RESUMEN
BACKGROUND: Canadian and international guidelines recommend specialized, multidisciplinary teams for the treatment of patients with idiopathic pulmonary fibrosis (IPF). The objective of this cross-sectional clinical study was to investigate the effect of a care coordinator on IPF patient satisfaction and quality of life. METHODS: Forty IPF patients were enrolled from the practices of two physicians (n=20/physician), with either low (LCU) or high-coordinator use (HCU). Patient satisfaction was measured with modified FAMCARE and IPF Care UK Patient Support Program (UK-CARE) surveys. Health related quality of life (HRQoL) was assessed with the living with IPF impacts (L-IPFi) survey. An economic model assessed the impact of the coordinator; staff surveys informed patient management requirements, and costs were derived from published literature. RESULTS: Patient satisfaction was similar between the clinics; a trend (P=0.1) towards increased satisfaction among HCU patients was observed. Patients in the HCU clinic reported increased satisfaction (P<0.05) with their current care compared with care prior to joining the tertiary-care clinic, while LCU patients did not. IPF patient HRQoL did not differ between clinics. The coordinator was estimated to alleviate approximately 30% of a physician's IPF-related work load, and to facilitate the care of more patients per physician. Modelled estimates suggest the coordinator lead to annual cost-savings of $137,212. CONCLUSIONS: Reliance upon a coordinator during routine management of IPF patients may improve patient satisfaction, spare physician time and lead to annual cost-savings. Future studies should examine the impact of a coordinator on healthcare resource utilization.
RESUMEN
This essay examines scenes of violence in the late medieval poem The Siege of Jerusalem in order to reveal the ways in which trauma is used as the grounds upon which Christian/Jewish difference is established. In particular, I argue that this poem serves as an example of a widespread element in Christian chivalric identity, namely the need to manage the repetitive invocation of Christ's crucifixion (ritually repeated through liturgical and poetic invocation) as a means of asserting both the bodily and psychic integrity of the Christian subject in contrast to the violently abjected figure of the Jewish body. The failure of The Siege protagonist, Wespasian, to navigate the cultural trauma of the crucifixion is contrasted to the successful management of trauma by the martial hero, Tancred, in Tasso's epic, Gerusalemme Liberata, illustrating the range of imaginative possibilities for understanding trauma in pre-modern war literature.
RESUMEN
This essay examines scenes of violence in the late medieval poem The Siege of Jerusalem in order to reveal the ways in which trauma is used as the grounds upon which Christian/Jewish difference is established. In particular, I argue that this poem serves as an example of a widespread element in Christian chivalric identity, namely the need to manage the repetitive invocation of Christ's crucifixion (ritually repeated through liturgical and poetic invocation) as a means of asserting both the bodily and psychic integrity of the Christian subject in contrast to the violently abjected figure of the Jewish body. The failure of The Siege protagonist, Wespasian, to navigate the cultural trauma of the crucifixion is contrasted to the successful management of trauma by the martial hero, Tancred, in Tasso's epic, Gerusalemme Liberata, illustrating the range of imaginative possibilities for understanding trauma in pre-modern war literature.
