Analysis of cranial nerve growthine improving quality of life in cerebral infarction

Background：Cranialnervegrowthine（CNG）isakindofnewbiochemicaldrugcontainingmanyspecialneuroactivesub－stanceswhichhaveagoodtherapeuticeffectincerebrovasculardiseases，andcandistinctlyimprovequalityoflifeforpatientswithcerebralinfarction．Thequalityoflifeisanimprotantfactorforrehabilitation，itislifesatisfaction，psychologicalwell－being，happiness，adaptationandmentalhealth．Objective：EvaluatetheinfluenceofCNGtoqualityoflifeincerebralinfarction．Method：Dividecerebralinfarctionpatientsi…     

Is patient satisfaction a legitimate outcome of pain management?

Though many studies have measured patient satisfaction with pain management using the American Pain Society (APS) Satisfaction Survey or its variants, little is known about the relationship among the survey items, or whether items relate to satisfaction at all. In an effort to refine the measurement of patient satisfaction, a modified version of the APS survey, which was given to 787 patients as part of a study of postoperative pain management in six community hospitals, was subjected to principal components analysis to determine the survey's empirical structure. Correlations among the five components found were low; a weak relationship (r = -0.24) was discovered between pain intensity and satisfaction. A heuristic model estimated by structural equations analysis yielded additional insights. Though many items thought to influence patient satisfaction were not closely related to patient-reported satisfaction, they indicate important clinical factors relevant to quality of care, and thus, to continuing quality improvement (CQI) efforts. Results suggest that satisfaction was influenced by effectiveness of medication, independent of pain intensity, and by communication. Pain severity ratings near the time satisfaction was measured were more influential than earlier ratings.     

Evaluation of a mobile phone-based, advanced symptom management system (ASyMS©) in the management of chemotherapy-related toxicity

Objectives

To evaluate the impact of a mobile phone-based, remote monitoring, advanced symptom management system (ASyMS^©) on the incidence, severity and distress of six chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand–foot syndrome and diarrhoea) in patients with lung, breast or colorectal cancer.

Design

A two group (intervention and control) by five time points (baseline, pre-cycle 2, pre-cycle 3, pre-cycle 4 and pre-cycle 5) randomised controlled trial.

Setting

Seven clinical sites in the UK; five specialist cancer centres and two local district hospitals.

Participants

One hundred and twelve people with breast, lung or colorectal cancer receiving outpatient chemotherapy.

Interventions

A mobile phone-based, remote monitoring, advanced symptom management system (ASyMS^©).

Main outcome measures

Chemotherapy-related morbidity of six common chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand–foot syndrome and diarrhoea).

Results

There were significantly higher reports of fatigue in the control group compared to the intervention group (odds ratio?=?2.29, 95%CI?=?1.04 to 5.05, P?=?0.040) and reports of hand–foot syndrome were on average lower in the control group (odds ratio control/intervention?=?0.39, 95%CI?=?0.17 to 0.92, P?=?0.031).

Conclusion

The study demonstrates that ASyMS^© can support the management of symptoms in patients with lung, breast and colorectal cancer receiving chemotherapy.     

Am I safe here?: improving patients' perceptions of safety in hospitals

Little is known about the current status of hospitalized patients' perceptions of safety or what affects them. This study analyzes safety ratings data of more than 600,000 patients. After describing how patients rate their safety in US acute care hospitals, we delineate the greatest opportunities for improving patient experiences of safety in hospitals. In addition, we offer practical strategies for planning improvements in safety-related elements of care from the patient's perspective.     

Optimal patient safety a computer chip away?

Discover the latest technologic initiatives used to increase patient safety.     

The Role of Endothelin in the Pathophysiology of Migraine—a Systematic Review

Purpose of Review

Vasoactive peptides play a key role in the attack-initiating cascade of migraine. Recent studies have highlighted a potentially important role for endothelin-1, a potent vasoconstrictor peptide, in migraine pathophysiology. Here, we review the current data on endothelin’s involvement in migraine.

Recent Findings

We identified 23 articles. Nine studies reported on endothelin-1 plasma concentrations in patients with migraine, eight studies investigated relevant genetic associations, five studies investigated endothelin-1 and spreading depression in animals, and one randomized controlled clinical trial tested the efficacy of an endothelin antagonist in the acute treatment of migraine in patients both with and without aura. Elevated endothelin-1 plasma levels have been reported in the early phase of migraine attacks. Genetic abnormalities related to the endothelin type A receptor have been reported in migraineurs. Endothelin-1 potently induces spreading depression in animals, which may explain the connection between endothelial irritation and migraine aura.

Summary

Endothelin-1 could be a primary factor in the attack-triggering cascade of migraine attacks with and without aura. Additional studies in humans and animal models are needed to further elucidate the role of endothelin-1 in migraine.

     

Does the patient's payer matter in hospital patient safety?: a study of urban hospitals

BACKGROUND: Previous studies have documented that hospitals decrease costs in response to reimbursement cutbacks. However, research concerning how this may affect quality of care has produced mixed results. Until recently, the ability to study changes in patient safety and payment has been limited. OBJECTIVE: The objective of the study was to determine whether changes in 4 hospital patient safety indicator (PSI) rates are related to changes in the generosity of payers over time. DATA AND METHODS: Study data are drawn from 1995-2000 hospital discharges in 11 states in the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Database. Following the same organizations over time, we estimate hospital fixed-effects regression models of the association of payer-specific time and post Balanced Budget Act (BBA) payment changes with risk-adjusted hospital PSI rates controlling for patient, organizational, and market characteristics. Four PSIs relevant to a large number of patients and hospitals that reflect general care processes are studied. RESULTS: The time trend during 1995-2000 is consistently significantly positive for private and Medicare hospital PSI rates. Thus, after controlling for patient characteristics and organizational and market factors, performance worsened. The trend is less consistent for Medicaid and does not exist for self-pay hospital PSI rates. After adjusting for multiple comparisons, we also find that the Medicare trend is fairly consistently higher than that of the other payers. In contrast, there is a less consistent BBA effect, especially for Medicare.     

What can the UK learn from the USA about improving the quality and safety of healthcare?

The US healthcare system provides evidence that spending more on healthcare does not result in better care, but also offers many lessons and surprises on how the quality and safety of healthcare can be improved. The US Institute of Medicine has clearly articulated what needs to be achieved. A series of US agencies, including the Joint Commission on Accreditation of Healthcare Organizations, the Centers for Medicare and Medicaid Services (CMS), other major players, and the Hospital Quality Alliance, routinely collect and report on numerous measures of the quality and safety of inpatient and outpatient healthcare. Most attention to improving care in the UK has focused on vertically integrated, closed healthcare systems, but the US experience provides additional models from the work of Quality Improvement Organizations and of numerous voluntary organisations that sponsor collaborative improvement.     

A world wide web-based user interface for a data management system for use in multi-institutional clinical trials—Development and experimental operation of an automated patient registration and random allocation system

We have employed the Hypertext Transfer Protocol (HTTP) and Hypertext Markup Language (HTML) to develop an automated patient registration and random allocation system for use in a multi-institutional clinical trial. We made it available on-line to World Wide Web clients in each hospital through a user friendly graphical user interface. During experimental operation, the physicians found it satisfactory from the viewpoint of both ease of operation and response time. For the development of a graphical user interface in a network-based information system for use in multi-institutional clinical trials, HTTP/HTML has several advantages over an ordinary client-server model. Therefore, we concluded that we would adopt HTP/HTML for the construction of user interfaces for physicians in each spital and for data managers in our coordinating center.     

Echocardiography as a guidance in CRT management: the GPS system in a labyrinth?

Although progress has been made to understand the factors for non-responsiveness, fine tuning and comprehensive strategies are needed to make echocardiography the GPS system in cardiac resynchronization. Taking the wrong turn in the labyrinth of dyssynchrony is expensive and time consuming without improving well being of the heart failure patient. Possibly other imaging techniques could help in fine tuning cardiac resynchronization.     

Contributions of tele–intensive care unit (Tele-ICU) technology to quality of care and patient safety

The deployment of remote monitoring of intensive care unit (ICU) patients, known as tele-ICU technology, promotes the efficient use of critical care resources. Although tele-ICU use has spread rapidly, the benefits vary widely among studies, and little is known about the specific characteristics of tele-ICU that provide benefits to patient care. The purpose of this study was to identify aspects of tele-ICU that contribute, whether positively or negatively, to care processes and patient outcomes. This study was not aimed at evaluating the impact of tele-ICU on care outcomes.     

The Caring-Disability Creation Process model: a new way of combining ‘Care’ in nursing and ‘Rehabilitation’ for better quality of services and patient safety

In an effort to continuously improve the quality of the services provided to persons in rehabilitation and patient safety, this article presents a model for the development of a Caring-Disability Creation Process that combines two elements that, in the past, have often been separated: care in nursing and rehabilitation. This new model and its underlying concepts introduce to a comprehensive approach in the recognition of the added value of caring by the contribution of rehabilitation nurses making an optimal development of the individual's potential and achieving successful social participation.