Background: Although hospital-based outpatient quick diagnosis units (QDU) are an increasingly recognized cost-effective alternative to hospitalization for the diagnosis of potentially serious ...diseases, patient perception of their quality of care has not been evaluated well enough. This cross-sectional study analyzed the perceived quality of care of a QDU of a public third-level university hospital in Barcelona. Methods: One hundred sixty-two consecutive patients aged ≥ 18 years attending the QDU over a 9-month period were invited to participate. A validated questionnaire distributed by the QDU attending physician and completed at the end of the first and last QDU visit evaluated perceived quality of care using six subscales. Results: Response rate was 98%. Perceived care in all subscales was high. Waiting times were rated as 'short'/'very short' or 'better'/'much better' than expected by 69-89% of respondents and physical environment as 'better'/'much better' than expected by 94-96 %. As to accessibility, only 3% reported not finding the Unit easily and 7% said that frequent travels to hospital for visits and investigations were uncomfortable. Perception of patient-physician encounter was high, with 90-94% choosing the positive extreme ends of the clinical information and personal interaction subscales items. Mean score of willingness to recommend the Unit using an analogue scale where 0 was 'never' and 10 'without a doubt' was 9.5 (0.70). On multivariate linear regression, age >65 years was an independent predictor of clinical information, personal interaction, and recommendation, while age 18-44 years was associated with lower scores in these subscales. No schooling predicted higher clinical information and recommendation scores, while university education had remarkable negative influence on them. Having ≥4 QDU visits was associated with lower time to diagnosis and recommendation scores and malignancy was a negative predictor of time to diagnosis, clinical information, and recommendation. Discussion: It is worthy of note that the questionnaire evaluated patient perception and opinions of healthcare quality including recommendation rather than simply satisfaction. It has been argued that perception of quality of care is a more valuable approach than satisfaction. In addition to embracing an affective dimension, satisfaction appears more dependent on patient expectations than is perception of quality. Conclusions: While appreciating that completing the questionnaire immediately after the visit and its distribution by the QDU physician may have affected the results, scores of perceived quality of care including recommendation were high. There were, however, significant differences in several subscales associated with age, education, number of QDU visits, and diagnosis of malignant vs. benign condition.
Purpose
Chemotherapy/radiotherapy-induced nausea and vomiting (CINV/RINV) can affect half of oncology patients, significantly impacting daily life. Nausea without vomiting has only recently been ...thought of as a condition in its own right. As such, the incidence of nausea is often underestimated. This survey investigated the incidence and impact of CINV/RINV in patients compared with estimations of physicians/oncology nurses to determine if there is a perceptual gap between healthcare professionals and patients.
Methods
An online research survey of physicians, oncology nurses and patients was conducted across five European countries. Participants had to have experience prescribing/recommending or have received anti-emetic medication for CINV/RINV treatment. Questionnaires assessed the incidence and impact of CINV/RINV, anti-emetic usage and compliance, and attribute importance of anti-emetic medication.
Results
A total of 947 (375 physicians, 186 oncology nurses and 386 patients) participated in this survey. The incidence of nausea was greater than vomiting: 60 % of patients reported nausea alone, whereas 18 % reported vomiting. Physicians and oncology nurses overestimated the incidence of CINV/RINV but underestimated its impact on patients’ daily lives. Only 38 % of patients reported full compliance with physicians’/oncology nurses’ guidelines when self-administering anti-emetic medication. Leading factors for poor compliance included reluctance to add to a pill burden and fear that swallowing itself would induce nausea/vomiting.
Conclusions
There is a perceptual gap between healthcare professionals and patients in terms of the incidence and impact of CINV/RINV. This may lead to sub-optimal prescription of anti-emetics and therefore management of CINV/RINV. Minimising the pill burden and eliminating the requirement to swallow medication could improve poor patient compliance with anti-emetic regimens.
Resumen Introducción: las caídas intrahospitalarias están dentro de las prioridades nacionales e internacionales en cuanto a calidad asistencial. Aunque se reconocen elementos intrínsecos y ...extrínsecos al paciente con la presencia de caídas, en Colombia existe poca evidencia al respecto. El objetivo es caracterizar las caídas de pacientes ocurridas entre 2013 y 2016, y sus factores asociados en un hospital de alta complejidad de Bogotá (Colombia). Materiales y métodos: estudio observacional retrospectivo basado en el registro de caídas que ocurrieron en el periodo de análisis en un hospital de alta complejidad. Se utilizó estadística descriptiva y análisis de regresión logística binaria. Resultados: de 951 caídas que ocurrieron entre 2013 y 2016, el 63.1 % se clasificó como eventos adversos. Según la gravedad, el 54.2 % fue "moderado" y "severo". De la muestra de pacientes, el 53.0 % fue hombres, el 65.5 % tenía 65 o más años (mediana = 71 años; mínimo = 16 años y máximo = 98 años), el 23.2 % tenía alguna enfermedad del sistema circulatorio. Se asoció con un mayor riesgo para una caída que culmina en evento adverso: ser mujer (IC95 %; OR=1.08-1.87), el turno laboral noche (IC95 % = 1.09-2.03) y las especialidades clínicas (IC95 % = 1.36-4.84) y quirúrgicas (ic95 % = 1.14-4.46). Conclusión: las caídas de pacientes son un evento adverso importante de intervenir en las instituciones hospitalarias. Se identificaron elementos intrínsecos, principalmente la edad, y extrínsecos, el turno laboral y la especialidad médica, relacionados con la probabilidad de generar un daño en el paciente ante una caída.
Traumatismele de energie înaltă au devenit parte a cotidianului, studiul aprofundat al impactului biochimic al politraumatismului asupra corpului uman devenind o prioritate. În faza iniţială ...posttraumatică, agresiunea asupra ţesuturilor produce un răspuns inflamator local şi general (SIRS). Fracturile de inel pelvin sunt leziuni relativ rare, cu o incidenţă raportată de aproximativ 2-8% din totalul fracturilor, dar la pacienţii politraumatizaţi această incidenţă poate creşte până la peste 25%. Riscul hemoragic face din fracturile de bazin una dintre cele mai serioase leziuni ale aparatului locomotor, având o mortalitate raportată ca fiind între 5 şi 50%. Priorităţile tratamentului iniţial sunt identificarea şi tratamentul leziunilor ce pun în pericol viaţa pacientului, obiectivul stabilizării definitive fiind corectarea diformităţii, restaurarea funcţiei şi reducerea ratei complicaţiilor.
Limfoamele non-Hodgkin (LNH) includ un grup de tumori maligne ale ţesutului limfatic, constituind cele mai frecvente hemopatii maligne. Tratamentul modern al LNH permit obținerea remisiunii complete, ...prelungirea duratei de viață al pacienților. În pofida tuturor celor de mai sus, modifi cările psihofi ziologice și emoționale cauzate de această boală pot persista timp îndelungat după finalizarea tratamentului specific. Obținerea remisiunii complete și supraviețuirea pacientului sunt principalele criterii pentru evaluarea rezultatelor tratamentului LNH, dar ele nu reflectă bunăstarea psihologică și emoțională al pacientului cu proces limfoproliferativ. Evaluarea calității vieții psihoemoționale al pacienților primari cu LNH este necesară și poate fi efectuată prin estimarea stării psihologice de bine, care s-a reliefat în rezultatele grupului de studiu GWB (Global Well Being). Informația obținută de la pacient, din acest chestionar, deși este subiectivă, contează la luarea deciziilor în conduita medicală și în recuperarea complexă, ulterioară. Lucrarea dată își propune evaluarea bunăstării psihologice al pacienților primari cu LNH, conform indicelui de bunăstare psihologică generală în funcție de vârstă, sex, tipul morfologic al limfomului malign și gradul de răspândire al procesului tumoral.
Chemical burns – case presentation Vasile, Laura; Tătar, Raluca; Enescu, Dan Mircea
Revista medicală Română,
9/2018, Letnik:
65, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Burns are entirely particular lesions, which must always be regarded as severe, especially at extreme ages, which affect the body in its entirety. Both the local lesion and the general bodily ...reaction are dynamic and entail characteristic sequences, which can be anticipated and prevented, in order to reduce the risk of complications and to provide the best possible vital, functional and aesthetic prognosis. The human skin, the largest organ of the body and the most important immune organ, consists of two layers – epidermis and dermis. The action of the thermal agent, irrespective of its aetiology, most commonly affects the epidermis and more or less deep areas of the dermis, depending on the temperature and duration of exposure. In the most severe cases, the dermis is destroyed in its entirety and sometimes, sub-dermic structures are affected as well.
La relación médico-paciente está sometida a varias presiones. La financiación de la asistencia sanitaria puede determinar tanto la percepción colectiva del acceso a los recursos sociales ...(prestaciones económicas, centros de atención especializada, ayudas a domicilio, entre otros) como la prescripción de medicamentos y de pruebas complementarias. Además de las prioridades del financiador o de los beneficiarios de los resultados económicos, las campañas publicitarias influyen también en el criterio del paciente, al que la industria farmacéutica halaga convenciéndolo de que posee conocimientos de medicina y de que es un consumidor con el poder de escoger, cuando en realidad decide porque tiene los medios económicos para pagar su elección. En este libro se analizan las razones que empujan a los profesionales de la sanidad hacia una parcialidad interesada, así como las consecuencias éticas que ello tiene sobre el individuo y sobre la eficiencia del sistema sanitario.
To study the significance of ‘therapeutic relationship’ between nurses and patients within the context of a psychiatric hospital.
Narrative literature review. Content analysis.
The significance of ...the therapeutic relationship is quite similar for both nurses and patients in psychiatric hospital units. Nevertheless, several factors may separate the two positions: the time available for the relationship, the negative perceptions on the part of both parties, and the insecurity of the setting.
Increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest.
Dealing with insistent patient demand for antibiotics is an all too common part of a General Practitioner's daily routine. This study explores the extent to which portable Immersive Virtual Reality ...technology can help us gain an accurate understanding of the factors that influence a doctor's response to the ethical challenge underlying such tenacious requests for antibiotics (given the threat posed by growing anti-bacterial resistance worldwide). It also considers the potential of such technology to train doctors to face such dilemmas.
Twelve experienced GPs and nine trainees were confronted with an increasingly angry demand by a woman to prescribe antibiotics to her mother in the face of inconclusive evidence that such antibiotic prescription is necessary. The daughter and mother were virtual characters displayed in immersive virtual reality. The specific purposes of the study were twofold: first, whether experienced GPs would be more resistant to patient demands than the trainees, and second, to investigate whether medical doctors would take the virtual situation seriously.
Eight out of the 9 trainees prescribed the antibiotics, whereas 7 out of the 12 GPs did so. On the basis of a Bayesian analysis, these results yield reasonable statistical evidence in favor of the notion that experienced GPs are more likely to withstand the pressure to prescribe antibiotics than trainee doctors, thus answering our first question positively. As for the second question, a post experience questionnaire assessing the participants' level of presence (together with participants' feedback and body language) suggested that overall participants did tend towards the illusion of being in the consultation room depicted in the virtual reality and that the virtual consultation taking place was really happening.
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