Various Aspects Of Patient Research Articles

Prevalence, characteristics, and predictors of chronic nonanginal postoperative pain after a cardiac operation: A cross-sectional study

This study was designed to assess the prevalence, characteristics, effect, and predictors of chronic postoperative pain 1 to 3 years after cardiac surgery. Seven hundred thirty-six patients who underwent coronary artery bypass surgery, valve replacement, or both between 1999 and 2002 were mailed questionnaires (response rate, 79% [n = 579]; 564 questionnaires were analyzed), and their hospital records were reviewed. Nonanginal chronic postoperative pain affected 23% of patients. Eighty percent of them had pain 1 or more days per week. The worst and usual pain intensities during the week preceding the survey reached moderate to severe levels (> or =4/10) in more than half of the patients. Thirty-one percent of the patients with chronic postoperative pain had taken analgesic pain medication during that week. During the same period, pain interfered significantly (> or =4/10) with various aspects of patients' daily life (eg, general activity level: 39.1%, sleep: 36.7%). When patients with and without chronic postoperative pain were compared, the former group had significantly higher levels of anxiety and depression, and they perceived their health-related quality of life as more compromised. Multivariate logistic regression analysis revealed that greater analgesic needs in the first few days postoperatively were associated with an increased risk of chronic postoperative pain. The only other significant factor was the time elapsed from surgical intervention to survey: the longer it was, the less likely the patients were to report chronic postoperative pain. The prevalence, severity, and effect of chronic postoperative pain after cardiac surgery should not be underestimated. Longitudinal prospective studies are needed to further evaluate risk factors, including inadequate postoperative pain relief in the acute period.

(911): Perceptions of communication and involvement in cancer pain management

The cancer pain experience may affect both patients and their significant others (SO). Significant others may influence pain management through communication with patients about their pain, and directly or indirectly by their involvement with specific pain management activities. This analysis of baseline data from a psychoeducational cancer pain intervention study examined the (1) differences between patient and significant other perceptions of communication about pain and (2) the SO’s participation in pain management activities. The sample consisted of 128 dyads (patient and patient-selected SO) who were both asked to indicate how much they communicated about various aspects of patient’s pain management (CAP-Q) and also how involved the SO was in pain management activities (SOPI-Q). Most patient and SO subjects were female (62%, 57%), Caucasian (86%, 90%) and married (69%, 75%). Significant correlations were found between patient reports and SO estimates of patient’s pain severity (r= .39, p= .000) and frequency of moderate to severe pain (r=.51, p=.000). Patients and SOs both rated the suggestion to talk with a doctor or nurse as their most frequent communication topic. Compared to patients, SOs reported significantly higher frequency of overall communication about pain (t=3.08, p=.003), although the mean scores were relatively low for both groups. There was no significant difference in how often patients and SOs rated SO involvement. Picking up medications, talking with doctors and nurses about the patient’s pain, and helping the patient decide if and when to take pain medicine were the most frequent pain management activities performed by the SO. Because SOs are involved in important pain management activities it is critical to include them in pain management discussions.

Healthcare Behaviors and Risky Business First, Do No Harm

In an opinion piece entitled “Risky Business,” which was published in Infection Control and Hospital Epidemiology in 1990, Susan Beekmann, Barbara Fahey, Julie Gerberding, and I wrote about the subject of occupational risk for blood-borne pathogen transmission in the healthcare setting.1 In that piece, we presented a table suggesting a group of prevention strategies that we believed could help mitigate some of the risks associated with managing patients infected with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and other blood-borne pathogens in healthcare settings (Table). In 1999, the Institute of Medicine of the National Academy of Sciences published an assessment of patient safety in U.S. healthcare institutions.2 The Institute of Medicine report was entitled “To Err Is Human.” This report underscored the frequency of adverse events in healthcare and emphasized the importance of getting healthcare workers to modify ingrained behaviors to improve patient safety and to mitigate risk in the healthcare setting.2 The first information about the acquired immunodeficiency syndrome (AIDS) was published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report on June 6, 1981.3 Because of the striking similarities between the epidemiology of this new syndrome and that of HBV, concern arose almost immediately about the risks for occupational and nosocomial transmission.4 As early as 1986, documented episodes of occupational infection were reported in the literature.5 Despite an awareness—as early as 1949—of the occupational hazards associated with handling blood from, and managing patients infected with, HBV,6 the healthcare profession had never seriously addressed issues related to workplace safety in a systematic way before the HIV epidemic. Interest in worker safety had just begun to develop concomitant with the marketing of the original HBV vaccine in the late 1970s, but this interest was truly galvanized by the HIV epidemic. The ensuing 25 years have seen a variety of interventions designed to facilitate both decreasing risks and “doing no harm” in the healthcare setting. In some respects, as a profession, we have come to understand these risks far better than one might have ever imagined in the early 1980s. That’s the good news. The bad news is that we continue to struggle on a daily basis with what must now be considered “routine” practice issues relating to the transmission of blood-borne pathogens in the healthcare setting. What must be considered simply “bad behaviors” continue to occur in our workplace on a far-toofrequent basis. As is so often the case in medicine, progress is incremental and not necessarily linear. This issue of Infection Control and Hospital Epidemiology contains no fewer than seven articles addressing various aspects of patient and healthcare worker safety relating directly to the presence of blood-borne pathogens in the healthcare environment. Unfortunately—from both the risky business and the first, do no harm perspectives— much of the news in this issue is not good. Four of these articles describe epidemics of blood-borne pathogen infections among patients receiving healthcare in four different TABLE* STRATEGIES TO PREVENT OCCUPATIONAL EXPOSURES AND INFECTIONS WITH BLOOD-BORNE PATHOGENS

???It??s Always Continuing???: First-Year Medical Students??? Perspectives on Chronic Illness and the Care of Chronically Ill Patients

Caring for patients with chronic health conditions is an important component of health care in the 21st century. This study uses qualitative research methods to take an in-depth look at the attitudes of first-year medical students toward chronic illness and the care of chronically ill patients. In Spring 2000, 26 first-year medical students at the College of Human Medicine, Michigan State University, were invited to participate in interviews focused on their attitudes toward caring for patients with chronic illness. Transcripts of the interviews were analyzed to identify iterative themes. Concurrently, all 105 first-year students were given a questionnaire that asked about their attitudes toward various aspects of patient care. Nineteen students participated in the interviews. Students viewed chronic illness as incurable, long running, life altering, and often terminal. Most students had firsthand experience with chronic illness in family members; many had premedical work experience with chronically ill patients. Most students described themselves as comfortable with a partnership relationship with patients. Students acknowledged responsibility for caring for those with chronic illness but anticipated sadness and frustration in this work. One hundred and four students completed the questionnaire. Respondents' attitudes were consistent with those expressed in the interviews, suggesting that the interview findings represent the class as a whole. Students enter medical school with complex attitudes toward chronic illness, many of which are more negative than previously reported. Qualitative instruments constitute important methods for studying the intricacies of students' attitudes and outlooks.

Concepts of patients with alopecia areata about their disease

BackgroundAlopecia areata (AA) is a common and chronic skin disease with an unknown etiology. It may significantly affect the patient quality of life. This study was designed to evaluate the illness perception in patients with AA.MethodsA questionnaire consisting of 25 questions about causes, timeline, consequences and control of disease were given to 80 patients with AA attending a skin clinic in Tehran, Iran. The impact of age, gender, duration of disease, education, extent of disease and family history of AA were also assessed.ResultsEighty patients (38 male and 42 female) with a mean age of 27.5 years (SD = 9.3) and disease duration of 7.8 years (SD = 7.7) completed the questionnaire. 76.9% of the patients believed that the role of stress was the cause of disease. 17.1 % believed genetic background to be the main cause, this found to be more frequent in patients with positive family history of AA. More than half of patients believed that their illness had major consequences on their lives and 40% of patients believed that their illness would be likely to be permanent rather than temporary, more in patients with longer duration of disease. Only 57.5% of patients considered their treatments to be effective.ConclusionAA may considerably affect various aspects of patients' lives. The patient knowledge about the causes and course of this disease is limited.

Caregiver Reports

We describe one method for comparing clinician and caregiver perspectives on dementia patients, avoiding classifying perspective either as correct (a “gold standard”). Sixty-two individuals (31 patients with formal diagnoses of dementia and each patient's primary caregiver) served as study participants. Caregivers completed questionnaires about their perceived caregiver burden, their mood state and various aspects of patients' functioning. For comparison purposes, both clinicians and caregivers completed ratings and rankings of dementia-related problems in 4 domains of functioning. A majority of clinician-caregiver comparisons were incongruent, predominately for patients with a moderate degree of dementia. Overall caregiver burden (r = .63, p < .05) and care-giver mood state (F(1,29) = 7.14, p < .05) were both significantly related to clinician-caregiver incongruence.

What patients with vitiligo believe about their condition

Vitiligo is a common disease with an unknown etiology. It is a chronic disease which causes severe disfigurement, and so may significantly affect a patient's quality of life. This study was designed to evaluate the illness perception and quality of life in patients with vitiligo. A questionnaire consisting of 25 questions on the causes, timeline, consequences, and control of disease was given to 80 patients with vitiligo attending a private skin clinic in Tehran, Iran, in 1999. The roles of age, sex, duration of disease, education, extent of disease, and family history of vitiligo were assessed. Eighty patients (22 males and 57 females, one not mentioned), with a mean age of 30 years (SD = 11 years) and a disease duration of 7.1 years (SD = 7.8 years), completed the questionnaire; 62.5% of the patients believed that stress played a role in their disease; 31.3% believed that their genetic background played a role in their disease, more so in patients with a positive family history of vitiligo. Almost one-half of patients believed that their illness had major consequences on their lives. One-half of patients believed that their illness was likely to be permanent rather than temporary, more so in patients with a longer duration of disease and a higher level of education. Only 60% of patients considered that their treatments were effective. Vitiligo may considerably affect various aspects of patients' lives. The knowledge of patients about the causes and course of their disease is limited.

Perceived Psychosocial Outcomes of Gastric Bypass Surgery: A Qualitative Study

Attempts to understand postoperative psychosocial changes in the lives of individuals who have undergone gastric bypass surgery for morbid obesity have 1) been guided by constructs emanating from the assumptions of researchers, and 2) have resulted in fragmented conclusions that catalogue changes without theoretically integrating them. Using unstructured and semi-structured interviews and in-depth focus groups, 31 patients were asked in an open-ended fashion about the ways, if any, in which gastric bypass surgery had affected their lives. Grounded theory methodology was utilized in order to identify emergent themes and their interrelations, and build a meaningful, comprehensive theory of life after gastric bypass. Patients' report of a rebirth/transformation was identified as the core process of the theory. The changes marking this process were clearly conceptualized in dichotomous terms comparing pre to postsurgical life. Patients reported changes that they regarded as unequivocally positive, a number of which had not been previously reported in the literature. Unique to this particular study was the finding of numerous life changes that generated tension and posed challenges in various aspects of patients' lives. The grounded theory proposes that the extent to which patients successfully negotiate tension-generating changes may be a major determinant in the long-term outcome of gastric bypass, both weight loss and psychosocial adjustment.

What do nurses and therapists think about the positioning of stroke patients?

At present, there are a number of different positioning strategies for stroke patients, but these are mainly based on clinical experience rather than research. Prior to developing a study to evaluate the effect of positioning on outcome after stroke, it was important to establish if nurses in our hospital had given much thought to the positioning of stroke patients. This study aimed to explore whether nurses working on the stroke unit at a Scottish teaching hospital held different views on the positioning of conscious and unconscious stroke patients to nurses working on other wards with stroke patients and therapists. Questionnaires on various aspects of patient positioning were sent to 150 nurses and 25 therapists working in five specialities where stroke patients are cared for in a large teaching hospital. Overall, the majority of nurses and therapists (74%) believed that the best position for conscious stroke patients was sitting in a chair. Also, 80% of them believed that the best position for unconscious stroke patients was lying on the nonparetic side. There was less of a consensus between nurses and therapists working in the five specialities as to whether it was appropriate for conscious or unconscious stroke patients to lie on their paretic side, lie supine or sit propped-up in bed in either a 30 or 70 degrees angle. The lack of consensus between nurses working in the five specialities is probably because at present there is little research to guide nursing practices for the positioning of stroke patients. Therefore, research to confirm which positions improves or hinders outcome after stroke is essential. Indeed, positioning is a simple inexpensive strategy, which could have a substantial public health impact, as stroke is so common.

Information to and communication with cancer patients: improvements and psychosocial correlates in a comprehensive care program for patients and their relatives

Between 1987 and 1989, 177 cancer patients who were to receive intensive chemotherapy with curative intention, participated in a comprehensive care project with the aim of improving their total situation, and that of their relatives ( n = 120). A number of steps were taken to improve, among other things, the information to, and communication with, patients and their relatives. Compared with a pre-project evaluation in 54 patients and 24 relatives, significantly lower problem scores were seen in most aspects relating to interaction with medical staff. Strong associations were seen between, on the one hand, various aspects of patient- and relative-staff interaction and, on the other, psychosocial problems, although they were weaker for problems relating to information, than for communication and control problems.

Analysis of observed behaviors displayed by depressed patients during a clinical interview: relationships between behavioral factors and clinical concepts of activation

In 61 drug-free depressed patients, relationships were studied between observed behaviors and measures of common clinical concepts of activation. The behaviors were observed during a clinical interview and analyzed with ethological methods. Activation was assessed by means of self-ratings (Thayer, AD-ACL) and global judgement (Hamilton, retardation, agitation). Various aspects of patients' speaking and listening behaviors were recorded and analyzed, such as looking, head movements, yes-nodding and no-shaking, leg movements, gesturing, and body and object touching. A factor analysis was applied, enabling grouping of behaviors without using a priori concepts. Five factors reflected different aspects of a conversation: restlessness (leg and hand movements), speech, active listening (head movements and intensive body touching, during listening), speaking effort (looking, gesticulating, head movements, during speaking), and eagerness (yes-nodding and no-shaking). Significant positive relationships were found between the speech factor, the speaking effort factor and the restlessness factor on the one hand, and activation on the other. The eagerness factor was related negatively with activation. The results give insight into the organization of behavior during an interview, and show how this is related to clinical concepts of activation.

How do general practitioners view their role in primary prevention?

GENERAL practitioners in the Severn Faculty of the Royal College of General Practitioners were asked about their attitudes to primary prevention and their ability to provide advice on various aspects of patients' life-styles and behaviour. The results show that, for eight out of nine areas of patients' behaviour, the doctors generally thought it was highly appropri ate for them to provide advice. Doubts were expressed about appropriateness and their com petence in providing advice to patients concerning coping with poverty. There were some small dif ferences in the responses which were related to the ages and personal life-styles of the doctors, and between those working in inner city and rural prac tices. The categories of patients which were rated as most important to be recipients of health education were the high-risk groups of smokers, drug injectors and pregnant women. Compared to the male doctors, female general practitioners considered it more important to give health education advice to eight out of 12 groups of patients. The findings indicate that general practitioners within the Severn Faculty hold strongly positive attitudes to prevention, and it is suggested that the role of general practitioners as health educators should be further supported.