Stigma and Alzheimer's disease: causes, consequences and a constructive approach

The term 'Alzheimer's disease' has entered the vocabulary of ordinary people. This has been useful, encouraging patients and families to seek medical help for conditions that were previously neglected as inevitable consequences of old age. Yet Alzheimer's itself can carry negative connotations. Some people who believe they have Alzheimer's disease are suffering from less sinister and more easily treated conditions. Even when the diagnosis is confirmed, many months of happy and worthwhile life continue for most patients and families if they are given appropriate information and support. It is important that neither families nor clinicians see life with presumed Alzheimer's disease as of no value.     

Knowledge,attitudes and beliefs about medical cannabis among the medical students of the Belarus State Medical University

Cannabis for medical purposes is prohibited in Belarus. Given that some countries have begun prescribing medical cannabis (MC) to certain categories of patients, a cross-sectional study was undertaken at the Belarusian State Medical University (BSMU) to determine the readiness of medical students to use cannabis in their future practice. 333 students responded to the questionnaire to find out their knowledge, attitudes and beliefs about MC. The data were analyzed using Pearson chi-squared test for categorical variables. Findings show most medical students prepared to recommend MC for patient treatment and believe it has benefits for physical or mental health purposes. The survey respondents believe MC can be effective for treatment -23.5 % for glaucoma to 76.9 % for chronic pain. Study results evidence that 83.1 % of the students receive no formal education about medical cannabis and 87.5 % believe professionals should have formal training about the substance.     

Spirituality of EMTs: a study of the spiritual nature of EMS workers and its effects on perceived happiness and prayers for patients

INTRODUCTION: There is reason to believe that traumatic events experienced on the job make emergency medical services (EMS) workers more skeptical about their spiritual beliefs. Little is known about the spiritual lives and experiences of emergency medical technicians (EMTs). No studies have measured the responses of EMTs to the spiritual needs of their patients. PURPOSE: This study investigates whether EMS workers are less spiritual than the average U.S. citizen, and what effect this has on prayer for patients and perceived happiness. METHODS: Data were collected in a major metropolitan EMS system from 125 EMTs and paramedics through a questionnaire about their beliefs and behaviors regarding their spirituality. Pearson product-moment correlation coefficients (r) were used to analyze variables. The religious attitudes of EMTs were compared with those of the general population as defined in the Gallup studies. RESULTS: Ninety-one percent of the EMS workers interviewed and 94% of Gallup's sample of the general population said they believe in God. The findings on other measures in the EMT sample also were very similar to those defined in the general population. Of the EMTs, 60% said they never have doubted the existence of God. Eighty-four percent believe God still works miracles, and 80% of the EMTs believe in life after death. Eighty-seven percent of EMS workers pray; 62% pray for their patients, and 54% pray for their coworkers. Frequency of church or synagogue attendance is positively and significantly correlated with the degree of perceived life happiness (r = 0.226, p < 0.025 > 0.005). Frequency of prayer also is correlated positively to perceived life happiness (r = 0.182, p < 0.025 > 0.005). CONCLUSION: Emergency medical services workers are interested and willing to talk about their spiritual lives. They do have more doubts about the existence of God than does the average civilian, but are just as spiritual. Those EMTs with more active spiritual lives perceive themselves as happier. The majority of EMS workers pray for their patients.     

The nursing dilemma of restraints

This study provides a data base for developing intervention strategies aimed at helping staff cope with concerns regarding restraints. Most respondents believe patients should be restrained for safety even if it means loss of dignity, and that a caring manner should be conveyed to restrained patients. A large percentage felt that family members did not have the right to refuse the use of restraints, but that they should have that right if they were patients, suggesting negative attitudes toward restraints, of which they are unaware. Personal and professional characteristics, such as knowledge about restraints, years in geriatrics, and experience with elderly family members, showed no significant relationship to attitudes.     

Primary injury prevention in an urban EMS system

Injury prevention is increasingly recognized as an important part of health care delivery. Emergency Medical Services (EMS) personnel may be called upon to deliver primary injury prevention (PIP) by educating both patients and peers about how to avoid future similar injury. The purpose of this study was to determine EMS provider attitudes toward PIP and knowledge and practice of PIP during day-to-day clinical work. A brief survey was administered to a sample of paramedics assessing their attitudes toward primary injury prevention, how often they practice it, and whether or not they have received any PIP education during their training. One hundred sixty-two paramedics completed surveys. Of those surveyed, 70% believe that PIP should be a core mission of EMS systems, and 82% believe PIP should be implemented at the local or regional level. However, only 33% routinely educate their patients how to modify injury risk behaviors, and only 19% routinely provide instruction about proper use of protective devices. Approximately 63% of our paramedics received any PIP education during their training. A majority of paramedics in our survey believe that PIP should be a routine part of EMS. However, many paramedics have not received any PIP education, and few paramedics practice PIP during their clinical practice.     

What do dermatology patients believe?

A study of 151 new outpatients attending a dermatology clinic in Bristol, England, has been performed to determine what patients with skin disease believe and are told about their condition. The factor most commonly blamed as a causative agent by the patients was worry or emotional upset. Forty-one percent of the patients had used self-medication before going to their general practitioner (GP). Forty-five percent of patients had attended their GP on 4 or more occasions before their referral to hospital. Forty-one percent felt the GP's treatment had either done no good or made things worse, and 13% had experienced some side-effects from treatment. Forty-two percent of patients had been given a diagnosis by their GP but only 16% had been told whether the condition was contagious. Eighteen patients believed they had a contagious disease, but this was subsequently confirmed by the hospital doctor in only 6 cases. Six patients had a skin cancer, but none of them appeared to suspect this diagnosis.     

An exploration of psychiatric nurses'' and patients'' opinions regarding in-patient care for suicidal patients

This study explores psychiatric nurses' and patients' opinions regarding the care provided for in-patients who were admitted following: (i) depression as a result of psychosocial difficulty, (ii) suicidal ideation, or (iii) an overt suicidal behaviour. It also explores how care for such patients could be improved. A total of 20 psychiatric nurses and 17 in-patients were interviewed. The results show that nurses and patients believe that communicating with patients about their difficulties is the most important skill in psychiatric nursing. Most nurses were disappointed with the limited time they had available to communicate with patients and they were constructively critical of their pre-registration training in communication skills. Patients suggested that nurses should spend more time in helping to problem-solve their difficulties. Both nurses and patients suggest that situational factors impinge on the time available for psychotherapeutic care. Findings have implications for pre- and post-registration education and practice. Responses from both cohorts suggest how care could be improved.     

Evaluating clinical performance using simulated patients

In summary, we believe that nurse practitioners use the nursing process in giving primary health care to patients, and their skill in using that process must be periodically evaluated as they move through their educational program. Further, we believe that consumers have the right to expect a beginning level of competence from graduates of nursing programs. Based on our experience, we believe that the use of the simulated patient, now used primarily in teaching, should be expanded to be of valuable assistance in clinical performance evaluation.     

The patients' experiences of their chronic non-malignant pain

This paper reports the results of a study which investigated the experiences of 75 people with chronic non-malignant pain People with chronic non-malignant pain can find that traditional medical techniques do not help their pain, and they have to learn to live with it However, pain can affect their lives in many ways Within this study, qualitative data were collected to illustrate what it meant to people to experience this chronic pain It was found that pain adversely affected many dimensions of sufferers' lives, and the effects extended to family and friends It seemed that having others believe the pain was crucial to many patients Health care professionals can offer these patients much in helping them come to terms with the way in which pain has affected both themselves and their lives     

Antithrombin in the treatment of burn trauma

Antithrombin (AT) is a natural anticoagulant with anti-inflammatory properties that has demonstrated value in sepsis, disseminated intravascular coagulation and in burn and inhalation injury. With high doses, AT may decrease blood loss during eschar excision, reducing blood transfusion requirements. There are no human randomized, placebo-controlled studies, which have tested the true benefit of this agent in these conditions. Two main forms of AT are either plasma-derived AT (phAT) and recombinant AT (rhAT). Major ovine studies in burn and smoke inhalation injury have utilized rhAT. There have been no studies which have either translated the basic rhAT research in burn trauma, or determined the tolerance and pharmacokinetics of rhAT concentrate infusions in burn patients. Advantages of rhAT infusions are no risk of blood borne diseases and lower cost. However, the majority of human burn patient studies have been conducted utilizing phAT. Recent Japanese clinical trials have started using phAT in abdominal sepsis successfully. This review examines the properties of both phAT and rhAT, and analyzes studies in which they have been utilized. We believe that it is time to embark on a randomized placebo-controlled multi-center trial to establish the role of AT in both civilian and military patients with burn trauma.     

Israeli nurses and genetic information disclosure

The debate continues about whether people have a duty to pass on the positive results of their genetic tests to relatives who are at risk from the same disease, and, should they refuse, whether physicians and genetic counselors then have the duty to do so. To date, the role and views of nurses in this debate have not been investigated. In our study, a sample of Israeli nurses, untrained in genetics, were asked for their theoretical opinions and what practical steps they would take in the case of patients' refusal to disclose. The nurses were very sure that patients should inform their families but were equally sure that nurses must respect their decision to disclose or not. Few said they would take practical steps to disclose information if the patient objected. The authors believe that the most useful and appropriate role for nurses in this field is in working to bring about co-operation between patients and family members.     

Le refus de transfusion sanguine en réanimation

Red cell transfusion is commonplace in the ICU. Jehovah witnesses refuse it because they believe it will jeopardize their eternal life. In the intensive care setting, Paul Hebert et al. have recently shown that patients’ survival was better when the hemoglobin content was 7 g/dl instead of 11 g/dl. Since, blood transfusion needs in the ICU have been globally re-evaluated. However, despite hemoglobin substitutes will be the ultimate solution to this problem, there is currently no alternatives for red blood cells transfusion in the case of acute anemia. In France, recent laws (in 1999 and more recently in 2002) have reinforced the obligation for physicians to respect their patients’ will, including the refusal of care, should death ensue. But in courts’ decisions filed last summer, the judges of the higher court (Conseil d’Etat) confirmed the obligation of physicians to save their patients’ life. The ethical dilemma still persists: ICU physicians have the uncomfortable choice between obeying their patients’ will and letting them die, or saving their lives but putting at risk their hope of eternal life.     

The emotional challenges faced by Sexual Assault Nurse Examiners: "ER nursing is stressful on a good day without rape victims"

Although research has indicated that counselors, advocates and social workers who assist rape victims experience vicarious trauma or psychological consequences as a result of their exposure to victims' traumatic experiences, little is known about Sexual Assault Nurse Examiners' (SANEs') experiences. This qualitative research explores SANEs' experiences of vicarious trauma and burnout as a result of treating rape victims, and the coping strategies they implement to reduce both. Data from interviews with 39 SANEs reveal that when asked about their difficulties as a SANE and the hardest part of their job, the majority (67%) discussed vicarious trauma, the emotional demands associated with the job, worrying about victims after they leave the hospital, and burnout. More than half (51%) of SANEs interviewed specifically indicated that they have experienced vicarious trauma as a result of treating rape victims, and 46% indicated they have experienced burnout at least to some degree. All SANEs, regardless of whether they believe they have experienced vicarious trauma or burnout, have ways to cope after hard cases. These coping mechanisms include talking to family members, calling or reaching out to other SANEs, program coordinators or rape victim advocates and detectives, participating in meetings with other SANEs where the focus is on problems after difficult cases, and finding relaxing activities.     

Development of Sexual Maturity

Before we can adequately treat the effects of sexual immaturity, we have to have a clear idea why the patient has not matured. Various sociological pressures give rise to an arresting of emotional drives and these pressures can often be removed by gentle reassurance. Many adolescents develop problems because they do not understand the physiology of maturation - for instance, boys believe girls to be as physically motivated as they are, while girls believe that boys have their depth of emotional commitment.     

The prevalence of constipation in patients receiving methadone maintenance treatment for opioid dependency

Constipation is a recognized adverse effect of strong opioids. Unlike patients receiving strong opioids for the relief of cancer pain, patients receiving methadone maintenance therapy for opioid addiction do not always appear to be routinely prescribed laxatives or have their symptoms of constipation assessed. This survey shows that in patients receiving methadone maintenance treatment symptoms of constipation were pronounced in 26% of patients surveyed. Interestingly, 29% of patients reported minimal or no symptoms of constipation. None of the patients at the start of the survey was co‐prescribed laxatives. We believe this study suggests that clinicians involved in prescribing for methadone maintenance programmes should routinely enquire about symptoms of constipation and treat as appropriate. This study also indicates that patients receiving methadone may develop a varying degree of tolerance to the constipating effects of strong opioids—a finding previously illustrated in cancer patients receiving strong opioids.     

A family's perspective on living with a highly malignant brain tumor

The purpose of the study is to describe what it like to live with a highly malignant brain tumor from a family perspective. It is a qualitative study in which 3 families, 3 patients, and 5 next of kin have described their experiences in 15 interviews. The study is prospective, with interviews occurring 2-3 weeks after surgery and 3 and 6 months after the onset of the illness. Inductive content analysis has been employed. The results indicate that when a highly malignant brain tumor is diagnosed, the effect on the family is devastating and there is a state of crisis. Characteristically, there is distancing and a sense of helplessness. The members of the family live from day to day in a state of constant anxiety and fear of losing the patient. The affliction limits the patient's capacity regarding activities of daily life, which increases the burden of the next of kin. The next of kin attempt to cope with their grief by occupying themselves with practical tasks and activities that they believe are meaningful. The family members have only good words to say about their encounter with healthcare staff and about the information given. Negative information that the family have not asked for can cause a long period of frustration and anxiety, and they believe that their hope has been taken away from them.     

Managing patient expectations.

Nurses and physicians are the leading advocates of patient education and patient safety. They believe that the more knowledge and understanding patients have about the procedures they are about to undertake, the better their expectations and recovery will be. Even though efforts are taken to ensure that patients have been adequately informed about risks, complications, and expectations, evaluation of patient comprehension and understanding remains difficult. Verbal information re-enforced by repetition, written text, and a signed consent do not ensure an accurate or adequate means of truly evaluating patient knowledge, understanding, or expectations.     

A multidisciplinary approach to cardiac rehabilitation.

As health care professionals we believe rehabilitation and patient education should commence on admission and continue through to discharge. Ideally it should be started from birth, with education by the family, school, GPs and well person clinics. This should include family screening an awareness of health and factors which may affect this. When patients develop angina, support should be given so that they can control the effects more adequately and reduce potential risk factors. There should be no exclusion criteria for patients accepted on these programmes as those who would probably be excluded are those who would require rehabilitation the most. Every individual can participate in discussion and any form of exercise can be tailored to meet the individual's needs. Many benefits have been mentioned, but the most important one is the improved quality of life for the patient and her or his family. Cardiac rehabilitation programmes and self-help groups may provide additional support to the patient and family during convalescence. Group programmes through their dynamics help to overcome feelings of isolation. Patients feel they gain support from their peer-group and they in turn can help each other overcome residual symptoms and practical difficulties. This 'social' rehabilitation is often the most beneficial aspect of the course; the group really helps them succeed. Rehabilitation must be accepted as part of the treatment and not a luxury for a few patients. This is a very exciting time when interest in this area is developing and research is examining the quality of life. We need to evaluate continually and undertake research to improve nursing practice.(ABSTRACT TRUNCATED AT 250 WORDS)     

Taking practice forward in paediatric oncology: the impact of a newly developed education programme for nurses working in shared-care hospitals.

Fundamental to any change or development in health care is the quality of the service received by patients and their families. Practitioner-led initiatives that are designed to improve the quality of care are more likely to succeed if they are underpinned with appropriate educational input. A structured programme in paediatric oncology nursing was developed to meet the needs of nurses working in District General Hospitals. Nurses' perceptions of the consequences of undertaking the programme were explored using a focus group approach. Findings have shown that there have been significant changes to nurses' roles and this in turn has had an impact on the individual and the organization. It was perceived that there are positive outcomes for both the service and quality of care for children with cancer and their families. The shared-care nurses believe that this has been the result of improved knowledge, skill and expertise, better communication between care providers, and the collaborative frameworks which have evolved.