Patient Self Research Articles

Advance Directives and Research Advance Directives

Advance Directives and Research Advance Directives

Coronary artery disease patients experience of patient education, follow up and self care support in rural areas of Iceland

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Icelandic regional development institute, The Icelandic Nurse´s Association, RHA-University of Akureyri, HSA, The Health Directorate of East-Iceland. OnBehalf KRANS People living in rural Iceland have higher rate of cardiovascular risk factors, healthcare utilization and death and worse self-reported health than people in urban areas. The aim of this qualitative study was to explore the experience of people with coronary heart disease, living in rural Iceland, of patient education, surveillance, and self-care support. The participants (N = 14, age 52-79 years, 8 male, 6 female) were interviewed 6-12 months after hospital discharge following a cardiac event (in 2018-2019). Systematic text-condensation was used for analysis. The findings were categorized into three main themes: 1) Education and support describes inadequate patient education and support from health professionals after discharge from hospital and how the internet was the main information source supplemented with spouse’s and family support. 2) Local health care services describe the lack of and importance of access to health professionals, stable services and underutilization of primary health care in the local area. 3) Self-care behavior describes the lack of professional support with lifestyle changes and how the participants manage self-care in their local area as well as their attitude towards the disease. In conclusion, the results indicate that access to continuous health services and person-centered support focusing on prevention strategies is widely impaired in rural areas in Iceland.

Transcutaneous Cervical Vagal Nerve Stimulation in Patients with Posttraumatic Stress Disorder (PTSD): A Pilot Study of Effects on PTSD Symptoms and Interleukin-6 Response to Stress.

Background:Posttraumatic stress disorder (PTSD) is a highly disabling condition associated with alterations in multiple neurobiological systems, including increases in inflammatory and sympathetic function, responsible for maintenance of symptoms. Treatment options including medications and psychotherapies have limitations. We previously showed that transcutaneous Vagus Nerve Stimulation (tcVNS) blocks inflammatory (interleukin (IL)-6) responses to stress in PTSD. The purpose of this study was to assess the effects of tcVNS on PTSD symptoms and inflammatory responses to stress.Methods:Twenty patients with PTSD were randomized to double blind active tcVNS (N=9) or sham (N=11) stimulation in conjunction with exposure to personalized traumatic scripts immediately followed by active or sham tcVNS and measurement of IL-6 and other biomarkers of inflammation. Patients then self administered active or sham tcVNS twice daily for three months. PTSD symptoms were measured with the PTSD Checklist (PCL) and the Clinician Administered PTSD Scale (CAPS), clinical improvement with the Clinical Global Index (CGI) and anxiety with the Hamilton Anxiety Scale (Ham-A) at baseline and one-month intervals followed by a repeat of measurement of biomarkers with traumatic scripts. After three months patients self treated with twice daily open label active tcVNS for another three months followed by assessment with the CGI.Results:Traumatic scripts increased IL-6 in PTSD patients, an effect that was blocked by tcVNS (p<.05). Active tcVNS treatment for three months resulted in a 31% greater reduction in PTSD symptoms compared to sham treatment as measured by the PCL (p=0.013) as well as hyperarousal symptoms and somatic anxiety measured with the Ham-A p<0.05). IL-6 increased from baseline in sham but not tcVNS. Open label tcVNS resulted in improvements measured with the CGI compared to the sham treatment period p<0.05).Conclusions:These preliminary results suggest that tcVNS reduces inflammatory responses to stress, which may in part underlie beneficial effects on PTSD symptoms.

Knowledge, attitude and practice of patients regarding cross infection and infection control in dental college and hospital, Nashik

Patient safety is an important medical discipline which aims at improving quality of patient care, minimizing treatment mistakes and improving safety. Infectious diseases represent an important public health problem facing health care systems in many countries. Cross infection can occur with transmission of infectious agents between patients and health workers. The objective of the study was to determine the level of Knowledge, Attitude and Practice (KAP) of patients attended dental clinics at MGV’S KBH Dental College and Hospital, Nasik, regarding cross infection and infection control in dentistry. A cross-sectional study was conducted among 1200 patients who attended the dental clinics. A standardized, confidential, anonymous, interviewing questionnaire was used. Knowledge about Dental infection was assessed by 10 MCQs. The attitude parameter was assessed through answering seven statements on a three- point Likert scale. Patient self reported practices were also evaluated. Descriptive and inferential statistics were done. Results of the study revealed that 48.6%, 29.3% and 22.1% of the participants obtained poor, fair and satisfactory level of knowledge about infection and infection control in dentistry, respectively. Participant's educational level was significantly associated with the level of knowledge about dental infection. Patients had positive attitudes towards infection control in dentistry. Regarding self-reported practice, almost half of the participants would ask dentists about sterilization of dental instruments (45.8%), wearing face mask (24.5%) and gloves (32.3%). In conclusion, our participants had good attitudes towards infection control in dentistry. However, their knowledge and practice need improvements. Awareness should be increased about cross infection and infection control in dentistry through mass media, TV programs, camps, posters, etc. KeyWords:- Cross infection,Cross-sectional study, Knowledge, Attitudes, Self-reported practice,Awareness

Older children are at increased risk of Plasmodium vivax in south-central Ethiopia: a cohort study

BackgroundBetter understanding of the distribution of Plasmodium vivax and its risk factors could be used to prevent and control malaria infection. Therefore, the aim of this study was to characterize the distribution and risk factors of P. vivax, and to compare them with Plasmodium falciparum occurrence in south-central Ethiopia.MethodsA cohort of 34,548 individuals were followed for 121 weeks between 2014 and 2016 as part of larger cluster randomized controlled trial to evaluate the effect of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) on malaria prevention in Ethiopia. Weekly home visit (active search) and patient self- report to health post (passive search) between the weekly home visits were used to register malaria cases. A blood sample was collected by finger prick and malaria was diagnosed using rapid diagnostic test (RDT). Generalized estimating equation (GEE) Poisson model that accounts for repeated measure of malaria episodes was applied to assess the risk factors of P. vivax episode.ResultsThe overall incidence rate of P. vivax was 7.4 episodes per 1000 person-years of observation. The study showed households closer to the lake Zeway and Bulbula river (potential mosquito breeding sites) were more at risk of P. vivax infection (incidence rate ratio (IRR): 1.33; 95% CI = 1.23–1.45). Furthermore, the age group under 5 years (IRR: 1.40, 95% CI = 1.10–1.79), the age group 5–14 years (IRR: 1.27, 95% CI = 1.03–1.57), households with less educated household head (IRR: 1.63, 95% CI = 1.10–2.44) and house roof made of thatch/leaf (IRR: 1.35, 95% CI = 1.11–1.65) were at higher risk for P. vivax. Similar explanatory variables such as distance from the breeding sites, age group (under 5 years but not 5–14 years old), educational status and type of housing were also found to be the predictors of P. falciparum incidence.ConclusionHouseholds living closer to a mosquito breeding site, age group under 15 years, less educated household heads and thatch/leaf roof housing were the risk factor for P. vivax. The result of this study can be used for tailored interventions for malaria control and prevention by prioritizing those living close to potential mosquito breeding site, enhancing bed net use of children less than 15 years of age, and improving housing.

A community response survey on an ABCD scoring system for patient's self assessment with symptoms of COVID-19

A community response survey on an ABCD scoring system for patient's self assessment with symptoms of COVID-19

Neurobiologische Grundlagen der Borderline-Störung: eine Integration in das ICD-11-Modell der Persönlichkeitsstörungen

Borderline personality disorder (BPD) is asevere mental disorder associated with far-reaching impairments in the self and interpersonal functioning. The broad database has contributed to the fact that BPD remains the only categorical personality diagnosis in ICD-11, even if coupled to the determination of the severity of impairments. Nevertheless, we need to deal with adimensional conceptualization of personality disorders-which is also supported by neuroscientific findings-at the latest in 2022 when the ICD-11 comes into effect . This narrative review provides an overview of neuroscientific findings regarding impairments in self and interpersonal functioning in patients with BPD. Alterations in the medial prefrontal cortex, temporoparietal junction and precuneus mediate deficits in self-referential thought processes and the mentalization of emotions and intentions of others. Enhanced connectivity between the amygdala and midline structures is associated with hypermentalization. At the same time, elevated insula activation seems to underlie the strengthened nonreflective parts of feelings of other people. Frontolimbic alterations are transdiagnostically associated with deficient emotional regulation and negative affectivity and alterations in reward and cognitive control regions are related to impulsivity. Neuroscientific findings help to have abetter understanding of the underlying mechanisms of central functional impairments in BPD and can support the transition to ICD-11 as well as the implementation of new interventions.

Neuronal Signatures of Negative and Positive Schemas towards the Self and Others in Patients with Early Stage Schizophrenia.

ObjectiveThe present study investigated the functional neuroanatomy underlying negative and positive schemas towards the self and others in patients with early stage schizophrenia spectrum disorders (SSDs) using a task-based fMRI procedure. MethodsThis study included 50 patients with SSDs and 52 controls. The schema-evoking task consisted of four active conditions and neutral condition. Differences in brain activation were compared between the two groups. Correlation analysis was performed between task-related activation and psychopathology. ResultsThe SSD patients exhibited higher activity of the left middle and inferior frontal gyri under the negative-others minus neutral contrast as well as greater activation of the left superior and middle frontal gyri and right medial superior frontal gyrus under the positive-self minus neutral and positive-others minus neutral contrasts. Under the positive-others minus neutral contrast, negative correlation was observed between activity of the right inferior parietal gyrus and right angular and total score of the Positive and Negative Syndrome Scale (PANSS), whereas positive correlation between activity of the left middle cingulate gyrus and left/right precuneus and positive-others score of the Brief Core Schema Scales (BCSS). Conclusion The present findings suggest that the frontal brain regions of SSD patients are more sensitive to negative and positive schemas towards the self and/or others compared to those of controls.

Meaning of critical traumatic injury for a patient's body and self.

Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient's body and self. To understand the meaning of traumatic injury for body and self for patients receiving intensive care. A qualitative descriptive study using Giorgi's phenomenological approach. Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30-60 min. Audiotaped interviews were transcribed and analyzed. This study was approved by the Institutional Review Board of the medical center. The impact of the experience of traumatic injury on participants' body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient's body and self that facilitates ethical care and recovery from injury.

Family History of Rheumatic, Autoimmune, and Nonautoimmune Diseases and Risk of Rheumatoid Arthritis.

Since comorbidities such as autoimmune diseases may be associated with rheumatoid arthritis (RA) risk, we hypothesized that a family history of these other conditions might also predict RA. Therefore, we aimed to determine the association between family history of 79 comorbidities and RA. This case-control study identified 821 cases of RA in the Mayo Clinic Biobank (positive predictive value 95%) and matched 3 controls to each case based on age, sex, recruitment year, and location. Patients self reported family history and characteristics (adjusted). Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for RA risk according to the presence of family history for each comorbidity, adjusted for body mass index, race, and smoking. Family history of several conditions was associated with developing RA, including rheumatic autoimmune diseases (ORadj 1.89 [95% CI 1.41-2.52]), pulmonary fibrosis (ORadj 2.12 [95% CI 1.16-3.80]), inflammatory bowel disease (ORadj 1.45 [95% CI 1.05-1.98]), hyper/hypothyroidism (ORadj 1.34 [95% CI 1.10-1.63]), and obstructive sleep apnea (ORadj 1.28 [95% CI 1.05-1.55]). Parkinson's disease and type 2 diabetes mellitus were associated with a statistically decreased risk of RA that did not reach the prespecified significance threshold of P < 0.01 (ORadj 0.70 [95% CI 0.49-0.98] and ORadj 0.81 [95% CI 0.67-0.97], respectively). Analyses among 143 cases of incident RA were similar and also suggested an association with a family history of autism (OR 10.5 [95% CI 2.51-71.3]). Family history of several autoimmune and nonautoimmune comorbidities was associated with increased risk of RA, providing an opportunity to identify novel populations at risk for RA.

Impact of Educational Program for Adolescents and Young Adults with Sickle Cell diseases on their knowledge, Perception, and Self-Care

Self-Management Program(SMP) has a significant positive effect on self-care of a patient with chronic disease.Improving self-care is the most essential stepsto control several complications. Aim: to assessthe influenceof applying educational program onknowledge, perception, and self-care of adolescent and early adulthoodindividual suffering from Sickle Cell Diseases ( SCD). Design of Quasi-experiment was implemented in thisstudy. The current research study was accomplished in the Center of Genetic Blood DiseasesinQatif CentralHospital in the East Area of Saudi Arabian. Subjects: Apurposivesample composed of 82 early adulthoodindividual suffering from SCD. Their ages were between 14-20years. Tools: Interview sheet, itincludedthree parts; socio-demographic data,SCDassessment sheetandtheknowledge assessment sheet. Tool forassessment of self-care management is The Adolescent and young adult Independence Checklist (AACSCD). Results:Theresult of the current study mentioned thataround 15 % of patients were receiving specialeducational services, and more than 80% reported that the SCD interfered with their school achievement.Also, most of them (79.3%) had no wish for complementing theSCD treatment before the program whileafter intervention two-third of themmentioned that they will completeSCD treatment.The differencewas statistical significant regarding patients self- care managementprior and after three months from theprogram, P&lt; 0.01.Conclusion:Results support the necessity for Self-Management Program to improve selfcare activities in adolescent and early adulthood individual suffering fromSCD.Recommendations: there arean obvious needsto implement those educational programs in ordered to increase awareness and improveself-careamongearly adulthood suffering fromSCD.

Chronic Disease Self-Management Digital Interventions: A Review and Recommendations for Future Design and Development of Patient Self- Management Interventions

Title: Chronic disease self-management digital interventions: A review and recommendations for future design and development of patient self-management interventions Methods: A literature review is carried out in Google scholar, PubMed and Scopus databases to summarize the information on chronic disease self-management interventions, their impact on health outcomes, and reasons for patient non adoption of such interventions. Keywords: Chronic disease, Self-management, Interventions, Digital interventions, Applications, User centered, health outcome Background: User centered designs of chronic disease self-management interventions is a pre requisite for successful adoption and utilization of such interventions. Social, cultural, ethical factors and user group expectations from such applications should be taken into account to utilize maximum potential of digital health interventions. There is evidence to suggest that applications that are tailored to the individual, participatory, personally relevant, and contextually situated are more likely to promote behavior change. Such user-centered interventions will ensure greater patient adoption and utilization to optimize their full potential. Conclusions: The review will discuss the potential of chronic disease self-management interventions on health outcomes. It has implications for future designs and it gives suggestions for patient centered portal designs to ensure patient engagement and utilization of maximum potential of chronic disease self-management interventions.

Interdisciplinary Primary Care Team Expertise and Diabetes Care Management.

Interdisciplinary primary care team expertise can aid patient self management of type 2 diabetes, but small community health centers (CHCs) may not have the volume to consistently provide interprofessional care. We examine whether care team role expertise is associated with patients' experiences of chronic care and whether the relationship is stronger for small CHC sites. Surveys of 1277 adults with diabetes (2012; response rate = 47%) that assessed nonphysician team roles involved in managing their chronic care, including community health workers, diabetes educators, nutritionists, pharmacists, mental health providers, and other general staff, were integrated with clinical and administrative data from 14 CHCs. Random effects regression models estimated the association of team expertise, CHC size, and 1) patients' experiences of chronic care; and 2) hemoglobin A1c control, controlling for patient comorbidities, sex, race/ethnicity/primary language, age, and insurance coverage. Care teams with community health workers ( β = 7.67, P < .01), diabetes educators ( β = 6.05, P < .01), nutritionists ( β = 5.21, P < .01), and other general staff ([Formula: see text] =4.96, P = .02) were associated with better patients' experiences of chronic care, but not hemoglobin A1c control. Patients of small CHC sites reported better experiences of care ( β = 2.15, P = .03) with each additional team role reported, but the relationship was not significant for large CHCs. Patients with access to care team expertise in self-management support, including diabetes educators, nutritionists, community health workers, and other general staff report better experiences of chronic care. These team roles may reduce barriers to patient self management and improve patients' overall experiences of chronic care, particularly in small CHC sites.

The quality of patient care in oncology departments in Karachi, Pakistan: patients' perceptions

PurposeThis study aims to assess the quality of care among adult oncology patients in tertiary care hospitals in Karachi by using an international standard of quality of care and to identify domains where improvement is needed.Design/methodology/approachThis is a cross-sectional study carried out at two tertiary care hospitals of Karachi, Pakistan, belonging to private and public sector, respectively, between February and April 2018. Face-to-face interviews were conducted using a modified questionnaire having five-point Likert scale questions regarding satisfaction of patients with doctors, nursing staff, information provided and the hospital standards. SPSS 20 was used for statistical analysis, and the results were expressed using mean, frequencies, percentages and p-values.FindingsThe authors approached 415 patients, out of which 389 patients agreed to participate in the study. For both hospitals, the lowest mean scores were for sections pertaining to satisfaction with psychosocial support and information provided. The mean satisfaction score of patients from the private hospital were found to be significantly higher as compared to patients from the public hospital for all domains of patient care (p-value < 0.01 using t-test for two independent samples). The data showed an increasing trend of “satisfied” responses as the household income increased.Research limitations/implicationsA comparative study should be conducted with the aim of pinpointing the differences in areas in which there is a significant difference in positive satisfaction levels between private and public sectors. Similar research could also be expanded adding other variables that affect quality of care such as doctor's approach to their patients, time given during each consultation and patient's understanding of doctor's knowledge. Further studies can be done to bridge the gaps between what a doctor views as standard care and what the patient knows will help them receive a more holistic approach to care.Practical implicationsAssessing the quality of care helps determine gaps in care and allocating health resources accordingly. In clinical practice, emphasis needs to be given on increased duration and improved quality of patient counselling to improve the low satisfaction levels of patients regarding the psychosocial support. Addressing patients' concerns should be made part of clinical teaching from an undergraduate level. As far as patient access to doctors of the specific speciality is concerned, hospital managements should adopt systems to ensure continuum of care and come up with mechanisms to bridge the discrepancy between a patient's needs and doctor availability.Social implicationsAfter being identified as a major deficiency, training doctors in the sensitivities of the population and demographics, especially with respect to socio-economic statuses, can aid in enhancing patient satisfaction to the treatment. Implementation of patient-centred care leads to greater satisfaction with care, which, in turn, increases a patient's self efficacy in managing important aspects of their care and improves health care-related quality of life.Originality/valueCancer patients have long-term exposure to the hospital environment. A patient's satisfaction with the quality of care is an important determinant in patient compliance to the treatment protocol and required hospital visits. There is a dearth of research on the outpatient quality of care in the oncology departments in Karachi. This study provides an overview of the quality of care available to cancer patients in Karachi both in public and private sectors. The results of our study identify the gaps in the quality of care being provided to the patients in a developing country like Pakistan, which can be used to improve the quality of care, leading to better patient outcomes.

Potential Space in Hospitals: Insight From a Health Psychologist.

Humanization is a challenge for the future of healthcare. Architecture may play a major role in designing spaces that enhance communication and help the patient to maintain mental health during physical illness. Health psychologists struggle to find adequate space for taking care of their patients. There is an urgent need to better define how relational space, defined here as potential, can be guaranteed in everyday hospital psychological consultations. The author relates to his work as a health psychologist and psychotherapist in a consultation-liaison psychiatry (CLP) service operating in a general hospital in Lugano (Switzerland). An autoethnographic method is applied through calling on childhood memories on architecture and analyzing insights regarding the healthcare space in everyday work as a psychologist. Photographs and drawings are employed as evocative material. Autoethnographical data show that building interiors can be a metaphor for an inner dimension. Spaces can be perceived as depersonalized in hospital. Through psychoanalytical theory, it is argued that space becomes ideal for CLP if it can ensure the continuity of the patient's self during hospitalization. Proximity, confidentiality, and privacy are healthcare design requirements to be considered for favoring potential space and psychological intervention. Fostering potential space represents an outstanding challenge for the hospital of tomorrow in order to humanize healthcare spaces and promote a person-centered approach.

A Cancer Survivorship Model from the Lens of Occupational Science Incorporating Patient Self Management - Model of Occupational Participation

Over the last few decades, several cancer survivorship models of care have evolved to address the needs of the rising population of cancer survivors worldwide. The various models of survivorship care have evolved from the perspective of cancer center, community setting, as well as country-wide health care system, as a way to address the unique, and heterogeneous needs of post treatment survivors. However, in line with the rationale survivors will require preventive and general supportive community care subsequent to their overall functioning and health-related care, a model of occupational participation in cancer survivorship is proposed, to empower survivors to work alongside the community they lived in for support and for advocating cancer control.

Role of social media in inter country cross border migrant TB/HIV patients self referral and feedback- Greater Mekong Sub Region

Role of social media in inter country cross border migrant TB/HIV patients self referral and feedback- Greater Mekong Sub Region

COVID-19-RELATED ARDS PHENOTYPES AND PROGRESSION BETWEEN THEM: A CASE REPORT

SESSION TITLE: Fellows' COVID-19 SESSION TYPE: Fellow Case Reports PRESENTED ON: October 18-21, 2020 INTRODUCTION: Since January 20th, 2020 when the first case of the novel coronavirus SARS-CoV-2 was confirmed in the United States [1], there have been several reports of the disease caused by the virus known as COVID19. In the recent literature there have been descriptions of two different phenotypes of the virus presentation among hospitalized patients and particularly those requiring mechanical ventilation. These phenotypes, known as “L type” and “H type”, report what appear to be two distinct presentations with drastically different management which a patient can transition between [2]. We present a case of a patient with confirmed COVID19 who progressed through both phenotypes during his treatment consistent with these theorized phenotypes. CASE PRESENTATION: A 40 year old male presented to the hospital with shortness of breath and cough. Medical and social history was unremarkable. Workup initially showed patchy bilateral infiltrates, negative procalcitonin, fever of 103, and sats of 93% on 4L. The patient’s respiratory status quickly degraded and he required mechanical ventilation. He tested positive for SARS-CoV-2 via PCR. Initially the patient had subpleural ground glass opacities and low peep requirements before stress index became >1. He developed dyssynchrony and required more peep causing higher pressure with worse compliance. Standard supportive care for ARDS was followed. After several days the peak and plateau pressures continued to be elevated. The patient was started on nitric oxide and flolan with paralytics. He returned to a high compliance state and was ultimately extubated and discharged. DISCUSSION: There are two phenotypes with COVID-19 ARDS. The first, L-type, has high compliance, low V/Q ratio, and low lung recruitability. It has been theorized that viral infection leads to interstitial edema with vasoplegia accounting for the severe hypoxemia. This leads to increased minute volume and a more negative intrathoracic pressure with little dyspnea. The increased negative intrathoracic pressure and high tidal volumes likely lead to edema due to inflammation and increased lung permeability. This leads to dependent atelectasis and increased work of breathing. It is unclear if this is from the virus itself versus and/or high-stress ventilation. The second, H-type, has decreased compliance and high recruitability. One of the crucial things to prevent progression from L to H type is controlling work of breathing. In community hospital settings this is hard to monitor. The patient's dyssynchrony caused a significantly negative intrathoracic pressure and resulted in a form of patient-self inflicted lung injury that caused the transition from L to H phenotype. Once this was controlled with paralytics, the patient returned to L-type and recovered. CONCLUSIONS: Control of the work of breathing in a patient with COVID-19 ARDS is critical in preventing progression between L and H phenotypes. Reference #1: 1. Holshue LH, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020; 382:929-936. Reference #2: 2. Gattinoni DC, Caironi P, Busana M, et al. COVID-19 pneumonia: different respiratory treatment for different phenotypes?. J Intens Care Med. 2020; DOI: 10.1007/s00134-020-06033-2. Reference #3: 3. Yoshida T, Grieco DL, Brochard L, Fujino Y. Patient self inflicted lung injury and positive end-expiratory pressure for safe spontaneous breathing. Curr Opin Crit Care. 2020; 26(1):59-65. DISCLOSURES: No relevant relationships by Muhammad Ahmed, source=Admin input no disclosure on file for Nisarfathima Kazimuddin; No relevant relationships by Ahmed Qadir, source=Web Response No relevant relationships by karan Singh, source=Web Response No relevant relationships by Rodney Steff, source=Web Response

Hubungan Dukungan Keluarga dengan Self Esteem pada Pasien Kanker Payudara di Poliklinik Bedah Onkologi RSUP Sanglah Denpasar

AbstractBreast cancer sufferers have a tendency to experience a decrease of self esteem that make patients shall showing symptoms such as blaming themself for what they experienced. One way to increase self esteem in cancer patients is by increasing family participation through family support. The aim of this study is to determine the relationship between family support and self esteem in breast cancer patients. This study was using cross sectional design. The study was taken place at the Surgical Oncology Polyclinic, found samples of 188 respondents which was selected with a purposive sampling technique.The results showed that the majority of respondents were in the category of moderate self-esteem were 98 respondents (52.1%) and the category of moderate family support were 96 respondents (51.1%). The Rank Spearmen test results shows p value 0,000 (p &lt;ɑ), means there is a relationship between self-esteem and family support in breast cancer patients with r value of 0.566 (positive relationship). It is expected that the family will always support the patient in every process of treatment, whether in the form of physical, psychological or financial support that could increase the patient's self esteem

"He's Back so I'm Not Alone": The Impact of Deep Brain Stimulation on Personality, Self, and Relationships in Parkinson's Disease.

Deep brain stimulation (DBS) for Parkinson's disease successfully alleviates motor symptoms, but unanticipated changes in personality, self, and relationships can occur. Little is known about how these nonmotor outcomes affect patients and families. We prospectively examined the experience and meaning of DBS-related changes in personality and self for patients and caregivers. In-depth, semi-structured interviews were conducted with 22 participants (11 patient-caregiver dyads) before and 9 months after DBS and analyzed using thematic analysis. We identified three themes present prior to DBS that reflected a time of anticipation, while three themes present after DBS reflected a process of adjustment. Participants noted both positive and negative personality changes, with some, but not all, attributing them to the stimulation. The risk of stimulation-related personality change should be weighed against the procedure's motor benefits and considered in the context of disease- and medication-related personality changes. Clinical implications including perioperative education and follow-up management are discussed.