Situation Of Patients Research Articles

Compassion training: Towards a better understanding of patients through self-exposure.

In healthcare, clinicians are expected to communicate in a compassionate way with patients.1 Although medical training for students at the University of Bern offers communication training, for example, breaking bad news or motivational interviewing, compassion or compassionate behaviour is not yet specifically addressed. An interdisciplinary team (medical education, psychology, communication and palliative care) designed and piloted an elective blended course with 1 day of classroom training to improve sixth-year medical students' compassion in patient–physician communication. The learning goals of the pilot included (a) understanding the role of compassion in the patient-physician relationship; (b) characterise the components of compassion; (c) reflecting one's own emotions and developing self-compassion techniques; (d) demonstrate understanding a patient's situation; and (e) developing a compassionate care plan together with the patient. In order to learn about the existing concepts and the importance of compassion, students (n = 8) received preparatory e-learning material in advance. Its contents were discussed and reflected upon during the classroom training. Preparatory reading included directions regarding self-compassion techniques and two case descriptions to initiate reflection about one's own emotions. These materials were contemplated during the training with an expert input about self-compassion and group discussions about integrating these techniques into daily clinical practice. Using simulation, students then explored their feelings and emotions from a patient perspective through self-exposure to various life conditions, such as physical restrictions (wearing bariatric suits or age simulator) or having stigmatising skin diseases (using a moulage of psoriasis or acne). The goal was to foster a deeper understanding of the patient's situation through own experiences. Based on these experiences (‘how did I feel myself, and what might be the related feeling of my patient?’), students created a communication guide for a conversation with simulated patients (SP). In a second step, students used this guide in SP interactions trying to shift from medical reasoning and counselling to assessing and addressing emotions and individual suffering. The final step in this interaction then was to create a compassionate care plan yielding to integrate medical treatment and emotional comfort. The evaluation of the course included (a) students' verbal feedback immediately after the training, (b) students' written evaluation in respect of content and learning goals as well as methodological and didactic aspects and (c) students' self-assessment of skills in compassionate communication using the Sinclair Compassion Questionnaire (SCQ) prior and after the training (www.compassionmeasure.com). Our interactive compassion training seems to address students' needs and expectations in terms of a high quality and compassionate patient-physician interaction. Students very much appreciated the exchange and the reflections within the group about compassion, communication and their own experiences during simulation. Before the training, the majority rated themselves according to the SCQ in most items as ‘somewhat competent’ or ‘neutral’. After the training, students' ratings were more differentiated, ranging from ‘somewhat lacking competence’ to ‘very competent’. All participants strongly recommended offering this ‘compassion training’ to all medical students as a mandatory class; one student even regarded this training as being one of the most important aspects of medical school. Andrea Lörwald, Seraina Petra Lerch, Daniel Bauer, Steffen Eychmüller and Sibylle Jeanine Felber made substantial contributions to conception and design of the course. Daniel Bauer, Steffen Eychmüller, Sibylle Jeanine Felber, Seraina Petra Lerch, Florence Liaudet and Andrea Lörwald conducted the training and acquired the data for evaluation. Florence Liaudet, Sibylle Jeanine Felber, Steffen Eychmüller, Seraina Petra Lerch and Andrea Lörwald analysed and interpreted the data. Sibylle Jeanine Felber and Andrea Lörwald drafted the manuscript. Daniel Bauer, Steffen Eychmüller and Seraina Petra Lerch revised it critically for important intellectual content. All authors approved the version to be published and agree to be accountable for all aspects of this study.

Primary Health Care: Our Experience From an Urban Primary Health Care Center in Greece.

This observational study reported patient data derived fromthe emergency files of a primary health care (PHC) center in Greece, with the aim of providing potential solutions for a well-organized, well-structured, and effective social healthcare system. This series was conducted at a single urban PHC center in Greece between August 2017 and March 2020. A total of 83,592 patient visitswere registered. The mean patient age was 42.5 years (range: three months to 93 years). Demographics, presenting complaints, and the need for patients who visited the healthcare center to be referred to tertiary hospitals were examined. Further perspectives and future strategies to strengthen the national PHC system were addressed. The most common reasons for visits were pathological (33.6%), followed by general surgery (21.2%) and orthopedics (18.1%). Pediatric conditions accounted for 12% of visits, cardiological conditions accounted for 8.6%, and dental problems accounted for 6.8%. The majority of the patients (n = 81,317, 97.3%) were managed within the health center, and only 2.7% of cases (n = 2275) needed to be referred to a secondary or tertiary healthcare structure. Reasons for patient referral included the severity or complexity of the patient's situation, lack of a specific medical specialty, and the unavailability of overnight laboratory tests. The PHC center remains the cornerstone of a high-quality healthcare system. A well-structured PHC unit can improve health outcomes and decongest secondary and tertiary health care.

Treatment strategies for endoleak after endovascular repair of the abdominal aortic aneurysm: A single center retrospective study

BackgroundEndovascular abdominal aortic aneurysm repair (EVAR) is the most frequently used treatment for aneurysm in abdominal aorta. The endoleak after EVAR causes the aneurysm sac to remain enlarged and risk for rupture. AimsThe purpose of the study was to assess the efficacy of strategies and techniques for endoleak treatment. MethodsThis study was a single center retrospective study of 30 patients who had kinds of endoleak. The 30 patients were from a cohort of 597 patients who received EVAR from the Secondary Xiangya Hospital, Central South University between Jan 2014 to Dec 2021, what is follow-up well and diagnosed as endoleak. Data included basic clinical information, aspects of the endoleak treatment techniques, and follow-up findings. ResultsThe 30 patients with endoleak were diagnosed by computed tomography angiography or digital subtraction angiography. Age is 69 ± 7.9 yrs. 26 patients are male with only 4 female patients. Immediate endoleak after EVAR is 46.7%and delayed endoleak is 53.3%. The classification of endoleak is type Ⅰ:76.6%; type Ⅱ 26.7%; type Ⅲ:6.7%; type Ⅳ:6.7%; type Ⅴ:13.3%. Different treatment of endoleak includes: screening, endovascular re-intervention and open surgery. There are 3 patients (10.0%) underwent emergency EVAR due to their rupture condition of aneurysm. All the endoleak patients’ CTA image characteristics has been reviewed. The follow-up rate is 93.3%. There are 6 patients (21.4%) died during follow-up. No aneurysm sac rupture death has been recorded. ConclusionsEndoleak after EVAR is the most frequent complication that directly affects survival and re-intervention rates. Our findings suggested that different treatment strategies based on the individual patient's situation is important for their endoleak treating result.

Best practices for interventional pain procedures in the setting of a local anesthetic shortage: A practice advisory from the Spine Intervention Society

Representatives from the Spine Intervention Society (SIS) Standards Division and Evidence Analysis Committee have developed the following best practice recommendations for the performance of interventional pain procedures in the setting of a local anesthetic shortage. The practice advisory has been endorsed by SIS, the American Academy of Pain Medicine, the American College of Radiology, the American Society of Neuroradiology, the American Society of Spine Radiology, the North American Neuromodulation Society, the North American Spine Society, and the Society of Interventional Radiology, who support the following best practice recommendations and statements for the performance of intra-articular, extra-articular, paraspinal, and epidural injections in the setting of a local anesthetic shortage.1.Use of preservative-containing local anesthetics is discouraged in the performance of neuraxial procedures where the injectate may enter the epidural (or intrathecal) spaces.2.When performing procedures with risk of arterial injection, ropivacaine should not be mixed with dexamethasone and injected due to the risk of crystallization and embolization.3.Physicians should not withdraw directly from vials of local anesthetic for multiple patients due to infection risk as per Centers for Disease Control and Prevention (CDC) and Joint Commission guidelines [1].4.Only pharmacists may repackage local anesthetic vials for multiple patients. This must be performed under strict, sterile conditions and only in times of critical need. In such situations, physicians must adhere to the beyond-use-date and storage conditions on the repackaged label [2,3].5.Joint, tendon, bursa, and/or ligament injections may be performed with local anesthetic with or without preservative.6.Interventional pain physicians should weigh the relative chondrotoxicity risks associated with each anesthetic when performing joint injections.7.Topical anesthetics, infiltration with diphenhydramine, and nonpharmacologic therapies (i.e., cognitive behavioral therapy, guided imagery, virtual reality, mechanodesensitization) may be used as alternatives to skin infiltration of local anesthetic for reducing procedural pain.8.Use of small-gauge needles (25 gauge or thinner) mitigates the need for local anesthetic prior to needle insertion.9.For local anesthetic infiltration prior to insertion of large bore needles or incision, 0.5% lidocaine may be as effective as 1%, and for that reason current supplies of lidocaine can be stretched by dilution with normal saline.10.If using an ester local anesthetic due to an amide local anesthetic shortage, interventional pain physicians should be aware (as always) of the potential for an allergic reaction and should be able to respond accordingly.11.Local anesthetic systemic toxicity (LAST) differs between the varying local anesthetics, and interventional pain physicians should be well acquainted with these differences when switching between local anesthetics.Physicians should carefully weigh the risks and benefits of performing procedures without local anesthetic or using an alternative agent in the context of each unique patient's situation and should involve patients in shared decision making before proceeding.Procedures should be performed following Spine Intervention Society Guidelines [4]. The physician should confirm placement of the needle in at least two imaging planes. Please refer to the SIS Practice Guidelines for the full details and standards related to each unique procedure [4].

Interoperability approach for Hospital Information Systems based on the composition of web services

Nowadays, many health centers use Hospital Information Systems (HIS) for the daily management of center activities such as patient data management. In Burkina Faso, many HIS are used for patient data management but these systems cannot cooperate because the data sources are often heterogeneous. In order to guarantee a better diagnosis in patient management, physicians need to access these data sources in a unique way through queries. For better analysis of a patient's situation, the health worker may want to access multiple data sources that do not belong to the same health center. This is only possible if the HIS involved interoperate. In a previous work, we proposed an interoperability architecture based on semantic web services. This solution has the advantage of not modifying the current organization of health centers. Indeed, for a complex query, a composition of web services is a solution to satisfy different needs. In this paper, we detail our approach for composing semantic web services. In our approach, the functionalities of each HIS application will be implemented by a web service semantically annotated by an ontology. An ontology-based mediation service is used to enrich the physician query and the MiniCon algorithm to create a composite web service. The composite web service is executed to return the requested data.

Main predictor scales of mortality associated with septic shock of abdominal origin in adults

Background: sepsis is defined as a condition that causes organ dysfunction, the abdominal type is the second most frequent cause of admission to the intensive care unit, especially in countries with economic decline.Aim: to describe the efficiency of the main scales predicting mortality in the evaluation of septic shock of abdominal origin in adults. Method: literature review using Scopus, Pubmed and Cochrane databases.Results: the research describes the efficacy of mortality predictor scales through 8 articles, mainly Sequential Organ Failure Assessment and Acute Physiology Assessment System and Chronic Health Assessment over others described in adult patients with septic shock of abdominal origin, demonstrating a great benefit of their use on mortality prediction.Conclusions: the scales that predict mortality with the greatest predictive value include APACHE II and SOFA, although other systems such as SAPS II, MEWS, NEWS are also very significant with respect to prediction, and this will depend on the patient's situation and comorbidities. The need for a scale that includes gastrointestinal criteria to facilitate the diagnosis and timely approach to septic shock of abdominal origin, including gastrointestinal signs and symptoms, will be more effective in predicting mortality

Controversy of subtalar arthroereisis in symptomatic flatfoot

Flatfoot could be divided into flexible flatfoot and rigid flatfoot. Flatfoot with symptoms is called symptomatic flatfoot, surgical treatment is required if conservative treatment is not effective. Subtalar arthroereisis is a minimally invasive procedure which has been used for many years with good results in flexible flatfoot, however, still has many controversial points. Controversial points focus on indications and contraindications, optimal age, subtalar arthroereisis alone or not, efficacy and safety of absorbable material implants, and implant removal. The paper reviewed and summarized the use and controversies of subtalar arthroereisis in symptomatic flatfoot as follows:the best indication for subtalar arthroereisis was pediatric flexible flatfoot syndrome and aged from 10 to 12 years old was optimal age for treatment;tarsal coalitions with flatfoot and adult flatfoot were relative indications. Stiff flatfoot, joint laxity, and subtalar arthritis were contraindications;obesity and neurogenic flexible flatfoot were relative contraindications. The correction ability of subtalar arthroereisis alone was limited, and it's combined with other procedures depending on patient's situation. The safety and efficacy of absorbable material implants had been reported. Routine removal of the implant was not necessary, the main reason of which was tarsal sinus pain.

Healthcare professionals' perceptions of psychosocial support for family members in palliative care inpatient units-A qualitative descriptive study.

This study aimed to describe the psychosocial support healthcare professionals in specialist palliative inpatient units provide to family members of palliative care patients. A qualitative descriptive design. The data were collected with focus group interviews and analysed with inductive content analysis. Altogether, 48 healthcare professionals, including physicians, registered nurses and practical nurses, participated in the study. Information sharing was recognised as an essential element of support. Methods to improve support of family members included an opportunity to allocate recourses to the families, systematic support and strengthening healthcare professionals' competence in family care. The healthcare professionals describe their perceptions of psychosocial support for family members primarily through patient care and the patient's situation rather than family needs. Direct support for the family members is realised principally by information sharing and conversations. Healthcare professionals express their opportunities to implement support focusing on family members' needs restricted by reason of organisational resources. The information can be used when developing and improving family care in palliative care context to recognise the most relevant needs from healthcare professionals' perspective and also when implementing healthcare professionals' education and training.

Clinical outcome analysis of frozen-thawed embryo transfer on Day 7.

To investigate the clinical outcomes of Day 7 (D7) frozen-thawed embryo transfer (FET) and to provide a reference value for clinical work. This was a retrospective cohort study. Patients undergoing FET cycles in the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University between December 2015 and January 2021 were included. According to the developmental stage of the embryos at transfer, the embryos were divided into three groups: Day (D) 5, D6 and D7 blastocysts. Group D7 was compared with Groups D5 and D6. Simultaneously, the preimplantation genetic testing (PGT) and non-PGT cycles in Group D7 were analyzed and compared. The main outcomes were the clinical pregnancy, live birth and miscarriage rates. The secondary outcomes were the implantation and euploidy rates. In total, 5945, 4094 and 137 FET cycles were included in the D5, D6 and D7 groups, respectively. The clinical pregnancy rate was significantly lower in Group D7 than in Groups D5 (13.9% vs 62.9%, P <0.001) and D6 (13.9% vs 51.4%, P <0.001). Additionally, the live birth rate was significantly lower in Group D7 than in Groups D5 (7.3% vs 50.7%, P <0.001) and D6 (7.3% vs 40.5%, P <0.001). However, the miscarriage rate was significantly higher in Group D7 than in Groups D5 (47.4% vs 18.2%, P =0.001) and D6 (47.4% vs 20.6%, P =0.004). The clinical pregnancy and live birth rates for D7 blastocysts were significantly higher in the PGT group than in the non-PGT group (41.7% vs 13.9%, P=0.012; 33.3% vs 7.3%, P =0.003). D7 blastocyst transfer can yield a live birth rate that is lower than that for D5 and D6 blastocysts but has value for transfer. PGT for D7 blastocysts may reduce the number of ineffective transfers and improve the outcome of D7 blastocyst transfer, which can be performed according to a patient's situation.

Shared decision making: Does a decision aid support patients with an atypical cartilaginous tumor in making a decision about treatment.

Due to new insights, atypical cartilaginous tumors (ACTs) of the long bones are no longer considered malignant and treatment is shifting from surgery to active surveillance. We developed a decision aid in order to support in shared decision making on treatment.The aim of this study is to evaluate the treatment preferences of patients with an ACT in the long bones. During thirty-four months, patients received a decision aid digitally with information about the disease, the treatment options, and the risks and benefits of active surveillance and surgical treatment. The given answers to patients' preference questions were evaluated qualitatively in relation to the final choice of treatment. Eighty-four patients were included. None of the patients who preferred active surveillance later underwent surgery. Only four patients underwent surgery based on patient preference. In our experience the decision aid is useful for shared decision making as it provides the patient with information and the clinician with insight into patient's preferences. The preference for treatment generally corresponds to the eventual treatment. When treatment changes, due to new insights, a decision aid seems helpful for both patients and clinicians to discuss the treatment that best suits the patient's situation.

Application of Patient Intelligent Monitoring System Based on Internet of Things and Cloud Platform

In order to reduce the work intensity of traditional medical staff on patient patrol and timely understand the status of various indicators of patients, a set of patient intelligent monitoring system which based on Internet of things and cloud platform is designed. This study uses the internet of things technology to monitor the patient's heartbeat, pulse, ballistocardiography, body position, whether out of bed and sleep quality. The data is transmitted through optical fiber sensing technology and uploaded to the cloud platform to understand the patient's situation in real time. The results show that the system has stable performance and can ensure the real-time and accuracy of medical information. Meeting the needs of ward front-line management, not only reduce the workload of nurses, but also improve work efficiency. It is great significance to ward management and the development of hospital information construction.

How patient-centredness takes place in pharmacy encounters: a critical common-sense interpretation of video-recorded meetings.

Counselling patients in community pharmacies is important to obtain the best usage of medicines. However, it does not seem to be sufficiently patient-centred. To become more patient-centred, communication guidelines could be used but the guidelines need to be supplemented with up-to-date research that specifies how patient-centredness takes place or could take place in the pharmacy encounters. To use a qualitative methodology to investigate how patient-centeredness unfolds in Danish pharmacy encounters by analysing video-recorded encounters. A maximal variation sampling strategy was applied, including staff from 2 pharmacies. A preunderstanding of 'patient-centredness' guided the analyses with focus on the development of relationships, understanding the patient's situation, and coordination of care. Data were then subjected to a 'critical common-sense' interpretation. To validate identified themes, 'structural corroboration', 'researcher triangulation', and a 'meaning saturation process' were carried out. Nineteen encounters were included. Overall, the staff took responsibility for ensuring patients' optimal medicine use and focused on biomedical aspects of the treatment. Important messages conveyed by staff appeared to be that there is one correct way of taking medicines and that taking the medicine is an uncomplicated process. Patients were rarely invited to provide their perspective. Staff showed commitment to ensuring patients' optimal medicine use, but during this process, they predominantly relied on a reductionist approach to medicine. This must be addressed as it hampers patient-centredness. Suggestions for how to become more patient-centred are given.

Getting real in interprofessional clinical placements: patient-centeredness in student teams’ collaborative learning

Collaboration between healthcare providers helps tackle the increasing complexity of healthcare. When learning teamwork, interprofessional students are expected to work patient-centered; recognizing the patient’s expertise and partnering with them. Research on interprofessional education (IPE) for undergraduates has illuminated learning outcomes, organization of learning activities, change in attitudes, etc. But, we know little about the interaction between patients and interprofessional student teams. This study aimed to explore how interprofessional student teams and patients interact in interprofessional clinical placements. With a focused ethnographic approach, participant observation and qualitative interviews were conducted in two contexts; a physical and an online arrangement. Central ideas in Goffman’s dramaturgy constituted a theoretical lens. A reflexive thematic analysis generated three themes: (1) Preparing safe and comfortable encounters with patients, (2) Including and excluding the patient in the encounter, and (3) Adjusting to the patient's situation. We identified students’ intentions of patient-centeredness when preparing encounters, but patients did not always feel included and listened to in encounters. After encountering patients, student teams adjusted their teamwork, by changing the team composition or the planned clinical interventions to better meet the patients’ needs. Notably, team-based patient encounters led to a different view of the patient, their health issues, and how to collaborate. Our findings can inform educators of the importance of addressing patient-centered care in interprofessional learning arrangements. Today, clinical interprofessional placements may not exploit the potential for learning about patient-centeredness. A thematization of this, e.g., in supervision in future clinical placements can ensure an enhanced focus on this in interprofessional teamwork.

Multimorbidität im Versorgungsalltag – Definitionen, Strategien und Grenzen

The challenge of multimorbidity, the occurrence of multiple medical conditions, lies in its complexity, considering their type and severity, their interactions, and the patient's social status and characteristics. Although the number of combinations appears unlimited, there emerge so-called multimorbidity patterns, that group diseases, that often coincide.The prevalence of multimorbidity will increase dramatically because of the demographic change and the medical progress, leading to exploding costs in healthcare. The definition and the therapeutic approaches of the field are ambiguous, while it also lacks an established assessment.The complex needs of a patient with multimorbidity are not addressed appropriately with the established one-disease-approach. Clinical guidelines can suggest conflicting treatment strategies, which result in decision dilemmas in daily work.Time, communication and decisions adapted to the patient's situation are the key to a successful treatment of multimorbidity. An integrated approach must be based on a comprehensive geriatric assessment. Action strategies and the integration of guidelines are needed and will support the clinician during the decision-making processes. Furthermore, clinical studies should include older adults with multimorbidity and should particularly consider their relevant outcomes.Geroscience is a new research area that addresses the hallmarks of aging with therapeutic approaches to delay or even avoid the onset of multimorbidity.

The General View of Psychotherapy / The Meta Model and Predictive / Preventative Mental Health Care Have Seven Groups of Reasons That Affect the Four Cornerstones of Well-Being

A common goal among the many schools of psychotherapy these days is to find elements of psychotherapy that apply to many of them. The basis for which a general view like this can be found consists at least of the language and terms used, discovery of new activities, the structure of therapy and the work environment. Since the realization of psychotherapy also attempts to prevent a patient's situation from worsening, the following question comes up: does the search for a psychotherapy metamodel feature elements that are similar to predictive mental health care? Mental health care in Finland employs a categorization of seven reasons and four cornerstones of well-being to prevent mental malaise, mental disorders, and negative exceptional behavior. This study collected a file of psychotherapeutic research results and compared it against a file regarding predictive mental health care, which affirmed the thesis “the general view of psychotherapy and preventative mental health care have a functional common categorization that consists of seven groups of reasons and four cornerstones”.

Correlation between medical student empathy and a Korean nationwide comprehensive clinical assessment score at a medical school in Korea.

Empathy is the ability to understand and communicate a patient’s situation, perspective, and feelings. When demonstrated by healthcare professionals, this can improve patient adherence, satisfaction, and treatment outcomes. Empathic students have stronger affective skills and can acquire, develop, reinforce, and display strong affective behaviors, abilities, and attitudes.We measured student empathy using the Student Version of the Jefferson Scale of Empathy (JSE-S) and assessed 3-year sequential clinical comprehensive assessment scores conducted by the Korean Medical Education Assessment Corporation to determine the relationship between JSE-S and clinical comprehensive assessment scores.The study population comprised of 80 males (74%) and 28 females (26%), among which 38 (35%) and 62 (57%) students wanted to become private physicians and attending faculty, respectively. Regarding future majors, 58 students (54%) considered medical fields, whereas 40 students (37%) considered surgical fields. No significant differences in Korean JSE-S were observed according to medical student gender, career aspirations, or future major fields.The modified Korean version of the JSE-S has 18 items. Item-total score correlations and Cronbach α evaluated the internal consistency reliability of the scale. The reliability of the Korean JSE-S was 0.910 by Cronbach α coefficient.Female students had better scores than males. Students who wanted to be an attending faculty had better scores than others who wanted to be private physicians; however, these findings were not statistically significant. Significantly higher scores were seen among students aspired to work in the medical field (65.6 ± 8.8) versus in the surgical field (60.4 ± 8.2) in their 5th year (P < .01).We were unable to show the positive correlations between the empathy scale and comprehensive assessment results. Among female medical students, comprehensive assessment results were inversely correlated with empathy toward the patient, but this was not statistically significant.The modified Korean JSE-S has acceptable reliability. Every student had a better comprehensive assessment after studying the medical curriculum between the 4th and 6th years. The current nationwide assessment tool does not measure student empathy.

Strategies for intraoperative management of the trigeminal nerve and long-term follow-up outcomes in patients with trigeminal neuralgia secondary to an intracranial epidermoid cyst.

BackgroundEpidermoid cysts (ECs) are one of the most common causes of secondary trigeminal neuralgia (TGN). However, most previous studies have primarily focused on whether complete tumor resection was achieved, and few studies have discussed the primary goal of pain relief.ObjectiveThe present study provides intraoperative strategies for trigeminal nerve (TN) management in patients with TGN secondary to an EC and observed long-term follow-up outcomes.MethodsA total of 69 patients with TGN secondary to an EC at our hospitals were included (January 2011–June 2021). The same surgical team performed all surgeries using a retrosigmoid approach. After EC removal, different methods for TN management were used, including microvascular decompression (MVD), sharp capsulectomy, nerve combing and embedded cholesterol crystal excision. The epidemiological, clinical, and surgical data were extracted.ResultsThe total EC removal rate was 92.8% (64/69). All patients achieved initial pain relief postoperatively, and 12 patients (17.4%) experienced varying degrees of hemifacial hypesthesia, which was relieved within 3–6 months. Three patients (4.3%) reported partial pain recurrence within a median follow-up period of 5.5 (0.5–10.5) years, which was relieved completely after low-dose carbamazepine administration.ConclusionThe primary goal of surgical tumor removal for patients with TGN secondary to an EC is relief of the main symptom of tormenting pain. The selection of an appropriate strategy for TN, including MVD, sharp capsulectomy, nerve combing or embedded cholesterol crystal excision, should depend on the patient's situation.

Quality of nursing records in a sector of the Public Hospital of the City of Oberá

Background: records are the main source of information regarding the patient's situation, and should contain complete and accurate information, as they allow retrospective evaluation of the care and attention provided. Aim: to analyze quality indicators of nursing records in a sector of the Public Hospital of the City of Oberá (Misiones) in Argentina. Methods: a retrospective, descriptive design was used for this study. The study was carried out from October 2021 to February 2022. The sampling process consisted in the selection of the patients' medical records, which finally consisted of 195 nursing records. Results: in relation to the distribution of compliance with nursing records according to the dimensions, problems are denoted in the home record, complete Kardex record (Digital Medical History System - RISMi) and complete record of nursing notes records. Conclusions: the evaluation of the quality of nursing records denoted that there are problems and weaknesses in terms of content, process and structure. The results of this study affirmed that nurses have failed to understand and apply the basic concepts of nursing diagnosis, planning, implementation and evaluation. This is alarming for the quality and effectiveness of nursing education, as well as for staff development and training programs for nurses

Neurologists’ views on patient reported outcomes in multiple sclerosis care

BackgroundThe value that patient reported outcomes (PROs) can bring to the clinical encounter is increasingly being recognized. Within the field of Multiple Sclerosis (MS), a number of activities have been initiated internationally with the aim of integrating PROs in MS care. Integration of PROs in MS care will, among other things, require MS neurologists' acceptance of PROs. This qualitative study aimed to explore MS specialized neurologists’ view on the potentials and barriers for the use of PROs in the clinical setting. MethodsEight neurologists specialized in MS participated in a series of individual in-depth semi-structured interviews. Interviews were audio-recorded and transcribed. A thematic analysis was conducted using a reflexive thematic approach to identify meaning units and themes emerging from the interviews. The analysis focused on barriers and potentials for PROs that relate to the specific characteristics of MS. ResultsThree main themes emerged from the data. “The role of PROs in describing the patient's situation” describes how informants perceived MS as a complex disease, and in this context, PROs can bring forth new or otherwise hidden information, but they may also blur the picture. The theme “The validity of PROs reported by MS patients may be questionable” describes how impairments caused by MS, such as cognitive and physical disabilities, were identified as risk factors that could cause unreliable self-reported outcome measures within this patient group. Finally, the theme “Involving the patient” regards how the clinical conversation was viewed as the most important source of patient reported information, but at the same time PROs carry the potential to enhance shared decision making. ConclusionThis study indicates that, according to MS neurologists, integration of PROs in MS clinical practice, though possibly valuable, is not without challenges. Possible benefits of PROs include the ability to bring forth otherwise hidden information on the patient's health status and the enhancement of shared decision making. Barriers include difficulties in capturing the full situation of the patient via PROs due to the complexity of MS as well as the issue of various MS-related impairments compromising the validity of PROs reported by MS patients.

NEO-ADJUVANT CHEMOTHERAPY, DOWN-STAGING, AND RESECABILITY OF NON-SMALL CELL BRONCHO-PULMONARY CANCERS

TYPE: Abstract TOPIC: Cardiothoracic Surgery PURPOSE: Non-small cell cancer (NSCC) constitutes 85% of bronchopulmonary cancers. Surgery is at the center of any curative strategy, but its indications remain limited because of the patient's situation and the often late diagnosis. METHODS: This was a retrospective study of 103 patients with different stages of NSCC and proposed for CNA. RESULTS: The median age was 55.5 years and the sex ratio M / F was 13.7. Forty-four percent of the tumors were adenocarcinomas and 36% were squamous cell carcinomas. Fifty percent were classified as stage IIIA. Eighty-eighteen patients have had NAC. According to RECIST criteria, 75% of patients had a partial response. Fifty-five percent of patients had down-staging. Among the 90 operated patients, 53 had a lobectomy, 29 had a pneumonectomy, 3 had a bilobectomy, 2 had a wedge-type resection, 2 had a lobectomy with Wedge and 22 had an enlargement to neighboring structures. The operative courses were uneventefull in 64.2% of cases. The resection was carcinological in 80 patients. The down-staging on pathological examination was 63.2%. Twenty-five patients had a recurrence, with a median time of 9.5 months. The mean overall survival was 25 months, with a median survival of 17 months (2 - 132 months). The 1 year, 3 year and 5 year survival was 85%, 56% and 50%, respectively. CONCLUSIONS: The primary objective of NAC is to improve the resectability of NSCC, with surgery being the only treatment that may offer a chance of recovery. CLINICAL IMPLICATIONS: Neo-adjuvant chemotherapy (NAC) aims to make nonoperable tumors resectable and improve survival. DISCLOSURE: Nothing to declare. KEYWORD: NEOADJUVANT TREATMENT