RESUMO
Members of the Society of Hospital Medicine were surveyed about geographic cohorting (GCh); 369 responses were analyzed, two thirds of which were from GCh participants. Improved collaboration with the bedside nurse, increased nonclinical interactions, decreased paging interruptions, and improved efficiency were perceived by >50%. Narrowed clinical expertise, increased fragmentation, increased face-to-face interruptions, and an adverse impact on camaraderie within the hospitalist group were reported by 25% to 50%. Academic practices were associated with positive perceptions while higher patient loads were associated with negative perceptions. Comments on GCh benefits invoked improvements in (1) interprofessional collaboration, (2) efficiency, (3) patient-centeredness, (4) nursing satisfaction, and (5) GCh mediated facilitation of other interventions. GCh downsides included (1) professional and personal dissatisfaction, (2) concerns about providing suboptimal care, and (3) implementation barriers. GCh is receiving attention. Although it facilitates important benefits, it is perceived to mediate unintended consequences, which should be addressed in redesign efforts.
Assuntos
Percepção , Recursos Humanos em Hospital/psicologia , Melhoria de Qualidade/organização & administração , Regionalização da Saúde/organização & administração , Adulto , Comportamento Cooperativo , Eficiência Organizacional , Feminino , Processos Grupais , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/organização & administração , Assistência Centrada no Paciente/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Carga de Trabalho/estatística & dados numéricosRESUMO
AIM: To compare the clinical utility of the Recursive Partitioning Analysis (RPA) and Graded Prognostic Assessment (GPA) in predicting outcomes for moderate prognosis patients with brain metastases. METHODS & MATERIALS: We reviewed 101 whole brain radiotherapy cases. RPA and GPA were calculated. Overall survival was compared. RESULTS: Sixty-eight patients had moderate prognosis. RPA patient characteristics for increased death hazard were ≤10 WBRT fractions or no surgery/radiosurgery. GPA patients had increased death risk with no surgery/radiosurgery or lower Karnofsky Performance Status. CONCLUSION: The indices have similar predicted survival. Patients scored by RPA with longer radiation schedules had longer survival; patients scored by GPA did not. This indicates GPA is more clinically useful, leaving less room for subjective treatment choices.
Assuntos
Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/radioterapia , Terapia Combinada , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
UNLABELLED: Building Our Solutions and Connections (BOSC) focused on enhancing problem-solving skills (PSS) of primary caregivers of children with mental health problems. Aims were determining feasibility, acceptability, and effect size (ES) estimates for depression, burden, personal control, and PSS. METHODS: Caregivers were randomized to BOSC (n=30) or wait-list control (WLC) groups (n=31). Data were collected at baseline, post-intervention, and 3 and 6 months post-intervention. RESULTS: Three-months post-intervention, ES for burden and personal control were .07 and .08, respectively. ES for depressed caregivers for burden and personal control were 0.14 and 0.19, respectively. CONCLUSIONS: Evidence indicates that the intervention had desired effects.
Assuntos
Cuidadores/psicologia , Transtornos Mentais/terapia , Resolução de Problemas , Adolescente , Adulto , Cuidadores/educação , Criança , Comportamento Infantil , Efeitos Psicossociais da Doença , Depressão/psicologia , Depressão/terapia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Testes PsicológicosRESUMO
PURPOSE: We examined a retrospective cohort of patients with biochemical recurrence after prostatectomy to determine whether prostate specific antigen doubling time would remain stable with time. We also examined the relationship between other clinical parameters and the change in prostate specific antigen doubling time. MATERIALS AND METHODS: We retrospectively reviewed the prostate cancer database from 1989 to 2008 to identify patients treated with radical prostatectomy for prostate cancer who experienced prostate specific antigen recurrence. Of the 2,237 patients identified 329 had biochemical recurrence. Prostate specific antigen doubling time was calculated at each visit and linear regression of prostate specific antigen doubling time with time was fit. Rate of change in prostate specific antigen doubling time was defined as the slope of the least squares regression line. RESULTS: Median followup was 5 years (range 0.2 to 18). High Gleason score and local recurrence within 5 years were significantly associated with shorter 2-year prostate specific antigen doubling time and a decreased rate of change in doubling time (p = 0.0096, 0.0119, 0.0195 and 0.0258, respectively). Metastasis within 5 years was significantly associated with shorter 2 and 5-year doubling time (p = 0.0006 and 0.0014, respectively). Using all prostate specific antigen values within 5 years of initial biochemical recurrence yielded an overall median prostate specific antigen doubling time of 52.8 months (range 5.4 to 100.0). The median rate of change in doubling time was -1.05 (range -64.7 to 27.0). Median time to metastasis after biochemical recurrence was 12.9 years. CONCLUSIONS: Median prostate specific antigen doubling time decreases with time. This may influence the decision to offer secondary therapy to patients with biochemical recurrence sooner since initial prostate specific antigen doubling time is long and may not accurately reflect the biological nature of the disease.
Assuntos
Antígeno Prostático Específico/farmacocinética , Neoplasias da Próstata/sangue , Adulto , Idoso , Humanos , Análise dos Mínimos Quadrados , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Metástase Neoplásica , Período Pós-Operatório , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Estudos RetrospectivosRESUMO
The feasibility of using an electronic device to self-monitor diet and fluid intake was assessed using the treatment implementation model. The three patients on hemodialysis who participated in this pilot study were asked to self-monitor diet and fluid intake for 12 weeks with a personal digital assistant. The intervention was delivered as intended; however, participants reported problems with usability, and compliance to self-monitoring was lower than desirable. Further adjustments to the intervention will be made before testing efficacy.
Assuntos
Computadores de Mão/estatística & dados numéricos , Comportamento de Ingestão de Líquido , Comportamento Alimentar/psicologia , Falência Renal Crônica/prevenção & controle , Cooperação do Paciente/psicologia , Autocuidado/métodos , Atitude Frente aos Computadores , Capacitação de Usuário de Computador , Registros de Dieta , Estudos de Viabilidade , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Falência Renal Crônica/psicologia , Masculino , Planejamento de Cardápio , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Pesquisa em Avaliação de Enfermagem , Pesquisa Metodológica em Enfermagem , Cooperação do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto , Projetos Piloto , Diálise Renal/psicologia , Autocuidado/psicologiaRESUMO
This retrospective study describes patterns of interdialytic weight gain (IWG) over the first year of hemodialysis in 27 individuals. IWG increased over the first 12 weeks and appeared to reverse after 12 weeks, increasing again after 32 weeks. Interventions may need to occur after the individual has been receiving treatment for 12 weeks; booster interventions may be indicated after 32 weeks. Variability in the two measures used (mean daily interdialytic weight gain and mean daily percent above dry weight) suggests a need for further study.
Assuntos
Falência Renal Crônica/terapia , Avaliação em Enfermagem/métodos , Diálise Renal/métodos , Aumento de Peso , Adulto , Idoso , Idoso de 80 Anos ou mais , Comportamento de Ingestão de Líquido/fisiologia , Feminino , Hidratação/enfermagem , Hidratação/psicologia , Necessidades e Demandas de Serviços de Saúde , Férias e Feriados , Humanos , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/psicologia , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Avaliação em Enfermagem/normas , Pesquisa em Avaliação de Enfermagem , Cooperação do Paciente/psicologia , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Diálise Renal/enfermagem , Diálise Renal/psicologia , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Aumento de Peso/fisiologiaRESUMO
Data were reviewed on treatment patterns, outcome, and hospital charges for children with idiopathic thrombocytopenic purpura (ITP). Records of 186 children with ITP, seen between January 1997 and April 2001, were reviewed. Hospital charges for initial management and first re-treatment were calculated by combining physician, hospital, and pathology charges. Anti-D immune globulin [anti-D IG] was used in 32.3%, intravenous immune globulin [IVIG] in 22.6%, steroids in 22.6%, combination therapies in 8%, and 14.5% were observed. Two patients had CNS bleeding, one with intraventricular hemorrhage at diagnosis, and the other with a parietal bleed 1 year from diagnosis. There was no significant differences in time to reach platelet counts of 20, 50, or 150 (x 10(9)/L) across different treatment groups. There was no significant difference in median charges for the IVIG and anti-D IG groups for the initial treatment of ITP. However, the IVIG was significantly more expensive than steroids or observation. Charges for the anti-D IG group were higher than the observation group but not the steroid group. After drug charges were excluded, patients in the IVIG group had statistically higher charges compared to patients in anti-D IG group. Almost half the patients were re-treated. There was no significant difference between anti-D IG, IVIG, and steroid groups when initial and re-treatment charges were combined. The observation group remained least expensive. Outcome for children with ITP is similar regardless of initial management. There is not a statistically significant difference in hospital charges between patients treated with anti-D IG and IVIG. The IVIG-treated group tends to be more costly, but this is not due to drug charges. Re-treatment is common and decreases the difference in patient charges among initial therapies.