Assessment of Patient Satisfaction Among Cancer Patients Undergoing Radiotherapy.

The patient-provider relationship is a key driver of patient satisfaction as it relates to overall healthcare experience. We surveyed patients undergoing radiation therapy to determine what they consider to be the most valued qualities in their interactions with the healthcare team. An ethics-approved 35-item patient satisfaction survey was developed in-house to gain insights on patients' perception of their relationship with the healthcare team throughout their cancer journey. There were 199 completed survey, median age 68 years, 54% women and 45% men. Almost all (95%) "agreed" or "strongly agreed" that their physicians had been sensitive and compassionate. Over 90% felt that they received adequate explanations about their treatment, and had their questions answered. The vast majority (93%) felt included in the decision-making process. Patients reported the 5 most highly rated qualities among their healthcare providers (HCPs) as knowledge, kindness, honesty, good communication, and a cheerful attitude. Overall satisfaction was high but areas for improvement were identified including being offered future appointments for further discussion, more information about clinical trials, other treatments, and community resources. Patients noted their HCPs tended to focus on the physical and emotional needs of patients, but spiritual and cultural needs were rarely addressed. Patients receiving radiotherapy reported high rates of satisfaction across many aspects of their care. These findings also reinforce the different aspects of holistic care that can be improved, and serve as a reminder to clinicians that patients perceive their role as more than just that of a medical expert.

Assessment of sleep impairment in persistent allergic rhinitis patients using polysomnography.

BACKGROUND: Although questionnaires have demonstrated an association between impairment of quality of sleep and symptoms in allergic rhinitis (AR) patients, to date there is no report of an objective assessment of sleep in patients with persistent allergic rhinitis (PER) as defined by ARIA guidelines. The aim of the present study was therefore to assess sleep disturbance in PER patients by polysomnography (PSG). METHODS: Ninety-eight PER patients with moderate-to-severe nasal obstruction and 30 healthy volunteers were included in the study. All patients underwent PSG during nocturnal sleep to assess the presence and severity of sleep disorders. Peak nasal inspiratory flow (PNIF) was also measured to assess nasal resistance. RESULTS: There were statistically significant, though clinically modest, differences between PER patients and healthy controls in most PSG parameters including sleep efficiency, arousal index, average SaO(2), lowest SaO(2), time spent with a saturation below 90%, and snoring time. Although the apnea-hypopnea index (AHI) was not significantly different between the 2 groups, 17 subjects (17.3%) in the PER group but none of the control subjects had an AHI >5. Patients with higher T5SS scores (12 ≤ T5SS ≤ 15) had a greater tendency to snore than did patients with lower scores (8 ≤ T5SS ≤ 11). Finally, PNIF in the PER group was significantly lower than in the control group. Weak correlations between the arousal index and PNIF, average SaO(2), and PNIF were found. CONCLUSION: PSG showed modest changes in PER patients versus control subjects.

Development of community nursing in Zhejiang Province, China: a report of the driving measures.

BACKGROUND: Community nursing is playing an important role in health care worldwide. METHODS: We reviewed recent developments in community nursing in the Zhejiang province of China and reported that the locally tailored practical guidelines, education programmes and management models are the driving measures for promoting local community nursing. RESULTS: In 2008, Zhejiang had 1200 community primary health-care service centres, an increase of 56% and 6789 service stations, a twofold increase, compared with 2004. At present, 27 000 community nurses, together with the same number of family doctors, are working in community health-care service centres and stations. Community nursing in Zhejiang has grown not only by numbers but also by the greatly improved infrastructures and functions of its community primary health care. CONCLUSION: It is the multi-pronged approach that has led to the change being successful in a local health-care system.

Real-time quantitative assay of HCV RNA using the duplex scorpion primer.

A novel real-time quantitative method for detecting HCV in serum was established in which the duplex scorpion primer was used to provide a unimolecular probing mechanism for hybridizing the highly conserved 5' noncoding region (5' NCR) of the HCV genome specifically. Through methodological evaluation, we found this new method had a wide linearity, high sensitivity, repeatability and specificity. Compared to the commercial TaqMan method, this method was found to be more sensitive and less costly, and the final results were obtained more quickly. Therefore, it could be applied to diagnose and monitor HCV infection in clinical practice.

Readmission to the intensive care unit after liver transplantation.

OBJECTIVE: We undertook this study to understand the factors at our transplant center that contribute to patients' return to the ICU after their liver transplant and their initial discharge from that unit. Patients who, after liver transplantation, fail discharge from the Intensive Care Unit (ICU) and must be readmitted to that unit may well utilize many more resources than those patients who are well enough to stay out of the ICU. DESIGN: A retrospective review of a prospectively maintained liver transplant research database followed by a retrospective review of (a subgroup) patient charts and contemporaneous controls. SETTING: A large metropolitan tertiary care center and adult liver transplant center. PATIENTS: A total of 1,197 consecutive adult patients who underwent their initial liver transplantation from 1984 to 1996. INTERVENTION: Readmission to the intensive care unit after adult liver transplantation and discharge from that unit. MAIN RESULTS: Only recipient age, pretransplant synthetic function labs (protime and albumin), bilirubin levels, and intraoperative blood product requirements could be statistically linked to the group requiring ICU readmission. The primary etiology for ICU readmission was cardiopulmonary deterioration. Readmission was associated with significantly lower patient and graft survivals. A detailed review of 23 patients transplanted from October 1994 to June 1996 was made, with special emphasis on cardiopulmonary status (hemodynamics, respiratory variables, and chest radiograph findings). This subgroup was compared with 30 temporally matched controls who were not readmitted to the ICU. Intravascular fluid overload and lower inspiratory capacity were significant factors related to ICU readmission. Readmitted patients had a longer hospitalization with higher hospital charges than the control group. CONCLUSIONS: We conclude that the most important means of preventing ICU readmission in liver transplantation patients is to optimize cardiopulmonary function and status. Close monitoring of fluid balance to avoid hypervolemia is essential. Readmitted patients have a greater resource utilization and have lower survival rates.

Indirect validation of benzene exposure assessment by association with benzene poisoning.

We present a validation study of a quantitative retrospective exposure assessment method used in a follow-up study of workers exposed to benzene. Assessment of exposure to benzene was carried out in 672 factories in 12 cities in China. Historical exposure data were collected for 3179 unique job titles. The basic unit for exposure assessment was a factory/work unit/job title combination over seven periods between 1949 and 1987. A total of 18,435 exposure estimates was developed, using all available historical information, including 8477 monitoring data. Overall, 38% of the estimates were based on benzene monitoring data. The highest time-weighted average exposures were observed for the rubber industry (30.7 ppm) and for rubber glue applicators (52.6 ppm). Because of its recognized link with benzene exposure, the association between a clinical diagnosis of benzene poisoning and benzene exposure was evaluated to validate the assessment method that we used in the cohort study. Our confidence in the assessment method is supported by the observation of a strong positive trend between benzene poisoning and various measures, especially recent intensity of exposure to benzene.

Resolution of racemic gossypol.

PIP: The resolution of gossypol for the purpose of comparing the biologic action of (-)-gossypol with its naturally occurring antipode has attracted the attention of scientists. Recently the 1st successful resolution accomplished by chromatographic separation of the hexa-acetates of the condensation products of (+)-gossypol with (S)-1-methylphenethylamine followed by acid hydrolysis of the 2 main hexa-acetate, to give (+)- and (-)-gossypol with identical mp and alpha D values, was reported. Treatment of racemic gossypol with either (R)- or (S)-methylphenethylamine afforded yellow solids with mp 197-200 degrees C and m/z 753 (M + 1)+. By quick chromatography of the condensation products of either the (S) or (R) amine with (+)-gossypol on a silica column with diethyl ether-light petroleum as eluant, pure compounds were obtained. The compounds were assigned as (S)-amino-(+)-gossypol and (R)-amino-(-)-gossypol. These gossypols contained less than 5% of their antipodes. Although different in their antifertility action, the (+ or -), (+), and (-) isomers of gossypol demonstrate the same degree of inhibitory activity against the enzyme lactate dehydrogenase-X. Comparison of the antifertility action of the 3 isomers in male rats revealed that (-)-gossypol in half the dose of the (+ or -) isomer showed comparable activity, while the (+)-gossypol proved to be inactive.^ieng