiological changes, as well as the impact of pain on the patient’s life and his/her environment, is often overlooked. The purpose of this article is to analyze the necessity and significance of applying the theory of unpleasant symptoms in everyday practice, as a way to assess pain, to understand its integral meaning, and to know the characteristics particular to each person, as well as their physiological, psychological and environmental factors. To this end, general concepts of pain, medium range theories and application of the theory of unpleasant symptoms are reviewed for an adequate and well-timed assessment of pain in critically ill patients.

Temporal similarity measures for querying clinical workflows

In this paper, we extend a preliminary proposal and discuss in a deeper and more formal way an approach to evaluate temporal similarity between clinical workflow cases (i.e., executions of clinical processes). More precisely, we focus on (i) the representation of clinical processes by using a temporal conceptual workflow model; (ii) the definition of ad hoc temporal constraint networks to formally represent clinical workflow cases; (iii) the definition of temporal similarity for clinical workflow cases based on the comparison of temporal constraint networks; (iv) the management of the similarity of clinical processes related to the Italian guideline for stroke prevention and management (SPREAD). Clinical processes are composed by clinical activities to be done by given actors in a given order satisfying given temporal constraints. This description means that clinical processes can be seen as organizational processes, and modeled by workflow schemata. When a workflow schema represents a clinical process, its cases represent different instances derived from dealing with different patients in different situations. With respect to all the cases related to a workflow schema, each clinical case can be different with respect to its structure and to its temporal aspects. Clinical cases can be stored in clinical databases and information retrieval can be done evaluating the similarity between workflow cases. We first describe a possible approach to the conceptual modeling of a clinical process, by using a temporally extended workflow model. Then, we define how a workflow case can be represented as a set of activities, and show how to express them through temporal constraint networks. Once we have built temporal constraint networks related to the cases to compare, we propose a similarity function able to evaluate the differences between the considered cases with respect to the order and duration of corresponding activities, and with respect to the presence/absence of some activities. In this work, we propose an approach to evaluate temporal similarity between workflow cases. The proposed approach can be used (i) to query clinical databases storing clinical cases representing activities related to the management of different patients in different situations; (ii) to evaluate the quality of the service comparing the similarity between a (possibly synthetic) case, perceived as the good one with respect to a given clinical situation, and the other clinical cases; and (iii) to retrieve a particular class of cases similar to an interesting one.

Only a Manic Depressive!: The Zone of the Untouchable and Exceeding Limits in Acute Psychiatric Care

This article addresses psychotic patients' fragile boundaries and need for professional help to restore their personal untouchable zone. We examine how nurses move into this inviolable zone and re-establish limits. Empirical data are drawn from an acute psychiatric setting and focus on one patient in different situations and on her relationships with nurses. Data from nurses' discussions and the researcher's experience are also included. The concept of the zone of the untouchable, by the Danish theologian and philosopher K. E. Løgstrup, guides interpretation. Analysis shows how and with which critical and constructive consequences the diagnosis-oriented understanding affects the patient-nurse relationship. Conclusions include premises that can guide nurses moving into the patient's untouchable zone.

An overview of research on the prediction of dangerousness

Mental health professionals are required to predict “dangerousness” of patients in different situations. But it is not always clear what is ment by the term “dangerousness”. It can mean simply stating whether or not a specific patient is likely to commit a crime in the future or it can mean identifying the situation or situations in which a specific patient is more or less likely to commit a crime. Epidemiological studies of birth cohorts followed to adulthood indicate that persons with major mental disorders are at increased risk, as compared to non-disordered persons, to commit crimes and crimes of violence. Another group of individuals at high risk to commit crimes are those who meet the the diagnostic criteria for psychopathy. This disorder can now be reliably and validly diagnosed using Hare's Psychopathy Checklist-Revised (PCL-R). Recently, procedures have been developed which allow for relatively accurate predictions of illegal behaviour. These procedures (sometimes referred to as prediction schemes) are specific to different types of persons—the mentally ill, the psychopath, the sex offender, etc. The predictive accuracy of these procedures depends on the collection of high quality objective information, both historical and current.

Pharmacists’ Views of Patient Counseling: Pharmacists believe that patient familiarity with a medication and the seriousness of possible outcomes from its use are important considerations in counseling.

The goal of this study was to assess whether pharmacists rate eight elements of counseling of equal importance in different dispensing situations. A sample of 708 pharmacists was asked to complete a pretested questionnaire about patient counseling; 697 provided usable responses for a response rate of 98%. Using multivariate analysis of variance, analysis of variance, we found significant differences (p<0.01) in pharmacists' ratings of the importance of counseling patients in different situations. Pharmacists used patient familiarity with the medication and the perceived seriousness of potential consequences to the patient to determine the importance of each element of counseling.

Convention for reporting amniotic fluid pressure

A proposed convention sets zero pressure at atmospheric pressure at the level of the surface supporting the supine patient and takes the cm of water as the unit of measurement. This ensures that measurements made in different clinics will be comparable. Statements about ‘higher’ and ‘lower’ pressures, in different patients or in the same patient in different situations, should specify the level of the uterus to which the statement applies.

Motivational determinants in modification of behavior by morphine and pentobarbital.

Many statements in pharmacological literature imply that most drugs exert invariable effects. When differences in the effects of administering the same amount of a drug to different patients have occurred, they have usually been ascribed to idiosyncratic reactions. This is undoubtedly true in the case of those persons who consistently display an unusual reaction to a drug regardless of the conditions under which it is administered. However, the concept of idiosyncrasy cannot explain the commonly observed clinical fact that some drugs exert widely different effects upon the same patient in different situations. The popular description of drugs as either stimulant or depressant, in view of such variability, appears to stem from two sources. One is the information about drug actions, which has been obtained largely in the course of treatment of patients in the relatively standardized situation of the general hospital. The other is knowledge obtained in the laboratory. On