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1.
Br J Nurs ; 33(7): S36-S42, 2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38578933

RESUMO

HIGHLIGHTS: Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. BACKGROUND: Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (eg peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. DESIGN AND METHODS: The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24 134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. AIMS AND OBJECTIVES: The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. RESULTS: From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. CONCLUSIONS: While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.


Assuntos
Cateterismo Periférico , Conforto do Paciente , Criança , Humanos , Estudos Retrospectivos , Melhoria de Qualidade , Coleta de Amostras Sanguíneas , Cateterismo Periférico/métodos , Dor
2.
Med Sci Monit ; 30: e944714, 2024 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-38572571

RESUMO

The published grant number was "OFJH2021008", while the correct should read "DFJH2021008". Reference: Yinghong Wu, Huiling Liu, Minghao Zhong, Xiyi Chen, Zhiqiong Ba, Guibin Qiao, Jiejie Feng, Xiuqun Zeng: Enhanced Patient Comfort and Satisfaction with Early Oral Feeding after Thoracoscopic Lung Cancer Resection. Med Sci Monit, 2023; 29: e941577. DOI: 10.12659/MSM.941577.


Assuntos
Neoplasias Pulmonares , Satisfação do Paciente , Humanos , Neoplasias Pulmonares/cirurgia , Conforto do Paciente , Satisfação Pessoal
3.
J Cosmet Dermatol ; 23(4): 1298-1303, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38400577

RESUMO

BACKGROUND: There are many post-procedural treatments touted to improve comfort and decrease downtime, but very few prospective randomized studies. AIMS: To analyze the safety and efficacy of a post-procedural biotech cellulose mask. PATIENTS/METHOD: Fifteen patients undergoing either a microneedling with radiofrequency (n = 5), non-ablative fractional (n = 5), or full erbium:YAG resurfacing (n = 5) treatment were randomized to receive a biotech cellulose mask on one side of the face for 30 min after the procedure and for 2 h a day until healed. Standardized photos and thermal images were taken 30 min after the procedure and daily until healed. The investigator and blind evaluators reviewed the photos, and subjects answered daily questionnaires. RESULTS: An analysis of the thermal images showed a significant reduction in facial temperature on the biotech cellulose mask side as compared to the control side in all groups with an average of 2.2 (range 0.2-6.5) degree Celsius reduction across all 15 subjects. All subjects reported less pain and heat immediately upon application of the mask. Thirty minutes after application, 13/15 continued to report less pain and heat, and 11/15 reported less erythema and swelling on the mask side while blind evaluators were able to choose which side had the mask 80% of the time. On average, subjects also reported significantly less swelling on Day 1 and Day 2. CONCLUSION: The biotech cellulose mask decreased patient's facial temperature, feelings of heat and pain, as well as downtime without any side effects for the subjects in this study undergoing a variety of treatments.


Assuntos
Lasers de Estado Sólido , Envelhecimento da Pele , Humanos , Estudos Prospectivos , Conforto do Paciente , Eritema/etiologia , Dor/etiologia , Dor/prevenção & controle , Biotecnologia , Resultado do Tratamento , Lasers de Estado Sólido/uso terapêutico
4.
J Parkinsons Dis ; 14(1): 209-219, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38217611

RESUMO

BACKGROUND: There are currently no recommendations on the therapeutic management of Parkinson's disease (PD) patients at the end of life. OBJECTIVE: To describe a cohort of patients with PD who benefited from continuous subcutaneous apomorphine infusion (CSAI) initiation at the end of their life as comfort care. METHODS: This real-life cohort includes 14 PD patients, who benefited from 24-h, low-dose CSAI (0.5-3 mg/h) in the context of terminal care. Patient's comfort (pain, rigidity, and/or ability to communicate) and occurrence of CSAI-related side-effects (nausea/vomiting, cutaneous and behavioral manifestations) were evaluated based on medical records. RESULTS: All patients (age 62-94 years, disease duration 2-32 years) presented with late-stage PD and a compromised oral route. Treatment lasted from a few hours to 39 days. CSAI led to substantial functional improvement, with a good safety profile. Overall clinical comfort was deemed improved by the medical team, the patient, and/or caregivers. CONCLUSIONS: CSAI might be a promising approach in PD terminal care, as it reduces motor symptoms and overall discomfort, with an apparent good safety profile. Use of the apomorphine pen, sublingual film or a classic syringe pump might be considered when apomorphine pumps are not available. Larger observational cohorts and randomized controlled trials are needed to establish the efficacy and tolerability of apomorphine in the context of terminal care and more broadly, in an advance care planning perspective.


Assuntos
Doença de Parkinson , Assistência Terminal , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Apomorfina , Doença de Parkinson/tratamento farmacológico , Antiparkinsonianos/uso terapêutico , Conforto do Paciente
5.
Acta Neurochir (Wien) ; 166(1): 52, 2024 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-38289497

RESUMO

Malignant transformation of vestibular schwannoma (VS) post-radiosurgery is an extremely rare but life-threatening complication. We present a patient who underwent two surgeries for a benign VS and received Gamma Knife radiosurgery for residual tumour. Five and a half years post-radiosurgery, the patient was reoperated for symptomatic recurrence of the tumour. Histopathology confirmed the diagnosis of a high-grade spindle cell sarcoma. Although near-total resection was uneventful, the patient deteriorated rapidly, and comfort care was chosen. This report is the 13th documented case of histopathologically confirmed malignant transformation of a benign VS that strictly meets the modified Cahan's criteria, suggesting the direct link to radiosurgery-induced malignancy.


Assuntos
Neuroma Acústico , Radiocirurgia , Sarcoma , Humanos , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/cirurgia , Radiocirurgia/efeitos adversos , Neoplasia Residual , Cuidados Paliativos , Conforto do Paciente
6.
BMC Oral Health ; 24(1): 139, 2024 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-38281911

RESUMO

BACKGROUND: Light-cured resins are widely used as gingival barriers to protect the gums from highly concentrated peroxides used in tooth bleaching. The impact of barrier brand on clinical outcomes is typically considered negligible. However, there is limited evidence on the effects of different brands on operator experience, barrier adaptation, and patient comfort. OBJECTIVE: This clinical trial assessed the impact of four commercial gingival barrier brands (Opaldam, Topdam, Lysadam, and Maxdam) on operator perception, adaptation quality, and patient comfort. METHODS: Twenty-one undergraduate students placed gingival barriers in a randomized sequence using blinded syringes. Photographs of the barriers were taken from frontal and incisal perspectives. After bleaching procedures, operators rated handling features and safety using Likert scale forms. Two experienced evaluators independently assessed barrier adaptation quality on a scale from 1 (perfect) to 5 (unacceptable). The absolute risk of barrier-induced discomfort was recorded. Data were analyzed using Friedman and Chi-square tests (α = 0.05). RESULTS: Opaldam and Topdam received the highest scores in most handling features, except for removal, which was similar among all brands. No significant difference was observed in barrier adaptation quality between the evaluated brands. Discomforts were mainly reported in the upper dental arch, with Maxdam having the highest absolute risk (35% for this arch and 24% overall). CONCLUSIONS: This study suggests that gingival barrier brands can influence operator perception and patient comfort. Opaldam and Topdam were preferred by operators, but all brands demonstrated comparable adaptation quality. CLINICAL TRIAL REGISTRATION: The study was nested in a randomized clinical trial registered in the Brazilian Clinical Trials Registry under identification number RBR-9gtr9sc.


Assuntos
Sensibilidade da Dentina , Clareadores Dentários , Clareamento Dental , Dente , Humanos , Sensibilidade da Dentina/induzido quimicamente , Sensibilidade da Dentina/prevenção & controle , Sensibilidade da Dentina/tratamento farmacológico , Peróxido de Hidrogênio , Conforto do Paciente , Percepção , Clareamento Dental/efeitos adversos , Clareadores Dentários/efeitos adversos , Resultado do Tratamento
7.
Cancer Nurs ; 47(2): 93-99, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37903178

RESUMO

BACKGROUND: Port catheter placement is usually an operation performed under local anesthesia. Being conscious during the interventions performed with local anesthesia can lead to anxiety and stress. OBJECTIVE: The aim of this study was to determine the effect of guided imagery performed before and during the procedure on vital signs and comfort, pain, anxiety, and satisfaction levels in patients with cancer undergoing port catheterization with local anesthesia. METHODS: A total of 80 patients were included in the study. Patients in the intervention group received standard treatment and nursing care, as well as a guided imagery intervention once before and once during the procedure. Patients in the control group received only standard treatment and nursing care. RESULTS: Patients in the guided imagery group reported lower pain and anxiety scores, higher patient satisfaction, and increased comfort compared with patients in the control group. Patients in the guided imagery group showed significantly lower respiratory rate and heart rate than the control group by the end of the procedure. There was no significant difference in blood pressure. CONCLUSION: Practicing guided imagery before and during a procedure performed under local anesthesia reduced cancer patients' pain, increased patient satisfaction and comfort, and had a positive effect on their respiratory and heart rates. IMPLICATIONS FOR PRACTICE: We recommend guided imagery as a practical, low-cost complementary therapy for patients receiving local anesthesia.


Assuntos
Neoplasias , Satisfação do Paciente , Humanos , Imagens, Psicoterapia/métodos , Anestesia Local , Estudos Prospectivos , Conforto do Paciente , Ansiedade/prevenção & controle , Ansiedade/diagnóstico , Dor/etiologia , Dor/prevenção & controle , Sinais Vitais , Neoplasias/complicações , Neoplasias/terapia , Cateterismo
9.
Foot Ankle Surg ; 30(3): 239-244, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38123374

RESUMO

BACKGROUND: The authors developed a simple extensible external fixator, which has the advantages of easy application and inexpensiveness. The present study aimed to make a comparison between this external fixator and calcaneal traction in preoperative temporary fixation for malaligned ankle fractures and pilon fractures. METHODS: From May 2020 to February 2022, patients with malaligned ankle fractures or Rüedi-Allgöwer type 2 or 3 pilon fractures with obvious soft tissue swelling were retrospectively reviewed and divided into the calcaneal traction group and the external fixation group. The two groups of patients were matched 1:1 before making comparisons. RESULTS: A total of 38 patients were included. Higher General Comfort Questionnaire score and lower visual analog scale score were noticed in the external fixation group during hospitalization (p < 0.05), while the operation latency time, total cost, patient satisfaction, and functional outcomes one year after surgery were not significantly different between the two groups. No wound complications were observed. CONCLUSION: Preoperative temporary fixation for fractures around the ankle using this simple extensible external fixator significantly improves patient comfort when compared to calcaneal traction. LEVEL OF EVIDENCE: III, retrospective comparative study.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo , Fraturas da Tíbia , Humanos , Estudos Retrospectivos , Fraturas do Tornozelo/cirurgia , Tornozelo , Conforto do Paciente , Fixação Interna de Fraturas , Resultado do Tratamento , Traumatismos do Tornozelo/cirurgia , Fraturas da Tíbia/cirurgia , Fixadores Externos
10.
J Health Popul Nutr ; 42(1): 125, 2023 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-37941052

RESUMO

The creation of a welcoming hospital atmosphere is necessary to improve patient wellbeing and encourage healing. The goal of this study was to examine the variables affecting hospitalised patients' comfort. The study procedure included a thorough search of the Web of Science and Scopus databases, as well as the use of software analytic tools to graphically map enormous literature data, providing a deeper understanding of the linkages within the literature and its changing patterns. Insights from a range of disciplines, including engineering, psychology, immunology, microbiology, and environmental science, were included into our study using content analysis and clustering approaches. The physical environment and the social environment are two crucial factors that are related to patient comfort. The study stress the need of giving patient comfort a top priority as they heal, especially by tackling indoor air pollution. Our research also emphasises how important hospital care and food guidelines are for improving patient comfort. Prioritising patients who need specialised care and attention, especially those who have suffered trauma, should be the focus of future study. Future research in important fields including trauma, communication, hospital architecture, and nursing will be built on the findings of this study. To enhance research in these crucial areas, worldwide collaboration between experts from other nations is also advised. Although many studies stress the significance of patient comfort, few have drawn conclusions from a variety of disciplines, including medicine, engineering, immunology, microbiology, and environmental science, the most crucial issue of thoroughly researching the improvement of patient comfort has not been addressed. Healthcare workers, engineers, and other professions will benefit greatly from this study's investigation of the connection between hospital indoor environments and patient comfort.


Assuntos
Poluição do Ar em Ambientes Fechados , Conforto do Paciente , Humanos , Meio Ambiente , Pessoal de Saúde , Hospitais
11.
Med Sci Monit ; 29: e941577, 2023 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-37953532

RESUMO

BACKGROUND The study aimed to compare the patient-reported outcomes in patients who underwent early vs conventional feeding after thoracoscopic lung cancer resection. MATERIAL AND METHODS The study enrolled 211 patients who underwent thoracoscopic lung cancer resection at a tertiary hospital between July 2021 and July 2022. Patients were randomly assigned to the conventional group or the early feeding group. There were 106 patients in the early feeding group and 105 patients in the conventional group. The conventional group received water 4 h after extubation and liquid/semi-liquid food 6 h after extubation. In contrast, the early feeding group received water 1 h after extubation and liquid/semi-liquid food 2 h after extubation. The primary outcomes were the degree of hunger, thirst, nausea, and vomiting. The secondary outcomes were postoperative complications, duration of hospital stay, and chest tube drainage. RESULTS No differences were found between the 2 groups in the degrees of postoperative nausea, vomiting, or pain after extubation for 1, 2, 4, and 8 h. Postoperative complications, duration of chest tube drainage, and duration of hospital stay were also similar (P=0.567, P=0.783, P=0.696). However, the hunger and thirst scores after extubation for 2 h and 4 h decreased and were lower in the early feeding group (both P<0.001). No patients developed choking, postoperative aspiration, gastrointestinal obstruction, or other complications. CONCLUSIONS Early oral feeding after thoracoscopic lung cancer resection is safe and can increase patient comfort postoperatively.


Assuntos
Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/cirurgia , Conforto do Paciente , Satisfação do Paciente , Náusea e Vômito Pós-Operatórios/etiologia , Satisfação Pessoal , Água , Tempo de Internação
12.
Medicine (Baltimore) ; 102(47): e36069, 2023 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-38013308

RESUMO

The purpose of the present study was to evaluate the subjectively perceived patient comfort during magnetic resonance imaging (MRI) examinations and to assess potential differences between a recently introduced low field MRI scanner and a standard MRI scanner. Among other characteristics, the low field MRI scanner differs from the standard MRI scanner by offering more space (wider bore size of 80 centimeter diameter) and producing less noise, which may influence the patient comfort. In total, 177 patients were surveyed after MRI scans with either the low field MRI scanner (n = 91, MAGNETOM Free.Max, Siemens Healthineers) or the standard MRI scanner (n = 86, MAGNETOM Avanto Fit, Siemens Healthineers). Patients rated different aspects of comfort on a 5 point Likert scale: (a) claustrophobia, (b) comfort of the scanner table, (c) noise level and (d) vertigo during the scanning procedure. In terms of claustrophobia and comfort of the scanner table, patients rated both MRI scanners similar (e.g., mean ratings for claustrophobia: standard MRI scanner = 4.63 ± 1.04, low field MRI scanner = 4.65 ± 1.02). However, when asked for a comparison, patients did favor the more spacious low field MRI scanner. In terms of noise level, the low field MRI scanner was rated significantly better (mean ratings: standard MRI scanner = 3.72 ± 1.46 [median 4 = "rather not unpleasant"], low field MRI scanner = 4.26 ± 1.22 [median 5 = "not unpleasant at all"]). Patients did not perceive any significant difference in terms of vertigo between both MRI scanners. The newly developed low field MRI scanner offers constructional differences compared to standard MRI scanners that are perceived positively by patients. Worth highlighting is the significantly lower noise level and the innovative bore diameter of 80 centimeter, which offers more space to the patients.


Assuntos
Conforto do Paciente , Transtornos Fóbicos , Humanos , Imageamento por Ressonância Magnética/efeitos adversos , Imageamento por Ressonância Magnética/métodos , Vertigem/diagnóstico por imagem , Percepção
13.
J Commun Healthc ; 16(3): 239-244, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37859460

RESUMO

BACKGROUND: : Following implementation of routine screening for depression in primary care, screening for other behavioral health issues is expanding. However, prior to implementing additional screening it is important to consider patient comfort answering sensitive questions related to behavioral health topics to determine screening acceptability and effectiveness. METHODS: : A self-report survey was completed by U.S. adults over the age of 18 (n = 378) using Amazon Mechanical Turk. The survey assessed comfort discussing demographics, physical health, behavioral health, oral health, and living conditions with medical providers. Comfort levels of behavioral health topics were compared to comfort discussing depression symptoms and reasons for discomfort discussing topics were also surveyed. RESULTS: : There were significant differences in comfort level discussing various behavioral health issues (F(8) = 51.70, P < .001). Participants reported being more comfortable discussing cigarette smoking and less comfortable discussing trauma, intimate partner violence (IPV) and gun ownership compared to depression. Privacy and perceived irrelevance were the most common reasons for discomfort. CONCLUSIONS: : Accurate indices of patient behavioral health are essential for patient care. However, patients may be uncomfortable discussing some topics such as trauma, IPV, and gun ownership that patients view as private and/or unrelated to their treatment. Patient comfort may increase through provider trainings that focus on communication skills training, clear administrative procedures that allow for privacy and adequate time for discussions, and community education that underscores how these issues impact physical health.


Assuntos
Violência por Parceiro Íntimo , Conforto do Paciente , Adulto , Humanos , Pessoa de Meia-Idade , Violência por Parceiro Íntimo/prevenção & controle , Inquéritos e Questionários , Autorrelato , Saúde Bucal
14.
Radiography (Lond) ; 29(6): 1029-1034, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37688802

RESUMO

INTRODUCTION: This paper analyses patient satisfaction with radiology services in the United Arab Emirates (UAE). The study evaluates the care, comfort, service, and accessibility of the services and patient satisfaction with imaging procedures. METHODS: The research design employed a descriptive, cross-sectional approach, and data were collected through a survey consisting of eight sections. A total of 444 participants completed the survey, providing valuable insights into their demographics, appointment experiences, waiting times, staff attitudes and overall satisfaction. RESULTS: 70.4% of the participants stated that it was easy to make appointments, and 66.1% stated that they were satisfied with the efficiency of check-ins. 54.9% felt they waited the right amount of time to make an appointment, and 56.1% were satisfied with the time waiting to receive the imaging report. The findings indicate that waiting times and staff attitudes significantly influence patient satisfaction, while demographic factors, such as nationality, education, and age, do not significantly impact them. The study concludes that healthcare providers should prioritise efficient appointment scheduling, reduce waiting times and foster positive patient-staff interactions to enhance patient satisfaction. The open-ended feedback provided by the participants also offers valuable suggestions for improving service quality. CONCLUSION: This study is a foundation for future research and provides healthcare organisations with valuable insights to enhance patient satisfaction in UAE radiology services. IMPLICATIONS FOR PRACTICE: Healthcare providers should focus on patient satisfaction to improve retention and loyalty, attract new patients and enhance their reputation.


Assuntos
Satisfação do Paciente , Radiologia , Humanos , Emirados Árabes Unidos , Conforto do Paciente , Agendamento de Consultas
15.
Medicine (Baltimore) ; 102(36): e34933, 2023 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-37682167

RESUMO

With the advancement of radiotherapy equipment, stereotactic radiotherapy (SRT) has been increasingly used. Among the many radiotherapy devices, Halcyon shows promising applications. This article reviews the dosimetric performance such as plan quality, plan complexity, and gamma passing rates of SRT plans with Halcyon to determine the effectiveness and safety of Halcyon SRT plans. This article retrieved the last 5 years of PubMed studies on the effectiveness and safety of the Halcyon SRT plans. Two authors independently reviewed the titles and abstracts to decide whether to include the studies. A search was conducted to identify publications relevant to evaluating the dosimetric performance of SRT plans on Halcyon using the key strings Halcyon, stereotactic radiosurgery, SRT, stereotactic body radiotherapy, and stereotactic ablative radiotherapy. A total of 18 eligible publications were retrieved. Compared to SRT plans on the TrueBeam, the Halcyon has advantages in terms of plan quality, plan complexity, and gamma passing rates. The high treatment speed of SRT plans on the Halcyon is impressive, while the results of its plan evaluation are also encouraging. As a result, Halcyon offers a new option for busy radiotherapy units while significantly improving patient comfort in treatment. For more accurate results, additional relevant publications will need to be followed up in subsequent studies.


Assuntos
Radiocirurgia , Humanos , Radiometria , Raios gama , Conforto do Paciente , PubMed
16.
Medicine (Baltimore) ; 102(39): e35339, 2023 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-37773808

RESUMO

I-131 radioiodine (RAI) ablation removes postoperative residual tissue and facilitates follow-up in low- and intermediate-risk differentiated thyroid cancer (DTC). Although low doses have been reported to be as effective as higher doses for ablation, the doses administered still vary depending on the patient and the practitioner. We aimed to evaluate the ablation efficiency, complications, and length of stay (LOS) of patients with DTC treated with 3 different doses for ablation. Patients with DTC who received RAI therapy were retrospectively reviewed. One hundred thirty patients with low-intermediate-risk, according to American Thyroid Association classification, without known lymph nodes or distant metastases were included. Patients were divided into 3 groups as 30 to 50 mCi, 75 mCi, and 100 mCi. Residue thyroid and salivary glands were evaluated from 9 to 12 months post-RAI I-131 scans. No significant difference was found between groups regarding ablation success (P = .795). In multivariable analyses, pretreatment thyroglobulin (hazard ratio = 0.8, 95% confidence interval 0.601-0.952, P = .017) and anti- thyroglobulin antibody (hazard ratio = 1.0, 95% confidence interval 0.967-0.998, P = .024) were 2 independent predictors of ablation success. The mean LOS was 2.1 ±â€…0.3, 2.6 ±â€…0.6, and 2.9 ±â€…0.4 days, respectively, (P = .001). LOS rates of ≥ 3 days were 13.2%, 54.3%, and 84.8%, respectively. Mild decreases in hemoglobin, white blood cell (WBC), and platelet counts were observed in all groups after 6 weeks without any clinically significant findings. A lower rate of change in WBC counts was observed in the 30 to 50 mCi group compared to others. There was no dose-dependent difference regarding the early complaints questioned. Ablation with 30 to 50 mCi provides benefits such as shorter LOS, better patient comfort, less salivary gland dysfunction, and less WBC suppression, thus reducing costs without decreasing efficacy.


Assuntos
Tireoglobulina , Neoplasias da Glândula Tireoide , Humanos , Radioisótopos do Iodo/efeitos adversos , Estudos Retrospectivos , Conforto do Paciente , Tireoidectomia , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia
17.
Radiography (Lond) ; 29(5): 926-934, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37499585

RESUMO

INTRODUCTION: A comfortable treatment position in radiotherapy may promote patient stability and improve outcomes such as accuracy. The aim of this study was to identify, prioritise and determine the feasibility of delivery of intervention components as part of a radiotherapy comfort intervention package. METHODS: Prior research, consisting of a systematic review and qualitative interviews with patient and therapeutic radiographers, was triangulated and 15 intervention components developed. An online nominal group technique consensus meeting with 7 patients who received radiotherapy exceeding 10 min for one of three anatomical cancer sites and 3 therapeutic radiographers (TRs) participated. Four activities were undertaken: 1) discussion of comfort intervention components; 2) initial vote; 3) prioritisation of intervention components; and 4) discussion of feasibility in radiotherapy and were analysed using established quantitative and qualitative methods. RESULTS: One intervention component was added from initial discussions to the 15 pre-determined components being discussed. 11 components were recommended as 'accepted' (n = 5) or 'accepted with caution' (n = 6) to proceed to development. The highest scoring intervention components were 'Compassionate & empathetic communication training for TRs' and 'Tailored information, e.g., TRs provide the required information only as part of preparation for treatment'. Anther that followed closely was 'Adjustments & supports provided for arms or legs during treatment by TRs'. Those 'accepted with caution' included 'Soft pads/mattress under the body to alleviate body discomfort managed by TRs'. Qualitative analysis highlighted concerns over the radiation environment and emphasised the importance of resources such as equipment, training, and time. CONCLUSION: The recommended comfort interventions have potential to improve patient comfort during radiotherapy and should be considered to incorporate into positioning and immobilisation guidelines. However, specific intervention strategies to address these components will need to be developed and robustly evaluated. IMPLICATIONS FOR PRACTICE: Comfort interventions might help patients relax and stay still during treatment, which could improve treatment accuracy and efficacy. Introducing these comfort interventions in practice have potential to lead to a more positive patient experience and improved overall quality of care during radiotherapy.


Assuntos
Conforto do Paciente , Radioterapia , Humanos , Consenso
18.
Eur J Pediatr ; 182(9): 3871-3881, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37330438

RESUMO

The aim of this study was to examine whether therapeutic communication improves children's comfort during venipuncture compared to standard communication. This study was registered in the Dutch trial register (NL8221), December 10, 2019. This single-blinded interventional study was carried out in an outpatient clinic of a tertiary hospital. Inclusion criteria were age between 5 and 18 years, use of topical anesthesia (EMLA) and sufficient understanding of the Dutch language. 105 children were included, 51 assigned to the standard communication group (SC group) and 54 patients to the therapeutic communication group (TC group). The primary outcome measure was self-reported pain based on the Faces Pain Scale Revised (FPS-R). Secondary outcome measures were observed pain (numeric rating scale (NRS)), self-reported/observed anxiety in child and parent (NRS), self-reported satisfaction in child, parent and medical personnel (NRS), and procedural time. No difference was found for self-reported pain. Self-reported and observed anxiety (by parents and medical personnel) was lower in the TC group (p-values ranged from p = 0.005 to p = 0.048). Procedural time was lower in the TC group (p = 0.011). Satisfaction level of medical personnel was higher in the TC group (p = 0.014).   Conclusion: TC during venipuncture did not result in lower self-reported pain. However, secondary outcomes (observed pain, anxiety and procedural time) were significantly improved in the TC group. What is Known: • Medical procedures, especially needle related procedures, cause anxiety and fear in children and adults. • In adults communication techniques based on hypnosis are effective in reducing pain and anxiety during medical procedures. What is New: • Our study found that with a small change in communication technique (called therapeutic communication or TC), the comfort of children during venipuncture improves. • This improved comfort was mainly reflected by reduced anxiety scores and shorter procedural time. This makes TC suitable for the outpatient setting.


Assuntos
Conforto do Paciente , Flebotomia , Adulto , Criança , Humanos , Pré-Escolar , Adolescente , Flebotomia/efeitos adversos , Dor/etiologia , Agulhas/efeitos adversos , Ansiedade/etiologia , Ansiedade/prevenção & controle , Comunicação
20.
N Engl J Med ; 388(25): 2326-2337, 2023 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-37125831

RESUMO

BACKGROUND: Although clinicians have traditionally used the Finnegan Neonatal Abstinence Scoring Tool to assess the severity of neonatal opioid withdrawal, a newer function-based approach - the Eat, Sleep, Console care approach - is increasing in use. Whether the new approach can safely reduce the time until infants are medically ready for discharge when it is applied broadly across diverse sites is unknown. METHODS: In this cluster-randomized, controlled trial at 26 U.S. hospitals, we enrolled infants with neonatal opioid withdrawal syndrome who had been born at 36 weeks' gestation or more. At a randomly assigned time, hospitals transitioned from usual care that used the Finnegan tool to the Eat, Sleep, Console approach. During a 3-month transition period, staff members at each hospital were trained to use the new approach. The primary outcome was the time from birth until medical readiness for discharge as defined by the trial. Composite safety outcomes that were assessed during the first 3 months of postnatal age included in-hospital safety, unscheduled health care visits, and nonaccidental trauma or death. RESULTS: A total of 1305 infants were enrolled. In an intention-to-treat analysis that included 837 infants who met the trial definition for medical readiness for discharge, the number of days from birth until readiness for hospital discharge was 8.2 in the Eat, Sleep, Console group and 14.9 in the usual-care group (adjusted mean difference, 6.7 days; 95% confidence interval [CI], 4.7 to 8.8), for a rate ratio of 0.55 (95% CI, 0.46 to 0.65; P<0.001). The incidence of adverse outcomes was similar in the two groups. CONCLUSIONS: As compared with usual care, use of the Eat, Sleep, Console care approach significantly decreased the number of days until infants with neonatal opioid withdrawal syndrome were medically ready for discharge, without increasing specified adverse outcomes. (Funded by the Helping End Addiction Long-term (HEAL) Initiative of the National Institutes of Health; ESC-NOW ClinicalTrials.gov number, NCT04057820.).


Assuntos
Síndrome de Abstinência Neonatal , Síndrome de Abstinência a Substâncias , Humanos , Recém-Nascido , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Entorpecentes/uso terapêutico , Síndrome de Abstinência Neonatal/terapia , Sono , Síndrome de Abstinência a Substâncias/diagnóstico , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Síndrome de Abstinência a Substâncias/terapia , Ingestão de Alimentos , Estados Unidos , Índice de Gravidade de Doença , Fatores de Tempo , Conforto do Paciente
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